Legislature(2021 - 2022)BARNES 124

03/29/2021 03:15 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 117 EXTEND BOARD OF DIRECT-ENTRY MIDWIVES TELECONFERENCED
Moved HB 117 Out of Committee
*+ HB 111 DENTAL HYGIENIST ADVANCED PRAC PERMIT TELECONFERENCED
Heard & Held
*+ HB 151 UNEMPLOYMENT BENEFITS FOR COVID-19 TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                                                                         
                         March 29, 2021                                                                                         
                           3:18 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Zack Fields, Co-Chair                                                                                            
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Calvin Schrage                                                                                                   
Representative Liz Snyder (via teleconference)                                                                                  
Representative David Nelson                                                                                                     
Representative James Kaufman                                                                                                    
Representative Ken McCarty                                                                                                      
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 117                                                                                                              
"An Act extending the termination  date of the Board of Certified                                                               
Direct-Entry Midwives; and providing for an effective date."                                                                    
                                                                                                                                
     - MOVED HB 117 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 111                                                                                                              
"An Act relating  to the practice of dental  hygiene; relating to                                                               
advanced  practice permits  for  dental  hygienists; relating  to                                                               
dental assistants; 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                                                                                                             
                                                                                                                                
HOUSE BILL NO. 117                                                                                                              
"An Act extending the termination  date of the Board of Certified                                                               
Direct-Entry Midwives; and providing for an effective date."                                                                    
                                                                                                                                
     - MOVED HB 117 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 151                                                                                                              
"An  Act relating  to unemployment  benefits during  a period  of                                                               
state or  national emergency resulting  from a  novel coronavirus                                                               
disease  (COVID-19)  outbreak;  and providing  for  an  effective                                                               
date."                                                                                                                          
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
Board of Certified Direct Entry Midwives                                                                                      
                                                                                                                                
     Rachel Pugh - Eagle River                                                                                                  
     Bethel Belisle - Anchorage                                                                                                 
     Hannah St. George - Fairbanks                                                                                              
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
Board of Barbers And Hairdressers                                                                                             
                                                                                                                                
     Michelle McMullin - Anchorage                                                                                              
     Holly Andrews - Wasilla                                                                                                    
     Connie Dougherty - Anchorage                                                                                               
     Khitsana Sypakanphay - Anchorage                                                                                           
     Tina Taylor - Soldotna                                                                                                     
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
Board of Certified Real Estate Appraisers                                                                                     
                                                                                                                                
     William "Leon" McLean - Anchorage                                                                                          
     Valery Kudryn - Wasilla                                                                                                    
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
Alcoholic Beverage Control Board                                                                                              
                                                                                                                                
     Dana Wakukiewicz - Anchorage                                                                                               
     Diane Thompson - Anchorage                                                                                                 
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 117                                                                                                                  
SHORT TITLE: EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                              
SPONSOR(s): REPRESENTATIVE(s) ORTIZ                                                                                             
                                                                                                                                
03/01/21       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/01/21       (H)       L&C, FIN                                                                                               
03/22/21       (H)       L&C AT 3:15 PM DAVIS 106                                                                               
03/22/21       (H)       Heard & Held                                                                                           
03/22/21       (H)       MINUTE(L&C)                                                                                            
03/22/21       (H)       L&C AT 6:30 PM DAVIS 106                                                                               
03/22/21       (H)       -- MEETING CANCELED --                                                                                 
03/29/21       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: HB 111                                                                                                                  
SHORT TITLE: DENTAL HYGIENIST ADVANCED PRAC PERMIT                                                                              
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/24/21       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/24/21       (H)       L&C, FIN                                                                                               
03/29/21       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: HB 117                                                                                                                  
SHORT TITLE: EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                              
SPONSOR(s): REPRESENTATIVE(s) ORTIZ                                                                                             
                                                                                                                                
03/01/21       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/01/21       (H)       L&C, FIN                                                                                               
03/22/21       (H)       L&C AT 3:15 PM DAVIS 106                                                                               
03/22/21       (H)       Heard & Held                                                                                           
03/22/21       (H)       MINUTE(L&C)                                                                                            
03/22/21       (H)       L&C AT 6:30 PM DAVIS 106                                                                               
03/22/21       (H)       -- MEETING CANCELED --                                                                                 
03/29/21       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: HB 151                                                                                                                  
SHORT TITLE: UNEMPLOYMENT BENEFITS FOR COVID-19                                                                                 
SPONSOR(s): LABOR & COMMERCE                                                                                                    
                                                                                                                                
03/26/21       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/26/21       (H)       L&C, FIN                                                                                               
03/29/21       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                              
WITNESS REGISTER                                                                                                              
                                                                                                                                
PAKAK BOERNER, Staff                                                                                                            
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint during the hearing                                                                
on HB 111 on behalf of Representative Spohnholz, prime sponsor.                                                                 
                                                                                                                                
JESSIE MENKENS, Policy & Partnerships Manager                                                                                   
Alaska Primary Care Association                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 111 and                                                                       
responded to committee questions.                                                                                             
                                                                                                                                
LISA BRYANT, Legislative Co-Chair                                                                                               
Alaska Dental Hygienists' Association                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 111 and                                                                       
responded to committee questions.                                                                                               
                                                                                                                                
LORI REETZ, President                                                                                                           
Alaska Dental Hygienists' Association                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided information and answered questions                                                              
during the hearing on HB 111.                                                                                                   
                                                                                                                                
SANDON FISHER, Legislative Counsel                                                                                              
Legislative Legal Services                                                                                                      
Legislative Affairs Agency                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information and answered questions                                                              
during the hearing on HB 111.                                                                                                   
                                                                                                                                
ANGIE STONE, Founder and CEO                                                                                                    
HyLife Oral Health Alliance                                                                                                     
Beloit, Wisconsin                                                                                                               
POSITION STATEMENT:  Testified in support of HB 111.                                                                          
                                                                                                                                
ANN LYNCH, Director of Advocacy and Education                                                                                   
American Dental Hygienists' Association                                                                                         
Chicago, Illinois                                                                                                               
POSITION STATEMENT:  Testified in support of HB 111.                                                                          
                                                                                                                                
REPRESENTATIVE DAN ORTIZ                                                                                                        
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As prime sponsor, provided information and                                                               
answered questions during the hearing on HB 117.                                                                                
                                                                                                                                
MEGAN HOLLAND, Staff                                                                                                            
Representative Ivy Spohnholz                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented the sectional analysis for HB 151                                                              
on behalf of Representative Spohnholz, prime sponsor.                                                                           
                                                                                                                                
PATSY WESTCOTT, Director                                                                                                        
Division of Employment and Training Services                                                                                    
Department of Labor and Workforce Development                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided  information and answered questions                                                             
during the hearing on HB 151.                                                                                                   
                                                                                                                                
NOLAN KLOUDA, Executive Director                                                                                                
Center for Economic Development                                                                                                 
University of Alaska Anchorage                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided testimony  during the hearing on HB
151.                                                                                                                            
                                                                                                                                
LENNON WELLER, Economist                                                                                                        
Research and Analysis Section                                                                                                   
Department of Labor and Workforce Development                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided  information and answered questions                                                             
during the hearing on HB 151.                                                                                                   
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:18:35 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  called the House Labor  and Commerce Standing                                                             
Committee  meeting  to  order  at   3:18  p.m.    Representatives                                                               
Spohnholz,   McCarty,   Schrage,    Fields,   and   Snyder   (via                                                               
teleconference)   were   present   at    the   call   to   order.                                                               
Representatives Nelson and Kaufman arrived  as the meeting was in                                                               
progress.                                                                                                                       
                                                                                                                                
          HB 117-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                      
                                                                                                                                
3:19:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that the  first order  of business                                                               
would be  HOUSE BILL NO.  117, "An Act extending  the termination                                                               
date  of  the  Board  of  Certified  Direct-Entry  Midwives;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
CO-CHAIR SPOHNHOLZ  invited questions from committee  members for                                                               
Legislative  Auditor   Kris  Curtis.    There   being  none,  she                                                               
announced that HB 117 would be taken up later in the meeting.                                                                   
                                                                                                                                
CO-CHAIR SPOHNHOLZ passed the gavel to Co-Chair Fields.                                                                         
                                                                                                                                
3:20:34 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
          HB 111-DENTAL HYGIENIST ADVANCED PRAC PERMIT                                                                      
                                                                                                                                
3:21:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced  that the next order  of business would                                                               
be  HOUSE BILL  NO.  111, "An  Act relating  to  the practice  of                                                               
dental hygiene; relating to advanced  practice permits for dental                                                               
hygienists;  relating to  dental  assistants; 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."                                                                                                         
                                                                                                                                
3:21:24 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ,  as prime  sponsor, introduced  HB 111.   She                                                               
explained that the advanced practice  permit created under HB 111                                                               
would allow  experienced, licensed  dental hygienists  to provide                                                               
preventative  oral  care  to underserved  populations  at  senior                                                               
centers, healthcare  facilities, daycares,  and schools,  as well                                                               
as  to  those  who  are   eligible  for  public  assistance,  are                                                               
homebound, or  who live  in an  underserved community.   Pointing                                                               
out  that 62  percent of  Alaska's elementary-aged  children have                                                               
tooth decay,  and many low  income families don't  regularly seek                                                               
dental care  due to  cost and difficulty  in finding  a provider,                                                               
she  explained that  HB  111  would create  a  permit for  dental                                                               
hygienists   similar  to   one  used   by  nurse   practitioners.                                                               
Currently, she said,  dental hygienists can either  practice in a                                                               
dental office  or collaboratively with a  supervising dentist; HB
111  would allow  hygienists who  have  at least  4,000 hours  of                                                               
clinical experience  and have been  approved by the  Alaska Board                                                               
of  Dental Examiners  to  work independently  via  a direct  care                                                               
agreement with a dentist.                                                                                                       
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  noted  that  the  proposed  legislation  was                                                               
developed  in consultation  with the  Alaska Dental  Society, the                                                               
Board  of  Dental  Examiners, and  the  Alaska  Dental  Hygienist                                                               
Association.  The advanced practice  permit holders would have to                                                               
maintain malpractice insurance, she  said, provide written notice                                                               
of their service limitations, and  make referrals to dentists for                                                               
cases in  which treatment  is needed.   Co-Chair  Spohnholz noted                                                               
that  Colorado,  Washington,  Montana,  Maine,  Connecticut,  and                                                               
California allow  dental hygienists  to practice under  a similar                                                               
permit,  with  40 other  states  allowing  dental hygienists  the                                                               
latitude  to initiate  treatment based  on their  patients' needs                                                               
without prior authorization from, or  presence of, a dentist.  At                                                               
the  recommendation of  the  Board of  Dental  Examiners and  the                                                               
Alaska Dental Society, she said,  HB 111 includes the requirement                                                               
that  dental hygienists  operating  under  the advanced  practice                                                               
permit  maintain patient  records for  at least  seven years,  as                                                               
well as be certified separately  by the Board of Dental Examiners                                                               
to administer local anesthesia.                                                                                                 
                                                                                                                                
