Legislature(2023 - 2024)DAVIS 106
03/30/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Opportunities to Grow the Health Workforce, Apprenticeship and Beyond | |
| HB96 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 96 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 30, 2023
3:03 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION(S): OPPORTUNITIES TO GROW THE HEALTH WORKFORCE~
APPRENTICESHIP AND BEYOND
- HEARD
HOUSE BILL NO. 96
"An Act relating to licensing and registration requirements for
certain wholesale drug distributors; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 96
SHORT TITLE: LICENSING:DRUGS/DEVICES FOR HOME DIALYSIS
SPONSOR(s): REPRESENTATIVE(s) PRAX
03/06/23 (H) READ THE FIRST TIME - REFERRALS
03/06/23 (H) HSS, L&C
03/30/23 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
CATHY MUNOZ, Acting Commissioner
Office of the Commissioner
Department of Labor and Workforce Development
Juneau, Alaska
POSITION STATEMENT: Introduced the discussion on apprentice
programs in Alaska.
ANNE VELARDI, Apprenticeship Coordinator
Alaska Workforce Investment Board
Alaska Department of Labor and Workforce Development
Anchorage, Alaska
POSITION STATEMENT: Presented the PowerPoint presentation,
titled "Healthcare Apprenticeships."
JOELLE HALL, President
Alaska American Federation of Labor and Congress of Industrial
Organizations
Anchorage, Alaska
POSITION STATEMENT: Presented on apprenticeship models.
NANCY MERRIMAN, CEO
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Provided a PowerPoint presentation, titled
"APCA (Alaska Primary Care Association) and Healthcare Workforce
Training Programs."
JENNIFER NIXON, Director
Workforce Development and Health Equity
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Answered a question addressing the Alaska
Primary Care Association's training programs.
CHADWICK VANCE, Staff
Representative Mike Prax
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB 96,
on behalf of Representative Prax, prime sponsor.
ELIZABETH STOLL, Director
State and Government Affairs
Baxter International Incorporated
Deerfield, Illinois
POSITION STATEMENT: Gave a PowerPoint presentation, titled
"Alaska House Bill 96," on behalf of Representative Prax, prime
sponsor.
ACTION NARRATIVE
3:03:57 PM
CHAIR MIKE PRAX called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Sumner, Saddler, McCormick, Mina, and Prax were
present at the call to order. Representatives Ruffridge and
Fields arrived as the meeting was in progress.
^PRESENTATION(S): Opportunities to Grow the Health Workforce,
Apprenticeship and Beyond
PRESENTATION(S): Opportunities to Grow the Health Workforce,
Apprenticeship and Beyond
3:05:02 PM
CHAIR PRAX announced that the first order of business would be a
presentation on the opportunities to grow the health workforce,
apprenticeships and more.
3:05:53 PM
CATHY MUNOZ, Acting Commissioner, Office of the Commissioner,
Department of Labor and Workforce Development, introduced the
discussion on apprentice programs in Alaska. She noted that the
state has access to apprenticeship programs, and she pointed out
the federal Registered Apprenticeship Program in Alaska. She
said that apprenticeships can be sponsored by a union, non-union
organization, and employers. She highlighted that, through the
Alaska Workforce Investment Board's coordination,
apprenticeships are being offered in the construction,
information technology (IT), healthcare, teaching, and aviation
fields.
3:08:51 PM
ANNE VELARDI, Apprenticeship Coordinator, Alaska Workforce
Investment Board, Alaska Department of Labor and Workforce
Development, gave a PowerPoint presentation, titled "Healthcare
Apprenticeships" [hardcopy included in the committee packet].
She started on slide 2, which addressed the American
Apprenticeship Initiative, which supplies a grant for
apprenticeship expansion. She stated that the grant involves
683 health care apprentices in the state and 17 occupations.
The grant has helped doubled the number of female apprentices in
Alaska and built strong partnerships with healthcare providers,
including the Providence Alaska Medical Center, the Pioneer
Home, and the Alaska Primary Care Association (APCA).
