Legislature(1993 - 1994)
03/17/1994 03:00 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
March 17, 1994
3:00 p.m.
MEMBERS PRESENT
Rep. Cynthia Toohey, Co-Chair
Rep. Con Bunde, Co-Chair
Rep. Gary Davis
Rep. Al Vezey
Rep. Pete Kott (arrived 4:25 p.m.)
Rep. Harley Olberg
Rep. Bettye Davis
Rep. Tom Brice
MEMBERS ABSENT
Rep. Irene Nicholia (excused)
COMMITTEE CALENDAR
*HB 341: "An Act relating to physician assistants; and
providing for an effective date."
PASSED OUT OF COMMITTEE
*HB 490: "An Act allowing a local bidder preference in
certain contracts for school construction."
PASSED OUT OF COMMITTEE
*HB 488: "An Act relating to the scholarship loan program;
and providing for an effective date."
NOT HEARD
(* First public hearing.)
WITNESS REGISTER
REP. JOE SITTON
Alaska State Legislature
State Capitol
Juneau, Alaska 99801-1182
465-2327
Position Statement: Prime Sponsor of HB 341
JOHN RILEY, President
Alaska Academy of Physician Assistants
1217 E. 10th Avenue
Anchorage, Alaska 99501
Phone: (907) 257-4600
Position Statement: Testified in support of HB 341
(testified in Juneau)
KIMBERLY BUSCH, Director
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 110660
Juneau, Alaska 99811
Phone: (907) 465-3355
Position Statement: Answered questions on HB 341
DAVE W. WILLIAMS
Medical Assistance Administrator
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 110660
Juneau, Alaska 99811
Phone: (907) 465-3355
Position Statement: Answered questions on HB 341
JACK HEESCH, Lobbyist
Alaska Academy of Physician Assistants
P.O. Box 201608
Anchorage, Alaska 99520
Phone: (907) 279-0478
Position Statement: Testified in support of HB 341
(Spoke via teleconference)
CLAY LANGLAND, P.A.
Pelican, Alaska 99832
Phone: (907) 735-2250
Position Statement: Testified in support of HB 341
(Spoke via offnet)
JOHN WINKELMAN, P.A.
Healy, Alaska 99743
Phone: (907) 683-2211
Position Statement: Testified in support of HB 341
(Spoke via offnet)
JEANNE CLARK, P.A.
479 Slater Drive
Fairbanks, Alaska 99701
Phone: (907) 452-4117
Position Statement: Testified in support of HB 341
(Spoke via teleconference)
DITA DE BOER
P.O. Box 1526
Seward, Alaska 99664
Phone: (907) 224-8468
Position Statement: Testified in support of HB 341
(Spoke via teleconference)
DAVID JOHNSON, P.A.
P.O. Box 3465
Seward, Alaska 99664
Phone: (907) 224-5205
Position Statement: Testified in support of HB 341
(Spoke via teleconference)
ROBERT WOODS
751 Old Rich Highway
Fairbanks, Alaska 99701
Phone: (907) 451-6561
Position Statement: Testified in support of HB 341
(Spoke via teleconference)
JESSICA STEVENS
Talkeetna, Alaska 99676
Phone: (907) 733-2273
Position Statement: Testified in support of HB 341
(Spoke via offnet)
BEVERLY HUGO, P.A.
