Legislature(2019 - 2020)BARNES 124

05/03/2019 03:15 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 3:25 pm --
+= HB 91 NATUROPATHS: LICENSING; PRACTICE TELECONFERENCED
Heard & Held
-- Public Testimony --
+= HB 24 LIMITED TEACHER CERTIFICATES; LANGUAGES TELECONFERENCED
Heard & Held
-- Public Testimony --
*+ HB 127 DENTAL HYGIENIST ADVANCED PRAC PERMIT TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                                                                         
                          May 3, 2019                                                                                           
                           3:24 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Adam Wool, Co-Chair                                                                                              
Representative Gabrielle LeDoux, Co-Chair                                                                                       
Representative Zack Fields                                                                                                      
Representative Sara Hannan                                                                                                      
Representative Louise Stutes                                                                                                    
Representative Josh Revak                                                                                                       
Representative Dave Talerico                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 91                                                                                                               
"An Act relating to the  practice of naturopathy; relating to the                                                               
licensure  of   naturopaths;  relating   to  the   Department  of                                                               
Commerce, Community, and Economic  Development; and providing for                                                               
an effective date."                                                                                                             
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 24                                                                                                               
"An  Act  relating  to  instruction  in  a  language  other  than                                                               
English; and relating to limited teacher certificates."                                                                         
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 127                                                                                                              
"An Act relating to the  practice of dental hygiene; establishing                                                               
an  advanced practice  permit; prohibiting  unfair discrimination                                                               
under  group  health insurance  against  a  dental hygienist  who                                                               
holds   an  advanced   practice  permit;   relating  to   medical                                                               
assistance  for dental  hygiene  services; and  providing for  an                                                               
effective date."                                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB  91                                                                                                                  
SHORT TITLE: NATUROPATHS: LICENSING; PRACTICE                                                                                   
SPONSOR(s): REPRESENTATIVE(s) JOHNSTON                                                                                          
                                                                                                                                
03/13/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/13/19       (H)       L&C, FIN                                                                                               
04/03/19       (H)       L&C AT 3:15 PM BARNES 124                                                                              
04/03/19       (H)       Heard & Held                                                                                           
04/03/19       (H)       MINUTE(L&C)                                                                                            
04/08/19       (H)       L&C AT 3:15 PM BARNES 124                                                                              
04/08/19       (H)       Heard & Held                                                                                           
04/08/19       (H)       MINUTE(L&C)                                                                                            
05/03/19       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: HB  24                                                                                                                  
SHORT TITLE: LIMITED TEACHER CERTIFICATES; LANGUAGES                                                                            
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS                                                                                    
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/7/19                                                                                
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       EDC, L&C                                                                                               
03/29/19       (H)       EDC AT 8:00 AM CAPITOL 106                                                                             
03/29/19       (H)       Heard & Held                                                                                           
03/29/19       (H)       MINUTE(EDC)                                                                                            
04/01/19       (H)       EDC AT 8:00 AM CAPITOL 106                                                                             
04/01/19       (H)       Heard & Held                                                                                           
04/01/19       (H)       MINUTE(EDC)                                                                                            
04/03/19       (H)       EDC AT 8:00 AM CAPITOL 106                                                                             
04/03/19       (H)       Heard & Held                                                                                           
04/03/19       (H)       MINUTE(EDC)                                                                                            
04/05/19       (H)       EDC RPT 5DP 2NR                                                                                        
04/05/19       (H)       DP: TUCK, ZULKOSKY, JOHNSON, STORY,                                                                    
                         DRUMMOND                                                                                               
04/05/19       (H)       NR: REVAK, HOPKINS                                                                                     
04/05/19       (H)       EDC AT 8:00 AM CAPITOL 106                                                                             
04/05/19       (H)       Moved HB 24 Out of Committee                                                                           
04/05/19       (H)       MINUTE(EDC)                                                                                            
04/24/19       (H)       L&C AT 3:15 PM BARNES 124                                                                              
04/24/19       (H)       Heard & Held                                                                                           
04/24/19       (H)       MINUTE(L&C)                                                                                            
05/03/19       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: HB 127                                                                                                                  
SHORT TITLE: DENTAL HYGIENIST ADVANCED PRAC PERMIT                                                                              
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
04/09/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/09/19       (H)       L&C, FIN                                                                                               
05/03/19       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ROSS TANNER                                                                                                                     
Alaska State Medical Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
MELINDA RATHKOPF, MD                                                                                                            
Alaska State Medical Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
LAURIE MONTANO                                                                                                                  
Alaska State Medical Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
STEVE SIVILS                                                                                                                    
Alaska State Medical Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
IRINA GRIMBERG                                                                                                                  
Alaska State Medical Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
TONYA CAYLOR                                                                                                                    
Alaska State Medical Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
MARY ANN FOLAND                                                                                                                 
Alaska State Medical Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
ALEXANDER VON HAFFTEN                                                                                                           
Alaska State Medical Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
PATRICK NOLAN                                                                                                                   
Alaska State Medical Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
CAMERON O'CONNELL, ND                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 91.                                                                           
                                                                                                                                
DAVID SCHLEICH, MD                                                                                                              
Alaska Association of Naturopathic Physicians                                                                                   
Portland, Oregon                                                                                                                
POSITION STATEMENT:  Testified in support of HB 91.                                                                           
                                                                                                                                
JOHN CULLEN                                                                                                                     
American Academy of Family Physicians                                                                                           
Valdez, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
KRISTIN MITCHELL                                                                                                                
American College of Physicians                                                                                                  
Soldotna, Alaska                                                                                                                
POSITION STATEMENT:  Testified during the hearing on HB 91.                                                                   
                                                                                                                                
JOSEPH RETH                                                                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 91.                                                                        
                                                                                                                                
ANNETTE O'CONNELL                                                                                                               
Kenai, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HB 91.                                                                           
                                                                                                                                
DANIEL YOUNG, ND                                                                                                                
Center for Natural Medicine                                                                                                     
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 91.                                                                           
                                                                                                                                