3:25:05 PM                                                                                                                    
                                                                                                                                
PAKAK BOERNER, Staff, Representative  Ivy Spohnholz, Alaska State                                                               
Legislature, presented  a PowerPoint  [hard copy included  in the                                                               
committee  packet]  titled  "HB   111:  Dental  Hygiene  Advanced                                                               
Practice  Permit,"   on  behalf  of  Co-Chair   Spohnholz,  prime                                                               
sponsor.   She began the presentation  on page 2, "Why  is HB 111                                                               
Important?",   which  read   as  follows   [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     43% of low-income Alaskans have difficulty biting and                                                                      
            1                                                                                                                   
     chewing.                                                                                                                   
                                                                                                                                
       Low-income families in Alaska don't regularly seek                                                                       
        oral health care due to cost, access, or trouble                                                                        
                       1                                                                                                        
     finding a provider.                                                                                                        
                                                                                                                                
      62% of Alaskan elementary students have a high tooth                                                                      
               2                                                                                                                
     decay rate .                                                                                                               
                                                                                                                                
      Pain is the top oral health problem for young adults                                                                      
                                     3                                                                                          
     and low-income adults in America.                                                                                          
                                                                                                                                
     1                                                                                                                          
      American Dental Association Health Policy Institute                                                                       
     2015: "Oral Health and Well-Being in the Alaska"                                                                           
     2                                                                                                                          
       Alaska Department of Health & Social Services 2012-                                                                      
     2016: " Alaska Oral Health Plan"                                                                                           
     3                                                                                                                          
      American Dental Association Health Policy Institute                                                                       
        2015: "Oral Health and Well-Being in the United                                                                         
     States"                                                                                                                    
                                                                                                                                
MR. BOERNER presented slide 3,  "Why is HB 111 Important?", which                                                               
read as follows [original punctuation provided]:                                                                                
                                                                                                                                
     ?   Dental  diseases   disproportionately  affect   our                                                                    
     state's most vulnerable people.                                                                                            
                                                                                                                                
     ?  Dental  hygienists  work  on   the  front  line  for                                                                    
     preventative  dental  care   and  education  about  the                                                                    
     critical  link between  oral health  and overall  well-                                                                    
     being.                                                                                                                     
                                                                                                                                
     ?  HB 111  increases  access to  oral  health care  for                                                                    
     underserved populations:                                                                                                   
          ? Children                                                                                                            
          ? Seniors                                                                                                             
          ? Alaskans with disabilities                                                                                          
          ? Alaskans in correctional facilities                                                                                 
                                                                                                                                
MS. BOERNER presented slide 4, "What Does HB 111 Do?", which                                                                    
read as follows [original punctuation provided]:                                                                                
                                                                                                                                
       HB 111 creates an advanced practice permit.                                                                              
                                                                                                                                
     ?  This  permit  allows  experienced,  licensed  dental                                                                    
     hygienists  to   work  independently   without  on-site                                                                    
     supervision when providing dental care.                                                                                    
                                                                                                                                
3:26:55 PM                                                                                                                    
                                                                                                                                
MS. BOERNER paused the PowerPoint to detail the sectional                                                                       
analysis, which read as follows [original punctuation provided]:                                                                
                                                                                                                                
     Section 1                                                                                                              
                                                                                                                                
     Ability of practice of dental hygienists.                                                                                
                                                                                                                                
     (e)  Amends AS  08.32.110. to  allow a  licensed dental                                                                    
     hygienist who holds an  advanced practice permit issued                                                                    
     by the board to perform duties allowed by the permit.                                                                      
                                                                                                                                
     Section 2                                                                                                              
                                                                                                                                
     Advanced practice permits.                                                                                               
                                                                                                                                
     Adds  a new  section under  AS 08.32.125.  creating the                                                                    
     advanced practice permit  and providing requirements as                                                                    
     follows:                                                                                                                   
                                                                                                                                
          (a)  The Board  of Dental  Examiners may  issue an                                                                    
     advanced  practice   permit   to  a   licensed   dental                                                                    
     hygienist with a    minimum  4,000 documented  hours of                                                                    
     clinical experience. This     subsection   lists   what                                                                    
     duties fall under advanced practice     permits:                                                                           
     general oral health & cleaning, providing    treatment                                                                     
     plans,    screenings,   taking    radiographs,   and/or                                                                    
          delegating to dental assistants.                                                                                      
                                                                                                                                
          (b)  A   licensed  dental  hygienist   holding  an                                                                    
     advanced  practice  permit may  provide  services to  a                                                                    
     patient who is      not   able    to   receive   dental                                                                    
     treatment because of age,     infirmity,             or                                                                    
     disability. The patient may be a resident of      a                                                                        
     senior center, residential health  facility, or held in                                                                    
     a    local correctional facility.  The patient may also                                                                    
     be   enrolled  in certain  schools, receiving  benefits                                                                    
     under the      Special   Supplemental    Food   Program                                                                    
     (WIC), homebound, or a   resident  of a  community that                                                                    
     has a shortage of dental      health professionals.                                                                        
                                                                                                                                
          (c)  A   licensed  dental  hygienist   holding  an                                                                    
     advanced  practice   permit  can   provide  appropriate                                                                    
     services to a  patient     without    the     presence,                                                                    
     authorization, and  supervision  of a  licensed dentist                                                                    
     and without an      examination    from   a    licensed                                                                    
     dentist.                                                                                                                   
                                                                                                                                
          (d)  Licensed dental  hygienists with  an advanced                                                                    
     practice  permits must  maintain professional liability                                                                    
     insurance.     They   must  also   give  the   patient,                                                                    
     parent, or legal guardian     written  notice that  the                                                                    
     treatment provided will be limited      to        those                                                                    
     allowed by the permit, a written recommendation   that                                                                     
     the  patient  be examined  by  a  licensed dentist  for                                                                    
          comprehensive   oral  care,   and  assistance   in                                                                    
     receiving a    referral  to  a   licensed  dentist  for                                                                    
     further oral treatment.                                                                                                    
                                                                                                                                
          (e)  Licensed  dental   hygienists  with  advanced                                                                    
     practice  permits    may   practice    as   independent                                                                    
     contractors.                                                                                                               
                                                                                                                                
          (f)  An advanced  practice permit  is valid  until                                                                    
     the license    of  the  dental   hygienist  expires.  A                                                                    
     licensed dental     hygienist can  renew their advanced                                                                    
     practice permit at the   same  time  they  renew  their                                                                    
     license.                                                                                                                   
                                                                                                                                
     Section 3                                                                                                              
                                                                                                                                
     Grounds  for discipline,  suspension, or  revocation of                                                                  
     license.                                                                                                                 
                                                                                                                                
     Amends  AS  08.32.160  to   exempt  a  licensed  dental                                                                    
     hygienist  as  permitted  under  an  advanced  practice                                                                    
     permit  from  supervision   requirements  for  clinical                                                                    
     procedures.  Licenses  may  be revoked  if  a  licensee                                                                    
     allows  a  dental  assistant to  perform  a  prohibited                                                                    
     procedure, or if the  licensee falsified, destroyed, or                                                                    
     failed  to maintain  a patient  or facility  record for                                                                    
     the last seven years.                                                                                                      
                                                                                                                                
     Section 4                                                                                                              
                                                                                                                                
     Allows a  dental hygienist holding an  advance practice                                                                    
     permit   to  delegate   to  a   dental  assistant   the                                                                    
     exposure/development  of  radiographs, the  application                                                                    
     of preventative  agents, and  other tasks  as specified                                                                    
     by the board in regulations.                                                                                               
                                                                                                                                
     Section 5                                                                                                              
                                                                                                                                
     Prohibits   insurance  providers   from  discriminating                                                                    
     against  dental  hygienists holding  advanced  practice                                                                    
     permits.                                                                                                                   
                                                                                                                                
     Section 6                                                                                                              
                                                                                                                                
     This  section is  amended to  include dental  hygienist                                                                    
     services  in  the  optional services  provided  by  the                                                                    
     Department of Health and Social Services.                                                                                  
                                                                                                                                
     Section 7                                                                                                              
                                                                                                                                
     Allows  the  Department  of  Commerce,  Community,  and                                                                    
     Economic  Development,  the  Department of  Health  and                                                                    
     Social Services,  and the Board of  Dental Examiners to                                                                    
     adopt  regulations necessary  to implement  the changes                                                                    
     made in this bill. The  regulations may not take effect                                                                    
     before the effective date of this bill.                                                                                    
                                                                                                                                
     Section 8                                                                                                              
                                                                                                                                
     Section 7 on regulations takes effective immediately.                                                                      
                                                                                                                                
     Section 9                                                                                                              
                                                                                                                                
     Effective date for sections 1-6 is July 1, 2022.                                                                           
                                                                                                                                
3:32:13 PM                                                                                                                    
                                                                                                                                
MS.  BOERNER resumed  the PowerPoint  presentation with  slide 5,                                                               
"Dental Health  Professional Shortage  Areas (DHPSA)  in Alaska,"                                                               
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
     In  2021 there  are 679  licensed dental  hygienists in                                                                    
     Alaska                                                                                                                     
                                                                                                                                
     Geographic DHPSAs  (e.g. Aleutians East  Borough, North                                                                  
     Slope Borough, Yukon-Koyukuk Census Area)                                                                                  
                                                                                                                                
     Alaskan  Native  Tribal  Populations  (e.g.  SEARHC/Mt.                                                                  
     Edgecumbe  Hospital,  Norton Sound  Health  Corporation                                                                    
     Outpatient Primary Care, Kana  Clinic Native Village of                                                                    
     Karluk,  . Chief  Andrew Isaac  Health Center,  Eklutna                                                                    
     Health Clinic,  Upper Tanana Health  Center,Dena' Nena'                                                                    
     Henash)                                                                                                                    
                                                                                                                                
     Correctional Facilities (e.g.  Lemon Creek Correctional                                                                  
     Facility, Yukon Kuskokwim  Correctional Facility, Anvil                                                                    
     Mountain Correctional Facility )                                                                                           
                                                                                                                                
     Federally Qualified Health  Centers (e.g. Bethel Family                                                                  
     Clinic,  Mat-Su   Health  Services,   Southeast  Alaska                                                                    
     Region Health Consortium)                                                                                                  
                                                                                                                                
     Full index  of all Dental Health  Professional Shortage                                                                    
     Areas    here:    https://data.hrsa.gov/tools/shortage-                                                                    
     area/hpsa-find                                                                                                             
                                                                                                                                