P.O. Box 677
Barrow, Alaska 99723
Phone: (907) 852-5333
Position Statement: Testified in support of HB 341
(Spoke via teleconference)
MICHAEL JOHNSON, Legislative Aide
Rep. Joe Sitton
Alaska State Legislature
State Capitol
Juneau, Alaska 99801
Phone: (907) 465-2327
Position Statement: Provided information on HB 341
BOB WARD
Associated General Contractors of Alaska
10003 Frank Maier Drive
Juneau, Alaska 99801
Phone: (907) 586-1648
Position Statement: Testified in support of HB 490
PREVIOUS ACTION
BILL: HB 341
SHORT TITLE: PHYSICIAN ASSISTANTS' SERVICES
SPONSOR(S): REPRESENTATIVE(S) SITTON,JAMES,Nicholia
JRN-DATE JRN-PG ACTION
01/03/94 2016 (H) PREFILE RELEASED
01/10/94 2016 (H) READ THE FIRST TIME/REFERRAL(S)
01/10/94 2017 (H) HES, FINANCE
03/02/94 2588 (H) COSPONSOR(S): NICHOLIA
03/17/94 (H) HES AT 03:00 PM CAPITOL 106
BILL: HB 490
SHORT TITLE: SCHOOL CONST: ALASKA BIDDER PREFERENCE
SPONSOR(S): REPRESENTATIVE(S) VEZEY
JRN-DATE JRN-PG ACTION
02/14/94 2379 (H) READ THE FIRST TIME/REFERRAL(S)
02/14/94 2379 (H) HES, FINANCE
03/17/94 (H) HES AT 03:00 PM CAPITOL 106
BILL: HB 488
SHORT TITLE: RESTRICT STUDENT LOANS TO ALASKA SCHOOLS
SPONSOR(S): REPRESENTATIVE(S) VEZEY
JRN-DATE JRN-PG ACTION
02/14/94 2379 (H) READ THE FIRST TIME/REFERRAL(S)
02/14/94 2379 (H) HES, STATE AFFAIRS
03/08/94 (H) MINUTE(HES)
03/17/94 (H) HES AT 03:00 PM CAPITOL 106
ACTION NARRATIVE
TAPE 94-54, SIDE A
Number 000
CHAIR TOOHEY called the meeting to order at 3:06 p.m., noted
members present and announced the meeting would begin with
hearing HB 341.
HB 341 - PHYSICIAN ASSISTANTS' SERVICES
Number 029
REP. JOE SITTON, Prime Sponsor of HB 341, read the sponsor
statement. He said HB 341 would amend several of Alaska's
current statutes relating to health care providers in order
to give Alaskans greater access to quality health care. He
added that no place is more unique than Alaska when it comes
to the role of the physician assistants (PA).
Number 072
CHAIR TOOHEY asked if, in the eyes of the medical
profession, the nurse practitioner and PA were seen as
equals and had an equal ability to give care.
Number 075
JOHN RILEY, President, Alaska Academy of Physician
Assistants, responded in the affirmative. He said the head
of the medical board told him about a month ago that he
considered both professions to be equal.
Number 087
REP. BUNDE asked if Medicare pays at the physicians's rate
if a Medicare patient sees a PA who is working under a
physician.
Number 095
MR. RILEY answered in the affirmative.
Number 097
REP. BUNDE asked, "If the PA had an independent operation,
as the law currently exists, why couldn't the PA charge
Medicare? And wouldn't the rate probably be lower than the
physician's rate?"
Number 104
MR. RILEY answered this probably was true, and each office
has its own fee structure.
Number 105
REP. SITTON added that he believed doctors charge more than
PAs in the Lower 48.
Number 111
REP. BUNDE clarified that the thrust of his question was
that, for the same work, if a PA worked in a physician's
office, Medicare probably would be charged at a higher rate
than if the PA worked alone.
Number 114
MR. RILEY agreed that this was true.
Number 120
CHAIR TOOHEY said KIMBERLY BUSCH and DAVE WILLIAMS would
address billing and clear some of this up.
Number 123
REP. GARY DAVIS asked if, under this bill, the PAs would
still be working for physicians. He also wondered if they
would be able to bill directly instead of going through the
mark-up phase.
Number 129
MR. RILEY said this bill does not really affect PAs that are
working in a physician's clinic because in that situation
they would continue to bill in the same manner. This bill
affects PAs who would apply for their own number and be in
solo practice situations.
Number 135
REP. BRICE asked how many of the 194 PAs mentioned in the
fiscal notes are currently billing under a physician.
Number 140
MR. RILEY said about 35 percent of the PAs in the state work
for Corrections, Industrial Medicine or Indian Health
Services, so perhaps 65 percent work in family practice
settings. He said he did not know how many of those were
billing under a physician.
