04/20/2022 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB131 | |
| SB174 | |
| SB151 | |
| HB276 | |
| HB176 | |
| HB392 | |
| Workers' Compensation Appeals Commission | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 131 | TELECONFERENCED | |
| += | SB 151 | TELECONFERENCED | |
| += | HB 276 | TELECONFERENCED | |
| += | HB 176 | TELECONFERENCED | |
| + | HB 392 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | SB 174 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
April 20, 2022
3:17 p.m.
MEMBERS PRESENT
Representative Zack Fields, Co-Chair
Representative Ivy Spohnholz, Co-Chair
Representative Calvin Schrage
Representative Liz Snyder
Representative David Nelson
Representative James Kaufman
MEMBERS ABSENT
Representative Ken McCarty
COMMITTEE CALENDAR
SENATE BILL NO. 131(TITLE AM)
"An Act relating to the presumption of compensability for a
disability resulting from certain cancers in firefighters."
- MOVED HCS SB 131(L&C) OUT OF COMMITTEE
CS FOR SENATE BILL NO. 174(EDC)
"An Act relating to dress codes and natural hairstyles."
- MOVED HCS CSSB 174(L&C) OUT OF COMMITTEE
SENATE BILL NO. 151
"An Act extending the termination date of the Alcoholic Beverage
Control Board; and providing for an effective date."
- MOVED HCS SB 151(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 276
"An Act relating to licensing of psychologists and psychological
associates; and relating to the practice of psychology."
- MOVED CSHB 276(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 176
"An Act relating to insurance; relating to direct health care
agreements; and relating to unfair trade practices."
- MOVED CSHB 176(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 392
"An Act relating to advanced practice registered nurses; and
relating to death certificates, do not resuscitate orders, and
life sustaining treatment."
- HEARD & HELD
CONFIRMATION HEARING(S):
Workers' Compensation Board
Matthew Barth Anchorage
Sara Faulkner Homer
Brad Austin Juneau
Randy Beltz Anchorage
Sarah Lefebvre - Fairbanks
Christopher Dean Fairbanks
- CONFIRMATION(S) HELD
Workers' Compensation Appeals Commission
Stephen Hagedorn Anchorage
- CONFIRMATION(S) HELD
Workers' Compensation Appeals Commission
PREVIOUS COMMITTEE ACTION
BILL: SB 131
SHORT TITLE: WORKERS' COMP DISABILITY FOR FIREFIGHTER
SPONSOR(s): SENATOR(s) HOLLAND
04/28/21 (S) READ THE FIRST TIME - REFERRALS
04/28/21 (S) CRA, L&C
05/06/21 (S) CRA AT 3:30 PM BELTZ 105 (TSBldg)
05/06/21 (S) Heard & Held
05/06/21 (S) MINUTE(CRA)
05/11/21 (S) CRA AT 3:30 PM BELTZ 105 (TSBldg)
05/11/21 (S) -- MEETING CANCELED --
05/13/21 (S) CRA AT 3:30 PM BELTZ 105 (TSBldg)
05/13/21 (S) Moved SB 131 Out of Committee
05/13/21 (S) MINUTE(CRA)
05/14/21 (S) CRA RPT 2DP 2NR
05/14/21 (S) DP: HUGHES, GRAY-JACKSON
05/14/21 (S) NR: MYERS, WILSON
05/14/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
05/14/21 (S) Moved SB 131 Out of Committee
05/14/21 (S) MINUTE(L&C)
05/17/21 (S) L&C RPT 4DP
05/17/21 (S) DP: COSTELLO, MICCICHE, GRAY-JACKSON,
STEVENS
05/18/21 (S) TRANSMITTED TO (H)
05/18/21 (S) VERSION: SB 131(TITLE AM)
05/19/21 (H) READ THE FIRST TIME - REFERRALS
05/19/21 (H) L&C
02/02/22 (H) L&C AT 5:15 PM BARNES 124
02/02/22 (H) Heard & Held
02/02/22 (H) MINUTE(L&C)
04/13/22 (H) L&C AT 3:15 PM BARNES 124
04/13/22 (H) Heard & Held
04/13/22 (H) MINUTE(L&C)
04/20/22 (H) L&C AT 3:15 PM BARNES 124
BILL: SB 174
SHORT TITLE: ALLOW NATURAL HAIRSTYLES
SPONSOR(s): SENATOR(s) WILSON
02/01/22 (S) READ THE FIRST TIME - REFERRALS
02/01/22 (S) EDC, L&C
02/16/22 (S) EDC AT 9:00 AM BUTROVICH 205
02/16/22 (S) Heard & Held
02/16/22 (S) MINUTE(EDC)
02/23/22 (S) EDC AT 9:00 AM BUTROVICH 205
02/23/22 (S) Moved CSSB 174(EDC) Out of Committee
02/23/22 (S) MINUTE(EDC)
02/25/22 (S) EDC RPT CS 1DP 4NR SAME TITLE
02/25/22 (S) DP: HOLLAND
02/25/22 (S) NR: HUGHES, STEVENS, BEGICH, MICCICHE
02/28/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/28/22 (S) Heard & Held
02/28/22 (S) MINUTE(L&C)
03/23/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/23/22 (S) Moved CSSB 174(EDC) Out of Committee
03/23/22 (S) MINUTE(L&C)
03/25/22 (S) L&C RPT CS(EDC) 3DP SAME TITLE
03/25/22 (S) DP: COSTELLO, GRAY-JACKSON, MICCICHE
03/30/22 (S) TRANSMITTED TO (H)
03/30/22 (S) VERSION: CSSB 174(EDC)
04/04/22 (H) READ THE FIRST TIME - REFERRALS
04/04/22 (H) L&C
04/11/22 (H) L&C AT 3:15 PM BARNES 124
04/11/22 (H) Heard & Held
04/11/22 (H) MINUTE(L&C)
04/15/22 (H) L&C AT 9:00 AM BARNES 124
04/15/22 (H) Scheduled but Not Heard
04/18/22 (H) L&C AT 3:15 PM BARNES 124
04/18/22 (H) <Bill Hearing Canceled>
04/20/22 (H) L&C AT 3:15 PM BARNES 124
BILL: SB 151
SHORT TITLE: EXTEND ALCOHOLIC BEVERAGE CONTROL BOARD
SPONSOR(s): SENATOR(s) MICCICHE
01/18/22 (S) PREFILE RELEASED 1/7/22
01/18/22 (S) READ THE FIRST TIME - REFERRALS
01/18/22 (S) L&C, FIN
02/09/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/09/22 (S) Moved SB 151 Out of Committee
02/09/22 (S) MINUTE(L&C)
02/11/22 (S) L&C RPT 3DP
02/11/22 (S) DP: STEVENS, MICCICHE, GRAY-JACKSON
02/24/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
02/24/22 (S) Heard & Held
02/24/22 (S) MINUTE(FIN)
03/01/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/01/22 (S) Moved SB 151 Out of Committee
03/01/22 (S) MINUTE(FIN)
03/04/22 (S) FIN RPT 3DP 3NR
03/04/22 (S) DP: STEDMAN, BISHOP, HOFFMAN
03/04/22 (S) NR: WILSON, WIELECHOWSKI, OLSON
03/09/22 (S) TRANSMITTED TO (H)
03/09/22 (S) VERSION: SB 151
03/14/22 (H) READ THE FIRST TIME - REFERRALS
03/14/22 (H) L&C, FIN
04/06/22 (H) L&C AT 3:15 PM BARNES 124
04/06/22 (H) -- MEETING CANCELED --
04/13/22 (H) L&C AT 3:15 PM BARNES 124
04/13/22 (H) Heard & Held
04/13/22 (H) MINUTE(L&C)
04/20/22 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 276
SHORT TITLE: PSYCHOLOGISTS: LICENSING AND PRACTICE
SPONSOR(s): LABOR & COMMERCE
01/18/22 (H) READ THE FIRST TIME - REFERRALS
01/18/22 (H) L&C, FIN
02/07/22 (H) L&C AT 4:30 PM BARNES 124
02/07/22 (H) -- MEETING CANCELED --
02/09/22 (H) L&C AT 4:30 PM BARNES 124
02/09/22 (H) Heard & Held
02/09/22 (H) MINUTE(L&C)
02/14/22 (H) L&C AT 3:15 PM BARNES 124
02/14/22 (H) <Bill Hearing Canceled>
04/11/22 (H) L&C AT 3:15 PM BARNES 124
04/11/22 (H) Heard & Held
04/11/22 (H) MINUTE(L&C)
