Legislature(2017 - 2018)BELTZ 105 (TSBldg)
02/13/2018 01:30 PM LABOR & COMMERCE
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SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD 1:33:10 PM CHAIR COSTELLO announced the consideration of SB 108. 1:33:36 PM SENATOR CATHY GIESSEL, Alaska State Legislature Juneau, Alaska, sponsor of SB 108, introduced the legislation speaking to the following sponsor statement: Senate Bill 108 is a streamlining bill which will improve the licensing process for physicians in Alaska. Outdated and overly cumbersome statutes and regulations are interfering with the ability of our medical community to meet the needs of Alaskans because of delays of licensure that negatively impact both doctors and patients. A fully qualified doctor in good standing should not be required to wait months to obtain a license to serve our state. The Alaska State Medical Board has requested this legislation so they may expeditiously and responsibly issue licenses to physician applicants. SB 108 gives the executive secretary of the State Medical Board expanded authority to review and issue licenses to applicants with uncomplicated applications. With a better system in place DCCED and the State Medical Board will be able to respond more efficiently at a time when healthcare access is of great concern in our state. SB 108 will authorize the board's executive secretary to grant licenses to qualified applicants for a permanent medical license, a temporary permit, or a locum tenens permit. It will also authorize the board to designate a board member to grant temporary permits to qualified applicants. [Sections 10 and 11] The bill outlines exceptions to that authority such as a suspended or revoked license or other special circumstances that would necessitate a full board review. The bill creates a new category of certified medical assistants who will perform additional duties in medical settings. The Board will set criteria for educational requirements, certification, renewal and revocations for Certified Medical Assistants. The bill provides for physician delegation of specific, routine activities to unlicensed personnel working in physician offices. [Sections 3, 6, and 13] SENATOR GIESSEL advised that licenses are currently issued within two months but just five percent of the applications are complete when they're submitted. That has contributed to the current backlog of about 290 applications. Also, the number of applicants has increased markedly, largely due to telemedicine applicants. She reminded members that any physician who provides care through telemedicine must be licensed in the state. 1:40:41 PM SENATOR GIESSEL explained that the request for the new category of "certified medical assistant" came from pain management doctors who need an assistant in the office who can look at the prescription drug monitoring program (PDMP) for them. She reminded members that when the legislature crafted the opioid bill it required licensure to look at the database. In practice this takes a lot of time in a physician's day. Certifying medical assistants provides a solution. The board will outline the criteria for certification in regulation. [Sections 4 and 5] Section 12 provides a penalty for anyone practicing as a CMA without a license. SENATOR GIESSEL said the State Medical Board and DCCED's Division of Corporations, Business and Professional Licensing support the bill. 1:43:27 PM CHAIR COSTELLO recognized that Senator Meyer joined the committee some time ago. SENATOR MICCICHE asked if it's typical that Section 3 leaves the definition for "routine medical duties" to the board instead of putting it in the bill. SENATOR GIESSEL said it's logical; similar authority is given to the Board of Nursing that also delegates to unlicensed assisted personnel. The board knows exactly which routine medical duties would be appropriate for an unlicensed person to do. SENATOR MICCICHE asked if the statutes allow an applicant who meets the qualifications to receive a temporary permit. SENATOR GIESSEL said yes. The bill allows the executive administrator or a board designee to issue the temporary license. 1:45:34 PM SENATOR STEVENS said he assumes the executive administrator would be carefully chosen, but it sounds a little loose to then extend authority to another person. SENATOR GIESSEL said the Board of Medicine in collaboration with the Division of Corporations, Business and Professional Licensing hires the executive administrator. It is generally a rigorous process and there are qualifying criteria for the individual that's hired. She added that it was the board that wanted the additional board member who could act if the executive administrator were absent. SENATOR STEVENS said he was reading on page 4 where it says, "allow another person designated by the board." He asked if that was in the bill because it doesn't say another board member. 1:47:13 PM At ease 1:47:47 PM CHAIR COSTELLO reconvened the meeting. SENATOR GIESSEL explained that the board requested the language and may have been thinking of delegating the authority to the licensing examiner who also scrutinizes applications. She added that the Board of Medicine is extremely careful about who receives licensure. She said this pertains to a temporary permit and she is confident in the board's judgement. SENATOR STEVENS summarized it is not a willy-nilly appointment of someone off the street. It's someone with qualifications and background. 