Number 147
KIMBERLY BUSCH, Director, Division of Medical Assistance
(DMA), Department of Health and Social Services, offered the
correction that the division assumes it is being billed for
PA services connected with Indian Health Services.
Number 155
CHAIR TOOHEY asked Ms. Busch to address the fiscal note and
the billing procedures.
Number 160
MS. BUSCH said PA services are an important part of the
state's health care delivery system. She explained that
Medicaid reimburses PA services if PAs work under a
physician or in a designated rural health clinic. Often PAs
are the only practitioner in a rural health clinic and under
that construct, the federal government sets a rate for the
service, a per-encounter rate. In the physician's office,
they are paid according to a fee schedule that varies from
70 to 85 percent of what the physician bills.
Number 192
CHAIR TOOHEY asked if the physician was differentiated from
the PA on the Medicaid bill.
Number 198
MS. BUSCH said the renderer is not identified on the bill.
She added that an assumption was made on the fiscal note to
be friendly regarding payment to PAs. She referred to a
bill brought forward by optometrists in which optometrists
would be paid the same as physicians for those procedure
codes which they are capable of rendering. She cautioned
that this is the trend in the health field and asserted her
concern for the future.
Number 218
CHAIR TOOHEY asked if payment would be forthcoming "down the
pike" if a specific price were set in statute.
Number 221
MS. BUSCH said she presumed a price would not be set in
statute because prices are raised or set in regulation. In
the future she would expect to hear from providers that for
the same procedure codes they should be paid "the same as".
She said it is an equity issue with providers and that
although she is sympathetic to this issue this is also a
cost issue for the departmental budget. She said there are
already two service providers, added by the legislature, for
which funding has not been appropriated. She asked for
careful consideration before adding yet another provider
category for which there would not be an appropriation of
funds. Ms. Busch emphasized that this would be an entirely
different matter if funds were being appropriated and she
asked that Alaskans not be promised something that would not
actually be put on the books.
Number 250
DAVE W. WILLIAMS, Medical Assistance Administrator, Division
of Medical Assistance, Department of Health and Social
Services, reiterated the department is not at odds with PAs.
He said PAs provide a valuable service, especially in rural
Alaska. He asserted one truth about cost in Medicaid
programs is that access affects the cost of the program; if
you increase access, you increase the cost. He stated his
belief that he is in the middle of the road regarding the
fiscal impact of this bill, but explained this is not an
exact science, and in the past they have made inexact
estimates. He further stated if this bill becomes law,
there will immediately be 170 professionals in Alaska who
will have the right to bill Medicaid. Mr. Williams said his
assumption is a minimum of ten percent of the PAs would
enroll during the first year. He pointed out that the bill
says nothing about PAs remaining in the physician's office,
so there is nothing that says you cannot bill as a PA, and
then refer to the doctor. He added there is nothing in the
bill that says you won't, on the other hand, take the 4.4
average visits per client per year to a physician and say
that one or more of those go to the PA. He said Medicaid
would probably pay less if a PA was billing directly. He
concluded that he could not exactly tell if his estimations
were high or low. He said the highest encounter rate
Medicaid pays right now is $53.00. He said if that figure
was used to estimate, the result would be around $800,000
instead of the $999,000 that is on this bill. He further
stated if he assumed the PA was going to bill in addition to
the physician, this would increase the fiscal note.
Number 306
REP. OLBERG asked if every PA worked under the direct
supervision of a physician.
Number 308
MR. WILLIAMS said this is an equity issue in that PAs are
not equal to advanced nurse practitioners (ANPs). He said
PAs need to have a collaborative agreement while ANPs do
not, and this bill does not change that situation. He
explained that ANPs by federal law are paid at 80 percent of
the charges, and this does not work well in Alaska because
often times the charges are to a fully or partially
Medicaid-eligible population. He estimated that payment to
a PA would be at 70 percent.
Number 328
CHAIR TOOHEY asked, if this bill passed, would PAs be number
six on the list, and would there automatically not be
funding available for that category?
