Legislature(1999 - 2000)
05/03/1999 03:23 PM House L&C
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
May 3, 1999
3:23 p.m.
MEMBERS PRESENT
Representative Norman Rokeberg, Chairman
Representative Andrew Halcro, Vice Chairman
Representative Jerry Sanders
Representative Lisa Murkowski
Representative John Harris
Representative Tom Brice
Representative Sharon Cissna
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 88(FIN)
"An Act relating to licensure of dietitians and nutritionists; and
providing for an effective date."
- MOVED CSSB 88(FIN) OUT OF COMMITTEE
HOUSE BILL NO. 183
"An Act relating to the powers and duties of the chair of the
Alaska Public Utilities Commission; relating to membership on the
Alaska Public Utilities Commission; and relating to the annual
report of the Alaska Public Utilities Commission."
- HEARD AND HELD
(* First public hearing)
PREVIOUS ACTION
BILL: SB 88
SHORT TITLE: DIETITIANS AND NUTRITIONISTS
SPONSOR(S): SENATOR(S) DONLEY
Jrn-Date Jrn-Page Action
2/25/99 364 (S) READ THE FIRST TIME - REFERRAL(S)
2/25/99 364 (S) L&C, FIN
3/16/99 (S) L&C AT 1:30 PM
3/16/99 (S) <BILL POSTPONED>
3/25/99 (S) L&C AT 1:30 PM BELTZ 211
3/25/99 (S) MOVED CS (L&C) OUT OF COMMITTEE
3/25/99 (S) MINUTE(L&C)
3/26/99 699 (S) L&C RPT CS 5DP SAME TITLE
3/26/99 699 (S) DP: MACKIE, LEMAN, TIM KELLY, DONLEY,
3/26/99 699 (S) HOFFMAN
3/26/99 699 (S) FISCAL NOTE (DCED)
4/07/99 804 (S) FISCAL NOTE (DCED)
4/10/99 (S) FIN AT 10:00 AM SENATE FINANCE 532
4/10/99 (S) SCHEDULED BUT NOT HEARD
4/10/99 (S) MINUTE(FIN)
4/22/99 (S) FIN AT 6:00 PM SENATE FINANCE 532
4/22/99 (S) MOVED CS (FIN) OUT OF COMMITTEE
4/23/99 1061 (S) FIN RPT CS 6DP 1DNP 2NR SAME TITLE
4/23/99 1062 (S) DP: TORGERSON, PARNELL, GREEN, LEMAN,
4/23/99 1062 (S) WILKEN, DONLEY; NR: PETE KELLY,
4/23/99 1062 (S) ADAMS; DNP: PHILLIPS
4/23/99 1062 (S) FISCAL NOTE INFORMATION FORTHCOMING
4/26/99 (S) RLS AT 12:00 PM FAHRENKAMP 203
4/26/99 (S) MINUTE(RLS)
4/27/99 1135 (S) RULES TO CALENDAR 4/27/99
4/27/99 1135 (S) READ THE SECOND TIME
4/27/99 1135 (S) FIN CS ADOPTED UNAN CONSENT
4/27/99 1135 (S) ADVANCED TO THIRD READING UNAN
4/27/99 1135 (S) CONSENT
4/27/99 1136 (S) READ THE THIRD TIME CSSB 88(FIN)
4/27/99 1136 (S) PASSED Y17 N1 E2
4/27/99 1136 (S) EFFECTIVE DATE(S) SAME AS PASSAGE
4/27/99 1138 (S) TRANSMITTED TO (H)
4/28/99 1042 (H) READ THE FIRST TIME - REFERRAL(S)
4/28/99 1042 (H) L&C, FIN
5/03/99 (H) L&C AT 3:15 PM CAPITOL 17
BILL: HB 183
SHORT TITLE: ALASKA PUBLIC UTILITIES COMMISSION
SPONSOR(S): SPECIAL COMMITTEE ON UTIL RESTRUCTURING
Jrn-Date Jrn-Page Action
4/09/99 702 (H) READ THE FIRST TIME - REFERRAL(S)
4/09/99 702 (H) URS, L&C
4/14/99 (H) URS AT 8:00 AM BUTROVICH ROOM 205
4/14/99 (H) SCHEDULED BUT NOT HEARD
4/16/99 (H) URS AT 2:00 PM CAPITOL 120
4/16/99 (H) MOVED CSHB 183(URS) OUT OF COMMITTEE
4/16/99 (H) MINUTE(URS)
4/20/99 880 (H) URS RPT CS(URS) NT 6DP
4/20/99 880 (H) DP: PORTER, KOTT, COWDERY, HUDSON,
4/20/99 880 (H) GREEN, ROKEBERG
4/20/99 880 (H) ZERO FISCAL NOTE (DCED)
4/20/99 880 (H) REFERRED TO L&C
4/23/99 (H) L&C AT 3:15 PM CAPITOL 17
4/23/99 (H) HEARD AND HELD
4/23/99 (H) MINUTE(L&C)
4/26/99 (H) L&C AT 3:15 PM CAPITOL 17
4/26/99 (H) HEARD AND HELD
4/26/99 (H) MINUTE(L&C)
4/28/99 (H) L&C AT 3:15 PM CAPITOL 17
4/28/99 (H) HEARD AND HELD
4/28/99 (H) MINUTE(L&C)
4/30/99 (H) L&C AT 3:15 PM CAPITOL 17
4/30/99 (H) HEARD AND HELD
4/30/99 (H) MINUTE(L&C)
5/03/99 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
SENATOR DAVE DONLEY
Alaska State Legislature
Capitol Building, Room 508
Juneau, Alaska 99801
Telephone: (907) 465-3892
POSITION STATEMENT: Sponsor of SB 88.
DEBRA MESTAS, registered dietician
8200 Frank Street
Anchorage, Alaska 99518
Telephone: (907) 349-8835
POSITION STATEMENT: Testified in support of SB 88.
JOHN WRAY, Registered Dietician
Bartlett Regional Hospital;
Alaska Dietetic Association
8440 Kimberly Street
Juneau, Alaska 99801
Telephone: (907) 586-8491
POSITION STATEMENT: Testified in support of SB 88 representing the
Alaska Dietetic Association.
CINDY SALMON, registered dietician
and certified personal trainer
828 Crossman Road
Fairbanks, Alaska 99712
Telephone: (907) 457-6688
POSITION STATEMENT: Testified in support of SB 88.
LINDA WILD, nutritionist
P.O. Box 20704
Juneau, Alaska 99802-0704
Telephone: (907) 586-2330
POSITION STATEMENT: Testified in support of SB 88.
CATHERINE REARDON, Director
Division of Occupational Licensing
Department of Commerce and Economic Development
P.O. Box 110806
Juneau, Alaska 99811-0806
Telephone: (907) 465-2534
POSITION STATEMENT: Testified on SB 88.
JANET SEITZ, Legislative Assistant
for Representative Rokeberg
Alaska State Legislature
Capitol Building, Room 24
Juneau, Alaska 99801
Telephone: (907) 465-4968
POSITION STATEMENT: Provided clarification on previous action to
Amendment I.1.
JONATHON LACK, Legislative Assistant
for Representative Halcro
Alaska State Legislature
Capitol Building, Room 418
Juneau, Alaska 99801
Telephone: (907) 465-4939
POSITION STATEMENT: Provided information on Amendment H.8.
LARRY MARKLEY, Lobbyist
Alaska Rural Electric Cooperative Association, Incorporated (ARECA)
P.O. Box 244902
Anchorage, Alaska 99524
Telephone: (907) 245-2252
POSITION STATEMENT: Inquired as to the possibility of Regulatroy
Cost Changes language.
ACTION NARRATIVE
TAPE 99-51, SIDE A
Number 0001
CHAIRMAN NORMAN ROKEBERG called the House Labor and Commerce
Standing Committee meeting to order at 3:23 p.m. Members present
at the call to order were Representatives Rokeberg, Halcro,
Sanders, Harris and Cissna. Representatives Murkowski and Brice
arrived at 3:31 p.m.