WAYNE ADERHOLD                                                                                                                  
Board of Chiropractic examiners                                                                                                 
Homer, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HB 91.                                                                           
                                                                                                                                
STEVE FRANK                                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 91.                                                                           
                                                                                                                                
KATIE GARDNER                                                                                                                   
Matsu Borough School District                                                                                                   
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 24.                                                                           
                                                                                                                                
REPRESENTATIVE IVY SPOHNHOLZ                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As prime sponsor, introduced HB 127.                                                                     
                                                                                                                                
KATRINA VIRGIN                                                                                                                  
Alaska Dental Hygienists Association                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the hearing on HB 127.                                                                  
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:24:54 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ADAM WOOL  called the House Labor  and Commerce Standing                                                             
Committee meeting to order at  3:24 p.m.  Representatives Hannan,                                                               
Revak, Talerico,  LeDoux, and  Wool were present  at the  call to                                                               
order.  Representatives Fields and  Stutes arrived as the meeting                                                               
was in progress.                                                                                                                
                                                                                                                                
            HB  91-NATUROPATHS: LICENSING; PRACTICE                                                                         
                                                                                                                                
3:26:03 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL  announced that the  first order of  business would                                                               
be  HOUSE BILL  NO.  91,  "An Act  relating  to  the practice  of                                                               
naturopathy; relating  to the licensure of  naturopaths; relating                                                               
to   the  Department   of  Commerce,   Community,  and   Economic                                                               
Development; and providing for an effective date."                                                                              
                                                                                                                                
3:26:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL opened public testimony.                                                                                          
                                                                                                                                
3:27:09 PM                                                                                                                    
                                                                                                                                
ROSS  TANNER,  Alaska  State Medical  Association,  informed  the                                                               
committee that he  is an internal medical  physician in Anchorage                                                               
and has practiced for the last  30 years.  He recounted a patient                                                               
with  Type 1  diabetes and  liver failure  who was  instructed to                                                               
discontinue   all   medications,    including   insulin,   by   a                                                               
naturopathic  doctor   (ND),  which   resulted  in   a  prolonged                                                               
hospitalization and near  death.  He opined that NDs  show a lack                                                               
of clinical experience  that put patients in harm in  Alaska.  He                                                               
continued by  saying that Naturopaths tend  to prescribe numerous                                                               
supplements  that  lack "therapeutic  efficacy  and  any kind  of                                                               
data."   He concluded by stating  that a lack of  residency, lack                                                               
of insurance,  personal experience, and no  improvement to access                                                               
of care are his primary [objections].                                                                                           
                                                                                                                                
3:29:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN  asked how Mr. Tanner's  comments relate to                                                               
the extended scope of practice that the bill proposes.                                                                          
                                                                                                                                
MR.  TANNER  said  it's  one example  that  illustrates  lack  of                                                               
competence  due  to  lack of  clinical  training,  knowledge  and                                                               
expertise.   He added  that "even  non-medical people  would know                                                               
not to discontinue medication."                                                                                                 
                                                                                                                                
REPRESENTATIVE HANNAN asked  if Mr. Tanner's objection  is to NDs                                                               
practicing  medicine period,  not  just this  bill's proposal  to                                                               
give  them a  scope of  practice that  includes prescription  and                                                               
minor surgery.                                                                                                                  
                                                                                                                                
MR.  TANNER offered  his belief  that  NDs should  stay in  their                                                               
scope   of  practice,   adding   that  they're   trained  to   be                                                               
complementary to  physicians.  He  continued by saying  that less                                                               
than 5  percent of  naturopaths do residencies  and that  to call                                                               
NDs doctors  is misleading  to patients  and harmful  to Alaska's                                                               
communities.                                                                                                                    
                                                                                                                                
3:33:57 PM                                                                                                                    
                                                                                                                                
MELINDA RATHKOPF, MD, Alaska  State Medical Association, informed                                                               
the   committee  that   she   is   a  board-certified   allergist                                                               
immunologist  who has  practiced in  Alaska  for 13  years.   She                                                               
shared  her educational  background,  which included  4 years  of                                                               
medical school, 3 years of  a pediatric residency training, and 2                                                               
years of  allergy and immunology  fellowship.  She  discussed her                                                               
experience  with  patients  who received  misinterpreted  allergy                                                               
testing from  naturopaths.  She  explained her opposition  to the                                                               
bill,  saying  that  increasing  ND's  scope  of  practice  would                                                               
increase the  number of patients  that seek their care  and think                                                               
they are equivalent to MDs.                                                                                                     
                                                                                                                                
3:36:00 PM                                                                                                                    
                                                                                                                                
LAURIE MONTANO, Alaska State  Medical Association, shared several                                                               
experiences with  patients who had previously  been mistreated by                                                               
NDs, adding that they were not  backed by science.  She expressed                                                               
major concern and strongly opposes HB 91.                                                                                       
                                                                                                                                
3:37:49 PM                                                                                                                    
                                                                                                                                
STEVE SIVILS,  Alaska State Medical  Association, stated  that he                                                               
is a  pediatric anesthesiologist in  Anchorage and  expressed his                                                               
opposition  to  the bill,  especially  including  surgery in  the                                                               
increased scope of  practice.  He offered  his understanding that                                                               
NDs don't  receive any formal  surgical training which  would put                                                               
Alaskans at risk.                                                                                                               
                                                                                                                                
3:39:49 PM                                                                                                                    
                                                                                                                                
IRINA   GRIMBERG,  Alaska   State  Medical   Board,  stated   her                                                               
opposition  to  HB  91.    She  opined  that  it  is  potentially                                                               
dangerous when  naturopaths act as  a legitimate MD.   year after                                                               
year,   she   said,   naturopaths  are   pushing   measures   for                                                               
prescriptive authority.  She offered  her belief that they should                                                               
be an alternative option to conventional medicine.                                                                              
                                                                                                                                