Number 335
MS. BUSCH explained if PAs were added to the list without
appropriating additional funding, then another provider on
the list would not receive funding. She pointed out that
LCSWs, psychologists, and direct entry midwives are three
provider categories above PAs on the list located in Section
47.07.035.
Number 356
REP. OLBERG asked if this list represented the order in
which people do not get paid.
MS. BUSCH replied this was correct.
REP. OLBERG commented that the list was upside down, which
was pathetic.
MS. BUSCH explained that this list is optional and about
nine services are mandatory, by federal law, before taking
this list into consideration.
REP. OLBERG said the list is still upside-down.
REP. BRICE commented that it was an inverse order of
funding.
Number 380
REP. G. DAVIS mentioned that it was ironic that PAs were not
on the list.
Number 391
MS. BUSCH responded that it lacks logic to add to this list
if there are not sufficient appropriations.
REP. BUNDE assumed a precedence was being set on this list
and asked if ANPs were funded.
MS. BUSCH said some ANP services are mandatory and some,
like those relating to the psychiatric or geriatric
specialties, are optional. The family nurse practitioner
and the pediatric nurse practitioner, who are analogous to
PAs, are mandated under federal law.
Number 422
REP. BUNDE asked what the fiscal note was on ANPs, as
compared to PAs.
Number 425
MR. WILLIAMS said this was problematic, but he would answer
the question. He explained that ANPs are split into two
main groups. He said there are nurse midwives, and PAs
don't deliver babies, but nurse midwives do. He said PAs do
some of what nurse midwives do, so the comparison is not
equal because PAs are not offering the same services. He
said one is working next to a doctor and the other is fairly
independent. He stated nurse practitioners have billed the
division through January at about $231,000 and PAs have
billed the division through January at about $171,000; the
division will pay roughly $800,000 for the year when these
are added together. He further said ANPs were not added,
previously, which makes this estimation difficult and
problematic.
Number 456
REP. BUNDE said according to federal mandate, ANPs were
funded and he wondered if ANPs were funded at approximately
the same level that it would cost to fund PAs, that rough
approximation being $800,000 to $1,000,000.
Number 465
MR. WILLIAMS replied that he did not see them as that equal.
Number 466
REP. BUNDE asked if they would cost the same. He said ANPs
provide a medical service and it costs a certain amount and
PAs provide a medical service and it should cost the same
amount, because neither are doctors.
Number 473
MR. WILLIAMS replied that it depends on how you value the
development of the profession. He said it was his
understanding that nurse practitioners have more on-the-job
training. He related that both have been to school, but PAs
work alongside of physicians. He said their services
encompass different things. He said he did not know the
specifics, but there is a PA school in Sitka which would
have more information. He said we do need better access in
rural Alaska, but the bottom line is we do not want to say
we are going to pay PAs and then not have the money to do
so.
Number 492
REP. BRICE said in attempts to avoid over or underfunding,
accurate information is needed to make good decisions. He
said for the fiscal year 1993 for ANP services there should
be a single number to determine what is needed. He asked
how many of the 194 PAs in Alaska were currently filing
their fees under a doctor or through a rural health clinic.
Number 514
MR. WILLIAMS said he didn't have that number with him. He
said there are 165 practicing in Alaska.
REP. BRICE expressed his concern about potential "double-
dipping," and said a clear delineation would need to be made
within the fiscal note indicating that some of these
services would be a wash. He referred to Section 47.07.035
and said we should be able to determine at the end of the
fiscal year how much money has been spent in each category.
TAPE 94-54, SIDE B
Number 077
MR. WILLIAMS said this fiscal note does not include "double
dipping" and noted the figures would be higher if this were
included, and would be lower if it were assumed that the PA
would split the number of visits with the physician.
Number 082
REP. BRICE asked what the expenditures were for the fiscal
year 1993 under the ANP category.
MR. WillIAMS said he did not price ANPs because they were in
a different practice, a different profession, and a
different setting.
Number 086
CHAIR TOOHEY acknowledged that the question was not
answered. She offered Mr. Williams some potentially helpful
unidentifiable written information (indiscernible).