3:16:52 PM
MS. VELARDI, concluding the presentation, moved to slide 3,
which listed some of the health care occupations utilizing the
Registered Apprenticeship Program in Alaska. These include the
occupations of clinical chiropractic assistant, medical coding
and billing, veterinary technician, certified nursing assistant,
pharmacy technician, surgical technician, medical assistant,
dental assistant, and more.
3:23:27 PM
REPRESENTATIVE SADDLER requested the number of registered
apprenticeships and the number of Alaskans who are participating
in the apprenticeships today.
MS. VELARDI answered that the figure is about 2,054, but this
varies seasonally. She noted that most of these apprenticeships
are in construction. In response to a series of follow-up
questions, she explained that it would be hard for a 16-year-old
to work in a health care apprenticeship because of the
restrictions, and most healthcare apprentices are 18 years old
or older. She responded that the length of the apprenticeships
are generally one to two years. She responded that using
construction apprenticeships as an example, apprenticeships
would start at about 60 percent of the journey worker's wage and
work up to 100 percent. She said that typically there will be
one or two wage increases during the apprenticeship, and then
one more on the completion of the apprenticeship. She explained
that any apprenticeship that did not show a wage increase would
not be approved.
3:26:20 PM
REPRESENTATIVE MINA asked about outreach for these
opportunities. She questioned whether there is a waitlist for
apprenticeship applicants.
MS. VELARDI shared that the outreach is more geared to sponsors
than job seekers, and these sponsors are starting to advertise
apprenticeships to entice new employees. She stated that there
is not a waitlist.
3:29:22 PM
JOELLE HALL, President, Alaska American Federation of Labor and
Congress of Industrial Organizations (AFL-CIO), address the
different apprenticeship models. She explained that there are
multi-employer apprenticeship systems, with private sector
employers who may be in competition or band together to train
the workforce. She further explained that the system is done in
joint with unions and employers. She voiced that as the Alaska
AFL-CIO president, there is an opportunity for the health care
industry to adopt this system. She explained that the system is
95 percent funded by member dues. She added that there are
currently no health care apprenticeships in the AFL-CIO
apprenticeship system.
3:36:19 PM
REPRESENTATIVE MINA asked whether there are more robust models
in other states.
MS. HALL answered that the topic has not come up in her talks
with other AFL-CIO leaders.
3:37:09 PM
REPRESENTATIVE FIELDS offered his understanding that the
Dartmouth-Hitchcock system in New Hampshire was the first to
build out system-wide apprenticeships.
3:38:07 PM
NANCY MERRIMAN, CEO, Alaska Primary Care Association (APCA),
gave the PowerPoint presentation, titled "APCA (Alaska Primary
Care Association) and Healthcare Workforce Training Programs"
[hardcopy included in the committee packet]. She moved to slide
2, which listed the portfolio of health workforce training
programs hosted by APCA. The list includes spring break and
summer scrubs camps, high school explore camps, pre-
apprenticeship for training in health, college credit
agreements, and more.
MS. MERRIMAN advanced to slide 3, which addressed the Area
Health Education Centers (AHEC) in Southcentral Alaska. She
pointed out that the mission of AHEC is to develop and enhance
education and training networks within communities, academic
institutions, and community-based organizations. She moved to
slide 4 and discussed the APCA's K-12 health care career camps.
She said the camps provide students with experience in mock
surgeries, vet clinics, and working with health care
professionals. She expressed that the program is popular. She
moved to slide 5 and discussed preparing Alaskans for the Pre-
Apprenticeship Training in Healthcare (PATH) Academy
3:44:31 PM
MS. MERRIMAN moved to slide 6, which addressed the federal
Registered Apprenticeship Program. She pointed out that APCA
has partnered with the US Department of Labor and the Alaska
Department of Labor and Workforce Development. She pointed out
that the slide listed some of the current apprenticeships
registered in the program.
MS. MERRIMAN transitioned to slide 7 and explained the federal
Good Jobs Challenge grant, which APCA has recently received.
She said the grant has allowed APCA to push the registered
apprenticeship programs out around the state. It has also
allowed APCA to partner with all of the organizations listed on
slide 7.
3:48:37 PM
MS. MERRIMAN moved to slide 9, which addressed APCA's college
credit and supports. At Alaska Pacific University (APU),
apprentices can receive college credit in the programs for
pharmacy technician, billing and coding specialist, community
health worker, medical assistant, and electronic health records.