3:44:14 PM                                                                                                                    
                                                                                                                                
TONYA  CAYLOR,   Alaska  State   Medical  Board,   informed  that                                                               
committee that  she is  opposed to  HB 91  and credited  her many                                                               
encounters with  poor judgement  made by  naturopathic providers.                                                               
She gave  a brief summary  of two  such encounters.   She offered                                                               
her   belief  that   naturopaths  lack   clinical  knowledge   in                                                               
pathophysiology  and   clinical  judgement  that  is   needed  to                                                               
practice  medicine.   She said  they  should not  be granted  the                                                               
ability to prescribe medication.                                                                                                
                                                                                                                                
3:47:31 PM                                                                                                                    
                                                                                                                                
MARY  ANN   FOLAND,  Alaska  State  Medical   Board,  voiced  her                                                               
opposition to  HB 91.  She  alleged that the state  medical board                                                               
also opposes the  bill and considers these  changes "the practice                                                               
of  allopathic medicine."   She  stated  that physicians  require                                                               
12,000-15,000  more hours  of training  than NDs  and shared  two                                                               
stories  of patients  who were  mistreated by  naturopaths.   She                                                               
added that all  the examples being shared today  reflect the lack                                                               
of  education in  pharmacology.   She  continued  by saying  that                                                               
naturopaths  don't   need  to  have  prescriptive   and  surgical                                                               
privileges  and  instead, can  continue  to  practice within  the                                                               
definition of naturopathy.                                                                                                      
                                                                                                                                
CO-CHAIR  LEDOUX  asked  if,   theoretically,  a  medical  school                                                               
graduate would be licensed to perform brain surgery.                                                                            
                                                                                                                                
MS.  FOLAND  answered yes.    She  offered  her belief  that  she                                                               
possesses a  medical surgical license, which  would theoretically                                                               
allow  her to  do that;  however, she  said that  her credentials                                                               
don't allow  her to [perform  brain surgery]  and if she  were to                                                               
practice  outside the  scope of  her training  she would  have to                                                               
answer to the state medical board.                                                                                              
                                                                                                                                
3:53:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  WOOL pointed  out that  nurse practitioners  (NPs) have                                                               
prescriptive  powers  and  questioned how  Ms.  Foland  justifies                                                               
that.                                                                                                                           
                                                                                                                                
MS.  FOLAND  offered her  understanding  that  NPs and  physician                                                               
assistants'  training  is  allopathic, adding  that  naturopathic                                                               
training is completely different content.                                                                                       
                                                                                                                                
3:54:41 PM                                                                                                                    
                                                                                                                                
ALEXANDER  VON  HAFFTEN,  Alaska  State Medical  Board,  said  he                                                               
opposes  HB 91.    Nonetheless,  he noted  that  he supports  the                                                               
values of  naturopathy and the  wholistic approach  to preventing                                                               
disease and  optimizing wellness.   he further noted that  he has                                                               
discussed naturopathy  during lessons as  a teacher in  the WHAMI                                                               
medical   program  and   has  referred   patients  to   NDs  when                                                               
naturopathy offers  a viable or better  alternative to allopathic                                                               
or  osteopathic  medicine.    However,  he  said,  "the  proposed                                                               
changes  eliminate   the  prerequisites   for  a  person   to  be                                                               
considered qualified as  a position and have  little adherence to                                                               
the core values  of naturopathy."  He questioned  whether NDs are                                                               
qualified to  prescribe and offered  his belief that HB  91 would                                                               
change the standard for disclosure,  change the standard of care,                                                               
and communicate  that "truth in  advertising is irrelevant."   He                                                               
concluded by reiterating that, while  he values naturopathy as an                                                               
alternative to allopathic  medicine, physicians possess expertise                                                               
in judgement  in accordance  with minimum  nationally established                                                               
requirements for education, training, and skill-competencies.                                                                   
                                                                                                                                
4:02:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS asked  if  Mr. Von  Hafften would  support                                                               
allowing "some degree" of  prescriptive authority for naturopaths                                                               
who went through a residency equivalent to that of an MD.                                                                       
                                                                                                                                
MR.  VON HAFFTEN  said no,  "the devil  is in  the details."   He                                                               
added that a  scope of practice already exists in  statute and he                                                               
sees no reason to change that.                                                                                                  
                                                                                                                                
REPRESENTATIVE FIELDS  asked if there  are any types  of medicine                                                               
that would  be appropriate for  naturopaths to  have prescriptive                                                               
authority for.                                                                                                                  
                                                                                                                                
MR.   VON    HAFFTEN   stated,   "I'm    regarding   prescriptive                                                               
responsibility."                                                                                                                
                                                                                                                                
4:04:17 PM                                                                                                                    
                                                                                                                                
PATRICK  NOLAN,   Alaska  State   Medical  Board,   informed  the                                                               
committee  that he  is a  board certified  endocrinologist and  a                                                               
member of the American  Association of Clinical Endocrinologists,                                                               
the  American College  of  Endocrinology,  and the  International                                                               
Endocrine Society;  as well as  a member of the  American College                                                               
of  Physicians and  a  fellow with  the  American Association  of                                                               
Clinical  Endocrinology.    He  also served  as  a  former  state                                                               
Medical  Board  member   for  four  years.     He  expressed  his                                                               
opposition to  HB 91 "for many  of the reasons that  were already                                                               
stated."   He  reflected  on  cases that,  in  his opinion,  were                                                               
misdiagnosed by NDs.                                                                                                            
                                                                                                                                
4:09:07 PM                                                                                                                    
                                                                                                                                
CAMERON  O'CONNELL, ND,  expressed her  support for  HB 91.   She                                                               
said she would not take up  the committee's time by relating some                                                               
of  the patients  she has  treated that  were under  the care  of                                                               
Medical Doctors  and were overprescribed medication  and "had bad                                                               
outcomes  from   medication  they  were  given."     Instead  she                                                               
addressed  the  ways  in  which   a  limited  scope  of  practice                                                               
influences her  day-to-day care  of patients.   She  concluded by                                                               
asking  the members  to  consider updating  [indisc.]  to a  more                                                               
modern scope, noting  that naturopathic medicine has  grown a lot                                                               
as a profession and the legislation should reflect that.                                                                        
                                                                                                                                
