Legislature(2021 - 2022)BUTROVICH 205

04/15/2021 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 38 NATUROPATHS: LICENSING; PRACTICE TELECONFERENCED
Heard & Held
+= SB 67 NURSING: LICENSURE; MULTISTATE COMPACT TELECONFERENCED
Heard & Held
+= SB 78 HEALTH CARE SERVICES BY TELEHEALTH TELECONFERENCED
Scheduled but Not Heard
+= SB 80 PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION TELECONFERENCED
Scheduled but Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
            SB  38-NATUROPATHS: LICENSING; PRACTICE                                                                         
                                                                                                                                
1:36:07 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 38                                                                  
"An  Act relating  to the  practice of  naturopathy; establishing                                                               
the  Naturopathy Advisory  Board;  relating to  the licensure  of                                                               
naturopaths; relating to  disciplinary sanctions for naturopaths;                                                               
relating to  the Department of Commerce,  Community, and Economic                                                               
Development; and providing for an effective date."                                                                              
                                                                                                                                
1:36:46 PM                                                                                                                    
JOE HAYES,  Staff, Senator Scott Kawasaki,  Juneau, Alaska, spoke                                                               
as sponsor staff on SB 38 stated he had no additional comments.                                                                 
                                                                                                                                
1:37:01 PM                                                                                                                    
SENATOR HUGHES moved Amendment 1.                                                                                               
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
                                               32-LS0318\A.2                                                                    
                                                      Fisher                                                                    
                                                     4/12/21                                                                    
                                                                                                                                
    OFFERED IN THE SENATE                 BY SENATOR HUGHES                                                                     
        TO: SB 38                                                                                                               
                                                                                                                                
     Page 4, following line 3:                                                                                                  
          Insert                                                                                                                
          "(2)  has completed a three-year naturopathic                                                                     
     residency program;"                                                                                                    
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
     Page 4, line 21:                                                                                                           
          Delete "AS 08.45.030(1)(A) and (2) - (4)"                                                                         
          Insert "AS 08.45.030(1)(A) and (2) - (5)"                                                                         
                                                                                                                                
CHAIR  WILSON objected  for purposes  of discussion  and restated                                                               
the Amendment being offered as Amendment 1 [A.2].                                                                               
                                                                                                                                
1:37:39 PM                                                                                                                    
SENATOR HUGHES stated naturopaths are  a great asset to the field                                                               
of healthcare. The  scope of a naturopath    practice is expanded                                                               
by  SB 38.  The bill  includes prescriptive  rights. Amendment  1                                                               
adds   a  three-year   residency  licensing   prerequisite.  This                                                               
prerequisite  mirrors  the  clinical  hours  and  oversight  that                                                               
physicians experience  and that  is embedded  in the  training of                                                               
physician assistants  and nurse practitioners. She  stated she is                                                               
in favor  of naturopathic  doctors having  prescriptive authority                                                               
if they have extra supervision.                                                                                                 
                                                                                                                                
SENATOR  REINBOLD stated  that  committee  members were  informed                                                               
that  naturopaths  would  not  be   available  to  testify.  This                                                               
amendment undermines the  naturopaths' prior testimony. Physician                                                               
assistants,   nurse  practitioners,   physical  therapists,   and                                                               
chiropractors   do  not   complete  residencies.   She  suggested                                                               
naturopaths could  work three  years in  an externship.  A three-                                                               
year  residency is  unconscionable, as  naturopaths have  thirty-                                                               
five years of established safe practice.                                                                                        
                                                                                                                                
1:40:13 PM                                                                                                                    
SENATOR  BEGICH  asked  why  there  are  not  enough  residencies                                                               
available.                                                                                                                      
                                                                                                                                
MR. HAYES replied  that there are more  students than naturopaths                                                               
and hospitals pay  for the residency of medical  doctors. They do                                                               
not pay for naturopathic doctors.                                                                                               
                                                                                                                                
1:40:41 PM                                                                                                                    
SENATOR BEGICH asked for the sponsor's view of this amendment.                                                                  
                                                                                                                                
