Legislature(2001 - 2002)

02/19/2002 02:03 PM Senate TRA

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                                                                                                                                
         SB 265-PHYSICIAN ASSISTANTS/NURSE PRACTITIONERS                                                                    
                                                                                                                              
SENATOR  OLSON, sponsor  of SB  265,  introduced the  bill on  the                                                              
advice and request of the Alaska  Academy of Physician Assistants.                                                              
He said he could  answer questions on Section 1 and  Section 2 but                                                              
the section  that was  of most  interest was  Section 3  under the                                                              
Committee Substitute (CS).  This  would allow physician assistants                                                              
to provide  proof of  eligibility for  a disabled veteran  license                                                              
plate and  for issuance of a  parking permit for a  handicapped or                                                              
disabled   person.     Currently   physicians,   other   mid-level                                                              
practitioners  and   specifically  advanced  nurse   practitioners                                                              
provide eligibility.                                                                                                            
                                                                                                                                
ED  HALL,  Physician   Assistant,  Alaska  Academy   of  Physician                                                              
Assistants, said  all three of the  issues in Sections 1,  2 and 3                                                              
were  very  important  to  physician assistants.    He  said  they                                                              
probably  had been  excluded  because  the statutes  were  written                                                              
before physician assistants were  a recognized presents in Alaska.                                                              
                                                                                                                                
SUSAN  MASON BOUTERSE,  Executive Director  of Sunshine  Community                                                              
Health Center,  expressed her  support of SB  265.  She  addressed                                                              
the first two  statutes being amended to add  physician assistants                                                              
as being  critical to health care  in Alaska.   Sunshine Community                                                              
Health  Center   is  a  mid-level   clinic  with   four  physician                                                              
assistants  providing primary  health  care.   They  work under  a                                                              
collaborative  agreement with a  physician in  Wasilla.   They are                                                              
critical  to health  care of residents  in the  community and  the                                                              
ongoing functioning of the health center.                                                                                       
                                                                                                                                
Because the  current state statute  denies inclusion  of physician                                                              
assistants  to   the  listing  of   health  care   providers  they                                                              
periodically  have their  billing  for medical  services by  those                                                              
providers  denied  by  third  party payers.    This  represents  a                                                              
significant  barrier  to health  care  for individuals  that  have                                                              
health insurance  as well  as for clinics  to be able  to maximize                                                              
potential revenue.   For all rural health clinics  every potential                                                              
revenue source is critical to ongoing support.                                                                                  
                                                                                                                                
CHAIRMAN COWDERY asked Senator Olson  to elaborate on duties taken                                                              
care of by physician assistants.                                                                                                
                                                                                                                                
SENATOR  OLSON   explained  physician   assistants  work   with  a                                                              
collaborative physician  and do many things a  physician would do.                                                              
Because they  do not have  the training  of a medical  doctor they                                                              
are  at  times  not  accorded  some   of  the  privileges  allowed                                                              
physicians  and in this  case advanced  nurse practitioners.   For                                                              
example they  are not  included in some  of the medical  liability                                                              
statutes  as  well as  recognition  by  some third  party  payment                                                              
recipients.   He  said  that was  the reason  the  bill was  being                                                              
presented  and specifically  the CS  that has  the provision  that                                                              
allows physician  assistants to  give specially disabled  veterans                                                              
license  plates and  parking  permits for  those  people that  are                                                              
handicapped.                                                                                                                    
                                                                                                                                
SENATOR TAYLOR said  the concern he had was the  impact this would                                                              
have on the ability of physician  assistants to get reimbursement.                                                              
He asked if that  was part of the purpose of the  bill because the                                                              
insurance company would recognize  them as a full service provider                                                              
and they can bill directly.                                                                                                     
                                                                                                                                
SENATOR OLSON  said that was  exactly what they  were specifically                                                              
trying to do in Section 2.  That was the intent of the bill.                                                                    
                                                                                                                                
SENATOR TAYLOR  said the bill  mentioned medical malpractice.   He                                                              
asked if  adding them to  the list would  require them  to provide                                                              
medical malpractice insurance or  did it give them the opportunity                                                              
to come  under the medical  malpractice insurance of  the hospital                                                              
or the physician they work with.                                                                                                
                                                                                                                                
SENATOR OLSON  said that question was  part of the whole  issue of                                                              
trying  to recognize  physician  assistants  as professionals  and                                                              
with that came  responsibility.  If they make a  mistake they need                                                              
to be named as  a defendant in a malpractice case.   That does not                                                              
mean they  are guilty  it just means  they need  to be able  to be                                                              
named by the  plaintiff's attorney.  He said with  this also comes                                                              
the ability  for them  to bill.   He said  being required  to have                                                              
malpractice insurance  was not addressed  in the bill and  not the                                                              
intent of the sponsor.                                                                                                          
                                                                                                                                
MR. HALL  said the  other aspect  of Section  2, brought  to their                                                              
attention  by  an  attorney, was  when  dealing  with  malpractice                                                              
claims sometimes there is an arbitration  board put together.  The                                                              
definition  of  who  can participate  on  that  arbitration  board                                                              
placed a limitation on physician  assistants because they were not                                                              
listed as  a health  care provider within  that statute.   Another                                                              
reason they were asking to have their  name recognized within that                                                              
statute  was  so  they  could  avail   themselves  to  be  on  the                                                              
arbitration board if called upon.                                                                                               
                                                                                                                                
MARY MARSHBURN,  Director, Division of Motor Vehicles  (DMV), said                                                              
she had not  seen the CS.   She had called Senator  Olson's office                                                              
and  suggested  the  CS.    She asked  Senator  Olson  if  the  CS                                                              
addressed AS  28.10.181 rather  than Section  3 from the  original                                                              
bill.                                                                                                                           
                                                                                                                                
SENATOR OLSON said yes, section 3  relating to AS 28.10.181(d) was                                                              
amended and they did have her concern addressed.                                                                                
                                                                                                                                
MS. MARSHBURN  said with that knowledge  DMV had no  opposition to                                                              
the  bill.    They  think  including  physician  assistants  is  a                                                              
reasonable and  good thing.  The  CS would allow them to  have the                                                              
same   authority   as   physicians,   nurse   practitioners,   and                                                              
chiropractors  in  terms  of signing  the  permit  for  disability                                                              
placards or plates.  If the CS is  not substituted the bill in its                                                              
current form  only allowed  the physician  assistants to  sign the                                                              
evidence for permits and not for  plates.  DMV felt they should be                                                              
able to sign for both.                                                                                                          
                                                                                                                                
SENATOR  WILKEN moved  to amend  the Committee  Substitute for  SB
265.    Hearing  no  objection, CSSB  265  (TRA)  was  moved  from                                                              
committee.                                                                                                                      

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