04/13/22 (H) FIN REFERRAL REMOVED
04/13/22 (H) BILL REPRINTED
04/20/22 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 176
SHORT TITLE: DIRECT HEALTH AGREEMENT: NOT INSURANCE
SPONSOR(s): RASMUSSEN
04/16/21 (H) READ THE FIRST TIME - REFERRALS
04/16/21 (H) L&C, HSS
05/03/21 (H) L&C AT 3:15 PM BARNES 124
05/03/21 (H) Heard & Held
05/03/21 (H) MINUTE(L&C)
05/07/21 (H) L&C AT 8:00 AM GRUENBERG 120
05/07/21 (H) Heard & Held
05/07/21 (H) MINUTE(L&C)
05/12/21 (H) L&C AT 3:15 PM BARNES 124
05/12/21 (H) <Bill Hearing Canceled>
03/23/22 (H) L&C AT 3:15 PM BARNES 124
03/23/22 (H) Heard & Held
03/23/22 (H) MINUTE(L&C)
04/06/22 (H) L&C AT 3:15 PM BARNES 124
04/06/22 (H) -- MEETING CANCELED --
04/11/22 (H) L&C AT 3:15 PM BARNES 124
04/11/22 (H) Heard & Held
04/11/22 (H) MINUTE(L&C)
04/20/22 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 392
SHORT TITLE: EXPAND ADV. PRAC. REG. NURSE AUTHORITY
SPONSOR(s): SNYDER
02/22/22 (H) READ THE FIRST TIME - REFERRALS
02/22/22 (H) HSS, L&C
03/24/22 (H) HSS AT 3:00 PM DAVIS 106
03/24/22 (H) -- MEETING CANCELED --
03/29/22 (H) HSS AT 3:00 PM DAVIS 106
03/29/22 (H) Heard & Held
03/29/22 (H) MINUTE(HSS)
03/31/22 (H) HSS AT 3:00 PM DAVIS 106
03/31/22 (H) -- MEETING CANCELED --
04/14/22 (H) HSS AT 3:00 PM DAVIS 106
04/14/22 (H) Moved CSHB 392(HSS) Out of Committee
04/14/22 (H) MINUTE(HSS)
04/20/22 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
RICH ETHERIDGE, Fire Chief
Alaska Fire Chiefs Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 131.
ED KING, Staff
Senator Roger Holland
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: During the hearing on SB 131, answered a
question on behalf of Senator Holland, prime sponsor.
SENATOR DAVID WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, answered questions
related to CSSB 174(EDC).
MORGAN LIM, Government Relations Manager
Planned Parenthood Alliance Advocates
Juneau, Alaska
POSITION STATEMENT: Testified in support of CSSB 174(EDC).
SENATOR PETER MICCICHE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, provided testimony during
the hearing on SB 151.
CRYSTAL KOENEMAN, Staff
Representative Sara Rasmussen
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: During the hearing on HB 176, answered
questions on behalf of Representative Rasmussen, prime sponsor.
HEATHER CARPENTER, Health Care Policy Advisor
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During the hearing on HB 176, answered
questions.
LORI WING-HEIER, Director
Division of Insurance
Alaska Department of Commerce, Community, and Economic
Development
Anchorage, Alaska
POSITION STATEMENT: During the hearing on HB 176, answered
questions.
ALLIANA SALANGUIT, Staff
Representative Liz Snyder
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Snyder, prime
sponsor, provided the sectional analysis for CSHB 392(HSS).
MARIANNE JOHNSTONE-PETTY, DNP, APRN, FNP-C, ACHPN
Alaska APRN Alliance
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony in support of
CSHB 392(HSS).
SHANNON HILTON, DNP, AGACNP
American Association of Nurse Practitioners
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony in support of
CSHB 392(HSS).
MATTHEW BARTH, Appointee
Workers' Compensation Board
Division of Workers' Compensation
Department of Labor and Workforce Development (DLWD)
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Board.
SARA FAULKNER, Appointee
Workers' Compensation Board
Division of Workers' Compensation
Department of Labor and Workforce Development
Homer, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Board.
BRAD AUSTIN, Appointee
Workers' Compensation Board
Division of Workers' Compensation
Department of Labor and Workforce Development
Juneau, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Board.
RANDY BELTZ, Appointee
Workers' Compensation Board
Division of Workers' Compensation
Department of Labor and Workforce Development
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Board.
SARAH LEFEBVRE, Appointee
Workers' Compensation Board
Division of Workers' Compensation
Department of Labor and Workforce Development
Fairbanks, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Board.
CHRISTOPHER DEAN, Appointee
Workers' Compensation Board
Division of Workers' Compensation
Department of Labor and Workforce Development
Fairbanks, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Board.
STEPHEN HAGEDORN, Appointee
Workers' Compensation Appeals Commission
Department of Labor and Workforce Development (DLWD)
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Workers'
Compensation Appeals Commission.
ACTION NARRATIVE
3:17:31 PM
CO-CHAIR ZACK FIELDS called the House Labor and Commerce
Standing Committee meeting to order at 3:17 p.m.
Representatives Nelson, Snyder, and Fields were present at the
call to order. Representatives Schrage, Kaufman, and Spohnholz
arrived as the meeting was in progress.
SB 131-WORKERS' COMP DISABILITY FOR FIREFIGHTER
3:17:52 PM
CO-CHAIR FIELDS announced that the first order of business would
be SENATE BILL NO. 131(title am), "An Act relating to the
presumption of compensability for a disability resulting from
certain cancers in firefighters." [Before the committee was
Version I, the proposed House committee substitute (HCS) for SB
131(title am), Version 32-LS0598\I, Marx, 2/23/22, adopted as
the working document on 4/13/22.]
3:17:58 PM
CO-CHAIR FIELDS opened public testimony on SB 131.
3:18:11 PM
RICH ETHERIDGE, Fire Chief, Alaska Fire Chiefs Association,
testified in support of SB 131. He stated that SB 131 is a
monumental bill for improving safety for all firefighters.
3:18:34 PM
CO-CHAIR FIELDS closed public testimony after ascertaining that
no one else wished to testify.
3:19:07 PM
REPRESENTATIVE KAUFMAN moved to adopt Amendment 1 to Version I
of SB 131, labeled 32-LS0598\I.2, Marx, 4/15/22, which read:
Page 2, line 11:
Delete "and"
Page 2, line 12, following "cancer;":
Insert "and
(xvi) ovarian cancer;"
3:19:10 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
3:19:15 PM
REPRESENTATIVE KAUFMAN explained that the purpose of Amendment 1
is to add "ovarian cancer", which is currently missing from SB
131 (title am) but is known to be amongst the cancers that this
bill is addressing.