Number 090
REP. OLBERG began by saying the fiscal note did not, for the
most part, represent additional spending.
Number 092
MR. WILLIAMS said there are 170 or so PAs in Alaska, and he
assumed approximately ten percent of them would enroll if
this bill were passed.
Number 098
REP. OLBERG said this did not address his question. He said
in theory, if PAs get $499,000 of the total "x" amount given
to the department then the amount spent on Medicaid is not
going to be "x" plus 499,000; it is going to remain at "x"
dollars, with PAs getting a share of that money. He
continued by theorizing that a fiscal note could be set at
zero, and would have a fiscal impact within the department,
but not on the total general fund budget.
Number 109
MS. BUSCH said that certainly if this were true there would
be some wonderful solutions to the increases in medical
costs, but unfortunately this was not the case. She
explained that physicians in the marketplace have certain
expectations of earnings, and the PAs can be a means to
generate income. She said the division has experienced
adding new practitioners and this has not saved them any
money. She explained the physician would continue to
generate the same income as before, and if the PA were
functioning as an independent, this would generate a
separate income.
Number 130
REP. OLBERG responded that it was not his assumption that
this would save money. He explained that if $300 million
were given to Medicaid and ten new practitioners were added,
each generating a million dollars each, Medicaid would still
spend $300 million. The total cost to the state would
remain the same and the money would come from some other
source.
Number 136
MS. BUSCH said she failed to understand because in her
experience when practitioners were added the cost increased.
She expressed her concern that the money would not be
appropriated.
Number 149
REP. OLBERG replied that his concern was not about the money
being available, nor was it about people's expectations. He
said he wanted to know if this fiscal note represented
spending beyond a certain level.
Number 153
MS. BUSCH apologized for not previously understanding the
question and said, "Yes, this represented going beyond the
budget and would have to be appropriated in addition to what
the governor had requested."
Number 158
REP. OLBERG asked, "So before we pay anybody, we
automatically do not pay the first five or six or ten or
fifteen people on this list?"
Number 160
MS. BUSCH responded this was correct and dependent upon
legislative appropriations.
Number 162
REP. OLBERG asked, "If the level stays the same, would
thirteen of these groups not receive money instead of
twelve?"
Number 164
MS. BUSCH said if the department does not get the growth
they have requested for 1995, it would be possible to go
down to number 25 on the list.
Number 169
CHAIR TOOHEY said her concern was philosophical in that the
PAs must not assume they are not qualified to be on the
list; they are as qualified as ANPs and others on the list.
She said not paying them was simply a matter of not having
the money to do so.
Number 176
MS. BUSCH said the division is purchasing services from PAs
who are working with physicians or in rural settings. She
agreed that it is not that PAs are not valued, but more a
matter of keeping costs down by not paying PAs directly.
Number 180
CHAIR TOOHEY asked, if this bill does not pass, would a PA
working in a clinic in the middle of Alaska get paid?
MS. BUSCH said if a clinic has been certified as a rural
health clinic, has met certain conditions and has been
licensed accordingly, then a PA can practice solo there.
She added that the PA pays a fee to the overseeing
physician.
Number 192
MR. RILEY said the purpose of this bill refers to PAs who
are enrolled (indiscernible).
Number 205
JACK HEESCH, Lobbyist, Alaska Academy of Physician
Assistants, stated they vehemently disagree with Mr.
William's statement about ANP certified nurse midwives
providing the same services as PAs. He said PAs provide the
same services as ANPs, but not as nurse midwives. He
further stated the amount of money spent on nurse midwives
should not be rolled in with the money spent on ANPs, and
then estimated to be part of an $800,000 fiscal note. He
said PAs don't deliver babies.
Number 221
CHAIR TOOHEY requested that witnesses indicate their desire
to communicate in writing rather than by head shaking.
Number 226
CLAY LANGLAND, Physician Assistant, testified from Pelican.