MR.  HAYES  replied  that Senator  Kawasaki  has  concerns  about                                                               
fiscal  ramifications and  who will  fund the  residencies. There                                                               
are fifty-two naturopaths practicing  in Alaska. Senator Kawasaki                                                               
has concerns  about how  the amendment  will affect  them. Alaska                                                               
would be the first state to require residency.                                                                                  
                                                                                                                                
1:41:49 PM                                                                                                                    
SENATOR HUGHES explained that Amendment  1 does not prescribe how                                                               
residency  would  be  crafted.  She   is  open  to  the  idea  of                                                               
grandfathering.  There  are  a  variety  of  ways  to  accomplish                                                               
supervision. Students coming  out of school could  be paired with                                                               
existing  naturopaths  or primary  care  providers.  MDs and  DOs                                                               
sometimes have residencies  lasting eight to ten  years. A three-                                                               
year  residency  is  a  minimum  requirement.  Chiropractors  and                                                               
physical  therapists  do  not  prescribe  medications.  Physician                                                               
assistants  have  clinical  hour  requirements  and  after  being                                                               
licensed  are supervised  by a  physician. She  concluded that  a                                                               
wider scope  of practice should  require an equivalent  amount of                                                               
training.                                                                                                                       
                                                                                                                                
SENATOR REINBOLD  offered Conceptual Amendment 1  to Amendment 1.                                                               
On  page 1  line  3 of  the amendment,  replace  the language  in                                                               
paragraph   (2)   and   insert  "has   completed   two-years   of                                                               
naturopathic  externship program    At  the  Chair's request  she                                                               
restated the conceptual amendment.                                                                                              
                                                                                                                                
SENATOR  HUGHES asked  the difference  between an  internship and                                                               
externship.                                                                                                                     
                                                                                                                                
1:44:49 PM                                                                                                                    
SENATOR REINBOLD replied  an externship is working  in a clinical                                                               
setting under supervision and earning money.                                                                                    
                                                                                                                                
SENATOR HUGHES stated residents are  interns that earn money. She                                                               
is open  to the  two-year adjustment  but has  reservations about                                                               
the appropriate terminology to use regarding residency.                                                                         
                                                                                                                                
SENATOR REINBOLD  answered that  an externship  offers supervised                                                               
hands-on clinical training in doctor's offices versus hospitals.                                                                
                                                                                                                                
                                                                                                                                
SENATOR  HUGHES  stated  she  is   agreeable  to  the  conceptual                                                               
amendment.                                                                                                                      
                                                                                                                                
SENATOR   BEGICH  read   the   definition   of  externships   as,                                                               
 Experiential  learning  opportunities, similar  to  internships,                                                               
provided  by partnerships  between  educational institutions  and                                                               
employers to give students practical  experiences in the field of                                                               
study."                                                                                                                         
                                                                                                                                
1:46:25 PM                                                                                                                    
CHAIR  WILSON   asked  if  there  was   objection  to  Conceptual                                                               
Amendment 1 to Amendment 1.                                                                                                     
                                                                                                                                
SENATOR COSTELLO asked  if Amendment 1 is intended to  make SB 38                                                               
more  stringent  because  it  offers  prescriptive  authority  to                                                               
naturopaths. She noted that in  SB 38 the pharmacological portion                                                               
of the exam  is elective. This amendment would  include those who                                                               
are not  interested in having  prescriptive authority.  She asked                                                               
if the residency requirement is intended for them.                                                                              
                                                                                                                                
SENATOR HUGHES  replied that  the residency  requirement pertains                                                               
to  the prescriptive  authority  and  outpatient procedures  that                                                               
naturopaths will  be allowed to  perform. She suggested  that the                                                               
amendment  could   be  changed   to  exclude   office  procedures                                                               
depending on how it will be defined.                                                                                            
                                                                                                                                
1:48:20 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:51:02 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
He  found no  further  objection and  Conceptual  Amendment 1  to                                                               
Amendment 1 passed.                                                                                                             
                                                                                                                                