3:32:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  noted that  in attendance  via teleconference                                                               
were   representatives   of   the   Alaska   Dental   Hygienists'                                                               
Association,  Alaska Primary  Care Association,  and HyLife  Oral                                                               
Health  Alliance.   Also in  attendance  via teleconference,  she                                                               
said,  is a  former state  senator from  Minnesota who  worked on                                                               
similar statutes.                                                                                                               
                                                                                                                                
3:33:06 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS referred to the language  of HB 111, page 3, line                                                               
31 through  page 4, line  1, which  read, "(e) A  licensed dental                                                               
hygienist holding an advanced practice  permit may practice as an                                                               
independent contractor."   He then asked for  explanation of that                                                               
subsection.                                                                                                                     
                                                                                                                                
CO-CHAIR SPOHNHOLZ  responded that a dental  hygienist holding an                                                               
advanced practice permit  ("advanced practice dental hygienist"),                                                               
and who is in a collaborative  agreement with a dentist, would be                                                               
able  to  have an  independent  practice  similar  to that  of  a                                                               
physician's assistant  (PA).   She said that  many of  the urgent                                                               
care centers  in Southcentral  Alaska are  owned and  operated by                                                               
PAs who have  direct care agreements with doctors;  under HB 111,                                                               
dental hygienists  with an advanced  practice permit  may operate                                                               
in a similar manner.                                                                                                            
                                                                                                                                
CO-CHAIR  FIELDS  said  that the  term  "independent  contractor"                                                               
usually has  other implications in  terms of labor  law, workers'                                                               
compensation, and  minimum wage.   He expressed  that he  did not                                                               
want   to   unintentionally   exclude   someone   from   workers'                                                               
compensation  coverage  through the  language  of  the bill,  and                                                               
asked for testimony  from Legislative Legal Services  at the next                                                               
meeting.                                                                                                                        
                                                                                                                                
CO-CHAIR SPOHNHOLZ said that she would follow up.                                                                               
                                                                                                                                
CO-CHAIR FIELDS pointed  out that pediatrics is an  area in which                                                               
advanced practice  dental hygienist could practice,  and he asked                                                               
whether there  is data on  accessibility for  pediatric dentistry                                                               
in Anchorage, and  how pediatric dentistry would  be addressed by                                                               
HB  111.   He said,  "My  sense is  there are  lots of  pediatric                                                               
dentists, so the  supply is there in terms  of the practitioners,                                                               
but what  are the barriers  in terms  of kids who  don't actually                                                               
have pediatric care?"                                                                                                           
                                                                                                                                
CO-CHAIR SPOHNHOLZ  replied that  the populations proposed  to be                                                               
served  by  the creation  of  the  advanced practice  permit  are                                                               
underserved populations,  such as  low income families  and those                                                               
who lack  access to adequate  dental health care.   She explained                                                               
that  underserved  populations  also include  those  who  receive                                                               
services through federally-qualified  health centers (FQHCs) like                                                               
Anchorage  Neighborhood  Health,  which could  hire  an  advanced                                                               
practice  dental  hygienist  to   provide  dental  care  for  the                                                               
population it serves.                                                                                                           
                                                                                                                                
CO-CHAIR FIELDS  asked Ms.  Menkens what  percentage of  kids are                                                               
not receiving adequate  dental care and, should HB  111 pass, how                                                               
she envisions care reaching the kids.                                                                                           
                                                                                                                                
3:36:06 PM                                                                                                                    
                                                                                                                                
JESSIE  MENKENS, Policy  & Partnerships  Manager, Alaska  Primary                                                               
Care  Association,   replied  that  she  doesn't   have  data  on                                                               
pediatric dental care  accessibility but that she  would be happy                                                               
to follow up.   She referred to  Co-Chair Spohnholz's description                                                               
of the  FQHCs and said  that those  facilities have a  mandate to                                                               
provide "safety  net" care regardless of  an individual's ability                                                               
to pay.   Within the FQHCs, she said, families  rely on pediatric                                                               
dental  health  care.    She   stated  the  Alaska  Primary  Care                                                               
Association's support of HB 111  and said that its provisions are                                                               
becoming a national "best practice" with positive impact.                                                                       
                                                                                                                                
3:37:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY referred to page  2, lines 5-8, of HB 111,                                                               
which read as follows:                                                                                                          
                                                                                                                                
     Sec.  08.32.125.  Advanced  practice permits.  (a)  The                                                                  
     board  may  issue  an advanced  practice  permit  to  a                                                                    
     licensed  dental  hygienist  with a  minimum  of  4,000                                                                    
     documented  hours of  clinical  experience. A  licensed                                                                    
     dental  hygienist holding  an advanced  practice permit                                                                    
     may                                                                                                                        
                                                                                                                                
REPRESENTATIVE MCCARTY  asked whether  there is a  definition for                                                               
"hours of clinical experience."                                                                                                 
                                                                                                                                
CO-CHAIR SPOHNHOLZ deferred to Ms. Bryant.                                                                                      
                                                                                                                                
3:37:58 PM                                                                                                                    
                                                                                                                                
LISA  BRYANT,  Legislative  Co-Chair, Alaska  Dental  Hygienists'                                                               
Association, explained  that 4,000  hours of  clinical experience                                                               
equates to  approximately two to  three years'  experience, which                                                               
is  the same  amount of  time  required by  the state  to have  a                                                               
collaborative agreement with a dentist.                                                                                         
                                                                                                                                
REPRESENTATIVE  MCCARTY  asked  whether  there  is  a  difference                                                               
between hours providing direct patient  care versus hours working                                                               
on notes or reviewing charts.                                                                                                   
                                                                                                                                
MS.  BRYANT responded  that there  is no  differentiation between                                                               
those tasks  because every  time care is  provided to  a patient,                                                               
the dental  hygienist is performing  tasks such as  reviewing the                                                               
patient's health  history, assessing patient needs,  or reviewing                                                               
radiographs.                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY  asked whether other  states differentiate                                                               
between  hours   providing  direct  patient  care   versus  hours                                                               
reviewing patient charts or notes.                                                                                              
                                                                                                                                
MS.  BRYANT  replied  that  she  has  not  experienced  any  such                                                               
differentiation.                                                                                                                
                                                                                                                                
3:39:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ interjected  that Ms.  Reetz, who  has earned                                                               
the equivalent of the advanced  practice permit in Oregon, may be                                                               
able to provide more details.                                                                                                   
                                                                                                                                
3:40:04 PM                                                                                                                    
                                                                                                                                
LORI  REETZ, President,  Alaska  Dental Hygienists'  Association,                                                               
clarified that she  has only practiced dental  hygiene in Alaska;                                                               
however,  she  graduated  with  a  bachelor's  degree  in  dental                                                               
hygiene  in Oregon,  where the  curriculum  includes practice  to                                                               
obtain an Oregon license similar  to the advanced practice permit                                                               
as proposed under HB 111.                                                                                                       
                                                                                                                                
3:41:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY  stated  that  one  of  his  concerns  is                                                               
ensuring  that a  practitioner has  experience with  patient care                                                               
instead of only paperwork experience.                                                                                           
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  said  that  the intention  of  the  proposed                                                               
legislation  is  to  make  the  licensure  available  only  to  a                                                               
practicing  dental hygienist  who has  4,000 hours  of experience                                                               
prior to seeking licensure.                                                                                                     
                                                                                                                                
REPRESENTATIVE MCCARTY stated his  understanding that in order to                                                               
receive  the  advanced practice  permit,  one  must be  a  dental                                                               
hygienist with 4,000 hours of practice.                                                                                         
                                                                                                                                
CO-CHAIR SPOHNHOLZ replied, "Yes, sir."                                                                                         
                                                                                                                                
REPRESENTATIVE MCCARTY  referred to the  text of HB 111,  page 4,                                                               
lines 2-4, which read as follows:                                                                                               
                                                                                                                                
     (f)  An advanced  practice permit  is  valid until  the                                                                    
     expiration  of   the  dental  hygienist's   license  to                                                                    
     practice.  A licensed  dental  hygienist  may renew  an                                                                    
     advanced  practice  permit  at   the  time  of  license                                                                    
     renewal under AS 08.32.071.                                                                                                
                                                                                                                                
REPRESENTATIVE MCCARTY  said, "Did I  overhear that a  person, as                                                               
an  advanced practitioner,  has to  have two  licenses, not  just                                                               
one?"                                                                                                                           
                                                                                                                                
CO-CHAIR SPOHNHOLZ  replied that one must  have received approval                                                               
and  licensure  in  order  to  become  a  dental  hygienist,  and                                                               
subsequently seek the additional licensure  in order to become an                                                               
advanced practice dental hygienist.                                                                                             
                                                                                                                                
REPRESENTATIVE  MCCARTY   asked  whether  the  same   process  is                                                               
followed for a nurse practitioner.                                                                                              
                                                                                                                                
CO-CHAIR  SPOHNHOLZ explained  that a  nurse practitioner  may go                                                               
all  the way  through school  to achieve  that licensure  without                                                               
independent  practice,  with  clinical   hours  as  part  of  the                                                               
training; for example,  a biology degree, followed  by a master's                                                               
or  doctoral  degree,  would include  clinical  experience,  with                                                               
independent practice  thereafter.   She said that  this licensure                                                               
is different because  one would do clinical training  to become a                                                               
dental  hygienist, followed  by  additional training  to get  the                                                               
advanced practice permit.                                                                                                       
                                                                                                                                
REPRESENTATIVE  MCCARTY stated  his understanding  that a  dental                                                               
hygienist with an  advanced practice permit would,  under HB 111,                                                               
have to  have two  licenses: a dental  hygienist license,  and an                                                               
advanced  practice  permit.    He  asked  why  two  licenses  are                                                               
necessary for  a dental  hygienist to  operate under  an advanced                                                               
practice permit,  when the same  thing is not required  for nurse                                                               
practitioners.                                                                                                                  
                                                                                                                                
