Legislature(2019 - 2020)BARNES 124
05/03/2019 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB91 | |
| HB24 | |
| HB127 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 91 | TELECONFERENCED | |
| += | HB 24 | TELECONFERENCED | |
| *+ | HB 127 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
May 3, 2019
3:24 p.m.
MEMBERS PRESENT
Representative Adam Wool, Co-Chair
Representative Gabrielle LeDoux, Co-Chair
Representative Zack Fields
Representative Sara Hannan
Representative Louise Stutes
Representative Josh Revak
Representative Dave Talerico
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 91
"An Act relating to the practice of naturopathy; relating to the
licensure of naturopaths; relating to the Department of
Commerce, Community, and Economic Development; and providing for
an effective date."
- HEARD & HELD
HOUSE BILL NO. 24
"An Act relating to instruction in a language other than
English; and relating to limited teacher certificates."
- HEARD & HELD
HOUSE BILL NO. 127
"An Act relating to the practice of dental hygiene; establishing
an advanced practice permit; prohibiting unfair discrimination
under group health insurance against a dental hygienist who
holds an advanced practice permit; relating to medical
assistance for dental hygiene services; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 91
SHORT TITLE: NATUROPATHS: LICENSING; PRACTICE
SPONSOR(s): REPRESENTATIVE(s) JOHNSTON
03/13/19 (H) READ THE FIRST TIME - REFERRALS
03/13/19 (H) L&C, FIN
04/03/19 (H) L&C AT 3:15 PM BARNES 124
04/03/19 (H) Heard & Held
04/03/19 (H) MINUTE(L&C)
04/08/19 (H) L&C AT 3:15 PM BARNES 124
04/08/19 (H) Heard & Held
04/08/19 (H) MINUTE(L&C)
05/03/19 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 24
SHORT TITLE: LIMITED TEACHER CERTIFICATES; LANGUAGES
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS
02/20/19 (H) PREFILE RELEASED 1/7/19
02/20/19 (H) READ THE FIRST TIME - REFERRALS
02/20/19 (H) EDC, L&C
03/29/19 (H) EDC AT 8:00 AM CAPITOL 106
03/29/19 (H) Heard & Held
03/29/19 (H) MINUTE(EDC)
04/01/19 (H) EDC AT 8:00 AM CAPITOL 106
04/01/19 (H) Heard & Held
04/01/19 (H) MINUTE(EDC)
04/03/19 (H) EDC AT 8:00 AM CAPITOL 106
04/03/19 (H) Heard & Held
04/03/19 (H) MINUTE(EDC)
04/05/19 (H) EDC RPT 5DP 2NR
04/05/19 (H) DP: TUCK, ZULKOSKY, JOHNSON, STORY,
DRUMMOND
04/05/19 (H) NR: REVAK, HOPKINS
04/05/19 (H) EDC AT 8:00 AM CAPITOL 106
04/05/19 (H) Moved HB 24 Out of Committee
04/05/19 (H) MINUTE(EDC)
04/24/19 (H) L&C AT 3:15 PM BARNES 124
04/24/19 (H) Heard & Held
04/24/19 (H) MINUTE(L&C)
05/03/19 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 127
SHORT TITLE: DENTAL HYGIENIST ADVANCED PRAC PERMIT
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
04/09/19 (H) READ THE FIRST TIME - REFERRALS
04/09/19 (H) L&C, FIN
05/03/19 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
ROSS TANNER
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
MELINDA RATHKOPF, MD
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
LAURIE MONTANO
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
STEVE SIVILS
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
IRINA GRIMBERG
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
TONYA CAYLOR
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
MARY ANN FOLAND
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
ALEXANDER VON HAFFTEN
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
PATRICK NOLAN
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
CAMERON O'CONNELL, ND
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 91.
DAVID SCHLEICH, MD
Alaska Association of Naturopathic Physicians
Portland, Oregon
POSITION STATEMENT: Testified in support of HB 91.