She pointed out that APCA works at reducing barriers that keep
Alaskans from pursuing careers in health care. She added that
it has financial resources to assist apprentices with items like
rent, insurance, gas, childcare, and others. She concluded the
presentation on slide 9 and informed members on how they can
access more information about apprenticeships.
3:50:40 PM
REPRESENTATIVE FIELDS, concerning the Good Jobs Challenge, asked
whether hospitals have partnered with APCA to expand
apprenticeship training opportunities.
MS. MERRIMAN answered that the Alaska Hospital and Healthcare
Association (AHHA) is one of the key partners, and it will be a
sub-recipient organization in the challenge grant. She stated
that AHHA will be working with hospitals to identify
apprenticeship pathways to develop. She said APCA has a list of
8 apprenticeships it offers, and through grants, the hope is to
increase the number of apprenticeships from 8 to 12 or more.
3:52:19 PM
REPRESENTATIVE MINA asked for a breakdown of the PATH Academy's
pre-apprenticeship program. She asked the number of graduates
who are connected with the apprenticeship program.
MS. MERRIMAN answered that it is common for a person to go from
PATH to a job, from PATH to an apprenticeship, or from PATH to
an academic program.
3:53:32 PM
JENNIFER NIXON, Director, Workforce Development and Health
Equity, Alaska Primary Care Association, responding to the
question, stated that this varies depending on the
apprenticeship program and the job the student has before the
pre-apprenticeship. She expressed uncertainty on the specific
percentages of graduates connected with apprenticeship programs
and offered to report back concerning the data.
MS. MERRIMAN commented that there are PATH Academies for
specific jobs, like direct support professionals. She noted
that 100 percent of the students involved in the direct-service
professionals' program are picked up by employers.
3:55:17 PM
REPRESENTATIVE MINA inquired about individuals who had not
connected to an apprenticeship and what additional resources it
would take for them to find employment.
MS. MERRIMAN responded that health care apprenticeships are new
to the health care sector, but they are growing. She stated
that apprenticeships are not currently advertised, but there are
opportunities for incumbent workers to enter an apprenticeship.
She said APCA is building the number of employment coordinators
to help people find the next step in employment.
3:57:37 PM
REPRESENTATIVE FIELDS stressed the need to build the
apprenticeship system over time, namely in the construction
industry. He speculated on the difference between the
construction and the health care sector. He asked how the
apprenticeship system could be expanded by informing employers
of the return on investment (ROI).
MS. MERRIMAN relayed that health care apprenticeships have been
growing, and this raises awareness. She pointed out that grant
funding is building up the system. She indicated that what
employers understand about apprenticeships needs to be
addressed. She added that there has been a growing awareness
about ROI when employers are investing in the apprenticeship
system.
REPRESENTATIVE FIELDS relayed concerns about the rising costs of
travel nurses in the state. He put forth that this reflects the
state's inability to supply local nurses. He asked how
apprenticeship pipelines could be used to address workforce
needs.
MS. MERRIMAN answered that APCA is considering "career ladders."
She explained that this is when a person enters a health care
career at an accessible level, and then progresses. She said
that this system leverages the importance of entry-level
positions.
4:04:32 PM
CHAIR PRAX asked how APCA markets apprenticeship programs.
MS. MERRIMAN expressed the opinion that APCA is getting better
at this, but it takes time to convey the meaning of an
apprenticeship. She stressed that employers are important to
the system's success. She stated that APCA's outreach includes
radio, social media, and the internet. In response to a follow-
up question, she explained that APCA is an association of
federally qualified health centers, and it supports 29 federally
qualified organizations. She said APCA partners with AHHA, as
well as with the Alaska Tribal Health System and Behavioral
Health.
CHAIR PRAX offered his understanding that APCA is marketing to
individual businesses and organizations outside of APCA.
MS. MERRIMAN responded that this is correct, as APCA can help
any Alaskan interested in a health care career.
4:08:06 PM
REPRESENTATIVE FIELDS recalled that primary care employees who
may already have a job were the first group of employees
marketed to. It was emphasized that with an apprenticeship, a
job could become a career.