CO-CHAIR SPOHNHOLZ  responded that  the advanced  practice permit                                                               
is  designed  to build  onto  a  dental hygienist  license  after                                                               
they've gotten the requisite clinical  experience.  She explained                                                               
that  a  nurse practitioner  can  proceed  forward through  their                                                               
training  and,  after  graduating   with  a  master's  degree  or                                                               
doctorate, go  directly into  practice.  She  pointed out  that a                                                               
nurse practitioner has  a much wider scope of  practice and isn't                                                               
required to  have a  direct care  agreement with  a doctor.   She                                                               
said that a better comparison  in training and licensure would be                                                               
the  process  of  becoming a  physician's  assistant:  a  medical                                                               
professional who has practiced in  their field, returns to school                                                               
to   receive  additional   training,   and   then  practices   in                                                               
partnership  with a  direct care  agreement  under a  supervising                                                               
physician.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  MCCARTY   referenced  Co-Chair   Fields'  earlier                                                               
questions about  page 3, line 31  through page 4, line  1, of the                                                               
proposed  legislation,   which  read,  "(e)  A   licensed  dental                                                               
hygienist holding an advanced practice  permit may practice as an                                                               
independent contractor."   He stated the  understanding that this                                                               
subsection would  give the advanced dental  hygienist the ability                                                               
to  have  their own  practice.    Co-Chair Spohnholz  stated  her                                                               
agreement, and  he said, "So they  would not be under  a dentist,                                                               
if  that's the  case."   He then  surmised that  in the  scenario                                                               
described  by   Co-Chair  Spohnholz,  advanced   practice  dental                                                               
hygienists "would  actually have  their own practice,  and they'd                                                               
have  people   working  for  them,  even   potentially  a  dental                                                               
hygienist under the advanced [practice permit]."                                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ responded,  "Both of those things  are sort of                                                               
true."   A  physician's assistant,  she explained,  has a  direct                                                               
care  agreement  with   a  physician,  yet  can   still  have  an                                                               
independent practice.  An advanced  dental hygienist would have a                                                               
direct  care  agreement with  a  dentist  but  would be  able  to                                                               
operate their own practice.                                                                                                     
                                                                                                                                
3:47:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS asked for input from Legislative Legal Services.                                                                
                                                                                                                                
3:47:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KAUFMAN asked  whether  the proposed  legislation                                                               
includes provisions for  radiography such as what  would be found                                                               
in a dental office.                                                                                                             
                                                                                                                                
CO-CHAIR SPOHNHOLZ deferred to Ms. Bryant.                                                                                      
                                                                                                                                
3:48:03 PM                                                                                                                    
                                                                                                                                
MS. BRYANT  explained that dental  hygienists are  highly trained                                                               
in  radiography and,  as advanced  dental  hygienists, could  use                                                               
portable  radiography   units  in   their  treatment   plans  and                                                               
assessments.   She  offered  clarification  on the  collaborative                                                               
agreements  and  said that  the  advanced  practice permit  would                                                               
allow   a  dental   hygienist  to   work   without  a   dentist's                                                               
authorization.                                                                                                                  
                                                                                                                                
REPRESENTATIVE KAUFMAN  asked how an advanced  practice hygienist                                                               
would manage radiation  safety.  He said that he  wants to ensure                                                               
that radiation  safety requirements would match  what is required                                                               
of a dentist office.                                                                                                            
                                                                                                                                
MS. BRYANT responded  that radiation safety devices  such as lead                                                               
aprons and  thyroid collars are  employed.  She said  that dental                                                               
hygienists practice  the radiation  safety training  given during                                                               
their education.                                                                                                                
                                                                                                                                
3:50:45 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  interjected to  point  out  that it  was  an                                                               
earlier  version  of  HB  111   that  included  the  direct  care                                                               
agreement; the  current version does not  include that provision.                                                               
She  then  pointed   out  that  the  issue   of  all  regulations                                                               
associated  with  radiography  are  determined by  the  Board  of                                                               
Dental Examiners,  and that an advanced  practice hygienist would                                                               
be required to follow all rules  and regulations set forth by the                                                               
board.                                                                                                                          
                                                                                                                                
CO-CHAIR FIELDS  asked to hear testimony  from representatives of                                                               
the Board of  Dental Examiners and the  Alaska Dental Association                                                               
during the next meeting.                                                                                                        
                                                                                                                                
3:51:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KAUFMAN  asked   whether  professional  liability                                                               
would be commensurate with that faced by dentists.                                                                              
                                                                                                                                
MS.  BRYANT  responded  that   professional  liability  would  be                                                               
covering practices performed as dental hygienists.                                                                              
                                                                                                                                
CO-CHAIR SPOHNHOLZ  explained that a dental  hygienist's scope of                                                               
practice  is much  narrower than  that of  a dentist.   She  also                                                               
noted that  a representative from  the Board of  Dental Examiners                                                               
is expected to provide testimony at the next hearing.                                                                           
                                                                                                                                
REPRESENTATIVE KAUFMAN  said, "I  appreciate that their  scope is                                                               
different,  but there's  a  little bit  of  convergence with  the                                                               
expanded scope."   He then asked whether the intent  of HB 111 is                                                               
to limit  services provided  by an  advanced dental  hygienist to                                                               
underserved populations, or to make care available to anyone.                                                                   
                                                                                                                                
CO-CHAIR SPOHNHOLZ  clarified that  the advanced  practice permit                                                               
would not expand the scope  of practice for dental hygienists, it                                                               
would simply  allow them  to practice  independently.   She said,                                                               
"What dental hygienists do will not  change, and I think that's a                                                               
very  important  distinction."    She   described  HB  111  as  a                                                               
"carefully  crafted  compromise"  between dental  hygienists  and                                                               
dentists, and she  expressed the belief that, if  HB 111 proposed                                                               
expanding the  dental hygienists'  scope of practice,  the dental                                                               
society  might not  be supportive  of  the proposed  legislation.                                                               
She  said that  the intention  is  to increase  access to  dental                                                               
health care  for underserved communities.   She noted  that there                                                               
are  many communities  throughout the  state with  economies that                                                               
don't support dental health care;  there are also people who live                                                               
in  facilities that  don't get  access to  regular dental  health                                                               
care.  Communities  to which dentists won't  travel could benefit                                                               
from  the   dental  health  care  provided   by  advanced  dental                                                               
hygienists.    She stressed  that  the  dental society  has  been                                                               
supportive of the proposed legislation for the past three years.                                                                
                                                                                                                                
REPRESENTATIVE   KAUFMAN  asked   whether  Anchorage,   with  its                                                               
adequate level of dental health  care access, could expect to see                                                               
businesses opening to practice the  scope of work as described in                                                               
the proposed legislation.                                                                                                       
                                                                                                                                
CO-CHAIR  SPOHNHOLZ   replied  that   nothing  in   the  proposed                                                               
legislation prohibits  an advanced dental hygienist  from opening                                                               
a business in Anchorage, given  that the hygienist operate within                                                               
their limited  scope of training  and authorization by  the Board                                                               
of Dental Examiners.                                                                                                            
                                                                                                                                
3:55:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS asked whether a  dental company could lay off all                                                               
of their dentists and hire dental hygienists instead.                                                                           
                                                                                                                                
CO-CHAIR  SPOHNHOLZ responded  that dentists  do not  provide the                                                               
preventative  care that  dental  hygienists do.   Typically,  she                                                               
said,  when one  goes  to  the dentist's  office,  it's only  the                                                               
dental hygienist  providing the care.   A dentist may do  a brief                                                               
exam, but it's the dental  hygienist taking any x-rays, cleaning,                                                               
and  doing  the  screening.    She  said  that  HB  111  wouldn't                                                               
necessarily change that practice.                                                                                               
                                                                                                                                
3:56:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NELSON asked whether there  is a rough estimate of                                                               
how many  people are in  the underserved categories  described in                                                               
the proposed legislation.                                                                                                       
                                                                                                                                
CO-CHAIR  SPOHNHOLZ replied  that she  doesn't have  an immediate                                                               
answer to that  question.  "What we do know,"  she said, "is that                                                               
there is a shortage of  dental health care access in correctional                                                               
facilities,  federally-qualified health  centers  for low  income                                                               
folks, and in many parts  of rural Alaska where dental hygienists                                                               
would be able  to practice using this  advanced practice permit."                                                               
She stressed that  HB 111 would increase access  to dental health                                                               
care in underserved communities.                                                                                                
                                                                                                                                
REPRESENTATIVE NELSON said  that he wanted to know  the number of                                                               
people in the "underserved" category.                                                                                           
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  said  that   Ms.  Menkens,  who  works  with                                                               
federally-qualified health  centers, may be  able to  address the                                                               
question.                                                                                                                       
                                                                                                                                
3:57:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NELSON  noted that  the fiscal note  is calculated                                                               
with  a  75  percent  federal   match.    He  asked  for  further                                                               
explanation  of   the  25   percent  for   which  the   state  is                                                               
responsible.                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ responded  that the amount in  question is the                                                               
state's contribution  for the increased  amount of  dental health                                                               
care that  could be  provided if a  certain percentage  of dental                                                               
hygienists were to become advanced practice providers.                                                                          
                                                                                                                                
REPRESENTATIVE NELSON asked, "And what's that percentage?"                                                                      
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  replied that  she  doesn't  have the  number                                                               
immediately accessible.                                                                                                         
                                                                                                                                
3:58:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS opened invited testimony on HB 111.                                                                             
                                                                                                                                
3:58:42 PM                                                                                                                    
                                                                                                                                
MS.  MENKENS, having  previously  provided  answers to  committee                                                               
questions, now  gave her  testimony in  support of  HB 111.   She                                                               
read a  letter from  Joe Zasada,  Policy Integration  Director of                                                               
the  Alaska  Primary  Care Association,  which  read  as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
      The Alaska Primary Care Association (APCA) supports                                                                       
         the operations and development of Alaska's 29                                                                          
     Federally  Qualified  Health  Centers (FQHCs  and  Look                                                                    
     Alikes). Alaska Health Centers  voted to support health                                                                    
     workforce  development initiatives  that introduce  new                                                                    
     provider  types to  the market  and increase  access to                                                                    
     care in their 2021 Policy Priorities.                                                                                      
                                                                                                                                
     All of  Alaska's Community Health Centers  are required                                                                    
     to provide oral  health services as a  component of the                                                                    
     comprehensive  medical,  dental,  behavioral,  pharmacy                                                                    
     and  care  coordination  services  they  offer.  Dental                                                                    
     services and  overall oral health are  vital components                                                                    
     in the whole person  care that Community Health Centers                                                                    
     provide their  patients. Many Health Centers  offer on-                                                                    
     site dental  services provided  by staff  or contracted                                                                    
     dental  health  professionals.  Other  more  rural  and                                                                    
     smaller sites  rely on sending  patients to  larger hub                                                                    
     health facilities  or neighboring urban  Health Centers                                                                    
     for dental  care. One frequently  cited reason  for the                                                                    
     shortage of dental services is the lack of providers.                                                                      
                                                                                                                                
     In  2019, almost  one third  of Alaska  Health Centers'                                                                    
     113,000   patients  received   dental  care   at  their                                                                    
     Community  Health  Center  through over  96,796  visits                                                                    
     provided   by   77   full-time   equivalent   dentists,                                                                    
     hygienists,    and   dental    therapists.   Persistent                                                                    
     shortages  of  providers  at all  levels  in  Community                                                                    
     Health Center  dental clinics  result in  providers not                                                                    
     working at  their highest level of  licensure; creating                                                                    
     inefficiencies,  decreased  provider satisfaction,  and                                                                    
     barriers  to patient  care.  The  addition of  Advanced                                                                    
     Hygienists  to   practices  would  add   an  additional                                                                    
     valuable layer  of staffing between dentists  and other                                                                    
     hygienists   and    dental   therapists    to   provide                                                                    
     comprehensive  services  and support  integration  with                                                                    
     other   Health  Center   services,  including   chronic                                                                    
     disease  management,  and  behavioral  health/substance                                                                    
     use disorder services.                                                                                                     
                                                                                                                                