JOHN CULLEN
American Academy of Family Physicians
Valdez, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
KRISTIN MITCHELL
American College of Physicians
Soldotna, Alaska
POSITION STATEMENT: Testified during the hearing on HB 91.
JOSEPH RETH
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 91.
ANNETTE O'CONNELL
Kenai, Alaska
POSITION STATEMENT: Testified in support of HB 91.
DANIEL YOUNG, ND
Center for Natural Medicine
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 91.
WAYNE ADERHOLD
Board of Chiropractic examiners
Homer, Alaska
POSITION STATEMENT: Testified in support of HB 91.
STEVE FRANK
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 91.
KATIE GARDNER
Matsu Borough School District
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 24.
REPRESENTATIVE IVY SPOHNHOLZ
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, introduced HB 127.
KATRINA VIRGIN
Alaska Dental Hygienists Association
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 127.
ACTION NARRATIVE
3:24:54 PM
CO-CHAIR ADAM WOOL called the House Labor and Commerce Standing
Committee meeting to order at 3:24 p.m. Representatives Hannan,
Revak, Talerico, LeDoux, and Wool were present at the call to
order. Representatives Fields and Stutes arrived as the meeting
was in progress.
HB 91-NATUROPATHS: LICENSING; PRACTICE
3:26:03 PM
CO-CHAIR WOOL announced that the first order of business would
be HOUSE BILL NO. 91, "An Act relating to the practice of
naturopathy; relating to the licensure of naturopaths; relating
to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
3:26:20 PM
CO-CHAIR WOOL opened public testimony.
3:27:09 PM
ROSS TANNER, Alaska State Medical Association, informed the
committee that he is an internal medical physician in Anchorage
and has practiced for the last 30 years. He recounted a patient
with Type 1 diabetes and liver failure who was instructed to
discontinue all medications, including insulin, by a
naturopathic doctor (ND), which resulted in a prolonged
hospitalization and near death. He opined that NDs show a lack
of clinical experience that put patients in harm in Alaska. He
continued by saying that Naturopaths tend to prescribe numerous
supplements that lack "therapeutic efficacy and any kind of
data." He concluded by stating that a lack of residency, lack
of insurance, personal experience, and no improvement to access
of care are his primary [objections].
3:29:50 PM
REPRESENTATIVE HANNAN asked how Mr. Tanner's comments relate to
the extended scope of practice that the bill proposes.
MR. TANNER said it's one example that illustrates lack of
competence due to lack of clinical training, knowledge and
expertise. He added that "even non-medical people would know
not to discontinue medication."
REPRESENTATIVE HANNAN asked if Mr. Tanner's objection is to NDs
practicing medicine period, not just this bill's proposal to
give them a scope of practice that includes prescription and
minor surgery.
MR. TANNER offered his belief that NDs should stay in their
scope of practice, adding that they're trained to be
complementary to physicians. He continued by saying that less
than 5 percent of naturopaths do residencies and that to call
NDs doctors is misleading to patients and harmful to Alaska's
communities.
3:33:57 PM
MELINDA RATHKOPF, MD, Alaska State Medical Association, informed
the committee that she is a board-certified allergist
immunologist who has practiced in Alaska for 13 years. She
shared her educational background, which included 4 years of
medical school, 3 years of a pediatric residency training, and 2
years of allergy and immunology fellowship. She discussed her
experience with patients who received misinterpreted allergy
testing from naturopaths. She explained her opposition to the
bill, saying that increasing ND's scope of practice would
increase the number of patients that seek their care and think
they are equivalent to MDs.
3:36:00 PM
LAURIE MONTANO, Alaska State Medical Association, shared several
experiences with patients who had previously been mistreated by
NDs, adding that they were not backed by science. She expressed
major concern and strongly opposes HB 91.
3:37:49 PM
STEVE SIVILS, Alaska State Medical Association, stated that he
is a pediatric anesthesiologist in Anchorage and expressed his
opposition to the bill, especially including surgery in the
increased scope of practice. He offered his understanding that
NDs don't receive any formal surgical training which would put
Alaskans at risk.
