Legislature(2017 - 2018)SENATE FINANCE 532
05/30/2017 03:30 PM Senate FINANCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB159 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 159 | TELECONFERENCED | |
SENATE FINANCE COMMITTEE
FIRST SPECIAL SESSION
May 30, 2017
3:47 p.m.
3:47:40 PM
CALL TO ORDER
Co-Chair MacKinnon called the Senate Finance Committee
meeting to order at 3:47 p.m.
MEMBERS PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Anna MacKinnon, Co-Chair
Senator Click Bishop, Vice-Chair
Senator Shelley Hughes
Senator Peter Micciche
Senator Donny Olson
Senator Natasha von Imhof
MEMBERS ABSENT
None
ALSO PRESENT
Sara Chambers, Director, Division of Corporations, Business
and Professional Licensing, Department of Commerce,
Community and Economic Development; Laura Cramer, Staff,
Senator Anna MacKinnon; Jay Butler, Chief Medical Officer,
Department of Health and Social Services.
PRESENT VIA TELECONFERENCE
Richard Holt, Vice Chair, Alaska Board of Pharmacy,
Department of Commerce, Community and Economic Development;
Paul Barney, Chair, Alaska Board Examiners in Optometry,
Department of Commerce, Community and Economic Development.
SUMMARY
HB 159 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES
SCS CSHB 159(FIN) was REPORTED out of committee
with a "do pass" recommendation and with two
previously published fiscal notes: FN2(DHS),
FN3(CED).
CS FOR HOUSE BILL NO. 159(FIN) am
"An Act relating to the prescription of opioids;
relating to voluntary nonopioid directives; relating
to the controlled substance prescription database;
relating to the practice of dentistry; relating to the
practice of pharmacy; relating to the practice of
medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to
the practice of nursing; relating to the practice of
optometry; relating to the practice of veterinary
medicine; relating to the duties of the Board of
Pharmacy; relating to pharmacists; providing for an
effective date by repealing the effective date of sec.
73, ch. 25, SLA 2016; and providing for an effective
date."
3:48:19 PM
Co-Chair MacKinnon directed attention to CSHB 159(FIN)am.
She asked for an overview of the bill.
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, introduced herself.
JAY BUTLER, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, introduced himself.
Ms. Chambers reviewed the sectional analysis (copy on
file):
Note: Sec. 1 adds legislative intent language
regarding the seven-day initial prescription limit
Sec. 1: Adds language stating the intent of the
legislature is for the seven-day supply limit not to
be considered the minimum appropriate time for an
initial prescription. The Center for Disease Control
and Prevention suggests a three-day initial
prescription limit and practitioners should use
professional judgment in determining prescription
lengths.
Note: Sec. 2 - 27 amend individual board statutes
regarding: education requirements for initial
licensure; continuing education requirements for
licensure renewal; disciplinary authority of Board's
pertaining to the maximum opioid prescription limit;
sets a maximum opioid prescription limit of 7 days for
the initial prescription (with exceptions); and
defines opioids.
Sec. 2: Amends the Board of Dental Examiners statutes
by requiring the Board to adopt regulations for
renewal of licensure to include a minimum of two hours
of continuing education in pain management and opioid
misuse and addiction in the previous two years
preceding renewal, unless the licensee has
demonstrated to the satisfaction of the Board that the
licensee does not currently hold a valid federal Drug
Enforcement Agency (DEA) registration number.
Sec. 3: Amends the Board of Dental Examiners statutes
by requiring the Board to adopt regulations for
licensure qualifications to include a minimum of two
hours of education in pain management and opioid
misuse and addiction in the two years preceding the
application for a license, unless the applicant has
demonstrated to the satisfaction of the Board that the
applicant does not currently hold a valid federal DEA
registration number.
Sec. 4: Amends the Board of Dental Examiners statutes
for disciplinary authority. It allows the Board to
discipline, revoke, suspend, reprimand or censure a
license of a dentist, if the Board finds a licensee
has prescribed or dispensed an opioid in excess of the
maximum dosage authorized under AS 08.36.355, or
procured, sold, prescribed, or dispensed drugs in
violation of a law, regardless of whether there has
been a criminal action or patient harm.