4:11:57 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  WOOL asked  if residency  was  a required  part of  her                                                               
degree program in Portland, Oregon.                                                                                             
                                                                                                                                
MS. O'CONNELL  said, currently, they  don't have the  funding and                                                               
there  aren't enough  residencies for  the amount  that would  be                                                               
needed  for  every  ND  to  go.   She  added  that  completing  a                                                               
residency is highly encouraged and competitive.                                                                                 
                                                                                                                                
CO-CHAIR   WOOL   asked   if  Ms.   O'connell's   residency   was                                                               
naturopathic, allopathic, or some combination of the two.                                                                       
                                                                                                                                
MS. O'CONNELL replied that it was a combination of both.                                                                        
                                                                                                                                
4:13:24 PM                                                                                                                    
                                                                                                                                
DAVID   SCHLEICH,   MD,   Alaska  Association   of   Naturopathic                                                               
Physicians, informed the  committee that is the  president of the                                                               
National  University of  Natural Medicine,  the oldest  federally                                                               
and regionally and  state accredited university in  the U.S. that                                                               
prepares  naturopathic  physicians   for  clinical  practice  and                                                               
careers.   He shared  his background  and experience  working for                                                               
many  different universities  and  colleges across  the U.S.  and                                                               
Canada and  expressed his support for  HB 91.  He  noted that the                                                               
professional preparation  of NDs has been  referenced erroneously                                                               
and often.   He said  it translates  into four years  of fulltime                                                               
study beyond a bachelor's degree.   He states that his colleagues                                                               
in the allopathic  profession who have said that  the content and                                                               
learning objectives  of naturopathy are different,  are mistaken.                                                               
He  added that  the clinical  record of  NDs is  more substantial                                                               
than   their  colleagues   would  suggest.     He   concluded  by                                                               
encouraging the members to endorse the current bill.                                                                            
                                                                                                                                
CO-CHAIR WOOL  said there has  been reference to a  philosophy or                                                               
underlying statement  behind naturopathy  and asked  Mr. Schleich                                                               
to speak to that.                                                                                                               
                                                                                                                                
DR. SCHLEICH  replied that his University  has recently published                                                               
12  volumes,  6,000  pages,  on   the  history,  philosophy,  and                                                               
derivation  of   naturopathic  practice.    He   added  that  the                                                               
underlying philosophies are not that different.                                                                                 
                                                                                                                                
4:23:17 PM                                                                                                                    
                                                                                                                                
JOHN CULLEN,  American Academy of Family  Physicians, stated that                                                               
he  is  the   president  of  the  American   Academy  for  family                                                               
Physicians and  expressed his opposition  to "the extent  of this                                                               
bill."    He  said  he  would  like  to  see  the  data  to  that                                                               
naturopaths  are capable  of prescribing  medication safely.   He                                                               
opined  that this  bill  will  not solve  the  solution to  rural                                                               
healthcare problems  and objected  to the "naming  of naturopaths                                                               
as physicians."  He encouraged members to vote no on this bill.                                                                 
                                                                                                                                
4:26:42 PM                                                                                                                    
                                                                                                                                
KRISTIN  MITCHELL, American  College of  Physicians, offered  her                                                               
belief that  the training  for naturopaths  is not  equivalent to                                                               
scientific  medical training  and should  be complementary.   She                                                               
expressed  concern about  a lack  of sufficient  evidence showing                                                               
that it is safe for patients  to receive care from naturopaths in                                                               
terms  of  prescribing  pharmaceuticals and  performing  surgery,                                                               
which  in her  opinion,  they  are not  trained  for.   She  said                                                               
patients have  a difficult  time distinguishing  between licensed                                                               
practitioners and  it is the  state's role to protect  the safety                                                               
of patients.                                                                                                                    
                                                                                                                                
4:30:45 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:31:28 PM                                                                                                                    
                                                                                                                                
JOSEPH  RETH expressed  his  opposition to  HB  91, offering  his                                                               
belief  that  naturopaths  don't  have  the  training  needed  to                                                               
prescribe medicine  and perform  minor surgeries  effectively and                                                               
safely.  He  addressed the concept of residency.   He argued that                                                               
physicians are  required to complete  a 3-year residency  after 4                                                               
years  of medical  school, during  which they  are taught  how to                                                               
safely and  effectively prescribe medicine along  with performing                                                               
surgical procedures.   In contrast,  he said, naturopaths  have 4                                                               
years of  schooling and no  residency requirement.   He mentioned                                                               
the placebo affect  and pointed out that it can  account for more                                                               
than 50  percent of positive outcomes.   He said that  he and his                                                               
colleagues have had too many  interactions with naturopaths where                                                               
it  was  clear that  they  did  not adequately  and  sufficiently                                                               
understand  the science  of medicine  and  as a  result have  put                                                               
patients health and their lives at risk.                                                                                        
                                                                                                                                
4:35:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REVAK sought clarification on the placebo effect.                                                                
                                                                                                                                
MR. RETH stated that  it is very powerful and can  occur up to 80                                                               
percent of the time.                                                                                                            
                                                                                                                                
4:36:35 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  WOOL  pointed out  that  many  naturopaths do  clinical                                                               
residency after medical school in  states that grant prescriptive                                                               
authority to  NDs.  He asked  if some go get  the proper training                                                               
to prescribe drugs, given that they came from that background.                                                                  
                                                                                                                                
MR. RETH  replied that there  are significantly  more residencies                                                               
available  for naturopaths  now than  there were  years ago.   He                                                               
described naturopathic  residencies as  "going to  someone else's                                                               
office  and  hanging  out  with  them,"  adding  that  it  wasn't                                                               
consistent.   He  said one  year of  residency is  not enough  to                                                               
learn how to safely prescribe medication.                                                                                       
                                                                                                                                
CO-CHAIR WOOL pointed out that  NPs have prescriptive ability and                                                               
do not  complete the  same amount  of school  as physicians.   He                                                               
asked how Mr. R justifies that.                                                                                                 
                                                                                                                                