3:39:49 PM
IRINA GRIMBERG, Alaska State Medical Board, stated her
opposition to HB 91. She opined that it is potentially
dangerous when naturopaths act as a legitimate MD. year after
year, she said, naturopaths are pushing measures for
prescriptive authority. She offered her belief that they should
be an alternative option to conventional medicine.
3:44:14 PM
TONYA CAYLOR, Alaska State Medical Board, informed that
committee that she is opposed to HB 91 and credited her many
encounters with poor judgement made by naturopathic providers.
She gave a brief summary of two such encounters. She offered
her belief that naturopaths lack clinical knowledge in
pathophysiology and clinical judgement that is needed to
practice medicine. She said they should not be granted the
ability to prescribe medication.
3:47:31 PM
MARY ANN FOLAND, Alaska State Medical Board, voiced her
opposition to HB 91. She alleged that the state medical board
also opposes the bill and considers these changes "the practice
of allopathic medicine." She stated that physicians require
12,000-15,000 more hours of training than NDs and shared two
stories of patients who were mistreated by naturopaths. She
added that all the examples being shared today reflect the lack
of education in pharmacology. She continued by saying that
naturopaths don't need to have prescriptive and surgical
privileges and instead, can continue to practice within the
definition of naturopathy.
CO-CHAIR LEDOUX asked if, theoretically, a medical school
graduate would be licensed to perform brain surgery.
MS. FOLAND answered yes. She offered her belief that she
possesses a medical surgical license, which would theoretically
allow her to do that; however, she said that her credentials
don't allow her to [perform brain surgery] and if she were to
practice outside the scope of her training she would have to
answer to the state medical board.
3:53:17 PM
CO-CHAIR WOOL pointed out that nurse practitioners (NPs) have
prescriptive powers and questioned how Ms. Foland justifies
that.
MS. FOLAND offered her understanding that NPs and physician
assistants' training is allopathic, adding that naturopathic
training is completely different content.
3:54:41 PM
ALEXANDER VON HAFFTEN, Alaska State Medical Board, said he
opposes HB 91. Nonetheless, he noted that he supports the
values of naturopathy and the wholistic approach to preventing
disease and optimizing wellness. he further noted that he has
discussed naturopathy during lessons as a teacher in the WHAMI
medical program and has referred patients to NDs when
naturopathy offers a viable or better alternative to allopathic
or osteopathic medicine. However, he said, "the proposed
changes eliminate the prerequisites for a person to be
considered qualified as a position and have little adherence to
the core values of naturopathy." He questioned whether NDs are
qualified to prescribe and offered his belief that HB 91 would
change the standard for disclosure, change the standard of care,
and communicate that "truth in advertising is irrelevant." He
concluded by reiterating that, while he values naturopathy as an
alternative to allopathic medicine, physicians possess expertise
in judgement in accordance with minimum nationally established
requirements for education, training, and skill-competencies.
4:02:04 PM
REPRESENTATIVE FIELDS asked if Mr. Von Hafften would support
allowing "some degree" of prescriptive authority for naturopaths
who went through a residency equivalent to that of an MD.
MR. VON HAFFTEN said no, "the devil is in the details." He
added that a scope of practice already exists in statute and he
sees no reason to change that.
REPRESENTATIVE FIELDS asked if there are any types of medicine
that would be appropriate for naturopaths to have prescriptive
authority for.
MR. VON HAFFTEN stated, "I'm regarding prescriptive
responsibility."
4:04:17 PM
PATRICK NOLAN, Alaska State Medical Board, informed the
committee that he is a board certified endocrinologist and a
member of the American Association of Clinical Endocrinologists,
the American College of Endocrinology, and the International
Endocrine Society; as well as a member of the American College
of Physicians and a fellow with the American Association of
Clinical Endocrinology. He also served as a former state
Medical Board member for four years. He expressed his
opposition to HB 91 "for many of the reasons that were already
stated." He reflected on cases that, in his opinion, were
misdiagnosed by NDs.