3:19:38 PM
ED KING, Staff, Senator Roger Holland, Alaska State Legislature,
answered on behalf of Senator Holland, prime sponsor of SB 131
(title am). He stated that Senator Holland is supportive of
Amendment 1.
3:19:52 PM
CO-CHAIR FIELDS removed his objection to Amendment 1. There
being no further objection, Amendment 1 was adopted.
3:20:13 PM
CO-CHAIR FIELDS moved to report the proposed HCS for SB
131(title am), Version 32-LS0598\I, Marx, 2/23/22, as amended,
out of committee with individual recommendations and the
accompanying fiscal notes.
3:20:35 PM
The committee took a brief at-ease.
3:20:57 PM
CO-CHAIR FIELDS announced that there being no objection, HCS SB
131(L&C) was reported out of the House Labor and Commerce
Standing Committee.
SB 174-ALLOW NATURAL HAIRSTYLES
3:21:08 PM
CO-CHAIR FIELDS announced that the next order of business would
be CS FOR SENATE BILL NO. 174(EDC), "An Act relating to dress
codes and natural hairstyles."
3:21:34 PM
The committee took an at-ease from 3:21 p.m. to 3:22 p.m.
3:22:05 PM
CHAIR SPOHNHOLZ, on behalf of Representative McCarty, moved to
adopt Amendment 1 to CSSB 174(EDC), labeled 32-LS1298\W.1, Marx,
4/8/22, which read:
Page 1, lines 6 - 7:
Delete "commonly or historically"
Page 2, lines 4 - 5:
Delete "commonly or historically"
3:22:19 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
3:22:23 PM
CO-CHAIR SPOHNHOLZ explained that Amendment 1 would delete the
language "commonly or historically" from within the bill, which
are terms used to describe hairstyles. She noted that the
amendment was drafted in consultation with the bill sponsor.
3:22:42 PM
SENATOR DAVID WILSON, Alaska State Legislature, as prime sponsor
of CSSB 174(EDC), stated he is supportive of Amendment 1. He
explained that there is confusion nationally when looking at
other states that have passed a CROWN Act [Create a Respectful
and Open World for Natural Hair Act], and it was felt that
deleting this language would make the bill a cleaner version.
3:23:00 PM
CO-CHAIR FIELDS removed his objection to Amendment 1. There
being no further objection, Amendment 1 was adopted.
3:23:09 PM
CO-CHAIR SPOHNHOLZ, on behalf of Representative McCarty, moved
to adopt Amendment 2 to CSSB 174(EDC), labeled 32-LS1298\W.2,
Marx, 4/12/22, which read:
Page 1, line 7:
Delete ", including wearing headwraps"
Page 2, line 5:
Delete ", including wearing headwraps"
3:23:12 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
3:23:13 PM
CO-CHAIR SPOHNHOLZ explained that Amendment 2 would delete in
two sections of the bill the language "including wearing
headwraps". She stated that the amendment was done in
consultation with the bill sponsor.
3:23:24 PM
SENATOR WILSON stated he is supportive of Amendment 2 because
headwraps do not pertain to hair necessarily. He said
"including wearing headwraps" was added in a Senate committee
and he would like to keep the bill related to hair and not hair
accessories. In response to Co-Chair Fields, he clarified that
he does support adopting Amendment 2.
3:24:32 PM
CO-CHAIR FIELDS removed his objection to Amendment 2. There
being no further objection, Amendment 2 was adopted.
3:24:54 PM
CO-CHAIR FIELDS opened public testimony on CSSB 174(EDC).
3:25:04 PM
MORGAN LIM, Government Relations Manager, Planned Parenthood
Alliance Advocates (PPAA), testified in support of CSSB
174(EDC). He stated that PPAA is committed to creating a world
in which all people have autonomy over their bodies and health.
He said dress codes banning certain hairstyles perpetuate racist
stereotypes and lead to over-policing and over-discipling of
BIPOC people [Black, Indigenous, and people of color], which has
real world consequences on educational, professional, and health
outcomes. He explained that, for many, Afrocentric and
Indigenous are an expression of identity and hold historic,
cultural, and spiritual significance. Over time hair has become
a link between history and current identities, he said, and
represents a rejection of Eurocentric notions that the texture
of white or European hair is inherently professional and
beautiful while the texture and styling of nonwhite hair is
inherently unprofessional and undesirable. He related that
extensive research shows that schools discriminatorily enforce
dress codes against Black students, especially Black girls due
to race and gender base stereotypes. Dress codes that police
hairstyles lead educators to discipline Black students and
students of color more often and more harshly than they do white
students. This discipline causes students to lose class time
which can deny equal opportunities and impact graduation rates
and access to higher education. He urged the bill's passage
from committee.
3:27:07 PM
CO-CHAIR FIELDS closed public testimony after ascertaining no
one else wished to testify.
3:27:26 PM
CO-CHAIR SPOHNHOLZ moved to report CSSB 174(EDC), as amended,
out of committee with individual recommendations and the
accompanying [zero] fiscal notes. There being no objection, HCS
CSSB 174(L&C) was reported out of the House Labor and Commerce
Standing Committee.
SB 151-EXTEND ALCOHOLIC BEVERAGE CONTROL BOARD
3:27:47 PM
CO-CHAIR FIELDS announced that the next order of business would
be SENATE BILL NO. 151, "An Act extending the termination date
of the Alcoholic Beverage Control Board; and providing for an
effective date."
CO-CHAIR FIELDS recounted that the committee heard a
recommendation that the Alcoholic Beverage Control Board (ABC
Board) be extended by four years and industry testimony asked
that the extension be longer. He said he is going to offer an
amendment that is an attempt to strike a balance with the two
recommendations.
3:28:37 PM
CO-CHAIR FIELDS moved to adopt Amendment 1 to SB 151, labeled
32-LS1280\A.2, Dunmire, 4/14/22, which read:
Page 1, line 5:
Delete "2026"
Insert "2027"
3:28:39 PM
CO-CHAIR SPOHNHOLZ objected for the purpose of discussion.
3:28:40 PM
CO-CHAIR FIELDS explained that Amendment 1 attempts a compromise
between the different positions offered by the Division of
Legislative Audit and industry. If adopted, the ABC Board would
be extended by five years and, if not adopted, the ABC Board
would be extended by four years. He said either way he will
support the bill.
3:29:08 PM
CO-CHAIR SPOHNHOLZ removed her objection to Amendment 1. There
being no further objection, Amendment 1 was adopted.
3:29:22 PM
CO-CHAIR FIELDS opened public testimony on SB 151, then closed
it after ascertaining that no one wished to testify.
3:30:03 PM
SENATOR PETER MICCICHE, Alaska State Legislature, as prime
sponsor of SB 151, stated that Amendment 1 is fair because it
listens to the concerns of the ABC Board yet respects the
concerns of the auditors.
3:30:55 PM
CO-CHAIR SPOHNHOLZ moved to report SB 151, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, HCS SB 151(L&C) was
reported out of the House Labor and Commerce Standing Committee.
HB 276-PSYCHOLOGISTS: LICENSING AND PRACTICE
3:31:20 PM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 276, "An Act relating to licensing of
psychologists and psychological associates; and relating to the
practice of psychology."
CO-CHAIR FIELDS reminded members that HB 276 is a committee bill
and that the proposed committee substitute (CS), labeled 32-
LS0963\I, Ambrose, 3/30/22, "Version I," was adopted as the
working document on 4/11/22. He said Version I reflects a
consensus with the industry and no amendments have been offered.
3:32:12 PM
CO-CHAIR FIELDS opened public testimony on HB 276, then closed
it after ascertaining that no one wished to testify.