MR.  RETH said  that NPs  are trained  in allopathic  medicine as                                                               
opposed to "natural substances."                                                                                                
                                                                                                                                
4:39:23 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX asked if both PAs and NPs work under a doctor.                                                                  
                                                                                                                                
MR. RETH said  he was unsure.  He offered  his understanding that                                                               
PAs  work   under  a  "collaborative  agreement"   and,  although                                                               
oversight is present, they are free to do what they need to do.                                                                 
                                                                                                                                
CO-CHAIR  LEDOUX  equated  NDs  to  osteopaths,  regarding  their                                                               
history,   specifically  their   desire  to   be  recognized   as                                                               
physicians.                                                                                                                     
                                                                                                                                
4:42:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   FIELDS   referenced  previous   comments   about                                                               
naturopathy   being   complementary   to  MDs   as   opposed   to                                                               
interchangeable and asked if that is true.                                                                                      
                                                                                                                                
MR. RETH  opined that they  are not interchangeable,  adding that                                                               
NDs and  MDs have  divergent approaches  to the  human body.   He                                                               
said  he   was  surprised  that  naturopaths   want  prescriptive                                                               
authority for medicine that isn't "natural."                                                                                    
                                                                                                                                
REPRESENTATIVE   FIELDS   asked   if  the   two   practices   are                                                               
complementary.                                                                                                                  
                                                                                                                                
MR.  RETH  opined that  it  comes  back  to the  placebo  affect;                                                               
meaning that if  an individual believes and trust  in someone, he                                                               
or she will  get a lot of  benefit from that person.   He further                                                               
stated that "going to a naturopath  for some people is the way to                                                               
go."   However, he added  that a  patient with a  serious problem                                                               
will need the addition of allopathic medicine.                                                                                  
                                                                                                                                
REPRESENTATIVE  FIELDS asked  if  there could  be a  sufficiently                                                               
rigorous process of residency for  naturopaths that would prepare                                                               
them for prescriptive authority.                                                                                                
                                                                                                                                
MR.  RETH  acknowledged  that a  more  limited  or  "restrictive"                                                               
prescriptive ability  could be considered, while  reiterating his                                                               
concern about granting NDs complete prescriptive authority.                                                                     
                                                                                                                                
4:46:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS  asked if the medical  association has ever                                                               
considered the  idea of  a more  regular and  regulated residency                                                               
process for NDs.                                                                                                                
                                                                                                                                
MR. RETH related  that the medical associate  has never discussed                                                               
residency, as it is a newer concept for naturopaths.                                                                            
                                                                                                                                
4:47:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN said  many  of the  doctors who  testified                                                               
today  spoke broadly  in opposition  to  naturopaths rather  than                                                               
against the specifics of HB  91, which is prescriptive authority.                                                               
She questioned whether the Alaska  Medical Association is opposed                                                               
to all  naturopathic medicine  or if their  objection is  just in                                                               
response  to the  surgical and  prescriptive authority  that this                                                               
bill addresses.                                                                                                                 
                                                                                                                                
MR.  RETH   affirmed  that  the  AMA   specifically  opposes  the                                                               
prescriptive authority.  He noted  that they have no problem with                                                               
NDs being licensed in Alaska.                                                                                                   
                                                                                                                                
REPRESENTATIVE   HANNAN  pointed   out  that   pharmacists  don't                                                               
complete a  residency for  the administration  of drugs  and more                                                               
specifically  vaccines.   She asked  if  the Medical  Association                                                               
opposes that.                                                                                                                   
                                                                                                                                
MR. RETH countered with the  assumption that pharmacists know how                                                               
to  administer  drugs, adding  that  he  was  unsure if  the  AMA                                                               
opposes  that.    He  clarified  that  the  AMA's  opposition  to                                                               
Naturopath's prescriptive  authority is not about  the ability to                                                               
prescribe vaccines,  but that  it would  allow them  to prescribe                                                               
anything   apart  from   scheduled   controlled  substances   and                                                               
chemotherapeutic agents.                                                                                                        
                                                                                                                                
REPRESENTATIVE  HANNAN asked  if the  Alaska Medical  Association                                                               
has  a position  on midwives  and doulas  and their  treatment of                                                               
patients.                                                                                                                       
                                                                                                                                
MR. RETH  said he was  unsure if the AMA  has a formal  policy on                                                               
midwives.                                                                                                                       
                                                                                                                                
4:51:10 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:51:13 PM                                                                                                                    
                                                                                                                                
ANNETTE  O'CONNELL,  reflected  on being  diagnosed  with  celiac                                                               
disease.   She  said she  was misdiagnosed  by MDs  until finally                                                               
going to  an ND  who retested  her and figured  out that  she was                                                               
allergic to  gluten.   She noted  that she  has been  better ever                                                               
since that diagnoses as long  as she follows her NDs suggestions.                                                               
She offered her  belief that the American  Medical Association is                                                               
campaigning  to  discredit NDs  and  blamed  MDs for  the  opioid                                                               
epidemic.  She concluded that  Alaska needs both naturopathic and                                                               
medical doctors  and expressed  hope that NDs  will be  given the                                                               
right to exercise within their full scope of practice.                                                                          
                                                                                                                                
4:55:26 PM                                                                                                                    
                                                                                                                                
DANIEL  YOUNG, ND,  Center for  Natural  Medicine, expressed  his                                                               
support  for  HB 91  and,  referencing  the previous  testifiers,                                                               
indicated that MDs are not  the experts on naturopathic medicine.                                                               
He offered  that NDs are not  trying to be MDs,  instead they are                                                               
providing a different model of  healthcare that is very affective                                                               
and works  for their patients.   He said the fact  that NDs still                                                               
exist is testament to that.   He stated that naturopathic medical                                                               
and  clinical  training   consists  of  more  than   2  years  of                                                               
supervised care with patients.  The  goal, he said, is to provide                                                               
effective  care  for  patients  and  added  that  the  state  has                                                               
recently  taken  away  their  ability   to  provide  things  with                                                               
prescription  labels, such  as  B12,  B-Complex, and  homeopathic                                                               
medicine,  which  is  all  medicine   they  regularly  use.    He                                                               
reiterated that the previous  testifiers' comments are anecdotal,                                                               
some of  which, he said  he has  before which makes  him question                                                               
their validity.                                                                                                                 
                                                                                                                                