Number 0092
CHAIRMAN ROKEBERG called a brief at-ease at 3:24 p.m. The
committee came back to order at 3:25 p.m.
Number 0101
CHAIRMAN ROKEBERG noted the committee would be taking up SB 88 and
HB 183 at this meeting, but HB 183 would be held over. An
amendment to SB 51 would be distributed and that legislation taken
back up on Wednesday, May 5.
CSSB 88(FIN) - DIETITIANS AND NUTRITIONISTS
Number 0137
CHAIRMAN ROKEBERG announced the committee's first order of business
is CSSB 88(FIN), "An Act relating to licensure of dietitians and
nutritionists; and providing for an effective date." Chairman
Rokeberg acknowledged the bill sponsor.
Number 0150
SENATOR DAVE DONLEY, Alaska State Legislature, came forward as the
sponsor of SB 88. Senator Donley stated that SB 88 would adopt
title licensure in Alaska for dieticians and nutritionists. Other
states currently have licensure for these individuals; some
Alaskans are going to other states for licensure so they can have
legitimate use of the title. The legislation has been requested by
these professionals who would be regulated. As is mandatory under
Alaska's occupational licensing rules, the program would pay for
itself. Additionally, this licensure would allow possible access
by Alaskans to federal funding at a future time. Senator Donley
noted there is legislation pending in Congress which would allow
reimbursement for nutrition services within the Medicare program.
However, this reimbursement would only be allowed to those
recognized by a state as nutrition professionals. If Alaska does
not have some minimum licensure, which is what title licensure is,
Alaskans would be denied this opportunity if the federal
legislation is passed. Senate Bill 88 would allow people to know,
when using the services of someone professing to be a dietician or
nutritionist, that person has at least the minimum standards
required by this legislation for licensure.
Number 0282
REPRESENTATIVE HARRIS questioned if any of Alaska's universities
offer the courses or degrees necessary to qualify for either of the
two portions.
SENATOR DONLEY noted a couple of the witnesses present have degrees
in these areas and are indicating the answer is yes. He commented
these witnesses might able to provide more detail in their
testimony.
REPRESENTATIVE HARRIS questioned if it is Senator Donley's
knowledge through his research that this is fairly standard for
other states.
SENATOR DONLEY indicated there is an accepted national standard for
the dietician license which is adopted by the legislation. The
nutritionists' licensure is a little more complicated; there is no
one accepted national standard. Therefore, the equivalent of a
three-part test is being adopted. Senator Donley referred to the
language regarding nutritionist licensure on page 2 of CSSB
88(FIN). [This language read:
Sec. 08.38.030. Nutritionist licensure. The
department shall issue a nutritionist license to an
individual who pays the required fee, applies on a form
provided by the department, and submits evidence
satisfactory to the department that the individual either
(1) has qualified as a diplomate of the American
Board of Nutrition or as a Certified Nutrition Specialist
with the Certification Board for Nutrition Specialists;
or
(2) meets the following qualifications:
(A) has received a master's or doctoral degree
from an accredited college or university with a
major in human nutrition, public health nutrition,
clinical nutrition, nutrition education, community
nutrition, or food and nutrition; and
(B) has completed a documented work experience
in human nutrition or human nutrition research of
at least 900 hours.]
CHAIRMAN ROKEBERG commented there are five witnesses signed up to
testify. He invited Senator Donley to remain with the committee at
the table.
Number 0435
DEBRA MESTAS, registered dietician (RD), testified next via
teleconference from Anchorage in support of the legislation. Ms.
Mestas informed the committee she has lived in Anchorage since
1980, has worked as the renal dietician for the Alaska Kidney
Center for those 13 years, and also worked at the WIC [Special
Supplemental Nutrition Program for Women, Infants, and Children]
clinic at the Anchorage health department for 12 years. In
addition to being a registered dietician, she is a certified
breast-feeding consultant and is looking forward to becoming a
certified diabetes educator. Ms. Mestas feels that registered
dieticians, and nutritionists with the qualifications listed on
page 2 [of CSSB 88(FIN)], are consumer advocates. She feels these
professionals are very serious about promoting education, usually
not charging for those services in many of their job situations.
These professionals are the prime source of information for
patients who need specialized care. Ms. Mestas said her patients,
in particular, have kidney failure. She indicated many of her
patients have diabetes which causes their renal failure, or cancer
along with their renal failure. Ms. Mestas further indicated her
patients have many other medical problems or diseases, mentioning
high blood pressure and lupus as two examples. She is very
concerned that people who go out into the community for services
know what they are getting. With this legislation, she feels these
people will be assured that the qualified dietician or nutritionist
has the schooling behind him/her and resources available from the
physicians, nurses, and other parts of the medical team.
Number 0551
MS. MESTAS indicated dieticians have been part of the medical team
for years but have not been recognized as licensed professionals.
She is particularly concerned about the Alaska Native population.
Ms. Mestas indicated she is seeing a rapidly expanding number of
diabetic Native patients in line to begin dialysis. She further
indicated that if the committee is unfamiliar with the national
cost of dialysis, it would want to discover those costs. Diabetes
is a very expensive disease and diabetics are now living long
enough to lose their kidneys and require dialysis. Alaska Natives
are very prone to diabetes. Ms. Mestas noted there are
approximately 1,750 diabetics currently registered at the Alaska
Native Medical Center ["Native hospital"]; this number includes
both insulin and non-insulin dependent diabetics. In 1989 there
were only 700 diabetics registered there. Ms. Mestas commented
this number is only increasing. She is very concerned that this
population is not going to be able to receive services from
qualified professionals. She stated, "And we need to ensure that
that is available to the Native population and that these people
out in villages and other smaller communities are assured they're
getting the right information from the right folks at the right
time, and I think Senate Bill 88 can ensure that." Ms. Mestas
indicated dieticians spend a lot of their own money to become
qualified and licensed, and to pay dues for professional
organizations and additional certifications, because they believe
in what they do and think education is the way to go. She feels
this does protect the consumers and she urges the committee's
support.
CHAIRMAN ROKEBERG asked Ms. Mestas if she had a college degree.
MS. MESTAS answered that her bachelor's of science is in dietetics
from Colorado State, Fort Collins. She received her internship
from Washington University's Barnes-Jewish Hospital in St. Louis,
Missouri.
CHAIRMAN ROKEBERG questioned if she had any other nursing
credentials or anything.
MS. MESTAS answered in the negative, but pointed out that
dieticians are basically in school with the physicians. Their
education track is the medical track; they take four years of
chemistry and are right along with the pre-med students.
Number 0770
JOHN WRAY, Registered Dietician, Bartlett Regional Hospital; Alaska
Dietetic Association, came forward in Juneau to testify in support
of the legislation, representing the Alaska Dietetic Association
(AKDA). He thanked the committee for considering the bill and
thanked Senator Donley for his sponsorship. Mr. Wray based his
comments on a prepared statement and provided the following
testimony:
"I represent the Alaska Dietetic Association, which is a
group which Debra's [Ms. Mestas] a member of. ... This
group represents dietitians and nutritionists in Alaska.
We strongly support this piece of legislation. Currently
39 states, the District of Columbia and Puerto Rico have
some form of licensing for dietitians and nutritionists.
"In Alaska there are over 120 dieticians and
nutritionists working in a wide variety of settings: in
hospitals, continuing care facilities, outpatient
clinics, school districts, the WIC Program like Debra
mentioned, ... the University of Alaska system, ... the
state Department of Education, Health and Social
Services, and we also have dieticians who ... are out in
private practice trying to make a go of it. These
individuals have at least a bachelor's degree, many of
them have master's, some of them have Ph.D.'s.
"There are 2 main reasons why we would like to have the
state of Alaska license dieticians and nutritionists.