4:09:07 PM
CAMERON O'CONNELL, ND, expressed her support for HB 91. She
said she would not take up the committee's time by relating some
of the patients she has treated that were under the care of
Medical Doctors and were overprescribed medication and "had bad
outcomes from medication they were given." Instead she
addressed the ways in which a limited scope of practice
influences her day-to-day care of patients. She concluded by
asking the members to consider updating [indisc.] to a more
modern scope, noting that naturopathic medicine has grown a lot
as a profession and the legislation should reflect that.
4:11:57 PM
CO-CHAIR WOOL asked if residency was a required part of her
degree program in Portland, Oregon.
MS. O'CONNELL said, currently, they don't have the funding and
there aren't enough residencies for the amount that would be
needed for every ND to go. She added that completing a
residency is highly encouraged and competitive.
CO-CHAIR WOOL asked if Ms. O'connell's residency was
naturopathic, allopathic, or some combination of the two.
MS. O'CONNELL replied that it was a combination of both.
4:13:24 PM
DAVID SCHLEICH, MD, Alaska Association of Naturopathic
Physicians, informed the committee that is the president of the
National University of Natural Medicine, the oldest federally
and regionally and state accredited university in the U.S. that
prepares naturopathic physicians for clinical practice and
careers. He shared his background and experience working for
many different universities and colleges across the U.S. and
Canada and expressed his support for HB 91. He noted that the
professional preparation of NDs has been referenced erroneously
and often. He said it translates into four years of fulltime
study beyond a bachelor's degree. He states that his colleagues
in the allopathic profession who have said that the content and
learning objectives of naturopathy are different, are mistaken.
He added that the clinical record of NDs is more substantial
than their colleagues would suggest. He concluded by
encouraging the members to endorse the current bill.
CO-CHAIR WOOL said there has been reference to a philosophy or
underlying statement behind naturopathy and asked Mr. Schleich
to speak to that.
DR. SCHLEICH replied that his University has recently published
12 volumes, 6,000 pages, on the history, philosophy, and
derivation of naturopathic practice. He added that the
underlying philosophies are not that different.
4:23:17 PM
JOHN CULLEN, American Academy of Family Physicians, stated that
he is the president of the American Academy for family
Physicians and expressed his opposition to "the extent of this
bill." He said he would like to see the data to that
naturopaths are capable of prescribing medication safely. He
opined that this bill will not solve the solution to rural
healthcare problems and objected to the "naming of naturopaths
as physicians." He encouraged members to vote no on this bill.
4:26:42 PM
KRISTIN MITCHELL, American College of Physicians, offered her
belief that the training for naturopaths is not equivalent to
scientific medical training and should be complementary. She
expressed concern about a lack of sufficient evidence showing
that it is safe for patients to receive care from naturopaths in
terms of prescribing pharmaceuticals and performing surgery,
which in her opinion, they are not trained for. She said
patients have a difficult time distinguishing between licensed
practitioners and it is the state's role to protect the safety
of patients.
4:30:45 PM
The committee took a brief at-ease.
4:31:28 PM
JOSEPH RETH expressed his opposition to HB 91, offering his
belief that naturopaths don't have the training needed to
prescribe medicine and perform minor surgeries effectively and
safely. He addressed the concept of residency. He argued that
physicians are required to complete a 3-year residency after 4
years of medical school, during which they are taught how to
safely and effectively prescribe medicine along with performing
surgical procedures. In contrast, he said, naturopaths have 4
years of schooling and no residency requirement. He mentioned
the placebo affect and pointed out that it can account for more
than 50 percent of positive outcomes. He said that he and his
colleagues have had too many interactions with naturopaths where
it was clear that they did not adequately and sufficiently
understand the science of medicine and as a result have put
patients health and their lives at risk.
4:35:39 PM
REPRESENTATIVE REVAK sought clarification on the placebo effect.