3:32:25 PM
CO-CHAIR SPOHNHOLZ moved to report the proposed CS for HB 276,
version 32-LS0963\I, Ambrose, 3/30/22, out of committee with
individual recommendations and the accompanying [zero] fiscal
note. There being no objection, CSHB 276(L&C) was moved out of
the House Labor and Commerce Standing Committee.
HB 176-DIRECT HEALTH AGREEMENT: NOT INSURANCE
3:32:45 PM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 176, "An Act relating to insurance; relating
to direct health care agreements; and relating to unfair trade
practices." [The proposed committee substitute (CS), Version
32-LS0784\B, Marx, 4/7/22 ("Version B"), was adopted as the
working document on 4/11/22.]
3:33:14 PM
REPRESENTATIVE SNYDER moved to adopt Amendment 1 to Version B of
HB 176, labeled 32-LS0784\B.1, Marx, 4/13/22, which read:
Page 2, line 17:
Delete the second occurrence of "and"
Page 2, line 23, following "sex":
Insert "; and
(7) specify the number of
patients the health care provider has the
capacity to serve and the number of patients the
health care provider is currently serving"
3:33:17 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
3:33:20 PM
REPRESENTATIVE SNYDER explained that Amendment 1, for purposes
of consumer protection, would require the provider to specify
the number of patients that the health care provider has the
capacity to serve and the number of patients the health care
provider is currently serving. She said this would give an
individual considering a health care agreement an understanding
of the level of care and amount of attention that might
reasonably be expected from the health care provider.
3:34:16 PM
CRYSTAL KOENEMAN, Staff, Representative Sara Rasmussen, Alaska
State Legislature, on behalf of Representative Rasmussen, prime
sponsor of HB 176, related that the prime sponsor has no
objection to Amendment 1.
3:34:39 PM
CO-CHAIR FIELDS removed his objection to Amendment 1. There
being no further objection, Amendment 1 was adopted.
3:34:49 PM
REPRESENTATIVE SNYDER moved to adopt Amendment 2 to Version B of
HB 176, labeled 32-LS0784\B.3, Marx, 4/13/22, which read:
Page 4, line 19:
Delete "and"
Page 4, following line 19:
Insert a new paragraph to read:
"(4) the percentage of the patients that
entered into or maintained a direct health care
agreement with the health care practice in the
preceding calendar year who are paying fees and
costs under a direct health care agreement
through
(A) the federal Medicare program; and
(B) medical assistance under
AS 47.07;"
Renumber the following paragraph accordingly.
3:34:52 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
3:34:54 PM
REPRESENTATIVE SNYDER noted that Version B, the proposed CS,
includes a reporting requirement so it can be determined how
well this new approach is working and whether any areas need to
be improved. She explained that Amendment 2 would add to the
short list of information that would be tracked by requiring the
percentage of patients who are paying fees under a direct health
care agreement through the federal Medicare program or through
medical assistance under AS 47.07. She said this would provide
a sense of the spectrum of patients who are receiving care under
a direct health care agreement.
3:35:50 PM
REPRESENTATIVE KAUFMAN inquired about the end purpose of
gathering this information.
REPRESENTATIVE SNYDER replied that early research is showing a
trend that health care providers adopting the direct health care
agreement model are reducing the percentage of patients under
Medicare or Medicaid that they serve. There isn't a firm
understanding nationally on the extent of that trend, she said,
so if this is adopted in Alaska, it would help in understanding
what happens.
REPRESENTATIVE KAUFMAN said it sounds like the intent of the
amendment's sponsor is to have a quota system.
REPRESENTATIVE SNYDER responded not necessarily, it is for
assessing what is happening and whether this is or isn't a good
thing for Alaska, or whether other requirements are needed in
the future for direct health care agreements. She said she
isn't suggesting what the solution might be, but just getting
the information to ensure that all Alaskans regardless of
financial situation are able to access care consistently.
REPRESENTATIVE KAUFMAN reiterated that it sounds like it may be
for the purposes of a quota system.
REPRESENTATIVE SNYDER answered that someone advocating for a
quota system may be able to utilize this data to support that
argument, depending on what the data show. It may not support a
quota, she continued, and that is not something she has thought
beyond this amendment, only that the information would inform
the legislature's decisions moving forward.
3:37:58 PM
CO-CHAIR SPOHNHOLZ commented that different iterations of this
bill have been heard over the years, and an earlier version in a
previous legislature did have a required percentage of people on
Medicaid. She offered her understanding that Amendment 2 is not
a quota system but a transparency element to be able to
understand the way that this new approach intersects with other
important populations - seniors covered by Medicare and low-
income and disabled people on Medicaid. She stated that Alaska
has a crisis in access to care, particularly for people on
Medicare trying to find providers because the Medicare rates are
so low. Information is needed to understand whether this is
helping to meet the shortfall in Alaska or creating an
unintended consequence that may need to be remedied.
REPRESENTATIVE SNYDER confirmed that that's a fair description
of the intent with Amendment 2. She said the purpose of HB 176
is to improve access to care and to monitor how that is going to
ensure that improvement is happening. If other issues are
instead being opened, she continued, then information will be
had for informed decisions on how to fix that.
3:40:05 PM
CO-CHAIR FIELDS said this is an important amendment to ensure
that affordability is being maintained for diverse care groups.
MS. KOENEMAN specified that the prime sponsor is still analyzing
Amendment 2 and the impacts that it will have, and that there is
a level of concern with including those on federal programs.
One thought with having a direct primary care system, she
explained, is to potentially pull retired doctors or doctors
close to retirement because they would not be inundated; a
direct primary care system would allow more doctors to keep
providing care instead of leaving the workforce. She said the
prime sponsor will, as the bill moves forward, continue to
analyze whether it is a quota system or just reporting, given
they are distinctly different.
CO-CHAIR FIELDS invited comment from the Department of Health
and Social Services.
3:42:06 PM
HEATHER CARPENTER, Health Care Policy Advisor, Office of the
Commissioner, Department of Health and Social Services (DHSS),
answered that the department's main concern is including
Medicaid beneficiaries as individuals who can access direct
primary care agreements. She explained that that is in part
because there are limitations with Medicaid a provider must be
an enrolled Medicaid provider to serve a Medicaid beneficiary.
The department is reimbursing in a fee-for-service Medicaid
environment so the department doesn't have the same flexibility
that managed care might have. Additionally, she said, Medicaid
is the payor of last resort, which means DHSS must chase and
require any other third party in a third-party liability
situation to pay first. So, if Medicaid were allowed to access
these direct primary care agreements, there would be lots of
difficulty and bureaucracy and increased cost to the Medicaid
program. Ms. Carpenter further explained that individuals who
are on the Medicaid program have limited co-pays based on the
rules of the federal program, making it a very affordable
program for those who are enrolled. She offered to talk with
Representative Snyder offline to determine language that would
address both the representative's and the department's concerns
at the same time.
3:44:03 PM
CO-CHAIR FIELDS offered his understanding that under HB 176 a
Medicaid recipient could pay out of pocket for his or her direct
primary care.
MS. CARPENTER replied that the department also interprets the
bill that way. But, she noted, Medicaid covers a large breadth
of services, so DHSS would be concerned about what services
might be outside of that scope for which the individual would
want a direct primary care [agreement], and he or she would be
paying out of pocket for those services. Therefore, she pointed
out, the fiscal note includes indeterminate because the
department is unsure of the full implications to the Medicaid
program.
CO-CHAIR SPOHNHOLZ asked whether there is any prohibition within
federal Medicaid statute about participating in a direct health
care agreement.
MS. CARPENTER responded that she has received mixed signals on
that, so she will get back to the committee after more research.