First, as Senator Donley mentioned, there is proposed
legislation within Congress that would provide coverage
for Part B portion of Medicare, which is outpatient
services, which would pay for nutrition therapy services
being furnished by dieticians or qualified nutritional
professionals. Currently, only a portion of these
services are covered."
Number 0872
"The legislation provides that the services will only be
reimbursed to those professionals who that state legally
recognizes as the expert in the specific health care
field, in this case nutrition therapy.
"Being able to provide covered nutrition services will be
a cost savings to Alaskans and to the health care
facilities where these people are staying. Speaking from
experience and also backed by many studies, proper
nutrition therapy reduces the length of stay for people
in hospitals, ... they recover from surgery, they recover
from trauma quicker, and more importantly, as Debra was
taking about, in the area of chronic diseases like
diabetes, proper nutrition therapy can reduce and/or
prevent the complications that many of these patients
have - just not in diabetes, but also in heart disease,
strokes, and some forms of cancer.
"The second reason ... we support licensure is again
similar to what Senator Donley said: professional
recognition. I have a degree in dietetics from UC
Berkeley [University of California at Berkeley], I have
a master's degree, I went through a year of internship,
... I passed an exam to get my RD license, very similar
to what an RN [registered nurse] does. ... Deborah's
comment ... was also very appropriate; ... a lot of my
training was medically-oriented. I teach - I teach
nutrition. I teach nutrition [and] I also end up
teaching some disease-state education because doctors are
so busy that they many times don't have the time to spend
the time with their patients that they would like to.
I'm part of a health care team at the hospital. Every
person in that health care team is licensed by the state
of Alaska except my profession. That includes
pharmacists, RNs, respiratory therapists, occupational
therapists, physical therapists, along with the doctors,
obviously."
Number 0986
"The bill before you, as someone mentioned, is for title
licensure or title protection. It simply says that the
person may not hold ... herself or himself out to be
dietician or nutritionist unless so licensed. We wish to
make it clear that this title licensure does not limit
others from engaging in nutritional care practices as
long as they do not call themselves dieticians or
nutritionists. There are number of other professions who
... currently can provide nutrition services in the
course of their work within the occupational licensing in
Alaska. There is no effect upon them with this
legislation. It's business as usual for them. Nor does
this bill affect people who work in the health food store
or diet centers, as long as they don't hold themselves
out to be dieticians or nutritionists unless they are so
licensed."
MR WRAY indicated he also wished to respond to Representative
Harris' question about the University of Alaska. The University of
Alaska Anchorage (UAA) offers a program called "AP4." A person can
come in through the nutrition program at UAA, overseen by Dr. Nancy
Overpeck, to attain a degree and receive his/her internship to
qualify to take the registered dietician examination. UAA is
currently the only school in the state which has a degree.
Number 1069
REPRESENTATIVE MURKOWSKI asked Mr. Wray to explain the meaning of
"registered dietician."
MR WRAY answered there is the American Dietetic Association in
Chicago. If a person wants to become registered, the association
requires that person to have a degree from an accredited
university, complete an internship, and pass the association's
day-long examination. The person receives the designation of
"registered dietician." Mr. Wray noted this is very similar to the
American Nurses Association's requirements for RNs. Registry does
not mean that a dietician is recognized by any individual state as
a nutrition expert.
REPRESENTATIVE MURKOWSKI questioned what the internship requires in
terms of the work experience. She noted the language in the bill
requiring 900 hours for licensure [of nutritionists] and asked how
that equates to the internship requirements for a registered
dietician. [The language in CSSB 88(FIN) regarding requirements
for licensure of dieticians read:
Sec. 08.38.020. Dietitian licensure. The
department shall issue a dietitian license to an
individual who pays the required fee, applies on a form
provided by the department, and submits evidence
satisfactory to the department of being certified as a
Registered Dietician by the Commission on Dietetic
Registration.]
Number 1131
MR WRAY replied they are exactly the same; it is basically slave
labor for a year for a hospital.
REPRESENTATIVE MURKOWSKI noted the packet contains some federal
guidelines, either for licensure or registration, with a
requirement that the work experience be under the supervision of a
registered dietician or a nutrition professional. Representative
Murkowski commented the legislation does not require this
supervision for the work experience. She asked if Mr. Wray feels
that is an issue, having gone through the registered dietician
process himself.
MR WRAY answered that any internship program available for a person
to complete has to be scrutinized very greatly by the American
Dietetic Association. The association does not bestow its
accreditation on just any program; it is very similar to the
internship a nurse would do. Therefore, their feeling is that if
it is a program which has been approved by the American Dietetic
Association, it fills the bill and all those other requirements,
such as who oversees it, the hours, and so forth, will be met.
REPRESENTATIVE MURKOWSKI commented she had one final question
regarding the educational requirements for a licensed dietician.
She referred to the definitions section on page 4 of CSSB 88(FIN),
specifically subsection (3) of Sec. 08.38.100, the definition of
"dietetics or nutrition practice". [This subsection (3) read:
(3) "dietetics or nutrition practice" means the
integration and application of scientific principles of
food, nutrition, biochemistry, physiology, food
management, and behavioral and social sciences to achieve
and maintain human health through the provision of
nutrition care services.]
REPRESENTATIVE MURKOWSKI questioned what "behavioral and social
sciences" have to do with the food end of things.
Number 1255
MR. WRAY responded that a large part of his education efforts with
patients is changing someone's behavior. He said, "You have, for
yourself, adapted certain nutritional habits since a very early
age. If you are referred to me by a physician that you have now
... liver disease or even diabetes, I'm gonna be asking you to make
changes in your behavior. I need to have a basic understanding of
the human psyche and how to go about facilitating that change in
behavior, because that actually is the biggest problem most people
have. ... We can give them the information. How to put that into
action, into place, is the ongoing efforts that we have."
REPRESENTATIVE MURKOWSKI remarked that makes perfect sense.
REPRESENTATIVE HALCRO asked how this affects what could be called
retail weight centers like "Jenny Craig" or "Weight Watchers,"
where they basically sell food products. Representative Halcro
questioned if the people selling those food products would have to
be registered.
MR. WRAY indicated that if these people are holding themselves out
as nutritionists and they meet the qualifications of a
nutritionist, under this legislation, they would have to be
licensed. In reality, he noted, most of the people who work for
diet centers or for health food stores don't call themselves
nutritionists but they dispense nutrition information. It would be
business as usual for these people. Mr. Wray indicated the use of
the title is the issue; there is no intent to dictate to anyone
what kind of information someone can provide.
Number 1353
REPRESENTATIVE BRICE questioned if there are a large number of
people passing themselves off as trained dieticians or
nutritionists. He asked what the consequences are.
MR. WRAY answered he could not provide exact numbers, indicating he
has heard stories. Currently, there is no mechanism - if someone
wants to call themselves a nutritionist and has no qualifications,
this person is free to do so. If someone wants to call
himself/herself a dietician, he/she can do that. The difficult
thing to document is that specific information supplied by an
individual to another person was bogus and caused the other person
a specific health problem. He commented it is impossible to prove.
Mr. Wray indicated other states with licensure don't even attempt
to show that. He summarized that within the health care setting
the dieticians' and nutritionists' work is cost effective. His
boss at Bartlett Regional Hospital knows it: Mr. Wray saves people
money by getting them out of the hospital faster.