MR. RETH stated that it is very powerful and can occur up to 80
percent of the time.
4:36:35 PM
CO-CHAIR WOOL pointed out that many naturopaths do clinical
residency after medical school in states that grant prescriptive
authority to NDs. He asked if some go get the proper training
to prescribe drugs, given that they came from that background.
MR. RETH replied that there are significantly more residencies
available for naturopaths now than there were years ago. He
described naturopathic residencies as "going to someone else's
office and hanging out with them," adding that it wasn't
consistent. He said one year of residency is not enough to
learn how to safely prescribe medication.
CO-CHAIR WOOL pointed out that NPs have prescriptive ability and
do not complete the same amount of school as physicians. He
asked how Mr. R justifies that.
MR. RETH said that NPs are trained in allopathic medicine as
opposed to "natural substances."
4:39:23 PM
CO-CHAIR LEDOUX asked if both PAs and NPs work under a doctor.
MR. RETH said he was unsure. He offered his understanding that
PAs work under a "collaborative agreement" and, although
oversight is present, they are free to do what they need to do.
CO-CHAIR LEDOUX equated NDs to osteopaths, regarding their
history, specifically their desire to be recognized as
physicians.
4:42:37 PM
REPRESENTATIVE FIELDS referenced previous comments about
naturopathy being complementary to MDs as opposed to
interchangeable and asked if that is true.
MR. RETH opined that they are not interchangeable, adding that
NDs and MDs have divergent approaches to the human body. He
said he was surprised that naturopaths want prescriptive
authority for medicine that isn't "natural."
REPRESENTATIVE FIELDS asked if the two practices are
complementary.
MR. RETH opined that it comes back to the placebo affect;
meaning that if an individual believes and trust in someone, he
or she will get a lot of benefit from that person. He further
stated that "going to a naturopath for some people is the way to
go." However, he added that a patient with a serious problem
will need the addition of allopathic medicine.
REPRESENTATIVE FIELDS asked if there could be a sufficiently
rigorous process of residency for naturopaths that would prepare
them for prescriptive authority.
MR. RETH acknowledged that a more limited or "restrictive"
prescriptive ability could be considered, while reiterating his
concern about granting NDs complete prescriptive authority.
4:46:30 PM
REPRESENTATIVE FIELDS asked if the medical association has ever
considered the idea of a more regular and regulated residency
process for NDs.
MR. RETH related that the medical associate has never discussed
residency, as it is a newer concept for naturopaths.
4:47:40 PM
REPRESENTATIVE HANNAN said many of the doctors who testified
today spoke broadly in opposition to naturopaths rather than
against the specifics of HB 91, which is prescriptive authority.
She questioned whether the Alaska Medical Association is opposed
to all naturopathic medicine or if their objection is just in
response to the surgical and prescriptive authority that this
bill addresses.
MR. RETH affirmed that the AMA specifically opposes the
prescriptive authority. He noted that they have no problem with
NDs being licensed in Alaska.
REPRESENTATIVE HANNAN pointed out that pharmacists don't
complete a residency for the administration of drugs and more
specifically vaccines. She asked if the Medical Association
opposes that.
MR. RETH countered with the assumption that pharmacists know how
to administer drugs, adding that he was unsure if the AMA
opposes that. He clarified that the AMA's opposition to
Naturopath's prescriptive authority is not about the ability to
prescribe vaccines, but that it would allow them to prescribe
anything apart from scheduled controlled substances and
chemotherapeutic agents.
REPRESENTATIVE HANNAN asked if the Alaska Medical Association
has a position on midwives and doulas and their treatment of
patients.
MR. RETH said he was unsure if the AMA has a formal policy on
midwives.
4:51:10 PM
The committee took a brief at-ease.
4:51:13 PM
ANNETTE O'CONNELL, reflected on being diagnosed with celiac
disease. She said she was misdiagnosed by MDs until finally
going to an ND who retested her and figured out that she was
allergic to gluten. She noted that she has been better ever
since that diagnoses as long as she follows her NDs suggestions.