4:58:38 PM                                                                                                                    
                                                                                                                                
WAYNE ADERHOLD,  Board of Chiropractic examiners,  stated that he                                                               
fully  supports  HB 91  as  a  clear, concise  and  comprehensive                                                               
statute  that  will  give naturopaths  the  structure  needed  to                                                               
practice to  the full  extent of the  training level  they choose                                                               
within  a  scope of  practice  defined  by  the profession.    He                                                               
continued  by praising  his experience  using naturopaths  as his                                                               
primary care doctor since 1993.   He offered his belief that this                                                               
committee has  the duty to  promote a free market  that maximizes                                                               
competition  by properly  trained professionals.   He  added that                                                               
the   tools  used   by   professionals,  including   prescriptive                                                               
authority,  should  be  determined by  the  regulated  profession                                                               
itself, not  the competing  profession.  He  pointed out  that he                                                               
has  had numerous  instances  in his  treatment  history where  a                                                               
prescriptive drug  was considered  a necessary  part of  a larger                                                               
treatment plan, adding  that he deserves the  option of receiving                                                               
the maximum  level of treatment.   He requested that  the members                                                               
pass HB 91  out of committee and  increase healthcare competition                                                               
in Alaska, adding that consumers deserve nothing less.                                                                          
                                                                                                                                
5:01:16 PM                                                                                                                    
                                                                                                                                
STEVE FRANK noted  that he has been seeing a  naturopath for many                                                               
years  as a  primary healthcare  provider and  received excellent                                                               
care.  He pointed  out that his ND has referred  him to MDs, such                                                               
as an  internist and  cardiologist, when  appropriate.   He added                                                               
that the  opposition to  this bill seems  to be  characterized by                                                               
anecdotal  fearmongering and  implored  members to  stick to  the                                                               
facts and  make fact-based decision.   He continued by  saying he                                                               
would like to see this bill moved out of committee.                                                                             
                                                                                                                                
5:04:34 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
CO-CHAIR WOOL closed public testimony on HB 91.                                                                                 
                                                                                                                                
[HB 91 was held over.]                                                                                                          
                                                                                                                                
5:05:10 PM                                                                                                                    
                                                                                                                                
         HB  24-LIMITED TEACHER CERTIFICATES; LANGUAGES                                                                     
                                                                                                                                
CO-CHAIR WOOL announced that the  next order of business would be                                                               
HOUSE BILL NO. 24, "An Act  relating to instruction in a language                                                               
other   than   English;   and   relating   to   limited   teacher                                                               
certificates."                                                                                                                  
                                                                                                                                
CO-CHAIR WOOL opened public testimony on HB 24.                                                                                 
                                                                                                                                
5:05:40 PM                                                                                                                    
                                                                                                                                
KATIE  GARDNER,  Matsu  Borough School  District,  expressed  her                                                               
support for  HB 24.   She  informed the  committee that  Matsu is                                                               
home to Fronteras  Spanish Immersion Charter School  and said the                                                               
borough needs  qualified immersion teachers to  run the immersion                                                               
program.  Doing that, she  said, will require cultural experience                                                               
as  well as  language  fluency.   She  stated  that the  teachers                                                               
employed in  Matsu are trained,  qualified, and  highly competent                                                               
educators  who's   only  limitation  to  accessing   the  regular                                                               
certification   is   their   limited  English   language,   which                                                               
ironically,  is  one  of  the   attributes  that  makes  them  so                                                               
qualified.  She  said that HB 24 will allow  the expansion of the                                                               
opportunities  that   already  exist  in  programs   like  career                                                               
technical education  and junior  ROTC, to the  language immersion                                                               
program.                                                                                                                        
                                                                                                                                
REPRESENTATIVE HANNAN  asked if Fronteras has  taken advantage of                                                               
the Type W certification.                                                                                                       
                                                                                                                                
MS. GARDNER  replied that they  have one teacher who  is employed                                                               
on the Type  W.  Nonetheless, she said there  is basic competency                                                               
requirement  under   Type  W  that  limits   its  usefulness  for                                                               
employing language  teachers.  The  basic competency exam  is the                                                               
main  limiting factor,  as the  only option  for the  test is  in                                                               
English.                                                                                                                        
                                                                                                                                
MS.   GARDNER,   responding   to  a   follow-up   question   from                                                               
Representative  Hannan,  acknowledged  that  the  candidates  for                                                               
employment  are  teachers from  different  countries  who have  a                                                               
verified  bachelor's degree  and have  completed and  completed a                                                               
teacher preparation program in their  country.  She restated that                                                               
the major limitation is the  basic competency exam and that there                                                               
is no option of taking it in their native language.                                                                             
                                                                                                                                
5:09:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN  proposed  allowing  a  2-year  window  to                                                               
complete  that  for  a  full   certification,  as  opposed  to  a                                                               
certification that is held by the district.                                                                                     
                                                                                                                                
MS. GARDNER  acknowledged that it  would be helpful;  however, it                                                               
would  not  solve  all  the  barriers facing  this  issue.    She                                                               
explained that in  the past there have been  some individuals who                                                               
had   around  1   year   to  work   on   the  basic   competency.                                                               
Unfortunately, she said, it didn't  present enough time for he or                                                               
she to pass the exam.  She added  that it takes more than 2 years                                                               
to learn the English language.                                                                                                  
                                                                                                                                
REPRESENTATIVE HANNAN  asked what  content areas, aside  from the                                                               
Spanish language, the educators should be teaching.                                                                             
                                                                                                                                