Number 1452
CINDY SALMON, registered dietician and certified personal trainer,
testified next via teleconference from Fairbanks in support of the
legislation. Ms. Salmon based her remarks on a prepared statement
and provided the following testimony:
"Hello, members of the House Labor and Commerce
Committee. My name's Cindy Salmon. ... I am a
registered dietitian, a certified personal trainer, and
a lifelong Alaskan. I'm in private practice here in
Fairbanks. ... I am also an adjunct lecturer at the
University of Alaska in Fairbanks [UAF]. My bachelor of
science degrees include nutrition science with a
chemistry minor. I obtained it at Northern Arizona
University in Flagstaff, Arizona because there is nowhere
to get a degree in nutrition in Alaska. However, I was
able to be accepted to and complete the requirements of
the first AP4 program in Anchorage, which lasted nine
months. My services are presently available at the
University of Alaska student rec [recreation] center,
Fairbanks Athletic Club, and at our outpatient facility,
as well as in the client's home. Clients come, or [are]
referred, for medical nutrition therapy from many walks
of life. There's UAF students, senior citizens, local
professionals, children and families, for conditions such
as low growth/failure to thrive, eating disorders,
anemia, osteoporosis, hyperlipidemia, heart disease,
hypertension, and of course diabetes, as well as [for]
sound nutritional guidance. I am a member of their
health care team and I'm working with other licensed
practitioners, closely with physical therapists,
occupational therapists, speech therapists, dentists,
physicians, nurses, nurse practitioners, social workers
and physician's assistants, all in an effort to decrease
medical cost and increase the client's quality of life."
Number 1537
"My practice is based on sound, scientific principles and
focuses on matching a client's nutritional status,
readiness to change, with the appropriate medical
nutritional therapy and lifestyle intervention. In
short, we teach people to separate fact from fallacy in
order to make informed choices about their present and
future health. At present, it's pretty easy for the
public to take a wrong turn when seeking nutritional
care. For example, if using the local phone directory,
there is a 50/50 chance a person looking under the
heading of Nutritionists would find six separate listings
- only three of which meet the proposed definition. So
state licensure of dieticians and nutritionists would
guide the public and reinforce the importance of
utilizing providers who have met the professional
standard and are qualified to provide nutritional care.
I hope this description of my practice helps increase
your insight of the present environment and the need to
pass this bill. If you have any questions, please feel
free to ask. Thanks for your consideration."
REPRESENTATIVE BRICE asked Ms. Salmon what type of work she does
with social workers: What is her interaction with them?
MS. SALMON replied her interaction with a social worker is a cross
reference. Social workers often work with clients who may be
experiencing, for example, depression or eating disorders; the
social worker has a "handle" on what may be happening in the
client's environment. Ms. Salmon referred to Mr. Wray's comments,
noting that nutrition therapy is all-encompassing; it is a person's
life. The many factors going on in a person's life have to be
dealt with, what the person has grown up with and where the person
is going. By working with a social worker, she can gain insight on
what is occurring in a client's life, what that client might be
working on, and how that influences the client's food and health
choices. Ms. Salmon indicated this back and forth interface
results in reinforcement to the client and a consistent message.
She noted this is really important - with nutrition it is very easy
to get inconsistent messages.
Number 1660
LINDA WILD, nutritionist, came forward to testify in Juneau in
support of SB 88. Ms. Wild informed the committee she is
representing herself and is also a member of the Alaska Dietetic
Association. She is a nutritionist, has a master's degree in
nutrition, and is currently certified in Washington State where she
received her master's degree. Ms. Wild noted certification is
Washington's equivalent of licensing and she pays annual fees to
the state of Washington to maintain that certification. She took
that step because Alaska does not license nutritionists and she
wanted the professional recognition that licensure/certification
brings. She indicated anyone could use that title if they wished,
there is no real meaning to it. If there isn't licensure, there
is no way of knowing if someone has had the appropriate training in
the field.
MS. WILD commented on all the letters someone looking in the phone
book for nutritional counseling might see after people's names.
She thinks most people don't really know what those letters mean
but "licensed by the state of Alaska" gives someone a high degree
of comfort. The public knows that person has met at least the
minimum qualifications for licensure in the state; that comfort and
security is important for the public. Ms. Wild continued that it
is important for the dietitians and nutritionists to be on the same
playing field as the other licensed health care professionals. She
noted dieticians and nutritionists are very passionate about their
field - about the benefits of healthy eating. To her, sound
nutrition is really the key to the establishment and maintenance of
good health. Additionally, to aging baby boomers like herself,
sound nutrition is really key to the prevention of many of the
chronic diseases which come with aging.
Number 1751
CHAIRMAN ROKEBERG asked what letters would follow Ms. Wild's name
as a nutritionist.
MS. WILD answered she could use "MSN" for master of science in
nutrition and "CN," certified nutritionist, in Washington State.
CHAIRMAN ROKEBERG asked what she would have if this legislation
passes.
MS. WILD answered she would be a licensed nutritionist.
CHAIRMAN ROKEBERG indicated the bill allows for letters or titles
that appear on all signs, stationery, et cetera. He noted they are
almost required to have initials.
MS. WILD replied she would say "LN." She added that she is close
to becoming a registered dietician. In response to the chairman's
comment, she noted would be able to have more initials.
CHAIRMAN ROKEBERG mentioned the bill requirements to become a
licensed nutritionist. He noted there is also a reciprocity
provision which would apply in Ms. Wild's case because she is
already certified ["registered"] in Washington.
Number 1808
REPRESENTATIVE MURKOWSKI commented she assumes Ms. Wild had to do
an internship-type work experience under the supervision of another
licensed or certified dietician or nutritionist, within the process
of her Washington State certification.
MS. WILD explained that to become certified in Washington, she is
required to have a master's degree, as opposed to a bachelor's
degree which is the minimum to be a dietician. Washington also
requires completion of a special training course in HIV/AIDS [human
immunodeficiency virus/acquired immunodeficiency virus]. She is
currently undergoing an 1,020-hour internship program.
REPRESENTATIVE MURKOWSKI noted that was the direction she was
going. She mentioned the 900 hours in the legislation, questioning
whether that is reasonable, in Ms. Wild's opinion, based on her
Washington experience.
MS. WILD replied she thinks it is. It is equivalent to the
registered dietician internship program. She noted there are a
variety of ways that experience can be obtained: in a community
setting, possibly working for WIC, a school district, the state
Department of Education, individual counseling, teaching classes,
et cetera. Ms Wild indicated she has experience with her own
business doing individual counseling.
REPRESENTATIVE HALCRO questioned where some of Ms. Wild's
individual clients came from, noting the phone book example and
also mentioning referrals.
MS. WILD responded that a lot come from word-of-mouth referrals, or
referrals from other health care professionals in the community.
She noted a lot of people do say, because she always asks how they
heard of her, that they found her name in the phone book.
Number 1908
CATHERINE REARDON, Director, Division of Occupational Licensing,
Department of Commerce and Economic Development (DCED), came
forward. If this legislation passes into law, the division will be
administering the program directly; there will not be a licensing
board. Ms. Reardon said she does not have a lot to add and is
available for questions regarding the fiscal note or any other
aspect. Because the division will be administering the program,
she has no concerns about the legislation's wording.
REPRESENTATIVE MURKOWSKI referred to the grounds for suspension,
revocation, or refusal to issue a license [Sec. 08.38.040]. She
noted one of the items is basically a determination that someone
has become unfit due to either professional incompetency, alcohol
or drug addiction, or physical or mental disability.
Representative Murkowski questioned how the division, without a
board, would make a determination that someone has an alcohol
dependency, for example, which renders them unfit. [Sec. 08.38.040
of CSSB 88(FIN) read:
Sec. 08.38.040. Grounds for suspension, revocation,
or refusal to issue a license. The department may refuse
to issue a license or impose a disciplinary sanction
authorized under AS 08.01.075 on an individual licensed
under this chapter when the department finds that the
license applicant or licensee, as applicable,
(1) secured or attempted to secure a license through
deceit, fraud, or intentional misrepresentation;
(2) engaged in deceit, fraud, or intentional
misrepresentation in the course of providing professional
services or engaging in professional activities;
(3) advertised professional services in a false or
misleading manner;
(4) has been convicted of a felony or of another
crime that affects the licensee's ability to continue to
practice competently and safely;
(5) failed to comply with this chapter, with a
regulation adopted under this chapter, or with an order
of the department;
(6) continued dietetics or nutrition practice after
becoming unfit due to
(A) professional incompetence;
(B) addiction or severe dependency on alcohol
or a drug that impairs the licensee's ability to
practice safely;
(C) physical or mental disability; or
(7) engaged in lewd or immoral conduct in connection
with the delivery of professional service to patients.