     Community  Health Centers  have  been  pioneers in  the                                                                    
     past  in  supporting  and  incorporating  expansion  of                                                                    
     health  professional  provider  types into  their  care                                                                    
     settings.  Community   Health  Centers  are   ready  to                                                                    
     embrace  this new  provider type  as  they continue  to                                                                    
     grow  and  expand  the increasing  need  of  integrated                                                                    
     dental care in primary care settings.                                                                                      
                                                                                                                                
     We urge passage of House Bill 111.                                                                                         
                                                                                                                                
4:00:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS asked  Ms. Menkens  what percentage  of children                                                               
are served under Medicaid versus private insurance.                                                                             
                                                                                                                                
MS.  MENKENS  responded  that  she  would  follow  up  with  that                                                               
information.                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS  opined that there  seems to be an  oversupply of                                                               
dentists and an undersupply of  affordable care in Anchorage.  He                                                               
wondered whether  parents know  where to  get dental  health care                                                               
for their  children, or whether  pediatric dentists  don't accept                                                               
Medicaid.  He  then asked whether schools  have dental screenings                                                               
and how families can access services.                                                                                           
                                                                                                                                
4:02:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  pointed out  that Co-Chair  Fields identified                                                               
that while there are many dentists  in Anchorage, that is not the                                                               
situation for  the entire  state of  Alaska.   She said  that she                                                               
mentioned Anchorage Neighborhood Health  because Anchorage is the                                                               
home  community of  the majority  of committee  members; however,                                                               
rural Alaska does not have  the supply of dentists that Anchorage                                                               
has.  She stressed that it's  not only the tribal communities but                                                               
also  communities on  the road  system with  shortages in  dental                                                               
health care providers.  She  recalled the inception of the Dental                                                               
Health Aide  Therapist program, intended  to help  communities in                                                               
rural Alaska,  and said that  the belief among dentists  was that                                                               
those therapists  may not provide  adequate care;  however, those                                                               
dentists  weren't  travelling to  rural  Alaska  to provide  that                                                               
care.  She  said, "[In] urban Alaska,  particularly in Anchorage,                                                               
we don't  have an access problem  when it comes to  dental health                                                               
care.   But  we're  not the  rest  of the  state,  we're just  40                                                               
percent of the population."                                                                                                     
                                                                                                                                
CO-CHAIR FIELDS  said he wants  to understand what  percentage of                                                               
kids in Anchorage don't have adequate dental care, and why.                                                                     
                                                                                                                                
4:04:31 PM                                                                                                                    
                                                                                                                                
MS. BRYANT,  having previously responded to  committee questions,                                                               
now gave testimony in support of HB  111.  She stated that she is                                                               
a registered dental hygienist (RDH), as  well as a U.S. Air Force                                                               
veteran.    She  said  that  as  of  March  8,  2021,  there  are                                                               
approximately  679  RDHs  in  Alaska,  with only  a  few  with  a                                                               
collaborative  agreement with  a  dentist.   The factor  limiting                                                               
collaborative agreements, she said, is  believed to be the number                                                               
of licensed dentists  in Alaska interested in  entering into such                                                               
an  agreement.   A  collaborative agreement  allows  an RDH  with                                                               
4,000 hours  of experience to  work under the authorization  of a                                                               
licensed dentist  without the  dentist being  onsite, in  an area                                                               
other than the  usual place of practice of  the licensed dentist,                                                               
and without  the dentist's diagnosis  and treatment  plan, unless                                                               
otherwise  specified   in  the  collaborative  agreement.     The                                                               
provisions under HB 111 would  break down barriers and bridge the                                                               
gap in  access to  dental health  care.   Based on  feedback from                                                               
RDHs  in  meetings  pertaining  to  this  bill,  approximately  5                                                               
percent have  expressed interest in seeking  an advanced practice                                                               
permit.   Advanced practice  for dental hygienists  is not  a new                                                               
concept, she  said; many states have  implemented legislation for                                                               
RDHs  to provide  varying degrees  of direct  patient care  since                                                               
1995,  with  many  states  advancing  legislation  as  lawmakers,                                                               
dental  associations,  and  medical professionals  recognize  the                                                               
benefits  of  utilizing RDHs  to  safely  provide services  while                                                               
increasing access to oral health care and education.                                                                            
                                                                                                                                
MS. BRYANT  pointed out that  there are no legal  cases regarding                                                               
treatment  issues, and  RDHs in  Alaska have  had a  longstanding                                                               
safety  record.    She  explained  that  care  provided  by  RDHs                                                               
includes  oral  cancer  screenings,  blood  pressure  assessment,                                                               
providing  tobacco  cessation   information,  and  educating  the                                                               
public about  oral health and  its systemic connection.   Routine                                                               
dental health  care, she said, correlates  to decreased emergency                                                               
dental  care, thereby  decreasing medical  costs.   She expressed                                                               
witnessing the suffering caused by  oral diseases among those who                                                               
live remotely  and have  experienced challenges  accessing dental                                                               
health care services.  She  implored the committee members to not                                                               
let  Alaska  be   known  as  the  "Last   Frontier"  for  passing                                                               
legislation that  could help increase  access to care,  and urged                                                               
them to  support HB  111.   She stressed  that the  Alaska Dental                                                               
Hygienists'    Association,     American    Dental    Hygienists'                                                               
Association,  Alaska  Dental Society,  and  the  Alaska Board  of                                                               
Dental Examiners support HB 111.                                                                                                
                                                                                                                                
4:08:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS  asked  Ms. Bryant  what  being  an  independent                                                               
contractor means.                                                                                                               
                                                                                                                                
MS.  BRYANT  replied  that  it means  a  dental  hygienist  would                                                               
practice  on  their  own,  creating   their  own  assessment  and                                                               
treatment plans for the patient,  and if necessary, referring the                                                               
patient to a licensed dentist for further care.                                                                                 
                                                                                                                                
CO-CHAIR  FIELDS interjected  and asked  Mr. Fisher  why language                                                               
allowing advanced practice dental  hygienists to be classified as                                                               
independent contractors is in the proposed legislation.                                                                         
                                                                                                                                
4:10:10 PM                                                                                                                    
                                                                                                                                
SANDON FISHER,  Legislative Counsel, Legislative  Legal Services,                                                               
Legislative Affairs Agency, explained  that the term "independent                                                               
contractor" is  a commonly used  term in the  employment context,                                                               
with  ramifications  for  the   relationship  between  the  party                                                               
contracting  for  the  services and  the  independent  contractor                                                               
themselves.     A  person  or   business  using   an  independent                                                               
contractor  would  generally  not withhold  employment  taxes  or                                                               
cover the contractor by workers' compensation insurance.                                                                        
                                                                                                                                
CO-CHAIR FIELDS thanked Mr. Fisher for the explanation.                                                                         
                                                                                                                                
4:11:39 PM                                                                                                                    
                                                                                                                                
LORI  REETZ, President,  Alaska  Dental Hygienists'  Association,                                                               
testified in  support of HB  111 on  behalf of the  Alaska Dental                                                               
Hygienists'  Association.    She   said  that  she  obtained  her                                                               
associate degree in dental hygiene  from the University of Alaska                                                               
Anchorage in  1997, and has been  practicing as an RDH  in Alaska                                                               
for 24  years.   In 2015  she obtained  her bachelor's  degree in                                                               
dental  hygiene from  the Oregon  Institute of  Technology where,                                                               
she   explained,  part   of  the   curriculum   is  training   to                                                               
successfully  become Oregon's  version  of  an advanced  practice                                                               
dental hygienist.  She described  learning how to provide care to                                                               
people in limited  access populations, and to  those with limited                                                               
mobility, without  the supervision of  a dentist.   She expressed                                                               
concern about her aging parents'  ability to access dental health                                                               
care if  they're not  able to  leave their  house, and  said that                                                               
with an expanded practice permit  she could provide care to those                                                               
with limited mobility.                                                                                                          
                                                                                                                                
4:15:13 PM                                                                                                                    
                                                                                                                                
ANGIE  STONE,  Founder  and CEO,  HyLife  Oral  Health  Alliance,                                                               
testified in support  of HB 111.  She said  that she first became                                                               
aware of the problems faced  by the elder population in accessing                                                               
dental health  care when a  family member entered a  nursing home                                                               
which  had no  dental health  care.   She said,  "As a  Wisconsin                                                               
dental hygienist,  I was  not allowed  to provide  dental hygiene                                                               
treatment  without  the  involvement   of  a  dentist,  which  is                                                               
currently the situation  in Alaska."  With no  dentist wanting to                                                               
provide care  at the  facility, she said,  her family  member was                                                               
left with  no treatment for periodontal  disease and subsequently                                                               
had recurrent lung infections.   Ms. Stone told of another family                                                               
member who, within two years of  entering a nursing home, lost 60                                                               
percent of the  teeth that she had  kept for 90 years.   She said                                                               
that the surgeon  general has reported that  elderly nursing home                                                               
residents  have extensive  oral disease,  poor oral  hygiene, and                                                               
suffer the  worst oral health of  any population.  She  said that                                                               
nursing  home  oral health  surveys  around  the country  reflect                                                               
this,  reporting  that 42  percent  of  residents have  untreated                                                               
tooth  decay, 31  percent  have  root tips  in  their mouths,  35                                                               
percent  have substantial  oral  debris, 22  percent have  severe                                                               
inflammation of the  gum tissues, and 20 percent have  a need for                                                               
periodontal care.  All of  the observed conditions, she said, are                                                               
things that dental  hygienists are trained to prevent.   On March                                                               
30, 2017,  Wisconsin passed a  law allowing dental  hygienists to                                                               
practice  without the  presence  of  a dentist.    She asked  the                                                               
committee to  ensure vulnerable nursing home  residents in Alaska                                                               
have access to dental health care.                                                                                              
                                                                                                                                
4:19:50 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS  asked whether dental hygienists  in Alaska could                                                               
sign  up  as  independent  contractors with  HyLife  Oral  Health                                                               
Alliance.  He also asked what the business model is.                                                                            
                                                                                                                                
MS. STONE responded that clinical  services had ceased due to the                                                               
COVID-19  restrictions, with  the dental  hygienists not  able to                                                               
enter nursing homes.   She said that dental  hygienists in Alaska                                                               
could register through HyLife Oral  Health Alliance, allowing the                                                               
company to  handle billing.   She said  that in Wisconsin  she is                                                               
able to  bill Medicaid,  but she doesn't  know how  billing would                                                               
work in Alaska.   She said that  she was of the  opinion that the                                                               
language  of HB  111 would  be most  beneficial if  the hygienist                                                               
could  be either  an employee  or an  independent contractor,  as                                                               
there  are  several  different  models  with  varying  levels  of                                                               
appropriateness for situations.                                                                                                 
                                                                                                                                