MS. GARDNER explained  that the Fronteras program  has grades K-8                                                               
splitting the  day with  some of the  subjects taught  in English                                                               
and some  in Spanish.   She  added that they  would want  them to                                                               
have  the  equivalency  of  at   least  an  elementary  education                                                               
endorsement.                                                                                                                    
                                                                                                                                
5:12:45 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL announced that public  testimony for HB 24 would be                                                               
left open.                                                                                                                      
                                                                                                                                
[HB 24 was held over.]                                                                                                          
                                                                                                                                
5:12:53 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 5:12 to 5:15 p.m.                                                                            
                                                                                                                                
          HB 127-DENTAL HYGIENIST ADVANCED PRAC PERMIT                                                                      
                                                                                                                                
5:15:35 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL  announced that the  final order of  business would                                                               
be  HOUSE BILL  NO.  127, "An  Act relating  to  the practice  of                                                               
dental  hygiene;   establishing  an  advanced   practice  permit;                                                               
prohibiting  unfair discrimination  under group  health insurance                                                               
against  a  dental  hygienist  who  holds  an  advanced  practice                                                               
permit;  relating  to  medical   assistance  for  dental  hygiene                                                               
services; and providing for an effective date."                                                                                 
                                                                                                                                
5:15:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE IVY SPOHNHOLZ, Alaska  State Legislature, as prime                                                               
sponsor,  introduced  HB  127.   She  paraphrased  parts  of  the                                                               
sponsor statement [included in the  committee packet], which read                                                               
in its entirety as follows [original punctuation provided]:                                                                     
                                                                                                                                
     Oral health plays a crucial  role in the overall health                                                                    
     and  well-being  of Alaskans.  The  lack  of access  to                                                                    
     dental  care in  Alaska  has created  enormous need  in                                                                    
     communities  that are  underserved  by the  traditional                                                                    
     system  of  care.  Dental  diseases  disproportionately                                                                    
     affect  our  state's  most vulnerable  populations  and                                                                    
     rural areas  where the access to  treatment is limited.                                                                    
     We need all dental  health care providers practicing to                                                                    
     the  full  scope  of their  training  to  address  this                                                                    
     issue.  Alaska  would   benefit  from  implementing  an                                                                    
     innovative oral health care delivery model.                                                                                
                                                                                                                                
     House  Bill 127  would establish  an Advanced  Practice                                                                    
     Permit  for  Alaska-licensed  dental  hygienists  while                                                                    
     continuing   the    collaborative   agreement   between                                                                    
     licensed   dentists  and   dental  hygienists.   Dental                                                                    
     hygienists  are   skilled,  licensed   oral  healthcare                                                                    
     professionals  who  focus  on preventing  and  treating                                                                    
     oral  diseases. HB  127 would  allow dental  hygienists                                                                    
     who meet  the necessary advanced  education, experience                                                                    
     and  licensure requirements  of  the Advanced  Practice                                                                    
     Permit  to work  independently  within  their scope  of                                                                    
     practice   across  a   variety  of   institutional  and                                                                    
     organizational   settings,  including   nursing  homes,                                                                    
     schools, hospitals and clinics.                                                                                            
                                                                                                                                
     The creation  of Advanced Practice Permits  would allow                                                                    
     access to individuals who need  oral care but cat   get                                                                    
     to a  dental office  because of illness  or disability,                                                                    
     create new  consumer choices for  preventive treatments                                                                    
     and  services,   educate  individuals,   families,  and                                                                    
     caregivers on  the basics of  dental hygiene,  and oral                                                                    
     health's connection  to overall health  and well-being.                                                                    
     Additionally,   licensed    dental   hygienists   would                                                                    
     identify more acute dental issues  early on before they                                                                    
     become  serious  and  provide  referrals  for  patients                                                                    
     needing restorative treatment.                                                                                             
                                                                                                                                
     HB   127  removes   barriers  by   allowing  qualified,                                                                    
     licensed  dental hygienists  to  practice  to the  full                                                                    
     extent of  their professional training,  experience and                                                                    
     scope  of practice  to help  promote  and restore  oral                                                                    
     health to Alaska's underserved communities.                                                                                
                                                                                                                                
5:18:36 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL suggested foregoing the sectional because of time                                                                 
constraints.                                                                                                                    
                                                                                                                                
5:18:51 PM                                                                                                                    
                                                                                                                                
KATRINA  VIRGIN,  Alaska  Dental Hygienists  Association,  stated                                                               
that dental hygienists would like  the ability to use their scope                                                               
of practice to  visit areas in Alaska that are  underserved.  The                                                               
4,000  clinical  hours  that  they  complete  under  a  dentist's                                                               
supervision makes them  more than competent to  provide this care                                                               
she said.                                                                                                                       
                                                                                                                                
5:20:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS requested  additional  information on  the                                                               
areas that Ms. Virgin anticipates  providing service to currently                                                               
underserved populations.                                                                                                        
                                                                                                                                
5:20:54 PM                                                                                                                    
                                                                                                                                
MS. Virgin  said would like  to provide services in  nursing care                                                               
facilities,  where  the  oral  systemic  link  has  been  greatly                                                               
associated with pneumonia.  Another  target population, she said,                                                               
would  be schools,  especially providing  sealants to  those with                                                               
underserved children.   Correctional facilities and  Homebound as                                                               
well,  as both  have individuals  that cannot  get into  a dental                                                               
facility.  She  said their goal is to help  asses oral health and                                                               
do as many  preventative measures as possible,  keep the bacteria                                                               
in the  oral environment  down to  help decrease  inflammation in                                                               
the overall body.                                                                                                               
                                                                                                                                
5:22:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  referenced  a list  of  dental  health                                                               
professional shortage areas [provided  in the bill packet], which                                                               
includes  a list  of geographic  areas  - healthcare  communities                                                               
that are  served by  FQHCs as  well as  the Alaska  Native Tribal                                                               
Healthcare Continuum.   She noted  that there  is also a  list in                                                               
the  bill  of   the  centers  and  facilities   in  which  dental                                                               
hygienists  would  like  the  opportunity  to  have  an  advanced                                                               
practice in.                                                                                                                    
                                                                                                                                