1:49:19 PM CHAIR COSTELLO opened public testimony for SB 108. 1:49:34 PM DR. DANNY ROBINETTE, Chief Medical Officer, Fairbanks Memorial Hospital and Tanana Valley Clinic, Fairbanks, Alaska, advised that the hospital has experienced periodic delays in getting physicians licensed. On three occasions in the past two years this has resulted in physician candidates accepting positions out of state because they needed a paycheck. A surgeon currently on staff had to wait eight months for his license. He said each candidate should be rigorously screened and those with issues should receive closer scrutiny and take more time. However, the process should be streamlined so that clean, unblemished candidates are not unduly held up causing good physicians to accept positions in other states. SENATOR STEVENS asked if there could be any justification for holding up an application for eight months. DR ROBINETTE said it could certainly be justified in some instances, but not the case he mentioned. SENATOR STEVENS asked if his belief was that this would speed the process while giving the board time to investigate concerns and red flags. DR. ROBINETTE said yes; the statute and regulations clearly define the things that constitute a clean application. There shouldn't be a timeline that rushes an application that isn't clean. 1:53:59 PM SENATOR MICCICHE read questions and answers about processing times from the legislative research document titled "State Medical Licensing Timeframes. He said it looks like the requirements for a temporary permit are the same as the requirements for a regular license, which makes him wonder about the timesaving. DR. ROBINETTE deferred a full answer to the board. He didn't know all the details for issuing a temporary permit, but Fairbanks Memorial Hospital typically issues temporary privileges to someone with a clean application and for exigent patient care reasons. SENATOR MICCICHE asked if someone from the board was available. CHAIR COSTELLO said she didn't see anyone from the board online but would try to get an answer before the end of the meeting. 1:56:16 PM KIRA BOYD, Chief Operating Officer, ALGONE, Wasilla, Alaska, testified in support of SB 108. She explained that the clinic offers regenerist medicine, interventional pain management, and dependency therapy with a focus on opioid use disorders. The clinic regularly treats a high-needs, high-touch patient population and is faced with high overhead costs, particularly because specialty providers often require lucrative compensation packages to lure them to the state. She said ALGONE has a team of over 40 medical assistants who team up with the providers to take care of the high-needs, high- touch patients. However, existing statute relating to opioid oversight and implementation of the PDMP has made these care teams dramatically less efficient. ALGON sought immediately to find the solution and eventually looked at other states that license medical assistants. They were able to send model legislation to the sponsor's staff. ALGON fully supports SB 108 and wants the committee to know that the process works. MS BOYD said the State Medical Board expressed concern about cost and resources to get medical assistants licensed. However, the choice is to either create an efficient system for licensing or require clinics to hire more nurses and pass that cost on to the already overburdened health care consumers. She said SB 108 is the solution that Alaska needs now. SENATOR STEVENS asked how many of the 40 currently unlicensed medical assistants would become certified should SB 108 pass. MS. BOYD said not all ALGON's medical assistants are unlicensed, but in a perfect world all their medical assistants would become certified. SENATOR STEVENS said he thought that certifying medical assistants was new. MS. BOYD clarified that some but not all ALGON medical assistants are certified. The ones that are not certified are not currently able to assist providers by looking at the PDMP database. 2:00:31 PM At ease 2:01:13 PM CHAIR COSTELLO reconvened the meeting and continued with public testimony on SB 108. 2:01:22 PM BRYAN FARTHING, President, Alaska Academy of Physician Assistants (PA), Anchorage, Alaska, said he appreciates the work that's been done on SB 108, but the PA community is concerned that when physicians and other medical professionals are listed in the bill physician assistants aren't always included. 