REPRESENTATIVE SNYDER clarified that Amendment 2 does not make
any requirement for Medicare or Medicaid to be eligible for
direct care agreements, it would simply be a reporting
requirement for monitoring the success of the legislation.
3:45:54 PM
CO-CHAIR FIELDS withdrew his objection to Amendment 2. There
being no further objection, Amendment 2 was adopted.
3:46:05 PM
CO-CHAIR FIELDS moved to adopt Amendment 3 to Version B of HB
176, labeled 32-LS0784\B.4, Marx, 4/13/22, which read:
Page 1, line 1:
Delete "and"
Page 1, line 2, following "practices":
Insert "; and providing for an effective date"
Page 5, following line 29:
Insert new bill sections to read:
"* Sec. 4. The uncodified law of the State of
Alaska is amended by adding a new section to read:
TRANSITION: REGULATIONS. The director of the
division of insurance may adopt regulations necessary
to implement the changes made by this Act. The
regulations take effect under AS 44.62 (Administrative
Procedure Act), but not before the effective date of
the law implemented by the regulations.
* Sec. 5. Section 4 of this Act takes effect
immediately under AS 01.10.070(c).
* Sec. 6. Except as provided in sec. 5 of this Act,
this Act takes effect January 1, 2023."
3:46:06 PM
CO-CHAIR SPOHNHOLZ objected for the purpose of explanation.
3:46:08 PM
CO-CHAIR FIELDS explained that Amendment 3 was drafted in
consultation with the Division of Insurance and would provide
clarity that the Division of Insurance may adopt such
regulations as are necessary to implement the changes within HB
176. He said the amendment has value because a whole new type
of health care is being legalized and it must be ensured that
the appropriate department has appropriate regulatory authority.
MS. KOENEMAN, on behalf of the prime sponsor, stated that
Amendment 3 is important for the division, and the prime sponsor
considers the benefit necessary.
CO-CHAIR FIELDS invited the Division of Insurance to provide
comment.
3:47:30 PM
LORI WING-HEIER, Director, Division of Insurance, Alaska
Department of Commerce, Community, and Economic Development
(DCCED), thanked Co-Chair Fields for talking to the division and
sponsoring Amendment 3. She related that as the division
reviewed the bill, it was thought that in time the division may
need to fine tune it through regulation, such as some of the
reporting requirements and transparency at which the committee
is looking.
3:47:51 PM
CO-CHAIR SPOHNHOLZ removed her objection to Amendment 3. There
being no further objection, Amendment 3 was adopted.
CO-CHAIR FIELDS stated that this makes more sense than having to
legislate fine tuning provisions later.
3:48:23 PM
The committee took a brief at-ease.
3:48:36 PM
CO-CHAIR FIELDS stated that Amendment 4 would not be offered due
to Representative McCarty not being present.
3:48:44 PM
REPRESENTATIVE KAUFMAN moved to adopt Amendment 5 to Version B,
HB 176, labeled 32-LS0784\B.5, Marx, 4/14/22, which read:
Page 5, lines 14 - 19:
Delete "Before terminating a direct health care
agreement with an existing patient, a health care
provider shall ensure that the patient is transferred
to a health care provider who
(1) is able to provide the level or type of
care the patient requires; and
(2) agrees to provide to the patient the
level or type of care the patient requires."
3:48:46 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
3:48:48 PM
REPRESENTATIVE KAUFMAN explained that Amendment 5 would delete
the language requiring a health care provider to transfer a
patient if the provider can no longer serve that patient. He
said he fears that providers who are aware of that liability may
choose to not engage in the service and therefore Amendment 5 is
a well-intentioned amendment to make this a better opportunity.
MS. KOENEMAN, on behalf of the prime sponsor, stated that the
prime sponsor understands the concern and the burden this may
put on providers and will defer to the will of the committee.
3:50:06 PM
REPRESENTATIVE SNYDER requested more context as to whether this
is typical language seen in other states or something uniquely
developed here.
MS. KOENEMAN replied that the language was included in the
original bill and is to ensure that a person is not "left out to
dry by a provider." For example, she related, her own primary
care provider ran some tests and discovered that the level of
care she needed was outside his scope of practice, so he
referred her to another provider to take on that level of care.
Had he not made that referral she would have not known what to
do and would have had to search for a provider on her own. This
language, she continued, is to ease that burden from the patient
while understanding that it may throw an additional burden on
the provider. She said she doesn't know if a referral instead
of a transfer would achieve the same thing or whether it is
better to remove the language.
3:52:00 PM
REPRESENTATIVE KAUFMAN offered his belief that there are ethical
responsibilities to refer and that that is implicit in the oath
under which providers operate. He related that that was the
case when his own provider retired. It is a well-intentioned
clause, he said, but he fears it will inhibit and that the code
of ethics under which doctors operate should be relied upon to
provide referrals.
CO-CHAIR SPOHNHOLZ said she is conflicted because it may take a
while for a handoff to occur and therefore a simple referral may
not meet the need; a handoff may be needed to meet the
Hippocratic oath. She is conflicted, she continued, because of
the importance of ensuring ongoing patient management for
certain chronic issues; for example, people with diabetes could
lose their vision or limbs.
REPRESENTATIVE KAUFMAN responded that he understands the
concern, but that if attractive legislation is not created then
doctors will not sign up for the program. He cautioned that
requiring doctors to sign up for placement rather than referral
could be a bar that may limit the number of providers willing to
engage in the program.
3:55:00 PM
REPRESENTATIVE SNYDER asked whether any providers are available
online to answer questions.
CO-CHAIR FIELDS noted that no providers are online. He asked
Ms. Wing-Heier to provide perspective.
MS. WING-HEIER responded that the division believes Amendment 5
would help the bill because it has the same concern as
Representative Kaufman. The division agrees with referral, she
said, but transfer is problematic. There will be providers who
can give a referral but cannot guarantee a transfer, she
advised, a provider may be full and unable to take a new
patient. Or it might create stumbling blocks for providers when
someone's condition gets to a point where the provider is not
qualified to treat and does not know anybody because it is a
condition for which the patient must go out of state.
3:56:23 PM
CO-CHAIR SPOHNHOLZ stated that Amendment 5 applies only to
people who are already in a current direct care agreement and is
about a "warm handoff" to another provider. She offered her
understanding that the division believes that requiring a warm
handoff could potentially be a barrier to providers entering
into direct care agreements and creating more market capacity.
MS. WING-HEIER confirmed that that is right. She said the
division looked at it as if the first direct care provider is
trying to transfer a patient, or handoff a patient, to a second
direct care provider and the other one is at capacity and cannot
take any additional new patients, then a barrier has been
created for that person to transfer on. Referrals are one
thing, she continued, but the division thinks that ensuring they
are transferred is problematic.
3:57:36 PM
CO-CHAIR FIELDS stated he is hesitant to remove his objection to
Amendment 5 when language has not been agreed to by the bill
sponsor and personally he is supportive of some consumer
protection. He asked whether Ms. Koeneman has suggestions for
how to have some degree of protection for referrals or transfers
without an unnecessary barrier.
MS. KOENEMAN responded that she understands the Hippocratic oath
and the desire that there be a referral. She suggested that on
page 5 of Version B, line 15, the word "transferred" be changed
to "referred" to provide some overarching language in the
statute that directs providers to refer. She said the prime
sponsor would defer to the committee, however.
3:58:58 PM
REPRESENTATIVE SNYDER stated she was going to offer two possible
alternatives, one being to [change "transferred" to "referred"].
Another alternative, she said, could be removing the language
here as a requirement and instead require the [direct care]
agreement itself to specify yes or no regarding whether transfer
assistance is part of the agreement.