MS. REARDON answered that the process is very similar to when there
is a board. However, the commissioner of the department serves in
the capacity of the board. Even when there are boards, it is
division staff who investigate complaints. Ms. Reardon noted
generally it is going to be citizen complaint driven, unless the
division somehow learns on its own of something troubling.
Therefore, a citizen complaint is received, the division
investigates it and sees if it has sufficient evidence to prove the
grounds for the complaint in a hearing process. The division works
with the Department of Law to determine whether it has sufficient
evidence. The Department of Law reviews the division's formal
accusation documents before the documents are issued under the
division's name. Often the division has to hire expert witnesses
because division staff asserting someone treated a client
improperly would not be that convincing in a hearing.
Number 2001
MS. REARDON continued that the division does a formal charging
document, and almost always the person decides to defend
himself/herself. There is a hearing before the department hearing
officer under the Administrative Procedure Act [AS 44.62]; the
division is represented by the Department of Law, the accused
either represents himself/herself or has an attorney. The hearing
officer makes a proposed decision. When there is a board, the
decision proposed by the hearing officer goes to the board for
adoption or rejection. When there is no board, the hearing
officer's proposed decision goes the department's commissioner for
adoption or rejection. Ms. Reardon noted there are 15 or 16
programs without boards, two examples are acupuncturists and
naturopaths. She commented the other place the department serves
in the board's capacity is in the adoption of regulations. This
means participation from the professionals and the public will be
particularly important when the department public notices proposed
regulations, since there won't be a board to provide that necessary
input.
REPRESENTATIVE MURKOWSKI noted the penalty provision provided on
page 1 of CSSB 88(FIN) imposed on those who use the title of
nutritionist or licensed dietitian without actually being licensed.
She asked, then, if it would be the department that would impose a
fine based on a consumer complaint. [This language regarding the
penalties in CSSB 88(FIN) read:
Sec. 08.38.010. License required. (a) An individual
may not, unless licensed as a dietician or nutritionist
by the department, use the title of "dietician,"
"licensed dietician," "nutritionist," "licensed
nutritionist," or an occupational title using the word
"dietician" or "nutritionist."
(b) The only penalty that may be imposed on an
individual who engages in conduct that violates (a) of
this section is a fine of not more than $1,000 under a
citation issued under AS 08.01.102 - 08.01.104.
(c) An individual who obtains or attempts to obtain
a dietician or nutritionist license by dishonest or
fraudulent means or who forges, counterfeits, or
fraudulently alters a dietitian or nutritionist license,
is punishable by a fine or not more than $1,000 under a
citation issued by the department. For a citation under
this subsection , the department shall use the citation
procedures applicable to citations for unlicensed
practice under AS 08.01.102 - 08.01.104, and an
individual who receives a citation under this subsection
is subject to the same requirements as an individual who
receives a citation under AS 08.01.102 - 08.01.104.]
MS. REARDON answered in the affirmative, although to enforce the
fine the department would probably need to go to the court system.
Ms. Reardon explained that this in lieu of the misdemeanor language
often seen in the department's statutes for unlicensed activity.
Any action would almost always be in response to citizen
complaints; the department does not initiate a lot of enforcement
actions on its own without a complaint.
Number 2106
REPRESENTATIVE HALCRO referred to language in the fiscal note:
"The division of occupational licensing anticipates existing staff
will perform the licensing and investigative functions; however,
like all licensing programs, time spent on this program will be
based on positive timekeeping." He questioned what "positive
timekeeping" is.
MS. REARDON indicated this is somewhat licensing jargon. The
division employees' record on their biweekly time sheets which
professions they spent time on and how much time per day per
profession. This is how the division figures out how much to bill
each profession during the year for the division's efforts.
REPRESENTATIVE HALCRO mentioned the licensing fees, noting it is
being assumed that 100 people will apply for these licenses.
Representative Halcro mentioned other boards and commissions,
especially with biennial licensing where there is a peak [in
funding]. He questioned if any money left over in a licensing
program remains credited to that program.
MS. REARDON answered in the affirmative, noting this would be
dependent on the front section of the state budget language
continuing as it has since fiscal year (FY) 1995. Unexpended
occupational licensing fee revenue rolls forward to the next year.
Program deficits also roll forward. If the division spends more
for a program than was brought in for it, the program has to pay
that back so that the other professions can be reimbursed.
Number 2189
REPRESENTATIVE MURKOWSKI referred to Section 4 of CSSB 88(FIN)
which allows individuals until June 30, 2001, to come into
compliance with this Act. She commented this would give a person
about a year once the legislation became law, although the
sectional analysis notes the legislation would give a person
approximately 1-1/2 years to get everything in order.
Representative Murkowski noted, however, the sectional analysis was
probably drafted at the same the legislation was introduced. She
asked Ms. Reardon if this time frame is reasonable, given
discussions they have had on similar issues this session.
MS. REARDON commented she thinks they would be able to get moving
somewhat more quickly because there is no board and corresponding
appointments. She could conceive that some regulations might need
to be written regarding the 900 hours of work experience for
nutritionists ["(B) has completed a documented work experience in
human nutrition or human nutrition research of at least 900
hours."]. These regulations might entail defining what the work
experience is that would count for an internship or something
similar; this would cause a small amount of delay. However, Ms.
Reardon said she would hope the division would have the application
forms and regulations by this January [2000]. This scenario is
more likely than 1-1/2 years. She said it is unlikely the division
would begin processing licenses on July 1, 1999. Ms. Reardon noted
she would also defer somewhat to the bill sponsor.
Number 2282
SENATOR DONLEY responded a normal workday for 6 months would be
approximately 900 hours. A person would not have to get this work
experience until July 1, 2001. Therefore, people would have all of
the year 2000 and until July 1, 2001, so it is still quite a ways
away.
MS. REARDON commented she had not done her math correctly.
CHAIRMAN ROKEBERG invited Ms. Wild to join the committee at the
table and asked her to explain the 900-hour requirement. He
mentioned there were two different directions to go for
nutritionists.
MS. WILD informed the committee that there are possibly two
nutritionists in the state of Alaska currently, herself and maybe
one other person. She noted the vast majority of the people are
already dieticians. Both the people they know of have already
completed that [work] experience. She thinks a grandfather clause
was included in case there is someone else unknown out there. Ms.
Wild indicated the grandfather clause gives a person time, if
he/she has the degree, to complete the work experience requirement,
and it seems sufficient to them. She commented they think
possessing the master's degree is very important.
Number 2341
CHAIRMAN ROKEBERG asked for confirmation that bachelor's degrees in
the field of nutrition are given.
MS. WILD agreed, noting this bachelor of science degree in
nutrition is the minimum requirement for a dietician. A dietician
must have a bachelor's or above, a nutritionist must have a
master's or above. She commented the master's degree takes two to
three years to obtain. In addition, in her case at least, there is
on-the-job training, practicums in different areas, counseling
experience, several quarters in clinic working one-on-one with
patients in the hospital or clinical setting. She said, therefore,
it is very similar.
CHAIRMAN ROKEBERG confirmed the dietician is not required to have
a master's degree. However, he indicated it is somewhat ironic
that dietician is the highest designation in the profession.
MS. WILD explained that the dietician has the bachelor's degree,
the 900-hour internship program, and has passed the examination
from the American Dietetic Association. The nutritionist has a
master's degree, which takes two or three years to obtain, and the
900-hour work experience. Those are equivalent work experiences.
She commented it is a different group; for one reason or another
there are people called nutritionists who have not gone through the
internship program and the registration through the American
Dietetic Association. This legislation recognizes that there are
other professionals in the nutrition field who have not chosen, for
one reason or another, to become registered dieticians. Ms. Wild
added that they feel this is quite appropriate.
Number 2421
CHAIRMAN ROKEBERG confirmed, then, it is a difference in
nomenclature rather than a significant difference in terms of
academic backgrounds and requirements.