1:51:33 PM                                                                                                                    
CHAIR  WILSON   withdrew  his   objection.  Finding   no  further                                                               
objection, Amendment 1, as amended, passed.                                                                                     
                                                                                                                                
1:51:57 PM                                                                                                                    
SENATOR HUGHES moved Amendment 2 [A.5].                                                                                         
                                                                                                                                
                                                                                                                                
                          AMENDMENT 2                                                                                       
                                                                                                                                
                                               32-LS0318\A.5                                                                    
                                                      Fisher                                                                    
                                                     4/12/21                                                                    
                                                                                                                                
    OFFERED IN THE SENATE                 BY SENATOR HUGHES                                                                     
        TO: SB 38                                                                                                               
                                                                                                                                
     Page 4, following line 3:                                                                                                  
          Insert                                                                                                                
               "(2)       has   passed    a   pharmaceutical                                                                
         examination approved by the department that is                                                                     
        equivalent to any examination of pharmaceutical                                                                     
     knowledge required under AS 08.64.210 or 08.64.220;"                                                                   
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
     Page 4, line 21:                                                                                                           
          Delete "AS 08.45.030(1)(A) and (2) - (4)"                                                                         
          Insert "AS 08.45.030(1)(A) and (2) - (5)"                                                                         
                                                                                                                                
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
1:52:14 PM                                                                                                                    
SENATOR  HUGHES stated  this  amendment  requires naturopaths  to                                                               
pass  a  pharmaceutical  exam  equivalent  to  what  medical  and                                                               
osteopathic  doctors pass  to acquire  a license.  If naturopaths                                                               
are  to be  called  physicians their  training, examinations  and                                                               
continuing education should be on  par with other doctors who are                                                               
called  physicians.   The  Alaska  Association   of  Naturopathic                                                               
Physicians  uses the  word  physicians on  their  website. It  is                                                               
important to  commensurate the requirements of  a naturopath with                                                               
the average Alaskan's expectation of a physician.                                                                               
                                                                                                                                
SENATOR REINBOLD  stated there is  a need to  address naturopaths                                                               
using the word physician.                                                                                                       
                                                                                                                                
1:54:22 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:59:15 PM                                                                                                                    
CHAIR  WILSON reconvened  the meeting  and resumed  discussion on                                                               
Amendment 2.                                                                                                                    
                                                                                                                                
1:59:21 PM                                                                                                                    
SENATOR HUGHES  stated that her legislative  intern could address                                                               
statute references.                                                                                                             
                                                                                                                                
RILEY  NYE,   Intern,  Senator   Shelley  Hughes,   Alaska  State                                                               
Legislature, Juneau,  Alaska, explained that Amendment  2 deletes                                                               
AS 08.45.030(1)  (A) and (2)    (4) and inserts the  same statute                                                               
but with a change that includes (2)  (5).                                                                                       
                                                                                                                                
SENATOR COSTELLO stated  that the statutes listed  in Amendment 2                                                               
clarify that "the board" is the medical board.                                                                                  
                                                                                                                                
SENATOR BEGICH asked whether the  medical board or the department                                                               
would  set  policy   regarding  pharmaceutical  examinations.  He                                                               
offered his  belief that Senator  Hughes intended  the department                                                               
to set policy and asked for confirmation from Ms. Chambers.                                                                     
                                                                                                                                
2:01:42 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional   Licensing,  Juneau,   Alaska,   stated  that   the                                                               
department is  to review examination requirements  under AS 08.64                                                               
and then approve an equivalent  exam. The medical board would not                                                               
be  involved  unless  advice  was   needed.  There  are  standard                                                               
examinations  that the  medical  board  approves. The  department                                                               
would be  looking for  an equivalent exam  that is  accessible to                                                               
naturopaths.                                                                                                                    
                                                                                                                                
SENATOR REINBOLD  offered a conceptual amendment  to Amendment 2.                                                               
On  page  4,  line  3  add,   If  a  naturopath  seeks  increased                                                               
prescriptive authority and.                                                                                                     
                                                                                                                                