She offered her belief that the American Medical Association is
campaigning to discredit NDs and blamed MDs for the opioid
epidemic. She concluded that Alaska needs both naturopathic and
medical doctors and expressed hope that NDs will be given the
right to exercise within their full scope of practice.
4:55:26 PM
DANIEL YOUNG, ND, Center for Natural Medicine, expressed his
support for HB 91 and, referencing the previous testifiers,
indicated that MDs are not the experts on naturopathic medicine.
He offered that NDs are not trying to be MDs, instead they are
providing a different model of healthcare that is very affective
and works for their patients. He said the fact that NDs still
exist is testament to that. He stated that naturopathic medical
and clinical training consists of more than 2 years of
supervised care with patients. The goal, he said, is to provide
effective care for patients and added that the state has
recently taken away their ability to provide things with
prescription labels, such as B12, B-Complex, and homeopathic
medicine, which is all medicine they regularly use. He
reiterated that the previous testifiers' comments are anecdotal,
some of which, he said he has before which makes him question
their validity.
4:58:38 PM
WAYNE ADERHOLD, Board of Chiropractic examiners, stated that he
fully supports HB 91 as a clear, concise and comprehensive
statute that will give naturopaths the structure needed to
practice to the full extent of the training level they choose
within a scope of practice defined by the profession. He
continued by praising his experience using naturopaths as his
primary care doctor since 1993. He offered his belief that this
committee has the duty to promote a free market that maximizes
competition by properly trained professionals. He added that
the tools used by professionals, including prescriptive
authority, should be determined by the regulated profession
itself, not the competing profession. He pointed out that he
has had numerous instances in his treatment history where a
prescriptive drug was considered a necessary part of a larger
treatment plan, adding that he deserves the option of receiving
the maximum level of treatment. He requested that the members
pass HB 91 out of committee and increase healthcare competition
in Alaska, adding that consumers deserve nothing less.
5:01:16 PM
STEVE FRANK noted that he has been seeing a naturopath for many
years as a primary healthcare provider and received excellent
care. He pointed out that his ND has referred him to MDs, such
as an internist and cardiologist, when appropriate. He added
that the opposition to this bill seems to be characterized by
anecdotal fearmongering and implored members to stick to the
facts and make fact-based decision. He continued by saying he
would like to see this bill moved out of committee.
5:04:34 PM
The committee took a brief at-ease.
CO-CHAIR WOOL closed public testimony on HB 91.
[HB 91 was held over.]
5:05:10 PM
HB 24-LIMITED TEACHER CERTIFICATES; LANGUAGES
CO-CHAIR WOOL announced that the next order of business would be
HOUSE BILL NO. 24, "An Act relating to instruction in a language
other than English; and relating to limited teacher
certificates."
CO-CHAIR WOOL opened public testimony on HB 24.
5:05:40 PM
KATIE GARDNER, Matsu Borough School District, expressed her
support for HB 24. She informed the committee that Matsu is
home to Fronteras Spanish Immersion Charter School and said the
borough needs qualified immersion teachers to run the immersion
program. Doing that, she said, will require cultural experience
as well as language fluency. She stated that the teachers
employed in Matsu are trained, qualified, and highly competent
educators who's only limitation to accessing the regular
certification is their limited English language, which
ironically, is one of the attributes that makes them so
qualified. She said that HB 24 will allow the expansion of the
opportunities that already exist in programs like career
technical education and junior ROTC, to the language immersion
program.
REPRESENTATIVE HANNAN asked if Fronteras has taken advantage of
the Type W certification.
MS. GARDNER replied that they have one teacher who is employed
on the Type W. Nonetheless, she said there is basic competency
requirement under Type W that limits its usefulness for
employing language teachers. The basic competency exam is the
main limiting factor, as the only option for the test is in
English.
MS. GARDNER, responding to a follow-up question from
Representative Hannan, acknowledged that the candidates for
employment are teachers from different countries who have a
verified bachelor's degree and have completed and completed a
teacher preparation program in their country. She restated that
the major limitation is the basic competency exam and that there
is no option of taking it in their native language.