MS. WILD confirmed the educational experiences would be relatively
parallel. The dietician would tend to have his/her experience in
a hospital setting. The nutritionist would tend to be more likely
to have his/her experience in a community or educational sort of
setting, rather than a hospital setting per se.
CHAIRMAN ROKEBERG confirmed, then, the recommendation that someone
shouldn't go to a dietician but instead to a nutritionist because
of a difference in knowledge wouldn't necessarily be correct. The
chairman continued, "It depends on their own personal knowledge and
background and specialties."
MS. WILD said, "The - the..." [TESTIMONY INTERRUPTED BY AUTOMATIC
TAPE CHANGE]
[From tape log notes: 'different initials']
TAPE 51, SIDE B
Number 0001
CHAIRMAN ROKEBERG requested Ms. Reardon rejoin the committee.
REPRESENTATIVE MURKOWSKI noted she thinks this is a question for
everyone - for the sponsor, Ms. Wild and possibly anyone else who
wishes to join in. Representative Murkowski commented she had
raised the point earlier about the 900-hour work experience being
under the supervision of a registered dietitian or nutrition
professional, at least for the federal requirements. She
questioned if they needed to indicate on page 2, line 23 ["22"]
where this work experience is coming from or that it should be
under the supervision of a registered dietitian or nutrition
professional; or if, in their experience, that is just how it
happens [CSSB 88(FIN), page 2, lines 23 and 24,"(B) has completed
a documented work experience in human nutrition or human nutrition
research of at least 900 hours."].
MS. WILD responded she thinks that when the department adopts
regulations, the regulations would define what the parameters of
that work experience are in the areas of nutrition. She noted it
may or may not be under the supervision of a registered dietician,
or it may be a combination of things.
MS. REARDON added it seems like there is a concern that if the
department did not adopt regulations requiring that type of
supervision, that possibly the licenses would not achieve the goal
in terms of Medicare reimbursement. Therefore, Ms. Reardon
indicated it would be pretty essential the department adopt
regulations which require that type of supervision, if this is the
intention.
Number 0075
SENATOR DONLEY indicated, however, the federal law has not passed
so it somewhat depends on the final version of that legislation.
CHAIRMAN ROKEBERG confirmed this relates to Medicare.
SENATOR DONLEY indicated, then, the current language in subsection
(B) on page 2 of CSSB 88(FIN) provides the department with some
flexibility to address the work experience, depending on what the
federal law would consider title licensure.
REPRESENTATIVE MURKOWSKI noted, then, it would be the sponsor's
preference to leave it as is and address it within the regulations
when the regulations come up.
SENATOR DONLEY answered in the affirmative.
MS. WILD added that the proposed [federal] legislation for Medicare
reimbursement says "licensed nutritional professionals in their
state". She said the legislation proposed in Alaska is quite
similar to the legislation that has gone through the other states.
REPRESENTATIVE MURKOWSKI said that satisfies her.
Number 0115
REPRESENTATIVE HALCRO mentioned fly-by-night operations and misuse
of the titles. He asked Senator Donley where the enforcement is.
SENATOR DONLEY answered that there is a provision that the person
can be cited for up to $1,000 by the department. He noted this
citation could occur if there was a consumer complaint or if the
department did its own investigation. Senator Donley said it would
not be a crime, it would simply be a citation.
REPRESENTATIVE HALCRO asked who would issue the citation.
MS. REARDON answered the Department of Commerce and Economic
Development, under AS 08.01. She noted the department has an
entire section of law that speaks about citations.
SENATOR DONLEY commented he thinks citations are a good way to go
in a regulatory system because the behavior is not being
criminalized; it is a much simpler procedural system to go through.
Number 0166
CHAIRMAN ROKEBERG referred to the $31,000 fiscal note, mentioning
it looked a bit high. He asked if the licensing examiner would be
drafting the regulations or what.
MS. REARDON responded the $31,000 is for two years, pointing out
that the chairman is looking at the "revenue" line. The division
is planning on spending $15,500 a year, but was showing it would
probably receive most of the money in one year because of the
biennial renewal cycle. The spending breakdown is on the second
page of the fiscal note. Ms. Reardon informed the chairman she has
asked for a quarter-time range 12 licensing examiner for $8,500;
the remaining $7,000 is in contractual services and supplies.
These costs would include AG [attorney general] time and phone,
postage, printing and advertising costs for regulations and things
like that. Ms. Reardon expressed that it is difficult to predict
in advance how much time something will take. However, she
anticipates that at least for the first two years, a quarter of
range 12 is not unreasonable. She indicated there will be others
working on this program but extra funds were not requested for
their services. There is a range 16 regulation specialist who
helps with the writing of regulations, some supervisors will assist
the range 12, but this will just be part of everyone's daily job.
Therefore, she is estimating about one day a week of a licensing
examiner would be appropriate for the first year or two. Ms.
Reardon indicated the examiner would be handling the telephone
calls, information requests, et cetera, from all of the 100 or so
potential licensees.
Number 0246
CHAIRMAN ROKEBERG questioned the fiscal note language, "Provides
2.5 months of an Occupational Licensing Examiner I position, Range
12, $8.5 [$8,500]." He noted the 2.5 months and the quarter time,
asking if most state employees only worked 10 months a year.
MS. REARDON commented she had overestimated - they are asking for
a bit less than quarter time. She noted it's not really possible
to hire a quarter-time person; she has a half-time employee whose
time she would intend to increase by an hour or two per day.
CHAIRMAN ROKEBERG commented this is not the House Finance Standing
Committee either, but he is concerned by her 50-50 overhead to
services. [From the 3/26/99 fiscal note: "REVENUE & FUND SOURCE:
Revenue will be generated by the licensing fees sufficient to cover
program costs. Approximately 100 licensees are expected to seek
licensure and renew licenses biennially. Licensing fees must cover
direct costs plus approximately $100 per licensee for
division/department overhead for the two-year period. Based on 100
licensees, licensing fees are estimated to be $410.00 for the first
biennium , and adjusted to actual costs based on positive
timekeeping for the first renewal."]
MS. REARDON responded she was probably waving a "red flag" by
typing that, but indicated it is included in the interests of
honesty. She added "overhead" might not be the most delicate way
of putting it. However, it is costing the department about that
amount for every licensee. This would be all costs the department
does not attribute down to the profession level; for example: her
time at this hearing, the receptionists' answering the telephone.
Ms. Reardon noted there are a variety of employees who would be
providing real services but whose services cannot be tracked
efficiently at the profession level. She noted there are real
things like receptionists, people who open the mail, photocopier
costs, that are billed out as overhead.
Number 0322
REPRESENTATIVE MURKOWSKI referred to the exemptions, questioning
why federal government employees and those in the armed services
would be exempted. Additionally, she asked if there are really
animal nutritionists, and if so, she needs the name of one.
MR. WRAY answered that there is an individual who teaches animal
nutrition at the University of Alaska Fairbanks and is a Ph.D. Mr.
Wray explained all the other 39 states with licensure/certification
have the same exemption.
REPRESENTATIVE MURKOWSKI asked about the exemptions for the
military and the federal government.
SENATOR DONLEY responded they just felt it was appropriate for
someone who is working for the armed forces or the federal
government. The government will be controlling that person; it is
not as if the person is out in the open marketplace offering
his/her services.
REPRESENTATIVE BRICE noted it is a practice commonly used as well
with the other professions. The state does exempt federal
employees and military employees from licensure.
REPRESENTATIVE HALCRO indicated he had posed this question earlier
that day to Ms. Wild. If someone is in the military and is using
the title dietician or nutritionist, the legislation clearly states
the person needs to be licensed if he/she is using the title
outside the scope of the person's military service. Representative
Halcro noted, however, it does not dictate that for a federal
government employee and he asked if there is a reason for that,
mentioning the possibility of someone moonlighting.
Number 0407
SENATOR DONLEY answered there was no particular reason other than
that a specific circumstance was being addressed in subsection (3)
[of the exemptions]. He noted it could be made to apply to both
and they have language available if that is the committee's will.