4:22:04 PM                                                                                                                    
                                                                                                                                
ANN LYNCH,  Director of Advocacy  and Education,  American Dental                                                               
Hygienists'  Association,  testified  in  support of  HB  111  on                                                               
behalf  of the  American Dental  Hygienists' Association  (ADHA).                                                               
She  read excerpts  from  her written  testimony,  which read  as                                                               
follows [original punctuation provided]:                                                                                        
                                                                                                                                
     ADHA  advocates  that   dental  hygiene  and/or  dental                                                                    
     practice  acts  be  amended so  that  the  services  of                                                                    
     dental  hygienists   can  be  fully  utilized   in  all                                                                    
     settings. Furthermore,  ADHA supports oral  health care                                                                    
     workforce models  that culminate in graduation  from an                                                                    
     accredited  institution;  professional  licensure;  and                                                                    
     direct  access to  patient  care.  ADHA defines  direct                                                                    
     access  as  the  ability  of   a  dental  hygienist  to                                                                    
     initiate  treatment  based  on their  assessment  of  a                                                                    
     patient's needs  without the specific  authorization of                                                                    
     a dentist, treat the patient  without the presence of a                                                                    
     dentist, and maintain a provider-patient relationship.                                                                     
                                                                                                                                
     In 1995, five states  allowed direct access. Currently,                                                                    
     42 states,  including Alaska, have policies  that allow                                                                    
     dental hygienists  to work in  community-based settings                                                                    
     to provide preventive oral  health services without the                                                                    
     presence or  direct supervision of a  dentist. Allowing                                                                    
     dental  hygienists   to  practice  under   an  advanced                                                                    
     practice  permit  will  further improve  upon  Alaska's                                                                    
     direct access and  provide additional opportunities for                                                                    
     the  safe   and  effective  care  provided   by  dental                                                                    
     hygienists in order to reach patients in need.                                                                             
                                                                                                                                
MS.  LYNCH explained  that HB  111  would further  the impact  of                                                               
dental hygienists by allowing them to  work to the full extent of                                                               
their  education and  license.   She expressed  gratitude to  Co-                                                               
Chair  Spohnholz  for  carrying  the  bill, as  well  as  to  the                                                               
committee for  hearing it.   She continued reading  excerpts from                                                               
her   written  testimony,   which  read   as  follows   [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     The  policies  cited  above are  further  supported  by                                                                    
     research  demonstrating  the impact  dental  hygienists                                                                    
     have   on   access   to    care   and   public   policy                                                                    
     recommendations supporting  dental hygienists providing                                                                    
     care in direct access settings, including:                                                                                 
                                                                                                                                
     ? In December 2018, the  U.S. Departments of Health and                                                                    
     Human   Services   (HHS),   Treasury,  and   Labor   in                                                                    
     collaboration  with the  U.S. Federal  Trade Commission                                                                    
     (FTC)   and   White    House   offices,   made   policy                                                                    
     recommendations  on  state   and  federal  policies  to                                                                    
     improve  choice  and  competition in  the  health  care                                                                    
     markets. The  report says dental hygienists  can safely                                                                    
     and  effectively  provide   some  services  offered  by                                                                    
     dentists, as  well as  complementary services.  It goes                                                                    
     on  to  recommend  states should  consider  changes  to                                                                    
     their   scope-of-practice   statutes   to   allow   all                                                                    
     healthcare providers  to practice  to the top  of their                                                                    
     license,  utilizing  their  full  skill  set.  It  also                                                                    
     recommends  that  States   eliminate  requirements  for                                                                    
     rigid    collaborative    practice   and    supervision                                                                    
     agreements  between dentists  and  hygienists that  are                                                                    
     not   justified  by   legitimate   health  and   safety                                                                    
     concerns.                                                                                                                  
                                                                                                                                
     ?  The  National  Governor's  Association  specifically                                                                    
     says,  "the rationale  that  state  dental boards  most                                                                    
     commonly   used   for   restricting   hygienists   from                                                                    
     practicing   in   unsupervised  settings   focuses   on                                                                    
     concerns  about  quality  and safety,  even  though  no                                                                    
     clear evidence exists to support such restrictions.                                                                        
                                                                                                                                
     ?  The FTC  previously wrote  to the  Georgia Board  of                                                                    
     Dentistry  regarding   regulation  of   dental  hygiene                                                                    
     supervision.  In the  letter, FTC  staff stated  "sound                                                                    
     competition   policy  calls   for  competition   to  be                                                                    
     restricted only  when necessary  to protect  the public                                                                    
     from  significant  harm.  Here,  we  are  aware  of  no                                                                    
     evidence   of  past   or  future   harm  from   current                                                                    
     practices."                                                                                                                
                                                                                                                                
     ? The  Oral Health Workforce Research  Center concluded                                                                    
     in  2016 that  "Scopes of  practice which  allow dental                                                                    
     hygienists to  provide services  to patients  in public                                                                    
     health  settings  without   burdensome  supervision  or                                                                    
     prescriptive requirements appear  to increase access to                                                                    
     educational and preventive care."                                                                                          
                                                                                                                                
MS. LYNCH said, "Simply put, House Bill 111 is good public                                                                      
policy."                                                                                                                        
                                                                                                                                
4:28:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS opened public testimony on HB 111.  There being                                                                 
no one who wished to testify, he closed public testimony.                                                                       
                                                                                                                                
[HB 111 was held over.]                                                                                                         
                                                                                                                                
          HB 117-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                      
                                                                                                                                
4:29:16 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced  that the next order  of business would                                                               
be  a  return to  HOUSE  BILL  NO.  117,  "An Act  extending  the                                                               
termination  date   of  the   Board  of   Certified  Direct-Entry                                                               
Midwives; and providing for an effective date."                                                                                 
                                                                                                                                
4:29:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY asked  Representative Ortiz  his thoughts                                                               
on extending  the sunset date  of the Board of  Certified Direct-                                                               
Entry Midwives for only two years.                                                                                              
                                                                                                                                
4:30:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DAN ORTIZ,  Alaska  State  Legislature, as  prime                                                               
sponsor  of  HB  117,  responded that  Legislative  Auditor  Kris                                                               
Curtis explained why  the audit recommended an  extension of only                                                               
two years,  and he doesn't  necessarily know the details  of what                                                               
may be a confidential matter.   He said that the solution brought                                                               
forward  by  Ms. Curtis  gives  the  board  time to  address  the                                                               
issues.   He noted that  he is offering the  proposed legislation                                                               
on behalf  of the  Board of  Certified Direct-Entry  Midwives and                                                               
doesn't necessarily have any knowledge of the matter.                                                                           
                                                                                                                                
4:31:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  noted that she  has served for the  past four                                                               
years on  the Legislative Budget  & Audit Committee  and directed                                                               
attention to  page 5,  paragraph 3, of  the sunset  report, which                                                               
read as follows [original punctuation provided]:                                                                                
                                                                                                                                
     The  reduced extension  is due  to an  issue identified                                                                    
     during the  audit that may  impact the  board's ability                                                                    
     to  protect the  public and  the board's  reluctance to                                                                    
     recommend  statutory  changes   in  the  public's  best                                                                    
     interest. The details of the  issue are not included in                                                                    
     this  report  to  preserve the  confidentiality  of  an                                                                    
     ongoing investigation.  The reduced  extension reflects                                                                    
     the need for continued oversight.                                                                                          
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  expressed  that  the sunset  date  could  be                                                               
extended  two  years   to  allow  the  board   to  implement  the                                                               
recommended changes, and subsequently have a longer extension.                                                                  
                                                                                                                                
4:33:00 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS opened  public testimony on HB 117.   There being                                                               
no one who wished to testify, he closed public testimony.                                                                       
                                                                                                                                
[HB 117 was held over.]                                                                                                         
                                                                                                                                
4:33:19 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
           HB 151-UNEMPLOYMENT BENEFITS FOR COVID-19                                                                        
                                                                                                                                
4:33:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced  that the next order  of business would                                                               
be HOUSE BILL NO. 151,  "An Act relating to unemployment benefits                                                               
during a period  of state or national emergency  resulting from a                                                               
novel coronavirus disease (COVID-19)  outbreak; and providing for                                                               
an effective date."                                                                                                             
                                                                                                                                
4:34:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ,  as prime  sponsor, introduced  HB 151.   She                                                               
explained  that   the  proposed  legislation  would   extend  the                                                               
provisions under  House Bill  308, passed  in March  2020, during                                                               
the  Thirty-First Legislative  Session,  and  which provided  for                                                               
temporary  changes   to  Alaska's  unemployment   insurance  (UI)                                                               
program in response to the COVID-19  pandemic.  She said that the                                                               
provisions would  be extended until  September 6, 2021,  to align                                                               
Alaska's UI  program with  the American Rescue  Plan Act  of 2021                                                               
(ARPA).  The  proposed legislation would waive  the standard one-                                                               
week  waiting  period  before receiving  benefits;  increase  the                                                               
weekly per-dependent benefit  from $24 to $75, as  well as remove                                                               
the cap  of three dependents  for which applicants can  receive a                                                               
supplemental  benefit;   and  it  would  waive   the  work-search                                                               
requirement for  workers who have  had to  stay home to  care for                                                               
family members as  a result of the pandemic.   She noted that the                                                               
proposed UI benefit  extension is at the request  of the Division                                                               
of  Employment  and  Training  Services   (DETS)  at  the  Alaska                                                               
Department of Labor and Workforce Development (DOLWD).                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ explained that  UI benefit claims during March                                                               
2021 were still  over 200 percent higher than  the previous year,                                                               
Alaskans  continue  to  suffer   record  levels  of  unemployment                                                               
through  no  fault  of  their  own,  and  one-third  of  Alaskans                                                               
receiving UI  benefits have dependent children  or family members                                                               
with  disabilities.     She  stressed  that  UI   is  not  public                                                               
assistance or  an entitlement program,  but an  insurance benefit                                                               
that  employees have  paid  into for  years,  expecting that  the                                                               
insurance  would be  there when  it was  needed.   She said  that                                                               
average weekly claims paid in the  past week were $440, and noted                                                               
that  the state  of  Alaska has  the lowest  UI  benefits in  the                                                               
nation.    For  example,  she  said,  an  unemployed  person  who                                                               
typically earns $100,000  per year can receive  a maximum benefit                                                               
of only  $370 per week,  totaling $19,610 annually.   The minimum                                                               
possible benefit, she  said, is $56 per week,  equating to $2,912                                                               
in  annual  equivalent  income.    She  stated  that  temporarily                                                               
extending  the  expansion  of  the   UI  benefits  would  provide                                                               
certainty for  Alaskans, support  families with  children, ensure                                                               
that no  federal dollars are left  on the table, and  support the                                                               
recovery of the economy.                                                                                                        
                                                                                                                                