Sec. 5: Adds a new section to the Board of Dental
Examiners statutes limiting the dosage for an opioid
prescription to a seven-day supply for an adult or
minor. The dentist must discuss with the parent or
guardian of a minor why the prescription is necessary
and the risks associated with the opioid use. A
dentist may issue a prescription for greater than a
seven-day supply to an adult or minor patient if, in
the professional judgement of the dentist, more than a
seven-day supply is necessary for; the chronic pain
management, or a patient who is unable to access a
practitioner within the time necessary for a refill of
the seven-day supply because of a logistical or travel
barrier. The dentist must document in the patient's
medical record the condition requiring the excess of a
seven-day supply, and indicate a non-opioid
alternative was not appropriate to treat the
condition. The section defines "adult" and "minor."
Sec. 6: Amends the Board of Dental Examiner statutes
by adding a definition of an "opioid."
Ms. Chambers highlighted that Sections 7 through 14
pertained to the medical board. She specified that the
sections dealt with education on opioid use, addiction, and
pain management for the various license types that had
prescribing authority and were managed by the medical
board.
Ms. Chambers continued discussing the Sectional Analysis:
Sec. 15: Amends Medical Board disciplinary authority.
The Board may impose a disciplinary sanction if the
Board finds that a licensee has prescribed or
dispensed an opioid in excess of the maximum dosage.
Ms. Chambers explained that Section 16 provided the Medical
Board the same limitation in prescribing opioids as dental
examiners (a seven-day supply). There was an opportunity to
exceed seven days using professional judgement or due to
logistical or travel barriers, which must be codified in a
patient's medical record.
Ms. Chambers relayed that Section 17 amended Medical Board
statute for prescription drugs without a physical
examination. She continued that the amendment harkened back
to legislation from the previous year regarding
telemedicine, and conformed the bill to existing session
law put in place in the current year.
Ms. Chambers continued discussing the sectional analysis:
Sec. 18: Amends Medical Board statute by adding and
defining "opioid" to include the opium and opiate
substances and opium and opiate derivatives listed in
AS 11.71.140.
Ms. Chambers communicated that Sections 19 through 21 all
pertained to education and discipline for the Board of
Nursing. There were requirements for two hours of education
on opioid use and addiction, as well as the ability to
discipline for overprescribing by an advanced nurse
practitioner.
3:53:01 PM
Ms. Chambers turned to Section 22, which limited licensees
of the Board of Nursing to prescribing a seven-day supply
of an opioid. The same waiver was in place - the
professional judgement or logistical or travel barriers
must be documented. Section 23 defined opioid and Board of
Nursing statutes. Sections 24 through 26 required education
for licensees of the Board of Optometry on opioid misuse,
addiction, and pain management. Optometrists would be
required to take two hours within the four years preceding
renewal as opposed to the previous licensing period.
Section 27 amended the Board of Optometry's disciplinary
authority (similar to the other license types discussed)
when there was overprescribing or illegal prescribing.
Ms. Chambers relayed that Sections 28 and 29 pertained to
the Board of Pharmacy. Section 28 included a technical fix
to conform to session law taking effect in July 2017. She
detailed that pharmacists did not obtain DEA registration
numbers, so it was being removed from law. Section 29
amended the Board of Pharmacy statutes to allow pharmacists
to partially fill prescriptions for Schedule II or III
controlled substances. She elaborated that if the
individual did not want to obtain the entire prescription,
they could obtain part of the prescription and go back for
the remainder at a later date.
3:55:04 PM
Vice-Chair Bishop asked for verification that if a patient
chose to only receive four days' worth of the seven-day
prescription, they would only receive the remaining balance
of the prescription if they came back at a later date.
Ms. Chambers answered in the affirmative.
Ms. Chambers continued discussing the Sectional Analysis.
Section 30 pertained to the Board of Veterinary Examiners.