In an attempt to simplify the discussion, he presented a
theoretical situation in which there were three Medicaid
patients in Alaska: one in Anchorage, one in Juneau and one
in Pelican. He asked, "Supposing there was a rural health
clinic designated in Pelican, would all three Medicaid
patients be able to receive reasonable medical care?" He
pointed out that the patients in Anchorage or Juneau would
have more choice and ease, whereas the patient in Pelican
would have limited access to reasonable care.
Number 250
CHAIR TOOHEY asked Mr. Langland if he worked in the same
office as a physician and asked if there was a physician in
Pelican. She said, according to Ms. Busch, Pelican would
qualify as a rural clinic and therefore would be paid;
whereas the other practitioners would not be paid except
through the physician.
Number 255
MS. BUSCH clarified that the clinic would need to be
licensed in order to qualify for payment.
Number 257
MR. LANGLAND said there is no physician in Pelican and he
confirmed that the clinic is a certified rural health
clinic. He said this afternoon's discussion needs to stay
focused on reasonable client services and accessibility.
Number 280
MS. BUSH agreed that accessibility is important. She said
the problem is really in nonrural areas because in order for
a PA practicing independently in a nonrural area to receive
Medicaid funding they have to bill through a physician. In
the given scenario, a Medicaid patient would not have a
choice between going to a PA independently or going to a
physician.
Number 300
CHAIR TOOHEY asked the witnesses to be brief in their
testimonies.
Number 307
JOHN WINKELMAN, a Physician Assistant at the Healy Clinic,
testified via teleconference that the Healy clinic is
located about 100 miles from Fairbanks. He explained that
the clinic is now privately owned, whereas it was previously
designated as a rural health clinic and received
reimbursement from state Medicaid for services. He said in
1988 the state cut reimbursement dollars and the clinic
dropped from the rural health setting status. He said the
clinic continues to see Medicaid patients on a fee for
service basis. He explained that in practical terms this
means that the Medicaid patients in that area have to travel
to Fairbanks, and the clinic continues to see the emergency
cases. Mr. Winkelman stated his support of HB 341 because
it would provide for services locally and would also promote
a level playing field in the health care arena.
Number 377
REP. BRICE asked for a brief at-ease from 4:08 p.m. to 4:09
p.m.
Number 390
JEANNE CLARK, Physician Assistant, Fairbanks, testified via
teleconference that this bill was drafted because of some
undesirable barriers to patients that need to be addressed.
She stated the current billing situation is advantageous to
PAs, so if this bill passes, PAs would not necessarily go
solo and obtain their own Medicaid numbers because
reimbursement from Medicaid would be at a much lower rate.
She said passage of this bill would not necessarily increase
costs in the way that was previously mentioned by Mr.
Williams. Ms. Clark acknowledged money as an important
issue, but emphasized that the focus needs to remain on
providing health care to all people.
CHAIR TOOHEY, as a point of clarification, said this bill
does not stop a PA from billing independently, but is for
Medicaid patients (indiscernible.)
Number 445
DITA DE BOER testified from Seward that PAs fulfill a very
special need in the medical field and should be integrated
into the medical practice. She supported the passage of HB
341.
CHAIR TOOHEY asked if Seward was a certified rural
caregiver.
MS. DE BOER replied that it was not.
Number 476
DAVID JOHNSON, Physician Assistant, testified from Seward
that he works at a Native health clinic. He explained that
the PAs role involves having a physician as a referral
source. He stated his support of HB 341.
Number 508
CHAIR TOOHEY said the purpose of this bill is to put the
funding under Medicaid and has nothing to do with
qualifications. She encouraged witnesses to testify on the
concept of the bill.
Number 527
CHAIR TOOHEY excused Rep. Bunde for another meeting.
Number 530
ROBERT WOODS testified from Fairbanks in support of HB 341.
He said maintaining certification as a rural health
provider is an expensive proposition. He added that the
majority of PAs in Alaska practice with primary private
practice physicians. Mr. Woods said there is a shortage of
qualified health care providers in this state and there
always will be. He said if he were unable to bill Medicaid
patients, he would have to deny them care in deference to
patients with insurance coverage that would pay 80 percent
reimbursement as opposed to a lower Medicaid rate of say 30
or 40 percent.