[The exemptions section of CSSB 88(FIN) read:
Sec. 08.38.080. Exemption. The requirements of
this chapter do not apply to
(1) an animal nutritionist whose activities are
limited to the nutritional care of animals; animal
nutritionists may use the title "nutritionist" as long as
they provide nutrition services only to animals;
(2) a person who is serving as an employee of the
federal government whose job title includes the term
"dietician" or "nutritionist"; or
(3) a person who is serving as a dietician or
nutritionist in the armed forces of the United States,
but the exemption provided under this paragraph does not
authorize the person to use the title "dietician,"
"licensed dietician," "nutritionist," "licensed
nutritionist," or an occupational title using the word
"dietician" or "nutritionist" outside the scope of the
person's military service.]
REPRESENTATIVE HALCRO indicated he had simply been curious.
MR. WRAY commented, regarding the military exemptions, that
Elmendorf Airforce Base hospital has a dietician and there are
number of dietitians in active military reserve. These dieticians
have all told him the direction received from their superiors, at
their commanders' discretion - and he noted this applies to all
health professions - is that person should obtain licensure in the
state he/she is assigned to if licensure exists for his/her
specific health care field. Mr. Wray indicated it had not been the
intention to dictate this with the legislation's language, adding,
"If it's their call, they make that call themselves ...."
CHAIRMAN ROKEBERG asked Mr. Wray if medical schools are now
including an integrated degree of nutritional training. He noted
they had never done anything in the past.
MR. WRAY replied his understanding is that it varies greatly.
There is some emphasis, but on the other hand, medical school is
"no walk in the park." He noted there is not a lot of free time
and trying to throw in electives is probably very difficult for any
sort of regular medical school program. His understanding is that
most medical school curriculums do offer a basic nutritional
program. Mr. Wray referred to Representative Halcro's question
about where Ms. Wild receives her patients; Mr. Wray receives all
of his from physician referrals. Physicians basically count on him
to teach nutrition to the patients, knowing that dieticians have a
level of knowledge the physicians didn't have a chance to get in
medical school.
Number 0505
CHAIRMAN ROKEBERG questioned the sponsor if there is anything in
the legislation that would require a payment to a dietician or a
nutritionist under an insurance contract that would not otherwise
be made without the bill. The chairman asked if there is anything
in this legislation which require an insurance company to make
payments they would not have to make otherwise.
SENATOR DONLEY replied he guesses it would depend on the insurance
contract. In response to the chairman's comment, the senator
answered that if a company wrote a contract which said the company
would pay a person's costs for a licensed dietician, then the
company would be obligated to do that if the state licenses
dieticians.
CHAIRMAN ROKEBERG noted he thinks the answer is correct but doesn't
believe it is typically a covered area. The chairman asked for Mr.
Wray's assistance.
Number 0553
MR. WRAY responded his understanding, from the other 39 states with
licensure/certification, is that there has been no additional cost
to any insurance companies involved. He said he would echo Senator
Donley's comment, stating, "What you find ... in the health care
reimbursement is the big player who's dictating the field is HCFA
[Health Care Financing Administration, United States Department of
Health and Human Services], the people who administer Medicare."
He commented HCFA decides the service is going to be covered. Many
times years later, the insurance companies may decide to cover
those services, but may not. Currently some of his services are
covered by insurance companies and some are not; it is the
insurance company's prerogative.
CHAIRMAN ROKEBERG commented that Alaska has an unusual insurance
statute - it has a special section or list. The chairman indicated
he did not see "dietician" or "nutritionist" appearing on that list
and simply wanted to put it on the record.
SENATOR DONLEY said perhaps another way to answer the chairman's
question is that nothing in this bill mandates that this is covered
by insurance.
CHAIRMAN ROKEBERG asked the pleasure of the committee.
Number 0605
REPRESENTATIVE HALCRO made a motion to move CSSB 88(FIN) out of
committee with individual recommendations and the attached fiscal
note. There being no objection, CSSB 88(FIN) moved out of the
House Labor and Commerce Standing Committee.
Number 0619
CHAIRMAN ROKEBERG called an at-ease at 4:26 p.m. The committee
came back to order at 4:47 p.m.
HB 183 - ALASKA PUBLIC UTILITIES COMMISSION
[Contains discussion relevant to SB 133.]
Number 0623
CHAIRMAN ROKEBERG announced the committee's next order of business
is HB 183, "An Act relating to the powers and duties of the chair
of the Alaska Public Utilities Commission; relating to membership
on the Alaska Public Utilities Commission; and relating to the
annual report of the Alaska Public Utilities Commission."
CHAIRMAN ROKEBERG indicated that the committee would be working off
Version I of HB 183. He announced that Amendment 3 was adopted at
the last meeting and Amendment 1 which was amended is back before
the committee. He asked if Amendment 1 was amended by deleting the
60 days.
JANET SEITZ, Legislative Assistant for Representative Rokeberg,
Alaska State Legislature, pointed out that the action was to delete
lines 12 through 14 on Amendment I.1, which if left in would have
deleted the 60 and inserted the 30, which refer to the days within
which the commission shall enter its order.
CHAIRMAN ROKEBERG asked if it was left at 30.
MS. SEITZ replied that it was left at 60.
CHAIRMAN ROKEBERG indicated that the committee still has before it
Amendment 1, which is amended and deletes the 30 and retains the
60. He noted that Representative Murkowski has an additional
amendment to Amendment 1.
The following is Amendment 1, labeled 1-LS0764\I.1, Cramer,
4/28/99, as amended by the committee on 4/28/99, which reads:
Amendment 1, labeled 1-LS0764\I.1, Cramer, 4/28/99, as amended
by the committee on 4/28/99, read:
Page 1, line 5, following ";":
Insert "relating to timely action by the Alaska
Public Utilities Commission;"
Page 3, line 26:
Delete "a new subsection"
Insert "new subsections"
Page 3, lines 28 - 30:
Delete ", the chair of the commission shall promptly
fix a date for hearing when a hearing is appropriate.
The hearing shall be without undue delay. The"
Insert "for which a hearing is clearly warranted,
the chair of the commission shall assign a priority
rating to the issue and promptly fix a date for hearing.
The hearing shall be expedited in accordance with the
priority rating. Regardless of the priority rating, a"
Page 4, following line 2:
Insert a new subsection to read:
"(c) Unless to do so would violate the due
process rights of a party, the commission shall
ensure that its dockets are closed in a timely
fashion and not delayed due to inaction, complexity
of issues, or another reason. Failure of a
commission member to comply with this subsection
constitutes grounds for removal from the commission
under AS 42.05.035. The chair of the commission
may dismiss a commission employee for failure to
comply with this subsection."
Number 0675
REPRESENTATIVE MURKOWSKI recommended that they delete the language
in new subsection (c) of the above amendment following the word
"inaction". Therefore, subsection (c) would read, "the commission
shall ensure that its dockets are closed in a timely fashion and
not delayed due to inaction." She also wanted to entertain a
discussion on whether to delete the language, "Failure of a
commission member to comply with this subsection constitutes
grounds for removal from the commission under AS 42.05.035. The
chair of the commission may dismiss a commission employee for
failure to comply with this subsection."
CHAIRMAN ROKEBERG wondered if Representative Murkowski's amendment
to the amendment had been adopted.
Number 0744
REPRESENTATIVE MURKOWSKI indicated that her amendment had not been
adopted. She stated that her amendment to the amendment is to
eliminate the remainder of the language after the word, "inaction",
on line 19 of the printed amendment.
CHAIRMAN ROKEBERG wondered if the remainder of the language was
possibly an amendment to the amendment.
REPRESENTATIVE MURKOWSKI said that the amendment to the amendment
is a period after the word, "inaction", in the new subsection (c).
CHAIRMAN ROKEBERG clarified that the amendment to the amendment is
to delete the language, "complexity of issues, or another reason."