MS. MERRIMAN commented that most of the apprentices that enter
the program are incumbent workers with the employer offering an
apprenticeship opportunity.
4:10:46 PM
MS. NIXON, in conclusion, commented that the apprenticeship
system has been an opportunity to be involved in something that
is positive. She stated that the Good Jobs Challenge grant
offers the opportunity to expand the apprenticeship program to
every populated area of Alaska.
4:12:49 PM
The committee took an at-ease from 4:12 p.m. to 4:15 p.m.
[Chair Prax passed the gavel to Vice Chair Ruffridge.]
HB 96-LICENSING:DRUGS/DEVICES FOR HOME DIALYSIS
4:15:30 PM
VICE CHAIR RUFFRIDGE announced that the final order of business
would be HOUSE BILL NO. 96, "An Act relating to licensing and
registration requirements for certain wholesale drug
distributors; and providing for an effective date."
4:15:50 PM
CHAIR PRAX, as prime sponsor, presented the sponsor statement on
HB 96 [copy included in the committee packet], which read as
follows [original punctuation provided]:
In Alaska, the Pharmacy Board requires a pharmacy that
only distributes dialysis supplies and solutions to
the home of dialysis patients, to comply with the same
arduous requirements as retail pharmacies (e.g.,
Walgreens, CVS) that handle controlled substances,
compounds, and dispense medications with varying
safety profiles. Pharmacies that deliver dialysis
supplies and solutions only offer a limited product
portfolio and follow all Quality and FDA requirements;
additional retail pharmacy mandates are onerous to the
operations.
Currently 24 states allow manufacturers that are
registered as wholesale drug distributors and who
distribute dialysis supplies and solutions, to deliver
directly to home dialysis patients. An additional 8
states provide for some form of special licensure for
the distribution of these products which ensures that
the dialysis supplies are available for delivery to
patients. Both Hawaii and Nevada have bills pending
this session to accomplish the same goal.
HB 96 would amend the pharmacy practice act to allow
manufacturers of home dialysis drugs, supplies and
devices to be exempted from pharmacy if they maintain
control of all products from manufacturing to the
patient. This would still require the pharmacy to
maintain any additional licenses such as a wholesaler
license.
4:18:26 PM
CHADWICK VANCE, Staff, Representative Mike Prax, Alaska State
Legislature, on behalf of Representative Prax, prime sponsor,
presented the sectional analysis for HB 96 [copy included in the
committee packet], which read as follows [original punctuation
provided]:
Section 1: This section amends AS 08.80.157(h) to
provide wholesale drug distributors the ability to
legally deliver dialysate drugs and devices directly
to patients.
4:19:14 PM
ELIZABETH STOLL, Director, State and Government Affairs, Baxter
International Incorporated, on behalf of Representative Prax,
prime sponsor, gave a PowerPoint presentation, titled "Alaska
House Bill 96" [hardcopy included in committee packet]. She
began on slide 2, which addressed the treatment of end state
renal disease (ESRD) in Alaska. She pointed out that there are
1,086 ESRD patients in the state, of which 154 are home dialysis
patients.
MS. STOLL moved to slide 3 and addressed how patients receive
dialysis products at home. She pointed out that for ESRD
patients who elect to receive dialysis in the home, they must
receive monthly home shipments of supplies. The slide lists the
details of the supplies, which when shipping, weighs between 500
and 1,000 pounds. She pointed out that because of this, home
delivery is an essential service for the home patient. She
moved to slide 4, which continued how patients receive dialysis
products at home. She stated that patients must be trained on
using the dialysis kits, while the physician would determine the
monthly supply needed and send this to the pharmacy where the
monthly shipment order is determined. This will then be shipped
to a nearby distribution center, where employees organize each
patient's monthly supplies into deliveries. After several
compliance checks the orders are delivered directly to the
patient's home.
4:25:01 PM
MS. STOLL advanced to slide 5 and addressed why the law needs to
be changed. The slide read as follows [original punctuation
provided].
The Alaska Pharmacy Board requires a pharmacy that
only distributes dialysis supplies and solutions to
the home of dialysis patients, to comply with the same
arduous requirements as retail pharmacies that handle
controlled substances, compounds, and dispense
medications with varying safety profiles.