2:03:10 PM FRED PARADY, Deputy Commissioner, Department of Commerce, Community and Economic Development (DCCED), said the workload of the State Medical Board has increased dramatically, primarily due to telemedicine legislation. In 2015 the application processing backlog reached an average of six months. Telemedicine companies were coming in to license 100 doctors at a time. Complaints came in from applicants and medical companies and the responding to those complaints was time consuming. MR. PARADY said the division processed 22 percent more medical licenses and 31 percent more nursing licenses last year than the year before and they've already received more this fiscal year to date than the entire previous year. Through the budget process and previous legislation, the division has been able to devote more staff to these programs. They have added two new PCNs that are paid by licensing fees and they went through a triage process to reduce the backlog. They also initiated a strategic planning process to streamline the application process for health care professions. That was identified as the highest priority. He shared the results of that hard-working team. The strategic planning process included a comprehensive examination of the application process to identify barriers or obstacles ("rubs"). Twenty-seven were identified. He directed attention to a handout and explained that the department requires applicants to send certified and true copies of their diploma and all certificates. The question the team asked was whether certified and true copies were necessary when verification was already required. He said rub 17 is specifically germane to the bill; it is the requirement that every application needs to be approved by the executive administrator. Considering the number of applications the department moves forward, waiting for approval can be time consuming both at the executive director and at the board level. The board might meet just once every three months. Rub 22 is that the board needs to review every file, even those that have no discrepancies. What SB 108 proposes is to delegate that authority. In answer to Senator Steven's question about delegation, he clarified that is an active delegation of authority to another board member or the director or deputy director of the division. CHAIR COSTELLO asked Mr. Parady to send a copy of the handout to the committee aide. MR. PARADY agreed. He continued to explain that the strategic planning process continued as the team evaluated the cause of each problem, determined whether it served a public safety need, and whether the process needed to be updated or simplified. In response to those 27 rubs the department initiated a three- pronged approach to implement solutions that would streamline the licensure process. The first prong was to make small changes through board regulations. Specific to SB 108, the State Medical Board proactively scrubbed its regulations. He cited an example of a regulation that served no public safety need. The second prong of the streamlining strategy adds two features to the technology platform. The first makes the online application process like the one used for the permanent fund dividend. The user cannot advance until the question is answered. The second implements a tracker so the applicant can see the progress of their application and what a holdup might be. Rollout of this technology enhancement is anticipated in March. The third prong of the streamlining strategy is a change in the statutes that would improve license processing times while continuing to ensure public safety. The minor changes in SB 108 will allow the State Medical Board to grant additional authority to the executive administrator to issue licenses that meet the strictest guidelines and allow further delegation to supervisors to expedite and issue temporary licenses. The bill also closes the loop with the prescription drug monitoring program (PDMP) by certifying medical assistants so they are eligible to access that database for the doctor. MR. PARADY concluded his comments emphasizing that the department is focused and attentive to these issues. "We've been hard at work on those granular details where we can better serve the public and, ultimately, better serving these professionals better serves Alaska citizens." 2:13:00 PM SENATOR MICCICHE asked 1) why there is a temporary permit and 2) if the temporary permit satisfies the requirements of the other permits why it is still considered temporary. 2:13:20 PM JANEY MCCULLOUGH, Director, Corporations, Business & Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Juneau, Alaska, said a temporary permit is a way of getting an applicant to work as fast as possible. Currently the executive administrator can approve a temporary license and the formal full license is issued after the board meets and approves every license. SENATOR MICCICHE said his point is that other than the board action, the requirements are no less rigorous for a temporary license. MS. MCCULLOUGH confirmed that other than the board approval, the criteria for a temporary license is the same as for a full license. CHAIR COSTELLO asked Mr. Parady if he shared the creative new application tracking process with other departments. MR. PARADY said he'd be happy to share but he wanted to make certain it operates correctly first. If it's successful, it will next be rolled out across the department's 43 license groups. 2:15:51 PM CHAIR COSTELLO closed public testimony on SB 108. 2:16:09 PM SENATOR MEYER moved to report SB 108, version U, from committee with individual recommendations and attached fiscal note(s). CHAIR COSTELLO announced that without objection, SB 108 moves from the Senate Labor and Commerce Standing Committee.