4:38:04 PM                                                                                                                    
                                                                                                                                
MEGAN HOLLAND, Staff, Representative  Ivy Spohnholz, detailed the                                                               
sectional  analysis  on  behalf   of  Co-Chair  Spohnholz,  prime                                                               
sponsor, which read as follows [original punctuation provided]:                                                                 
                                                                                                                                
     Section  1: Removes  the  work  search requirement  for                                                                    
     applicants  who cannot  fulfill  it as  a  result of  a                                                                    
     COVID-19  outbreak  and   are  otherwise  eligible  for                                                                    
     unemployment  insurance  (UI)  benefits.  Additionally,                                                                    
     this section waives the  one-week waiting period before                                                                    
     applicants begin receiving UI benefits.                                                                                    
                                                                                                                                
     Section 2: Increases the per  dependent UI benefit from                                                                    
     $24 per  dependent to $75 per  dependent. Additionally,                                                                    
     this  section   removes  the  existing  cap   of  three                                                                    
     dependents   for  which   applicants   can  receive   a                                                                    
     supplemental benefit.                                                                                                      
                                                                                                                                
     Section   3:  Amends   uncodified  law   to  give   the                                                                    
     Commissioner   of  Labor   and  Workforce   Development                                                                    
     authority to  adopt regulations necessary  to implement                                                                    
     this act.                                                                                                                  
                                                                                                                                
     Section  4:   Repeals  the  act  in   its  entirety  on                                                                    
     September 6th, 2021.                                                                                                       
                                                                                                                                
     Section 5:  Provides an effective date  for sections 1-                                                                    
     3, retroactive to April 1, 2021.                                                                                           
                                                                                                                                
     Section 6: Provides for an immediate effective date.                                                                       
                                                                                                                                
4:39:39 PM                                                                                                                    
                                                                                                                                
PATSY  WESTCOTT, Director,  Division of  Employment and  Training                                                               
Services,   Department  of   Labor  and   Workforce  Development,                                                               
provided testimony during the hearing  on HB 151.  She reiterated                                                               
the provisions in the proposed  legislation and said that she has                                                               
nothing  to  add  to  Co-Chair   Spohnholz's  and  Ms.  Holland's                                                               
statements.                                                                                                                     
                                                                                                                                
4:40:38 PM                                                                                                                    
                                                                                                                                
NOLAN   KLOUDA,   Executive   Director,   Center   for   Economic                                                               
Development, University  of Alaska Anchorage, told  the committee                                                               
that he  was asked to give  an overview of the  employment status                                                               
in Alaska,  as well  as some  of the effects  of the  UI benefits                                                               
disbursed  since  the  Coronavirus   Aid,  Relief,  and  Economic                                                               
Security (CARES) Act  of 2020 was passed at the  beginning of the                                                               
pandemic.   He noted that in  the months of April  through August                                                               
of 2020 the state saw a  loss of approximately 48,000 jobs, or 15                                                               
percent  of total  employment; the  number accounted  for general                                                               
job loss resulting  from the pandemic as well  as the seasonality                                                               
of employment in Alaska.  For  reference, he said, the state lost                                                               
only 13,000 jobs in the entirety  of the 2013-2015 recession.  He                                                               
expressed that the total year-over-year  job losses in the months                                                               
of  November  2020  through   February  2021  were  approximately                                                               
24,000,  and that  the winter  job losses  are lower  than summer                                                               
only because  of the  seasonality.   "We actually  really haven't                                                               
seen  a clear  sign of  employment recovery  in the  last several                                                               
months," he  said, with the  biggest job  losses in the  areas of                                                               
leisure  and hospitality,  food  service,  and personal  services                                                               
such as beauty salons.   He said that many of  the job losses are                                                               
among workers who are younger and lower paid.                                                                                   
                                                                                                                                
MR.  KLOUDA said  that  unemployment levels  are  expected to  be                                                               
elevated for  "quite some time," with  projections for employment                                                               
growth of 2-3 percent per year,  taking up to five years to reach                                                               
2019  levels.   Even  with  a recovery  well  underway, he  said,                                                               
unemployment  will  remain   high.    As  far   as  the  pandemic                                                               
unemployment compensation  (PUC), he noted that  the pre-pandemic                                                               
average  UI  benefit  was  $260 per  week,  versus  the  national                                                               
average of  $360.  When  the CARES Act  added $600 per  week PUC,                                                               
there  was research  looking at  the effect  of the  PUC benefit.                                                               
The "bonus"  benefit, he  said, did  not decrease  employment; it                                                               
didn't lower  the number of  jobs that  were available.   He said                                                               
that   while  the   conventional   wisdom   says  more   generous                                                               
unemployment compensation  would cause  more people to  not work,                                                               
resulting in  a decline  of overall  levels of  employment, which                                                               
has not been the case.                                                                                                          
                                                                                                                                
4:44:41 PM                                                                                                                    
                                                                                                                                
MR. KLOUDA  cited a 2020  study by economists at  Yale University                                                               
which found  that, when given  the opportunity to return  to work                                                               
and  forego  unemployment  benefits   that  were  larger  than  a                                                               
paycheck, workers tended to return  to employment.  Another study                                                               
examined  the data  around the  July 2020  expiration of  the PUC                                                               
benefits,  looking  for evidence  of  increased  employment as  a                                                               
result  of the  expiration  and  found, he  said,  "There was  no                                                               
evidence of that at all."   He said that a third study duplicated                                                               
the findings,  finding only that  there was "a slight  decline in                                                               
the level of  search intensity" of unemployed  people looking for                                                               
jobs, but that it was  a "relatively small" effect, with multiple                                                               
applicants per job  opening.  He stressed that  when the pandemic                                                               
first hit,  the number  of vacancies  declined about  300 percent                                                               
faster  than   the  number  of  applicants,   so  the  employment                                                               
situation was  more about  the availability  of jobs  rather than                                                               
the generosity of benefits.                                                                                                     
                                                                                                                                
MR. KLOUDA,  regarding the  impacts of the  PUC, said  that local                                                               
spending  increased  by  approximately  44  percent,  creating  a                                                               
stimulative effect  in the  local economy.   He  recalled hearing                                                               
from  business owners  who claim  that they  can't get  people to                                                               
work because they're receiving UI  benefits; while there may be a                                                               
few  instances of  such, he  said, the  data doesn't  support the                                                               
claim.  He said that one  aspect of deciding whether to return to                                                               
work is  the question  of childcare; there  is ample  evidence of                                                               
people not  being able  to return to  the workforce  because they                                                               
don't  have  a  good  childcare solution,  which  has  especially                                                               
affected  women.   He  cited  a statistic  that  said that  women                                                               
between the  ages of 25 and  44 are three times  more likely than                                                               
men to  be not  looking for  work due to  childcare demands.   He                                                               
said that the $600 PUC is  now long over, though benefits of $300                                                               
per  week  have  been  extended,  which  is  a  much  lower  wage                                                               
replacement  rate; thus,  he  said, any  effect  from the  larger                                                               
benefit is now diminished by the smaller supplement.                                                                            
                                                                                                                                
4:48:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KAUFMAN directed  attention to  the provision  on                                                               
line  14, page  1,  of  HB 151,  "(1)  providing care,  including                                                               
medical care, to  one or more persons;".  He  asked, "Is that any                                                               
care?"                                                                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ deferred to Ms. Westcott.                                                                                    
                                                                                                                                
4:49:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KAUFMAN  repeated his  question for  Ms. Westcott,                                                               
saying, "What  I'm wondering  is if that's  not overly  broad, in                                                               
that that  could be  almost anything,  that could  be interpreted                                                               
literally  wide open  ...  can you  advise if  that  seems to  be                                                               
adequately defined?"                                                                                                            
                                                                                                                                
MS. WESTCOTT answered that the  federal guidelines related to the                                                               
provision   are   being   followed,   and   she   expressed   her                                                               
understanding that  HB 151 contains language  consistent with the                                                               
federal legislation.  She stressed  that DOLWD has been following                                                               
the guidelines since they were first issued in March 2020.                                                                      
                                                                                                                                
REPRESENTATIVE KAUFMAN  asked whether the provisions  outlined in                                                               
page 1,  line 14,  and page  2, lines  1-2, are  necessary, given                                                               
that the federal guidelines are already being followed.                                                                         
                                                                                                                                
4:52:51 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  answered that every  time the law  is changed                                                               
in the  state, the  department has to  issue new  regulations and                                                               
write new software code, which can  take "many months".  She said                                                               
that  because of  the time  factor, the  proposed legislation  is                                                               
written as closely as possible  to the previous statutes in order                                                               
to  reduce the  administrative burden  and lessen  the chance  of                                                               
having   eligible  beneficiaries   waiting   months  to   receive                                                               
benefits.  She gave an example  of a provision change in the per-                                                               
dependent benefits which took almost  six months to update in the                                                               
software, and she  said that the issue of  providing medical care                                                               
is "incredibly relevant" because there  could be an outbreak in a                                                               
person's childcare  arrangement, rendering that person  unable to                                                               
work while their  child is under quarantine.  She  noted that the                                                               
number of  people filing claims  as of  March 2021 is  much lower                                                               
than the previous  summer; however, it still makes  sense to keep                                                               
consistency in  the provisions.   She  stressed that  the current                                                               
provisions expire  on April 1, 2021,  and if they lapse  it means                                                               
that new laws would have to  be written, software code would have                                                               
to be  updated, and implementation  could take months.   She said                                                               
that the  state's actuary  has stated  that the  provisions would                                                               
not  have an  impact on  the ability  of the  state's UI  fund to                                                               
remain solvent.                                                                                                                 
                                                                                                                                
4:54:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS asked  Ms. Wescott  if the  committee should  be                                                               
contemplating an end-date on the  proposed legislation later than                                                               
September  6, 2021,  given that  the legislature  wouldn't be  in                                                               
session at that time to respond.                                                                                                
                                                                                                                                
MS. WESTCOTT  responded that there  have been certain  sectors of                                                               
the economy  opening back  up.  She  expressed that  she foresees                                                               
the situation improving over the  summer, now that the vaccine is                                                               
widely  available; however,  she can't  predict what  will happen                                                               
over the fall and winter.                                                                                                       
                                                                                                                                
CO-CHAIR FIELDS  asked whether the DOLWD  commissioner would have                                                               
the  flexibility to  extend  benefits if  the  committee were  to                                                               
extend the date beyond September 6.                                                                                             
                                                                                                                                