Number 558
JESSICA STEVENS testified from Talkeetna. She said because
of all the paperwork involved, the clinic in her community
functioned for nine months without designation as a rural
health clinic. During those nine months Medicaid patients
were seen, but the clinic will never get reimbursed for that
time. She described her community as a poor rural area
where people do not have access to the kind of health care
they need. She said the clinic provides a necessary service
but has been in danger of closing precisely because it has
been unable to bill Medicaid for services rendered. She
said she recognizes PAs as providers equal to ANPs. She
emphasized the designation process as a lengthy one and
mentioned the clinic will probably be subsidizing care for
another three months because their status is still
undetermined.
TAPE 94-55, SIDE A
Number 003
CHAIR TOOHEY thanked Ms. Stevens and asked if there were any
further questions on-line.
Number 008
BEVERLY HUGO, Physician Assistant, testified from Barrow in
support of HB 341. She said Medicaid should honor the
services PAs give in rural areas or areas away from
metropolitan areas. She added that they provide a vital
service for people that otherwise would have no access. She
said she is in school health services and she works with a
physician at the Barrow health clinic.
Number 022
CHAIR TOOHEY said for the record the bill would not be moved
out today but amendments could be addressed. She asked Mr.
Riley if he wanted to give a wrap-up.
Number 030
MR. RILEY expressed the expectation that PAs be put on the
optional list in Section 47.07.035. He said they want to
have a precedent in order even though it is likely that
there will not be funding this year. He said it does not
necessarily follow that PAs should not be put on the list
because of that. He said, in reference to the fiscal note
discussed earlier by Mr. Williams, that there are about 200
adult ANPs, and of those, about 20 have billed Medicaid. He
said that means there are 20 ANPs who are not nurse midwives
but who are billing the state for $400,000 total. The cost
to the state is half of that, which is $200,000. He further
stated there are eight certified nurse midwives who are
responsible for the other $400,000 in charges. Mr. Riley
concluded that charges generated by the ANPs need to be
further looked into because the work done by PAs is,
essentially, identical to the work done by ANPs.
Number 058
CHAIR TOOHEY asked if this bill would allow rural providers
to be paid.
Number 059
MR. RILEY said PAs work in 38 communities in Alaska and
there are only eleven certified rural health clinics, so
there are a bunch of communities that are not rural health
clinics that cannot bill Medicaid.
Number 063
CHAIR TOOHEY asked if they worked under a physician.
Number 063
MR. RILEY said yes, they are under licensure to work under a
physician, but the physician is not in the practice with
them. He said they cannot legally bill Medicaid because the
physician is not in the clinic. Mr. Riley specified that HB
341 is for those situations. He added that the Alaska State
Medical Association, the Nurses' Association, the Alaska
Nursing Home and Hospital Association, the Public Health
Association, and the Health Care Coalition all support this
bill.
MR. RILEY addressed the issue of cost shifting. He said
this process took root when insurance companies told PAs
they would no longer be processing their claims. He said
there were PAs in clinics who were not supposed to be
billing through their physicians. He said this is no longer
occurring. Mr. Riley said they hope that reimbursement will
be set at the same rate as ANPs, at 80 percent, which will
be a reduction from the 100 percent that is now being used.
He added that this could be a cost savings. He stated HB
341 also prohibits insurance companies from discriminating
against services provided by PAs, and that almost all of the
health care providers in the state have this protection
under law except PAs. He stated another reason to include
this legislation would be because it allows PAs to provide
workmen's compensation evaluations. He said PAs are already
doing this, and the legislation would formalize that
procedure.
Number 102
CHAIR TOOHEY asked if there were any questions.
Number 105
REP. BRICE made a motion to move Amendment 1.
Number 110
REP. B DAVIS asked to speak before considering the
amendment.
Number 115
CHAIR TOOHEY called for a brief at-ease from 4:30 p.m. to
4:32 p.m. She stated she wanted to move the amendments and
then continue tomorrow.