3:59:45 PM
REPRESENTATIVE KAUFMAN stated that the issue is still with
placing that obligation of placement. He said referral is
within the control of the physician, but transfer is not;
placing an obligation on someone for something on which they
have no control creates an untenable situation. He said he
could withdraw Amendment 5 and suggest a conceptual amendment
that states "referred" or "directed" rather than "transferred",
which would achieve more of a consensus agreement around what is
being looking for.
4:00:34 PM
CO-CHAIR FIELDS agreed with withdrawal of the amendment.
4:00:37 PM
REPRESENTATIVE KAUFMAN withdrew Amendment 5.
4:00:45 PM
The committee took a brief at-ease.
4:01:34 PM
CO-CHAIR SPOHNHOLZ moved to adopt Conceptual Amendment 1 to
Version B of HB 176.
4:01:52 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
4:01:53 PM
CO-CHAIR SPOHNHOLZ described Conceptual Amendment 1 as follows:
Page 5, line 15:
Delete "transferred"
Replace with "referred"
4:02:13 PM
REPRESENTATIVE KAUFMAN agreed with Conceptual Amendment 1.
4:02:20 PM
CO-CHAIR FIELDS removed his objection to Conceptual Amendment 1.
There being no further objection, Conceptual Amendment 1 was
adopted.
4:02:31 PM
REPRESENTATIVE KAUFMAN moved to adopt Amendment 6 to Version B
of HB 176, labeled 32-LS0784\B.7, Marx, 4/14/22, which read:
Page 1, line 8:
Delete "an annual"
Insert "a periodic"
Page 1, line 10:
Delete "annual"
Insert "periodic"
Page 1, line 11:
Delete "annual" in both places
Insert "periodic" in both places
Page 2, line 1:
Delete "annual"
Insert "periodic"
Page 2, line 9:
Delete "annual"
Insert "periodic"
Page 2, line 10:
Delete "annual"
Insert "periodic"
Page 2, line 18:
Delete "annual"
Insert "periodic"
Page 2, line 19:
Delete "annual"
Insert "periodic"
Page 3, line 11:
Delete "annual"
Insert "periodic"
Page 3, line 13:
Delete "annual"
Insert "periodic"
Page 4, line 17:
Delete "annual"
Insert "periodic"
4:02:36 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
4:02:38 PM
REPRESENTATIVE KAUFMAN said Amendment 6 would create greater
flexibility in the time period to allow agreements that are not
necessarily annual. He explained that by striking "annual" and
allowing "periodic" there could be six-month, monthly, or other
agreements to provide a structure that is most beneficial for
both a provider and the patient.
4:03:11 PM
MS. KOENEMAN, on behalf of the prime sponsor, stated that this
is the language which was contained in the original version of
the bill, so the prime sponsor is supportive of this language.
MS. WING-HEIER related that the division had asked for
"periodic" to be changed to "annual" simply because insurance
policies are annual. She posed a scenario of someone choosing
to buy a health care policy with a high deductible of $20,000
and buying a direct health care agreement at $100 a month. If
that changed in three months, she pointed out, then the person's
decision for the $20,000 deductible health care policy might not
have been the best one. That is the only reason the division
had asked for annual, she stated, but it is not a huge deal.
CO-CHAIR SPOHNHOLZ said she appreciates the intent to be more
flexible but since insurance is done on an annual basis, direct
care agreements should also be made on an annual basis.
Periodic is an undefined term whereas annual is clear, she
stated, and passage of this bill is to ensure access to this
kind of care as well as provide clarity, transparency, and
protection. She said she cannot support Amendment 6 as drafted.
4:05:37 PM
CO-CHAIR FIELDS maintained his objection.
4:05:42 PM
A roll call vote was taken. Representative Kaufman voted in
favor of Amendment 6 to HB 176, Version B. Representatives
Schrage, Snyder, Nelson, Fields, and Spohnholz voted against it.
Therefore, Amendment 6 to HB 176 failed to be adopted by a vote
of 1-5.
4:06:25 PM
The committee took a brief at-ease.
4:06:30 PM
CO-CHAIR SPOHNHOLZ moved to report the proposed CS to HB 176,
version 32-LS0784\B, Marx, 4/7/22, as amended, out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, CSHB 176(L&C) was moved out of
the House Labor and Commerce Standing Committee.
4:06:58 PM
CO-CHAIR FIELDS stated that he gives the Legislative Legal
Services the ability to make any necessary and conforming
changes.
HB 392-EXPAND ADV. PRAC. REG. NURSE AUTHORITY
4:07:14 PM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 392, "An Act relating to advanced practice
registered nurses and physician assistants; and relating to
death certificates, do not resuscitate orders, and life
sustaining treatment." [Before the committee was CSHB
392(HSS).]
4:07:55 PM
REPRESENTATIVE SNYDER, as the prime sponsor, introduced HB 392.
She stated that CSHB 392(HSS) would give advanced practice
registered nurses (APRNs) and physician assistants (PAs) the
signature authority for death certificates, do not resuscitate
(DNR) orders, and physician orders of life sustaining treatment
(POLST). She explained that APRNs are registered nurses with
additional education and specialized training that adequately
prepares them for this authority. She said APRNs have had the
authority to practice independently in Alaska since 1984 and are
recognized as primary care providers. Similarly, she continued,
PAs have master's degrees, plus additional clinical training,
and work as part of a health care team to examine, diagnose, and
treat patients. She stated that both APRNs and PAs frequently
oversee end of life care, but current statute does not allow
APRNs or PAs to sign the official papers documenting and
finalizing these decisions, only physicians can do so. This
creates an unnecessary paperwork bottleneck that can cause
additional delays and stress for families during an already
stressful time, she pointed out. She noted that the bill has
received broad support since its introduction, is narrow in
scope in that it simply allows APRNs and PAs to sign off on the
care they have provided, and it helps a vulnerable population
through difficult times.
4:10:22 PM
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska
State Legislature, on behalf of Representative Snyder, prime
sponsor, provided the sectional analysis for CSHB 392(HSS). She
paraphrased from the document in the committee packet titled
"SECTIONAL ANALYSIS HB 392: EXPAND ADV. PRAC. REG. NURSE
AUTHORITY Ver. B," which read as follows [original punctuation
provided]:
Sec. 1: Amends AS 08.68.700(a) Determination of death
by registered nurse by allowing a Registered Nurse
(RN) to pronounce or determine a death of a person if
a physician or an advanced practice registered nurse
(APRN) or physician assistant (PA) has documented in
the person's medical or clinical record that the
person's death is anticipated.
Sec. 2: Amends AS 08.68.700(b) by allowing an RN to
sign a determination of death if a physician, APRN, or
PA has previously documented the person's condition.
Sec. 3: Amends AS 08.68.700(c) by allowing an APRN or
PA to certify a death determined by an RN within 24
hours of the determination of death.
Sec. 4: Amends to 08.68.700(d) by adding "an advanced
practice registered nurse, or a physician assistant"
and physician assistant as a conforming change to
statute regarding health care facilities' policies and
procedures for determination and pronouncement of
death by a registered nurse.
Sec. 5: Amends AS 13.62.065 Do not resuscitate
protocol and identification requirements (a) by
allowing APRNs and PAs to issue a do not resuscitate
order.
Sec. 6 & 7: Adds conforming language to AS 13.62.065
Do not resuscitate protocol and identification
requirements to ensure APRNs and PAs are subject to
the same rules and protocols as physicians.
Sec. 8: Adds language to AS 13.62.065(f) Do not
resuscitate protocol and identification requirements
allowing APRNS and PAs to revoke a do not resuscitate
order.
Sec. 9: Adds "or an advanced practice registered
nurse, or a physician assistant" to 13.52.080(a)(5)
Immunities as a conforming change.