5:09:59 PM
REPRESENTATIVE HANNAN proposed allowing a 2-year window to
complete that for a full certification, as opposed to a
certification that is held by the district.
MS. GARDNER acknowledged that it would be helpful; however, it
would not solve all the barriers facing this issue. She
explained that in the past there have been some individuals who
had around 1 year to work on the basic competency.
Unfortunately, she said, it didn't present enough time for he or
she to pass the exam. She added that it takes more than 2 years
to learn the English language.
REPRESENTATIVE HANNAN asked what content areas, aside from the
Spanish language, the educators should be teaching.
MS. GARDNER explained that the Fronteras program has grades K-8
splitting the day with some of the subjects taught in English
and some in Spanish. She added that they would want them to
have the equivalency of at least an elementary education
endorsement.
5:12:45 PM
CO-CHAIR WOOL announced that public testimony for HB 24 would be
left open.
[HB 24 was held over.]
5:12:53 PM
The committee took an at-ease from 5:12 to 5:15 p.m.
HB 127-DENTAL HYGIENIST ADVANCED PRAC PERMIT
5:15:35 PM
CO-CHAIR WOOL announced that the final order of business would
be HOUSE BILL NO. 127, "An Act relating to the practice of
dental hygiene; establishing an advanced practice permit;
prohibiting unfair discrimination under group health insurance
against a dental hygienist who holds an advanced practice
permit; relating to medical assistance for dental hygiene
services; and providing for an effective date."
5:15:45 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, as prime
sponsor, introduced HB 127. She paraphrased parts of the
sponsor statement [included in the committee packet], which read
in its entirety as follows [original punctuation provided]:
Oral health plays a crucial role in the overall health
and well-being of Alaskans. The lack of access to
dental care in Alaska has created enormous need in
communities that are underserved by the traditional
system of care. Dental diseases disproportionately
affect our state's most vulnerable populations and
rural areas where the access to treatment is limited.
We need all dental health care providers practicing to
the full scope of their training to address this
issue. Alaska would benefit from implementing an
innovative oral health care delivery model.
House Bill 127 would establish an Advanced Practice
Permit for Alaska-licensed dental hygienists while
continuing the collaborative agreement between
licensed dentists and dental hygienists. Dental
hygienists are skilled, licensed oral healthcare
professionals who focus on preventing and treating
oral diseases. HB 127 would allow dental hygienists
who meet the necessary advanced education, experience
and licensure requirements of the Advanced Practice
Permit to work independently within their scope of
practice across a variety of institutional and
organizational settings, including nursing homes,
schools, hospitals and clinics.
The creation of Advanced Practice Permits would allow
access to individuals who need oral care but cat get
to a dental office because of illness or disability,
create new consumer choices for preventive treatments
and services, educate individuals, families, and
caregivers on the basics of dental hygiene, and oral
health's connection to overall health and well-being.
Additionally, licensed dental hygienists would
identify more acute dental issues early on before they
become serious and provide referrals for patients
needing restorative treatment.
HB 127 removes barriers by allowing qualified,
licensed dental hygienists to practice to the full
extent of their professional training, experience and
scope of practice to help promote and restore oral
health to Alaska's underserved communities.
5:18:36 PM
CO-CHAIR WOOL suggested foregoing the sectional because of time
constraints.
5:18:51 PM
KATRINA VIRGIN, Alaska Dental Hygienists Association, stated
that dental hygienists would like the ability to use their scope
of practice to visit areas in Alaska that are underserved. The
4,000 clinical hours that they complete under a dentist's
supervision makes them more than competent to provide this care
she said.
5:20:22 PM
REPRESENTATIVE FIELDS requested additional information on the
areas that Ms. Virgin anticipates providing service to currently
underserved populations.