Number 117
REP. KOTT objected to Amendment 1.
Number 118
MR. RILEY said federal law does not allow PAs to hand out
handicapped parking permits, but Section 3 of the bill
establishes that PAs can hand out handicapped parking
permits, therefore placing state law in conflict with
federal law. Mr. Riley suggested some housecleaning, given
his understanding that this was a friendly amendment offered
by the sponsor.
Number 129
MICHAEL JOHNSON, Legislative Aide to Rep. Sitton, said when
the bill was originally drafted, PAs suggested issuing
handicapped parking permits and this seemed to be a good
idea. It was later learned that federal law controls this
function. This amendment merely deletes that section from
the bill.
Number 141
REP. KOTT withdrew his objection.
Number 142
CHAIR TOOHEY, hearing no objection, adopted Amendment 1.
She asked for a motion on Amendment 2.
Number 145
REP. G. DAVIS moved Amendment 2.
Number 146
CHAIR TOOHEY asked for discussion on this amendment. She
asked if the committee was assuming that PAs were going to
be put on the list. She asked for the pleasure of the
committee.
Number 153
REP. G. DAVIS moved Amendment 2.
Number 155
CHAIR TOOHEY, hearing no objection to Amendment 2, the
motion carried. She asked for the pleasure of the committee
on this amendment.
Number 158
REP. BRICE made a motion to move HB 341 with individual
recommendations. He suggested that major questions relating
to the fiscal note be addressed by the Finance Committee.
He said it was fine public policy to have PAs added to the
list.
Number 168
REP. OLBERG stated for the record that since a straight
answer from the department on fiscal matters was not
forthcoming, the bill might as well be sent to the Finance
Committee.
Number 170
REP. KOTT associated with Rep. Olberg's comment, and said
the fiscal note was out of proportion and possibly wildly
incorrect.
Number 176
CHAIR TOOHEY asked that a roll call vote be taken. Reps.
Toohey, G. Davis, Vezey, Kott, Olberg, B. Davis, Brice voted
yea. HB 341 passed unanimously out of the committee with
individual recommendations.
HB 490 - SCHOOL CONST: ALASKA BIDDER PREFERENCE
Number 189
CHAIR TOOHEY brought HB 490 to the table.
Number 192
REP. OLBERG asked if the chair would entertain a motion.
Number 193
REP. AL VEZEY, Prime Sponsor of HB 490, gave a sponsor
statement and said HB 490 was a simple bill. He noted a
regulation in Title 4 of the Alaska Administrative Code that
bars school districts from giving a local bidder preference.
He stated this is not in keeping with good public policy and
explained that HB 490 does not mandate a local bidder
preference, it merely prohibits the prohibitions on a local
bidder preference. Rep. Vezey made a motion to move HB 490
from committee with the attached fiscal note.
Number 209
CHAIR TOOHEY asked the sponsor if there would be a problem
with this being brought to court.
Number 215
REP. VEZEY said no, he did not think this would be a
problem, but he did mention that the cost of filing a
lawsuit is only $75.00.
Number 216
REP. BRICE mentioned there are other Alaskan provider
preference statutes that are in use, and this would just be
added to those preferences.
Number 224
BOB WARD, Associated General Contractors of Alaska (AGC),
testified in support of HB 490. He said the bill does not
break new ground as the concept of bidder's preference has
been in existing law for years. He said it allows for
municipalities in rural (indiscernible). Mr. Ward further
stated this bill helps Alaska contractors support the state
financially and it also helps the local people who work for
the local contractors.
Number 241
REP. KOTT asked what AGC policy is on hiring Alaskans.
Number 247
MR. WARD replied that his understanding was that Alaskan
contractors were Alaskans.
Number 250
CHAIR TOOHEY asked for the pleasure of the committee.
Number 255
REP. KOTT made a motion to move HB 490.
Number 256
CHAIR TOOHEY, hearing no objection, passed HB 490 out of the
committee with attached fiscal note.
Seeing no further business before the committee, CHAIR
TOOHEY adjourned the meeting at 4:42 p.m.
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