5:22:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HANNAN questioned  whether dental  hygienists are                                                               
allowed  prescriptive authority  in  Alaska  and what  additional                                                               
training it takes.                                                                                                              
                                                                                                                                
5:23:19 PM                                                                                                                    
                                                                                                                                
MS.  VIRGIN explained  that currently.  there is  no prescriptive                                                               
authority  for dental  hygienists in  this state;  however, eight                                                               
other states  provide limited prescriptive authority.   She added                                                               
that  they  are  limited  to  fluoride  prescriptions  and  anti-                                                               
microbial   mouthwash,  which   would  be   the  extent   of  the                                                               
prescriptive authority being asked for in this bill.                                                                            
                                                                                                                                
5:24:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  noted that on  page 2, lines  24-25, it                                                               
clearly  defines   the  prescriptive  authority  that   is  being                                                               
outlined in the bill.                                                                                                           
                                                                                                                                
REPRESENTATIVE  HANNAN sought  clarification  on whether  limited                                                               
prescriptive authority is being granted in HB 127.                                                                              
                                                                                                                                
REPRESENTATIVE SPONHOLZ acknowledged that  the bill grants dental                                                               
hygienists  the   authority  to  prescribe  fluoride   and  anti-                                                               
microbial mouthwash.                                                                                                            
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ,  responding  to a  follow-up  question                                                               
from  Representative Hannan,  said  that a  business license  and                                                               
billing  structure would  be  needed  to practice  independently,                                                               
adding  that this  bill creates  the opportunity  for independent                                                               
self-employment of advanced practice  dental hygienists to set up                                                               
their  own practice  with their  own Medicaid  billing, which  is                                                               
currently impossible without a collaborative agreement.                                                                         
                                                                                                                                
5:25:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REVAK asked what the fiscal note is for.                                                                         
MS. VIRGIN said that was a base  estimate due to the time it took                                                               
to  collaborate  with the  ADS  and  the  state Board  of  Dental                                                               
Examiners.   She noted that it  would be for the  Medicaid system                                                               
portal that would be built for providing reimbursements.                                                                        
                                                                                                                                
REPRESENTATIVE  REVAK  asked  if  this would  allow  for  billing                                                               
Medicaid for reimbursement.                                                                                                     
                                                                                                                                
5:27:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  explained  that  HB  127  would  allow                                                               
dental hygienists  to bill  Medicaid.   She noted  that currently                                                               
they are  already paid for through  Medicaid, so the bill  is not                                                               
adding a  new population  of providers, just  a new  class within                                                               
the  preexisting population.   She  said  the fiscal  note is  to                                                               
update the MMIS system that processes and tracks the payments.                                                                  
                                                                                                                                
5:29:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES pointed  out that this will  be helpful for                                                               
communities, like her own, with  many rural villages.  She sought                                                               
clarification  if this  bill would  allow someone  to set  up own                                                               
their own business.                                                                                                             
                                                                                                                                
5:29:35 PM                                                                                                                    
                                                                                                                                
MS. VIRGIN said she answered  the question incorrectly yesterday,                                                               
adding that  she should have said  it would be very  difficult to                                                               
set up shop in a rural area.   She said the intention of the bill                                                               
is  to provide  underserved  communities that  do  not have  oral                                                               
healthcare, not to  open individual practices.   She continued by                                                               
saying that  they are providing  dental hygiene  services because                                                               
the scope of practice is very limited.                                                                                          
                                                                                                                                
5:31:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS commented that  this bill has potential for                                                               
cost-savings if  it's allows to identify  dental problems earlier                                                               
instead of  manifesting later at the  ER, adding that it  will be                                                               
interesting to see how the cost-savings materialize.                                                                            
                                                                                                                                
5:32:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REVAK sought clarification  on what HB 127 solves,                                                               
regarding helping underserved communities.                                                                                      
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  said  it's  much  like  a  physician's                                                               
assistant  collaborative  agreement  that defines  the  scope  of                                                               
practice; this  would allow  for them to  provide work  without a                                                               
collaborative  agreement set  up and  increases access  to dental                                                               
care.                                                                                                                           
                                                                                                                                
5:34:35 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL announced that HB 127 was held over.                                                                              
                                                                                                                                
5:36:38 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Labor and  Commerce Standing Committee  meeting was  adjourned at                                                               
5:36 p.m.                                                                                                                       

Document Name Date/Time Subjects
HB 91.Sponsor.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Bill Version M.PDF HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Sectional.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Fiscal.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91. Backup Support Letters Index April 3.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Support Letters UPDATED 4.8.19.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Index of New Support Letters May 3.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Support Letters as of May 3.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Response to Committee Questions.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Perscriptive Authority Comparison.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Education and Scope Comparison.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Naturopath One-Pager.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Naturopathic Concerns and Answers.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Naturopathic Medicine Background.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Naturopathic Perscriptive Authority.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Naturopathic Regulation.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Opposition Alaska State Medical Association.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Index for New Opposition Letters May 3.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 91.Backup Opposition Letters as of May 3.pdf HL&C 5/3/2019 3:15:00 PM
HB 91
HB 24.Sponsor.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Bill version A.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Sectional.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Fiscal Note DEED.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Backup Updated Support Letters 4.24.19.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Backup Support Letters.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Backup Support Letter Margi Dashevsky.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Backup Support Letter Leslie Harper.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Backup Support Letter ANLPAC.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 24.Backup Immersion Student Acheivement.pdf HL&C 5/3/2019 3:15:00 PM
HB 24
HB 127.Sponsor.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Bill Version A.PDF HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Sectional.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Fiscal DCCED.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Fiscal DHHS.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Fiscal DHHS2.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup Support Melissa Davis.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup Support Letters.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup Support Letters May 1.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup Support Jeff Kilgore.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup State by State.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup Support ADHA.pdf HL&C 5/3/2019 3:15:00 PM
HB 127
HB 127.Backup Alaska Dental HPSA.pdf HL&C 5/3/2019 3:15:00 PM
HB 127