He asked if there was any objection to the second amendment to the
amendment. There being no objection, the second amendment to the
amendment was adopted.
Number 0783
REPRESENTATIVE MURKOWSKI noted that there was discussion on the
language, "Failure of a commission member to comply with this
subsection constitutes grounds for removal from the commission
under AS 42.05.035. The chair of the commission may dismiss a
commission employee for failure to comply with this subsection."
She indicated that after making the amendment to the amendment she
doesn't have as much problem with the additional language.
CHAIRMAN ROKEBERG referred to a memorandum from Teresa Cramer,
Legislative Counsel, dated April 28, 1999, that speaks to certain
internalized sanctions within the commission. Ms. Cramer developed
the one patterned after the salary warrant, where a judge's salary
could be withheld until an opinion was issued.
Number 0844
REPRESENTATIVE HARRIS inquired as to how a commissioner would be
delayed by inaction.
REPRESENTATIVE MURKOWSKI referred to HB 183, version I, under
"Removal of commissioners", it states, "The governor may remove a
commissioner from office only for cause, including incompetence,
neglect of duty, or misconduct in office." She indicated that she
changed her mind and would like to delete the last two sentences of
the amendment.
CHAIRMAN ROKEBERG referred to the last sentence which states, "The
chair of the commission may dismiss a commission employee for
failure to comply with this subsection." He pointed out there is
a difference between commission members and commission employees.
REPRESENTATIVE MURKOWSKI agreed, and noted that commission
employees aren't addressed.
Number 0938
REPRESENTATIVE HALCRO indicated that the commission employees would
already be responsible for following the direction of their
supervisors.
CHAIRMAN ROKEBERG commented that it is almost redundant.
REPRESENTATIVE MURKOWSKI agreed with Representative Halcro.
CHAIRMAN ROKEBERG asked whether Representative Murkowski wanted to
move the third amendment to the amendment.
REPRESENTATIVE MURKOWSKI made a motion to adopt the third amendment
to the amendment and delete, "Failure of a commission member to
comply with this subsection constitutes grounds for removal from
the commission under AS 42.05.035. The chair of the commission may
dismiss a commission employee for failure to comply with this
subsection."
REPRESENTATIVE HALCRO objected for a question. He asked, "So, by
removing this, we still leave intact, of course, the underpinnings
of the removal of commissioners, correct?"
CHAIRMAN ROKEBERG replied yes.
REPRESENTATIVE HALCRO removed his objection.
CHAIRMAN ROKEBERG wondered whether there was any reason that the
first sentence coudn't be removed.
REPRESENTATIVE HALCRO stated that the second sentence, "The chair
of the commission may dismiss a commission employee for failure to
comply with this subsection," is redundant.
Number 1059
CHAIRMAN ROKEBERG stated that there being no further objection, the
third amendment to the amendment was adopted.
CHAIRMAN ROKEBERG referred to the language on lines 17 through 19
of the printed amendment which states, "Unless to do so would
violate the due process rights of a party, the commission shall
ensure that its dockets are closed in a timely fashion and not
delayed due to inaction complexity of issues, or another reason."
All the language seems superfluous. He recommended a fourth
amendment to the amendment, which would delete the whole
paragraph, "Unless to do so would violate the due process rights of
a party, the commission shall ensure that its dockets are closed in
a timely fashion and not delayed due to inaction complexity of
issues, or another reason. Failure of a commission member to
comply with this subsection constitutes grounds for removal from
the commission under AS 42.05.035. The chair of the commission may
dismiss a commission employee for failure to comply with this
subsection." There being no objection, the fourth amendment to the
amendment was adopted.
Number 1139
REPRESENTATIVE MURKOWSKI informed the committee that she spoke with
Mr. Zobel and had asked him if he thought the priority issue was
reasonable. Mr. Zobel said it is already done informally in the
commission and in his opinion, the language is not a problem and is
perhaps helpful.
REPRESENTATIVE HARRIS made a motion to adopt Amendment I.1 as
amended, which read:
Page 1, line 5, following ";":
Insert "relating to timely action by the Alaska Public
Utilities Commission;"
Page 3, line 26:
Delete "a new subsection"
Insert "new subsections"
Page 3, lines 28-30:
Delete ", the chair of the commission shall promptly fix
a date for hearing when a hearing is appropriate. The hearing
shall be held without undue delay. The"
Insert "for which a hearing is clearly warranted, the
chair of the commission shall assign a priority rating to the
issue and promptly fix a date for hearing. The hearing shall
be expedited in accordance with the priority rating.
Regardless of the priority rating, a"
CHAIRMAN ROKEBERG asked if there was any objection. There being
none, Amendment I.1 as amended was adopted. He referred to an
amendment offered by Mr. Zobel in a memorandum dated May 3, 1999.
He indicated that the committee has decided to hold the amendment
in abeyance. Chairman Rokeberg announced his intention to hold HB
183 over until the next meeting.
Number 1404
CHAIRMAN ROKEBERG asked Representative Halcro if Amendment H.8 is
consistent with SB 133 and the Alaska Oil and Gas Conservation
Commission (AOGCC) methodology.
REPRESENTATIVE HALCRO said that Amendment H.8 is consistant with SB
133. He reminded the committee that Amendment H.8 was held to get
an opinion from Legislative Legal as to whether it is
constitutional. He indicated that it is constitutional. The
commission can elect a commissioner and then the governor would
need to approve the election. The corrected amended does need to
be amended to reflect the direction set forth by Legislative Legal.
He made a motion to adopt amendment H.8, which read:
Page 1, line 8, following "(b) The" delete "governor shall
designate one member of the commission as chair. The chair
shall serve as chair for a term of four years, but may be
appointed for successive terms." and insert "commission shall
select one member of the commission to serve as chair for a
term of two years. A commissioner may be elected to
successive terms as chair of the commission."
REPRESENTATIVE HARRIS objected for the purpose of discussion.
REPRESENTATIVE HALCRO stated that he has his own language that
could be inserted to satisfy the legal need. He made a conceptual
amendment to the amendment, "line 4, after the period after 'years'
would insert, 'the governor shall approve the commission's
selection as chair'."
JONATHON LACK, Legislative Assistant for Representative Halcro,
stated that it could be worded in the reverse, which would make it,
"the governor may reject the commission's selection as chair."
CHAIRMAN ROKEBERG pointed out that would give the governor veto
power over the chair; he asked if that was the intent?
REPRESENTATIVE HALCRO changed the conceptual amendment to read,
"the governor may reject the commission's selection of chair."
CHAIRMAN ROKEBERG asked if there was any objection. There being
none, Amendment H.8 as amended was adopted.
REPRESENTATIVE HARRIS requested clarification on whether the
governor appoints the commissioners.
REPRESENTATIVE HALCRO clarified that the governor appoints the
commissioners, the commissioners elect a chair and then the
governor has the option of rejecting the chair.
Number 1714
LARRY MARKLEY, Alaska Rural Electric Cooperative Association
(ARECA), wondered if the committee is going to consider any
adjustment or amendment to the bill that would allow for Regulatory
Cost Changes (RCC) proportionate to the type of cases the
commission undertakes. For instance, if it's three-quarter
electric and one-quarter telephone would it ...
CHAIRMAN ROKEBERG interjected that the chair is not rejecting the
concept, it's just that there isn't satisfactory language.
REPRESENTATIVE HALCRO wondered if SB 133 reflected the proposed
amendments to regulatory cost charges (RCCs).
Number 1798
MR. MARKLEY responded that it moves toward what the industry is
looking for.
CHAIRMAN ROKEBERG interjected that it was for minimum modification,
but not with that language.
MR. MARKLEY indicated that he would be happy to submit a simplified
amendment.
CHAIRMAN ROKEBERG expressed the need to have a committee substitute
before there is any more confusion, and to take up any additional
amendments at the next meeting.
ADJOURNMENT
CHAIRMAN ROKEBERG adjourned the House Labor and Commerce Standing
Committee at 5:12 p.m.
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