Legislature(2019 - 2020)BARNES 124
05/03/2019 03:15 PM LABOR & COMMERCE
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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.