Sec. 10: Amends AS 13.52.100(c) Capacity by adding "an
advanced practice registered nurse, or a physician
assistant" to language regarding protocols and how do
not resuscitate orders govern decisions regarding
cardiopulmonary resuscitation and other life-
sustaining procedures.
Sec. 11: Amends AS 13.52.300 Optional Form by adding
"an advanced practice registered nurse, or physician
assistant" to the Advanced Health Care Directive Form.
Sec. 12: Amends AS 13.52.390(12) Definitions by adding
"an advanced practice registered nurse, or physician
assistant" to language defining "do not resuscitate
order."
Sec. 13: Amends AS 13.52.390(23) Definitions by adding
"an advanced practice registered nurse, or physician
assistant" to language defining "life-sustaining
procedures."
Sec. 14: Adds a new paragraph to AS 13.52.390(38)
defining an "advanced practice registered nurse" and
"physician assistant" by referring to the definition
in AS 08.68 Nursing and AS 08.64.107 Regulation of
Physician Assistants and Intensive Care Paramedic
respectively.
Sec. 15: Amends AS 18.15.230(c) by adding "advanced
practice registered nurse, or the physician assistant"
to the instructions for completing a death
certificate.
4:12:12 PM
REPRESENTATIVE SNYDER explained that the bill does not break new
ground, it updates Alaska statute to reflect current practices
elsewhere to improve access to care. The bill would bring
Alaska in line with 34 other states and the District of Columbia
where APRNs have full practice authority and are allowed to sign
DNR and POLST forms; 37 other states and the District of
Columbia where APRNs have full practice authority and can sign
death certificates; 30 states where PAs can sign DNR and POLST
forms; and 28 other states where PAs can sign a death
certificate. She added that nothing in the bill would change
practice protocol or guidelines with respect to patients wishes
for any of these actions, it would simply add APRNs and PAs to
the list of medical professionals who can sign the final
paperwork reflecting a patient's wishes.
4:13:20 PM
CO-CHAIR FIELDS opened invited testimony on CSHB 392(HSS).
4:13:38 PM
MARIANNE JOHNSTONE-PETTY, DNP, APRN, FNP-C, ACHPN, Alaska APRN
[advance practice registered nurse] Alliance, provided invited
testimony in support of CSHB 392 (HSS). She noted that she
holds a doctorate degree and specializes as an advanced
certified hospice and palliative nurse (ACHPN). She stated that
the bill would decrease costs, barriers, obstructions, and
inefficiencies in the care of the seriously ill. She said the
bill would simply update Alaska statutes to align with the APRN
state practice and licensing laws. She noted that APRN is an
umbrella term that includes certified nurse mid-wives, clinical
nurse specialists, certified registered nurse anesthetists, and
certified nurse practitioners, but that today's focus is
specifically on nurse practitioners.
DR. JOHNSTONE-PETTY pointed out that since 1984 nurse
practitioners in Alaska have had full practice authority as
independent practitioners. She said Alaska's practice and
licensing laws permit independent practitioners to diagnose,
order, and interpret diagnostic tests, and initiate and manage
treatments, including prescribing medications, meaning
independent practitioners do all this without having to have a
collaborative or supervisory agreement. In being able to do
this, she explained, APRNs have serious illness conversations
with patients and their families to help better care for them.
Part of those conversations need to lead to the completion of
forms, including POLST forms, death at home forms, DNR forms,
and death certificates. But at this time, she continued, APRNs
must rely on physician colleagues to come in and review what
they've done to take care of their patients.
DR. JOHNSTONE-PETTY conveyed that this is ongoing across the
nation - it is to align current practice with the statute and
ensure that APRNs can complete the forms for the practice that
they are providing for their patients. The best care of the
seriously ill, she said, requires that APRNs have signature
authority for medical orders and forms, such as DNR orders and
Alaska POLST and death certificates. That signature authority
is lacking right now, and the bill would simply update the
statutes to better align current practice.
4:16:26 PM
SHANNON HILTON, DNP, AGACNP, American Association of Nurse
Practitioners, provided invited testimony in support of CSHB 392
(HSS). She noted that she holds a doctorate degree in nursing
practice and is a board-certified adult gerontology acute care
nurse practitioner (AGACNP) and board-certified adult health
nurse practitioner. She stated that with their advanced
education, APRNs provide a tremendous amount of care for
Alaskans throughout the state. But, she continued, the statutes
that were written before nurse practitioners were providing the
level of care that they are today have not been updated to
include APRN signature on these very important documents. These
challenges for nurse practitioners and patients have caused
significant delays in care and unnecessary conversations during
very sensitive times in patient care, she related.
DR. HILTON pointed out that the documents in CSHB 392(HSS) serve
as an important guide and source of communication between health
care providers and their patients and the families of their
patients prior to a patient's advanced illness. For example,
she related, she may be the clinician directing the course of
treatment for a patient and facilitating difficult conversations
with family members, but the law does not recognize her
extensive knowledge and advanced care planning discussions on
this necessary paperwork. As a result of that, patients are
left with alternatives. The first is to locate and establish a
new patient relationship with another health care provider who
is recognized to complete these standard patient care forms.
Or, in the instance of critical care, [Alaska's] current health
care system is obligated to provide care that patients did not
want initially and that patients had prior indicated to their
primary care nurse practitioner that they did not want. The
disconnect between treating patients and signing paperwork, she
advised, contributes to costly unnecessary interruptions in care
and to delays at a very trying time.
DR. HILTON urged support for the bill because it would authorize
APRNs who are already treating the patients to also treat the
paperwork and to protect the autonomy of patients and respect
patient choices. She reiterated that similar reforms have
already been successfully implemented in other states.
4:19:59 PM
REPRESENTATIVE KAUFMAN, regarding the forms embedded in the
bill, stated that there is probably a variety of ways to create
the templates for the forms. He inquired whether the prime
sponsor wants these forms embedded in the bill.
REPRESENTATIVE SNYDER replied that those forms are already in
statute and are not embedded [in the bill].
REPRESENTATIVE KAUFMAN asked whether the prime sponsor is sure
that that is how to do this.
REPRESENTATIVE SNYDER deferred to the medical professionals to
answer the question.
4:21:04 PM
CO-CHAIR FIELDS relayed Representative Kaufman's question to the
witnesses and asked whether there should be further changes to
the underlying statute that CSHB 392(HSS) would change.
DR. JOHNSTONE-PETTY responded that as a hospice and palliative
care nurse practitioner she doesn't have a strong opinion one
way or another whether it is in statute, but her understanding
is to minimize statutes as much as possible. She said there are
multiple templates for advanced care planning documents in the
community that can be used and are readily available.
REPRESENTATIVE SNYDER drew attention to page 5, Section 11, of
the bill and said the form provided there is an optional sample
form that may be used. She agreed it may be worth having
discussion on the necessity of that since it isn't something
that is addressed in this specific bill.
MS. SALANGUIT related that in conversations with Legislative
Legal Services during the bill's drafting, the form was added as
a conforming change to make it line up with the rest of the
statutory changes.
4:22:51 PM
CO-CHAIR SPOHNHOLZ noted that her own advanced healthcare
directive is included with her legal documents, including her
will, which have been submitted to the court system to have on
file. She said a confidential paper copy has also been
submitted to local hospitals in Anchorage so her wishes can be
known should she arrive at the hospital while unconscious.
REPRESENTATIVE KAUFMAN responded that he understands the
function and that it is optional, but he is trying to determine
whether there is a more optimal place to park a template.
4:24:11 PM
REPRESENTATIVE NELSON inquired about the conversations that
happen in relation to a DNR.