She detailed the section would require board licensees to
take educational courses that would help them to identify
resources to assist them with identifying an animal owner
who may be at risk for abusing or misusing an opioid. The
section would also require the board to identify and
develop related educational materials to provide to its
licensees. The education requirement was slightly different
from the other license types who were prescribing directly
to a human. Section 31 provided the Board of Veterinary
Examiners the opportunity to discipline a licensee who
prescribed or dispensed an opioid in excess of the maximum
dosage authorized under a previous section. She continued
with the sectional analysis:
Sec. 32 - Establishes the Voluntary Nonopioid
Directive
Sec. 32: The section allows an individual who is 18
years of age or older, an emancipated minor or a
parent or legal guardian of a minor, or an
individual's guardian or other person appointed by the
individual or court to manage the individual health
care to execute a voluntary non-opioid directive in a
format prescribed by the Department of Health and
Social Services. The section further provides that a
licensed healthcare providers, hospitals, and
employees, and pharmacists are exempt from licensing
board discipline, civil and criminal liability for
failure to administer, prescribe, or dispense an
opioid to an individual who has executed a voluntary
non-opioid directive. The directive does not limit a
healthcare provider or pharmacist from prescribing,
dispensing, or administering an opioid overdose drug
or an opioid for the treatment of substance abuse or
opioid dependence.
Note: Sec. 33-42 - Changes relating to the
Prescription Drug Monitoring Program (PDMP); updating
the definition of opioid; and prescriber "report
cards."
Sec. 33: Amends AS 17.300.200(a) to exclude certain
facilities from the requirements of the controlled
substance prescription database (also known as the
PDMP). This section references a section "u" of the
PDMP (see section 42) where by correctional facilities
are exempt from the PDMP except when prescribing
opioids to an inmate at the time of the inmate's
release as in-patient pharmacies and emergency rooms
are exempt if they are only prescribing less than a
24-hour supply of opioids (see also section 41).
Sec. 34: Amends AS 17.300.200(b) to exclude
correctional facilities from the requirements of the
controlled substance prescription database except when
prescribing opioids to an inmate at the time of the
inmate's release. Note: This is required due to the
delayed effective dates from SB 74 and this bill.
Sec. 35: Amends AS 17.30.200(b) as amended by sec. 23,
ch. 25, SLA 2016 by substituting "weekly" with
"daily." The change will require the pharmacist-in-
charge of a pharmacy, and each practitioner who
dispenses a schedule II, III, or IV controlled
substance, to submit the information to the controlled
substance prescription database daily instead of
weekly. (Note: This is required due to the delayed
effective dates from SB 74 and this bill).
Sec. 36: Amends AS 17.30.200(d) as amended ch. 25, SLA
2016 to clarify that information contained in the PDMP
can be shared with federal, state and local law
enforcement that have a valid search warrant or court
order.
Sec. 37: Amends AS 17.30.200(e) as amended by ch. 25,
SLA 2016 to clarify that a pharmacist, the individual
filling a prescription, is required to submit
information into the database. It is the
responsibility of the practitioner, the individual
writing the prescription, to review the database.
Sec. 38: Amends AS 17.30.200(p) as amended by ch. 25,
SLA 2016 to require the Board of Pharmacy shall
promptly notify the Board of Veterinary Examiners when
a practitioner registers with the database under (o)
of the section.
3:59:28 PM
Ms. Chambers continued to discuss the sectional analysis:
Sec. 39: Amends AS 17.30.200(q) as amended by, ch. 25,
SLA 2016 is amended by allowing the Board of Pharmacy
to provide unsolicited notification to the
practitioner's licensing board if a patient has
received one or more prescriptions for controlled
substances in quantities or with a frequency
inconsistent with generally recognized standards of
safe practice. The unsolicited notification to a
practitioner's licensing board under the section must
also be provided to the practitioner, is considered
confidential, may not disclose confidential
information under the section, and may be in a summary
form sufficient to provide notice of the basis for the
unsolicited notification.
Sec. 40: Amends AS 17.30.200(r) as amended by ch. 25,
SLA 2016 to provide guidance so to when the Board must
update the requirement that pharmacists and
prescribers must comply with the database on a daily
basis rather than a weekly basis.
Sec. 41: Amends AS 17.30.200(n) as amended by ch 25,
SLA 2016 to update the definition of opioid to include
the opium and opiate substances and opium and opiate
derivatives listed in AS 11.71.140.