2:03:26 PM                                                                                                                    
CHAIR  WILSON   announced  SB  38   will  be  held   for  further                                                               
consideration.                                                                                                                  
                                                                                                                                
SENATOR COSTELLO stated  that the next committee  of referral for                                                               
SB 38 is Senate Labor and  Commerce. She was committed to working                                                               
with Senator Kawasaki's  office on a committee  substitute. If it                                                               
is  held in  the Health  and Social  Services committee,  parties                                                               
should  work  together  to rectify  issues  that  the  amendments                                                               
address.  There is  a lot  of interest  in crafting  a successful                                                               
bill.                                                                                                                           
                                                                                                                                
SENATOR HUGHES  stated this bill  has been fourteen years  in the                                                               
making. She  offered her belief that  it is important to  get the                                                               
bill right. She  supports Chair Wilson holding it  so parties can                                                               
work together.                                                                                                                  
                                                                                                                                
2:05:10 PM                                                                                                                    
CHAIR  WILSON  clarified that  the  bill  is  being held  so  the                                                               
sponsor and  members of the  committee can work  through language                                                               
in the amendments and produce a better bill.                                                                                    
                                                                                                                                
SENATOR  REINBOLD  stated  the  remaining  amendments  would  not                                                               
consume as much time and the  members should keep working to move                                                               
the bill out of committee.                                                                                                      
                                                                                                                                
CHAIR  WILSON stated  it would  be better  to get  a CS  from the                                                               
sponsor than to keep amending amendments.                                                                                       
                                                                                                                                
SENATOR HUGHES stated she is willing  to work with the sponsor on                                                               
her amendments.                                                                                                                 
                                                                                                                                
2:06:38 PM                                                                                                                    
SENATOR   REINBOLD   expressed    her   dislike   for   committee                                                               
substitutes.  She prefers  to  work through  an  open process  in                                                               
committee  rather than  two people  working behind  closed doors.                                                               
Working through the  amendments in committee is  difficult but it                                                               
is what the committee is for.                                                                                                   
                                                                                                                                
CHAIR WILSON replied he understands.                                                                                            
                                                                                                                                
SENATOR  BEGICH  commented  that   amendments  are  in  committee                                                               
members hands.  Members should  offer suggestions  before Tuesday                                                               
so the bill can be moved out of committee.                                                                                      
                                                                                                                                
2:07:45 PM                                                                                                                    
[CHAIR WILSON held SB 27 in committee.]                                                                                         

Document Name Date/Time Subjects
SB 38 Letter of Opposition Mignon Benjamin.pdf SHSS 4/15/2021 1:30:00 PM
SB 38
SB 67 Letters of Support 4.12.21 Redacted.pdf SHSS 4/15/2021 1:30:00 PM
SB 67
SB 67, Letters of Opposition, 2.26.21_Redacted.pdf SHSS 4/15/2021 1:30:00 PM
SB 67
SB 67, Letters of Support, 2.26.21_Redacted.pdf SHSS 4/15/2021 1:30:00 PM
SB 67
SB 80 Public Input 4.11.21 Redacted.pdf SHSS 4/15/2021 1:30:00 PM
SB 80
SB38 Alderhold Letter of Support.pdf SHSS 4/15/2021 1:30:00 PM
SB 38
SB 67 Letters of Support 4.14.21 Redacted.pdf SHSS 4/15/2021 1:30:00 PM
SB 67
SB 78 National Multiple Sclerosis Society Letter of Support.pdf SHSS 4/15/2021 1:30:00 PM
SB 78
SB 78 APRN Alliance Letter.pdf SHSS 4/15/2021 1:30:00 PM
SB 78
SB 78 ASMA Letter of Opposition.pdf SHSS 4/15/2021 1:30:00 PM
SB 78
SB 78 Fiscal Note DHSS Health Care Svcs.pdf SHSS 4/15/2021 1:30:00 PM
SB 78
SB 78 Fiscal Note DHSS Medicaid Svcs.pdf SHSS 4/15/2021 1:30:00 PM
SB 78