5:20:54 PM
MS. Virgin said would like to provide services in nursing care
facilities, where the oral systemic link has been greatly
associated with pneumonia. Another target population, she said,
would be schools, especially providing sealants to those with
underserved children. Correctional facilities and Homebound as
well, as both have individuals that cannot get into a dental
facility. She said their goal is to help asses oral health and
do as many preventative measures as possible, keep the bacteria
in the oral environment down to help decrease inflammation in
the overall body.
5:22:03 PM
REPRESENTATIVE SPOHNHOLZ referenced a list of dental health
professional shortage areas [provided in the bill packet], which
includes a list of geographic areas - healthcare communities
that are served by FQHCs as well as the Alaska Native Tribal
Healthcare Continuum. She noted that there is also a list in
the bill of the centers and facilities in which dental
hygienists would like the opportunity to have an advanced
practice in.
5:22:38 PM
REPRESENTATIVE HANNAN questioned whether dental hygienists are
allowed prescriptive authority in Alaska and what additional
training it takes.
5:23:19 PM
MS. VIRGIN explained that currently. there is no prescriptive
authority for dental hygienists in this state; however, eight
other states provide limited prescriptive authority. She added
that they are limited to fluoride prescriptions and anti-
microbial mouthwash, which would be the extent of the
prescriptive authority being asked for in this bill.
5:24:03 PM
REPRESENTATIVE SPOHNHOLZ noted that on page 2, lines 24-25, it
clearly defines the prescriptive authority that is being
outlined in the bill.
REPRESENTATIVE HANNAN sought clarification on whether limited
prescriptive authority is being granted in HB 127.
REPRESENTATIVE SPONHOLZ acknowledged that the bill grants dental
hygienists the authority to prescribe fluoride and anti-
microbial mouthwash.
REPRESENTATIVE SPOHNHOLZ, responding to a follow-up question
from Representative Hannan, said that a business license and
billing structure would be needed to practice independently,
adding that this bill creates the opportunity for independent
self-employment of advanced practice dental hygienists to set up
their own practice with their own Medicaid billing, which is
currently impossible without a collaborative agreement.
5:25:47 PM
REPRESENTATIVE REVAK asked what the fiscal note is for.
MS. VIRGIN said that was a base estimate due to the time it took
to collaborate with the ADS and the state Board of Dental
Examiners. She noted that it would be for the Medicaid system
portal that would be built for providing reimbursements.
REPRESENTATIVE REVAK asked if this would allow for billing
Medicaid for reimbursement.
5:27:14 PM
REPRESENTATIVE SPOHNHOLZ explained that HB 127 would allow
dental hygienists to bill Medicaid. She noted that currently
they are already paid for through Medicaid, so the bill is not
adding a new population of providers, just a new class within
the preexisting population. She said the fiscal note is to
update the MMIS system that processes and tracks the payments.
5:29:01 PM
REPRESENTATIVE STUTES pointed out that this will be helpful for
communities, like her own, with many rural villages. She sought
clarification if this bill would allow someone to set up own
their own business.
5:29:35 PM
MS. VIRGIN said she answered the question incorrectly yesterday,
adding that she should have said it would be very difficult to
set up shop in a rural area. She said the intention of the bill
is to provide underserved communities that do not have oral
healthcare, not to open individual practices. She continued by
saying that they are providing dental hygiene services because
the scope of practice is very limited.
5:31:44 PM
REPRESENTATIVE FIELDS commented that this bill has potential for
cost-savings if it's allows to identify dental problems earlier
instead of manifesting later at the ER, adding that it will be
interesting to see how the cost-savings materialize.
5:32:20 PM
REPRESENTATIVE REVAK sought clarification on what HB 127 solves,
regarding helping underserved communities.
REPRESENTATIVE SPOHNHOLZ said it's much like a physician's
assistant collaborative agreement that defines the scope of
practice; this would allow for them to provide work without a
collaborative agreement set up and increases access to dental
care.
5:34:35 PM
CO-CHAIR WOOL announced that HB 127 was held over.
5:36:38 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
5:36 p.m.