DR. JOHNSON-PETTY replied that she has these conversations every
day as a hospice and palliative nurse practitioner. She said it
is not a situation of a patient wanting DNR and the practitioner
just hands the paper to the patient. Rather, she explained, it
is an in-depth conversation discussing who the patient is, what
the patient hopes to gain from it, what are the goals of the
patient's medical care, and why the patient would want something
like a DNR. Then it is a conversation about the forms that are
to be used and that are the legal forms in Alaska to protect the
patient from having procedures that the patient does not want.
The POLST form, she stated, is to ensure that the patient's and
family's wishes are abided.
4:25:36 PM
REPRESENTATIVE NELSON noted that not all APRNs specialize in
hospice care. He asked whether other APRNs would be qualified
to have that in-depth conversation about the various options,
especially the DNR option.
DR. JOHNSON-PETTY answered that she believes they do. She
pointed out that there are many nurse practitioners and PAs
across Alaska who are caring for patients and families,
including patients in rural and remote settings. She noted that
there is a lengthy amount of training through the website of
akpolst.org. She further pointed out that all physicians, not
just physicians with hospice training, are able to complete
these forms and there haven't been issues with that. She also
noted that other states have not made it just for a specific
type of APRN, it has been for all APRNs to ensure that the
patient has access to these documents.
REPRESENTATIVE NELSON related his understanding that while in
medical school physicians must take classes in ethics, end of
life care, and DNR. He inquired about the training for APRNs.
DR. JOHNSON-PETTY replied that nurse practitioners receive
extensive training in advanced physiology, ethics, and
pharmacology, along with completing clinical hours, to become an
APRN. She said APRNs therefore have the training to have these
types of conversations.
4:28:06 PM
CO-CHAIR SPOHNHOLZ pointed out that advanced health care
directives are developed in consultation with health care
practitioners and in estate planning conversations. She said it
is a form used by many professionals who have this expertise so
it can be acted upon if the person becomes unable to make those
decisions for himself or herself. The bill, she continued, is
referencing a form that is used by a broad group of providers
who are trained in having these conversations with folks.
[CSHB 392(HSS) was held over.]
^CONFIRMATION HEARING(S):
^CONFIRMATION HEARING(S):
^Workers' Compensation Board
Workers' Compensation Board
^Workers' Compensation Appeals Commission
Workers' Compensation Appeals Commission
4:29:29 PM
CO-CHAIR FIELDS announced that the final order of business would
be consideration of the governor's appointees to two boards.
4:29:44 PM
MATTHEW BARTH, Appointee, Workers' Compensation Board, Division
of Workers' Compensation, Department of Labor and Workforce
Development (DLWD), testified as appointee to the Workers'
Compensation Board. He stated he has been a police officer in
Anchorage for about 15 years and is excited to apply his skills
and abilities as a member of this board. He said he was
appointed to the board earlier this year and has worked as a
board member attending multiple hearings to date.
4:30:57 PM
CO-CHAIR FIELDS asked whether Mr. Barth is a member of the
Anchorage Police Department Employees Association (APDEA).
MR. BARTH replied that he has been an APDEA member for about 15
years. He said he is also an APDEA trustee and a member on
multiple committees for the APDEA.
4:31:40 PM
SARA FAULKNER, Appointee, Workers' Compensation Board, Division
of Workers' Compensation, Department of Labor and Workforce
Development, testified as appointee to the Workers' Compensation
Board, Southcentral Panel industry seat. She stated that she
worked for ARCO in the 1980s, then in 1990 she and her husband
moved to Homer after having purchased Land's End Resort in 1988.
She noted that she has served on the board since 2019 and enjoys
serving because of the positive impact that the board's work has
in the life of the injured worker and in improving business
practices. She said listening is one of her skills and she
respects her fellow board members and collaborates with them
during deliberations.
4:32:57 PM
BRAD AUSTIN, Appointee, Workers' Compensation Board, Division of
Workers' Compensation, Department of Labor and Workforce
Development, testified as appointee to the Workers' Compensation
Board. He stated that he works for the Plumbers and Pipefitters
Local Union 262. He said he is the labor member of the board's
two-person Southeast Panel and has served on the board since
October 2010. Longevity on the board is important, he added,
because of sometimes dealing with complex legal and medical
issues. He noted that the Southeast Panel approves the self-
insurance for employers that provide their own workers'
compensation insurance. He said the board also takes care of
the regulations for the Division of Workers' Compensation, sits
as panel members for quasi-judicial hearings, and reviews and
approves or disallows settlement agreements.
4:34:40 PM
RANDY BELTZ, Appointee, Workers' Compensation Board, Division of
Workers' Compensation, Department of Labor and Workforce
Development, testified as appointee to the Workers' Compensation
Board. He stated he is currently the North Slope manager for
North Star Equipment Services/North Star Terminal and Stevedore
Company, and incoming president of the Alaska Support Industry
Alliance. He said this would be his second three-year
appointment on the board and added that he concurs with Mr.
Austin about the importance of longevity on the board. He said
he is a good listener and a fair and impartial board member.
4:36:04 PM
SARAH LEFEBVRE, Appointee, Workers' Compensation Board, Division
of Workers' Compensation, Department of Labor and Workforce
Development, testified as appointee to the Workers' Compensation
Board. She said she is up for re-appointment to the industry
seat of the board's Northern Panel. She stated she has been on
the board since about 2008 and has worked in heavy civil
construction since 1998. She said she agrees that longevity on
the board is important and that the work done by the board is
important because lives are at stake.
4:37:10 PM
CHRISTOPHER DEAN, Appointee, Workers' Compensation Board,
Division of Workers' Compensation, Department of Labor and
Workforce Development, testified as appointee to the Workers'
Compensation Board. He said his background is health care
related, both in care delivery and administration, that he
currently works for Foundation Health Partners, and that he is a
licensed athletic trainer. He stated that he has a long history
of professional and civic service and enjoys the opportunity to
serve his profession and the community, having served on boards
and committees at the local, state, and national levels. He
said he understands and respects the responsibility that his
appointment to this board represents.
4:38:26 PM
CO-CHAIR SPOHNHOLZ observed from Mr. Dean's application that he
originally applied to serve on two other boards. She asked how
he came to apply to serve on the Workers' Compensation Board.
MR. DEAN responded that when he applied last spring there was an
opening on the Physical Therapy and Occupational Therapy Board,
but it was determined that he was ineligible to serve on that
board because his organization owns a physical therapy and
occupational therapy practice. The governor's office asked him
whether he would be interested in serving on the Workers'
Compensation Board given his experience with administrative work
in his practice, he continued, and that is how he applied. He
said he has already attended some hearings and is excited to
serve because the board provides a much-needed service to the
state and to injured workers.
4:40:11 PM
STEPHEN HAGEDORN, Appointee, Workers' Compensation Appeals
Commission, Department of Labor and Workforce Development
(DLWD), testified as appointee to the Workers' Compensation
Appeals Commission. He said he worked for the Alaska Railroad
Corporation from 1975-2009 and was the Corporate Risk Manager
for the last 24 years of his career. He noted that he was first
appointed to the board in 1991 by Governor Walter Hickel where
he served for a little over 15 years before accepting an
appointment to the Workers' Compensation Appeals Commission, on
which he has served since 2008. He said he has enjoyed the task
of appeals that come from the Workers' Compensation Board as it
keeps him very involved with the law and the caseload.
4:41:55 PM
CO-CHAIR FIELDS opened public testimony on the governor's
appointees to the two boards, then closed it after ascertaining
that no one wished to testify.
[The confirmation hearings were held over.]
4:42:38 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:42 p.m.