MS. WESTCOTT replied  that if the legislature were  to extend the                                                               
provisions   to  December,   the  commissioner   would  have   no                                                               
discretion, as the benefits would be  in place.  If Alaska was to                                                               
extend the waiting  week beyond the federal level,  she said, the                                                               
cost of paying  that week would be fully absorbed  by the state's                                                               
fund  instead  of  being  federally funded.    In  addition,  she                                                               
explained,  if the  flexibility of  the work-search  requirements                                                               
was extended  beyond what the  federal provisions  have directed,                                                               
Alaska  could  be  potentially out  of  conformity  with  federal                                                               
directives if  the federal government  also does not  extend them                                                               
beyond September.                                                                                                               
                                                                                                                                
4:59:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY  asked  how  many  people  are  currently                                                               
receiving  UI  benefits.    He  then  asked  what  would  be  the                                                               
anticipated  rise  in  summer   employment,  should  the  tourism                                                               
industry restart.                                                                                                               
                                                                                                                                
MS. WESTCOTT replied that the  number of individuals receiving UI                                                               
benefits changes week  to week, and is very  fluid, but currently                                                               
approximately 50,000  individuals receive UI benefits  on a week-                                                               
to-week  basis.   For  the  question  on summer  employment,  she                                                               
deferred to Mr. Weller.                                                                                                         
                                                                                                                                
5:00:30 PM                                                                                                                    
                                                                                                                                
LENNON   WELLER,  Economist,   Research  and   Analysis  Section,                                                               
Department   of   Labor    and   Workforce   Development,   asked                                                               
Representative  McCarty  to  clarify his  question  about  summer                                                               
employment.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  MCCARTY  said,  "Just  what  do  we  see  in  the                                                               
average?"                                                                                                                       
                                                                                                                                
MR. WELLER  said that  summer employment,  defined as  the second                                                               
and third quarters of the  year, tends to be significantly higher                                                               
than  winter employment.   Aggregate  summer employment  averaged                                                               
300,000  in 2020  and 335,000  in 2019.   The  current employment                                                               
forecast, he said, is 272,000  covered jobs in the second quarter                                                               
of  2021, compared  to 269,300  in 2020.   Third  quarter covered                                                               
employment  in  2021  is  expected to  be  287,100,  compared  to                                                               
283,600  in 2020.    He  said that  probably  the single  largest                                                               
factor in summer employment is  whether cruise ships will come to                                                               
Alaska.  He  noted that construction and  seafood processing jobs                                                               
increase in  the summer,  but the bulk  of employment  comes with                                                               
those business  that focus  on tourism.   He  described expecting                                                               
summer 2021 employment to be "much more muted."                                                                                 
                                                                                                                                
5:04:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   MCCARTY  asked   whether  a   similar  rise   in                                                               
employment in the fishing industry.                                                                                             
                                                                                                                                
MR. WELLER  replied that he's not  expecting much of a  change in                                                               
seafood  processing,  as  employment   in  that  sector  was  not                                                               
significantly decreased.                                                                                                        
                                                                                                                                
5:04:57 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS   expressed  understanding  that   employees  in                                                               
leisure  and hospitality,  construction,  and seafood  processing                                                               
will be  laid off at the  end of the  season.  He asked  if trust                                                               
fund could  handle a one or  two month extension beyond  what the                                                               
federal government will pay for.                                                                                                
                                                                                                                                
MR. WELLER said  that a waiting week doesn't  change the duration                                                               
an  individual would  receive  UI benefits,  it  only shifts  the                                                               
period of eligibility  by one week.  He said  that it's been nice                                                               
having the  federal government  paying for  that first  week, but                                                               
that  week is  built into  the  targets for  trust fund  solvency                                                               
anyway.   He  noted that  most people  receiving UI  compensation                                                               
don't  exhaust their  benefit, and  that he  would expect  to see                                                               
even fewer  exhausting the benefit  going forward.  He  said that                                                               
he  would expect  the extension  to not  have a  large impact  on                                                               
trust  fund  solvency,  especially  because  regular  claims  are                                                               
expected to  fall considerably  with the  arrival of  late summer                                                               
and fall of 2021.                                                                                                               
                                                                                                                                
5:07:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  shared that  unemployment is not  expected to                                                               
be nearly  as bad as  it was in summer  of 2020, when  there were                                                               
67,600 claims per week at the  peak in May and continuing through                                                               
mid-July.  She expressed that  the fiscal impact of the provision                                                               
under HB 151, with an attached  fiscal note of $13 million, would                                                               
be much lower than  it would have been last year.   She said that                                                               
the  summertime  is  traditionally  the  "high  water  mark"  for                                                               
employment,  with unemployment  rising with  the transition  into                                                               
fall.    She  said  that  the  UI fund  in  Alaska  is  built  to                                                               
accommodate the ebb and is  well-capitalized.  She mentioned that                                                               
DOLWD is  continuing to work  with unemployment  beneficiaries to                                                               
move  towards employment,  providing retraining  and work  search                                                               
support  services.   She  described  HB 151  as  a "common  sense                                                               
measure  that  aligns our  state  statute  with federal  law  and                                                               
federal funding."                                                                                                               
                                                                                                                                
5:10:21 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS announced  that the  amendment deadline  of 3:15                                                               
p.m. on March 30, 2021.                                                                                                         
                                                                                                                                
REPRESENTATIVE  KAUFMAN asked  why the  amendment deadline  is so                                                               
soon.                                                                                                                           
                                                                                                                                
CO-CHAIR  FIELDS explained  that the  provisions expire  in April                                                               
and the intention is to move  the bill along quickly, in order to                                                               
give DOLWD time to update their regulations to align with ARPA.                                                                 
                                                                                                                                
MS.  WESTCOFF  commented  that  if the  waiting  week  waiver  is                                                               
extended beyond September 6, the  first week of extended benefits                                                               
would  have to  be fully  funded by  the state  instead of  being                                                               
funded by the federal government.                                                                                               
                                                                                                                                
REPRESENTATIVE KAUFMAN  asked why HB 111  also had a due  date of                                                               
March 30, 2021, for amendments.                                                                                                 
                                                                                                                                
CO-CHAIR  FIELDS replied  that there  is  a fairly  long list  of                                                               
administration bills  in process,  so when one  seems to  be non-                                                               
controversial,  the  intent  is  to give  committee  members  the                                                               
opportunity  to move  it  right away.    He asked  Representative                                                               
Kaufman whether he  would like a longer amendment  deadline on HB
111.                                                                                                                            
                                                                                                                                
REPRESENTATIVE  KAUFMAN   said  that   he  had   questions  about                                                               
radiation safety  which may  take longer  than overnight  to find                                                               
out.                                                                                                                            
                                                                                                                                
CO-CHAIR FIELDS responded that if  there are still questions, the                                                               
committee can return to HB 111 later.                                                                                           
                                                                                                                                
[HB 151 was held over.]                                                                                                         
                                                                                                                                
          HB 117-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                      
                                                                                                                                
5:13:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced  that the next order  of business would                                                               
be  a  return to  HOUSE  BILL  NO.  117,  "An Act  extending  the                                                               
termination  date   of  the   Board  of   Certified  Direct-Entry                                                               
Midwives; and providing for an effective date."                                                                                 
                                                                                                                                
5:13:54 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ moved  to report HB 117 out  of committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There being no  objections, HB 117 was reported out  of the House                                                               
Labor and Commerce Standing Committee.                                                                                          
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                    CONFIRMATION HEARING(S)                                                                                 
                                                                                                                              
^Board of Certified Direct Entry Midwives                                                                                       
            Board of Certified Direct Entry Midwives                                                                        
                                                                                                                              
^Board of Barbers and Hairdressers                                                                                              
               Board of Barbers and Hairdressers                                                                            
                                                                                                                              
^Board of Certified Real Estate Appraisers                                                                                      
           Board of Certified Real Estate Appraisers                                                                        
                                                                                                                              
^Alcoholic Beverage Control Board                                                                                               
                Alcoholic Beverage Control Board                                                                            
                                                                                                                              
5:14:22 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced that the  final order of business would                                                               
be  confirmation hearings  for the  governor's appointees  to the                                                               
Board of  Certified Direct-Entry  Midwives, Board of  Barbers and                                                               
Hairdressers, the Board of Certified  Real Estate Appraisers, and                                                               
the Alcoholic Beverage Control Board.                                                                                           
                                                                                                                                
CO-CHAIR  FIELDS  announced that  the  House  Labor and  Commerce                                                               
Standing  Committee  had  reviewed   the  qualifications  of  the                                                               
governor's appointees and recommends  that the names be forwarded                                                               
to a  joint session  for consideration:   Bethel  Belisle, Rachel                                                               
Pugh, and  Hannah St. George  for the Board of  Certified Direct-                                                               
Entry  Midwifes;   Holly  Andrews,  Connie   Dougherty,  Michelle                                                               
McMullin, Khitsana Sypakanphay, and Tina  Taylor for the Board of                                                               
Barbers  and  Hairdressers;  Valery  Kudryn  and  William  "Leon"                                                               
McLean for  the Board of  Certified Real Estate  Appraisers; and,                                                               
Diane Thompson  and Dana Wakukiewicz  for the  Alcoholic Beverage                                                               
Control  Board.   He  said  that  signing the  reports  regarding                                                               
appointments  to boards  and commissions  in no  way reflects  an                                                               
individual member's  approval or  disapproval of  the appointees,                                                               
and the nominations are merely  forwarded to the full legislature                                                               
for confirmation or rejection.                                                                                                  
                                                                                                                                
5:15:49 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Labor and  Commerce Standing Committee  meeting was  adjourned at                                                               
5:16 p.m.                                                                                                                       

Document Name Date/Time Subjects
HB 111 FN - DCCED, 3.26.21.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 v. A.PDF HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 FN - DHSS, 3.26.21.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 Presentation 3.27.2020.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 Supporting Document - Oral Health and Well-being in the U.S..pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 FAQ Document.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 v. A Sponsor Statement.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 111 v. A Sectional Analysis.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
HB 151 v. B.PDF HL&C 3/29/2021 3:15:00 PM
HB 151
HB 151 Sponsor Statement.pdf HL&C 3/29/2021 3:15:00 PM
HB 151
HB 151 Sectional Analysis.pdf HL&C 3/29/2021 3:15:00 PM
HB 151
HB 151 FN, DOLWD 3.26.21.pdf HL&C 3/29/2021 3:15:00 PM
HB 151
Supporting Document - UI General Information Brochure.pdf HL&C 3/29/2021 3:15:00 PM
HB 151
Supporting Document - Wage Replacement Data, DOLWD.pdf HL&C 3/29/2021 3:15:00 PM
HB 151
HB 111 Letters of Support Received as of 3.27.21.pdf HL&C 3/29/2021 3:15:00 PM
HB 111
Supporting Document - UI Claims, DOLWD.pdf HL&C 3/29/2021 3:15:00 PM
HB 151