These Pharmacies that deliver dialysis supplies and
solutions only offer a limited product portfolio and
follow all Quality and FDA requirements.
The law also requires a licensed pharmacist (above and
beyond the Alaska licensed out of state central
pharmacy that has processed the order) to physically
view the boxes before they can leave the warehouse,
which is onerous and unnecessary.
MS. STOLL moved to slide 6, which read as follows [original
punctuation provided]:
What does the Bill DO?
This bill will:
Amend the pharmacy practice act to allow manufacturers
of home dialysis drugs, supplies and devices to be
exempted from being licensed as a pharmacy if they
maintain control of all products from manufacturing to
the patient.
This would still require the location to maintain any
additional licenses, such as an Alaska wholesaler
license.
This means the Alaska Board of Pharmacy still has
jurisdiction over the location and its operations.
MS. STOLL moved to slide 7, which read as follows [original
punctuation provided]:
Why Is this Change Ok for Alaskans?
In Alaska, we believe the requirement to require a
pharmacist to review and place a second label onto the
boxes prior to leaving the warehouse is onerous and
unnecessary.
This bill will mirror what the National Board of
Pharmacy's Model Act outlines for these pharmacies and
distribution centers.
There are 24 states that currently operate under the
model and an additional 8 states provide for some form
of special licensure for the distribution of these
products with zero instances of harm to any patient.
4:26:36 PM
MS. STOLL moved to slide 8 and pointed out that this is the
standard of practice in 32 other states. She advanced to slide
9 to present a map of states that exempt ESRD distribution and
those which require minimal pharmacy audits. She transitioned
to slide 10, which addressed things to consider, including that
the proposed legislation would not include diabetes supplies or
any other type of device, no compounding or manipulation of
products would occur, and solutions would be under the
manufacturers control from the licensed manufacturing plant to
the patient's home.
4:28:08 PM
REPRESENTATIVE SUMNER asked why the change is good for Alaskans.
MS. STOLL answered that the change simplifies the distribution
model and removes unnecessary regulations. She added that this
therapy would save money for Medicaid recipients.
4:29:19 PM
VICE CHAIR RUFFRIDGE inquired as to what the distribution model
looks like for rural Alaska.
MS. STOLL responded that nothing of what currently happens would
change. She explained that there is an Anchorage distribution
facility with a system of boat and air transport that would move
orders to rural Alaska.
VICE CHAIR RUFFRIDGE questioned whether the Anchorage
distribution center or the facility in North Carolina is
licensed.
MS. STOLL explained that Baxter International has a
manufacturing license in North Carolina, and the Anchorage
distribution center is licensed as a wholesaler and a pharmacy.
She added that with the proposed legislation, Baxter
International would be removing the pharmacy license at the
Anchorage distribution center.
4:30:53 PM
REPRESENTATIVE PRAX questioned the dialysis kits.
MS. STOLL explained the contents of a dialysis kit. In response
to a follow-up question, she elaborated that the process is
overseen by a physician or a dialysis center.
4:34:21 PM
VICE CHAIR RUFFRIDGE announced that HB 96 was held over.
4:34:27 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:34 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 96 Fiscal Note DCCED.pdf |
HHSS 3/30/2023 3:00:00 PM |
HB 96 |
| HB 96 Presentation Slides v.2.pptx |
HHSS 3/30/2023 3:00:00 PM |
HB 96 |
| HB 96 Sectional Analysis.pdf |
HHSS 3/30/2023 3:00:00 PM |
HB 96 |
| HB 96 Sponsor statement.pdf |
HHSS 3/30/2023 3:00:00 PM |
HB 96 |
| HB0096A.PDF |
HHSS 3/30/2023 3:00:00 PM |
HB 96 |
| APCA Workforce Panel AkLeg 20230328.pdf |
HHSS 3/30/2023 3:00:00 PM |
APCA Presentation |
| HB96- Licensing-Drugs.Devices for Home Dialysis- Letter of Opposition from AK Board of Pharmacy.pdf |
HHSS 3/30/2023 3:00:00 PM |
HB 96 |
| 2023_0330_Health Care Apprenticeships in Alaska.pptx |
HHSS 3/30/2023 3:00:00 PM |
Cathy Munoz |