Sec. 42: Adds a new section (t) to AS 17.30.200,
giving the Board of Pharmacy the authority to issue
periodic unsolicited "report cards" with non-
identifiable information comparing the practitioner's
opioid prescribing practices with others in the same
occupation. However, this information is confidential
and cannot be released to others. Also adds a new
section (u) to AS 47.17.200, giving the Board of
Pharmacy the ability to exempt in-patient pharmacies
and emergency rooms from the review and submission
requirement of the PDMP when they are dispensing no
more than a 24-hour supply of opioids upon discharge.
4:01:14 PM
Co-Chair MacKinnon asked for verification that Sections 33
and 34 exempted correctional facilities from reporting
requirements. Ms. Chambers answered in the affirmative.
Co-Chair MacKinnon remarked that subsection (u) [Section
45, subsection (u)] was broader than language in Sections
33 and 34. She noted that subsection (u) pertained to a
health care facility or a correctional facility. She
elaborated that the 24-hour threshold was for an in-patient
pharmacy like a senior home (e.g. Pioneer Homes) or
emergency departments. She asked for the accuracy of her
statements.
Ms. Chambers responded that the statements were accurate.
Ms. Chambers continued to review the sectional analysis:
Note: Sec. 43-45 - Relate to regulations and repeal
PDMP effective dates
Sec. 43: Amends AS 18.05.040 to give authority for the
Commissioner of Health & Social Services shall adopt
regulations consistent with existing law for
implementation of AS 13.55, Voluntary Nonopioid
Directive Act.
Sec. 44: Repeals various sections from ch. 25, SLA
2016 related to the July 2018 effective dates for the
PDMP in SB 74.
Sec. 45: Provides transitional authority for the
Department of Commerce and Economic Development and
Department of Health and Social Services to draft
regulations to implement changes to the PDMP prior to
the effective date of certain sections. This is a
technical fix.
Note: Sec. 46-55 - Refer to Effective Dates
Sec. 46, 47, 48, 49, 50, 51, 52: Relate to the various
changes to the PDMP related to the effective dates
under SB 74. This is necessary because the changes to
the PDMP under SB 74 are not in effect until July 18,
2017.
Sec. 53: These are the new effective dates from the
PDMP (July 1, 2018).
Sec. 54: The advance directive sections of the bill
(sections 32 and 43) take effect on July 1, 2019.
Sec. 55: All other provisions of the bill take effect
immediately.
Co-Chair MacKinnon asked if the weekly requirement would go
into effect July 2017.
Ms. Chambers agreed that the weekly requirement would take
place for a period of one year and the daily requirement
would be implemented in July 2018.
4:03:26 PM
Co-Chair MacKinnon asked Dr. Butler if he had any comments
regarding the work draft. Dr. Butler responded in the
negative.
Vice-Chair Bishop MOVED to ADOPT proposed committee
substitute (CS) for CSHB 159(FIN)am, Work Draft 30-GH1021\N
(Mischel/Bruce, 5/30/17).
Co-Chair MacKinnon OBJECTED for discussion. She asked her
staff to review changes in the CS (version N).
LAURA CRAMER, STAFF, SENATOR ANNA MACKINNON, informed the
committee that the CS incorporated several changes made in
the Senate Health and Social Services committee as well as
changes identified in conversations with the various boards
outlined in the legislation.
Ms. Cramer discussed a document titled "Summary of Changes"
(copy on file):
Page 2, lines 2-3 and lines 10-11: Conforming language
to Section 28 relating to the four-day supply limit
for an initial opioid prescription for the Board of
Examiners in Optometry.
Page 7, line 9: Amends the definition of opioid to
include Schedule IIIA controlled substances
(11.71.160).
Page 15, line 20: Conforming change for the inclusion
of Schedule IIIA controlled substances (11.71.160) to
the definition of opioid.
Page 19, line 28: Conforming change for the inclusion
of Schedule IIIA controlled substances (11.71.160) to
the definition of opioid.
Page 22, line 2-10: Amends statute for the Board of
Optometry removing the hour requirement for the
board's education in prescription of pharmaceutical
agents and injection of therapeutic pharmaceutical
agents which will be handled through regulation.
Ms. Cramer elaborated on the change on page 22. She relayed
the intent was to manage the number of hours through
regulation, not statute.
Co-Chair MacKinnon asked the language was consistent with
all or most other boards.
Ms. Cramer replied in the affirmative. She added that the
educational requirement set by the Board of Optometry was
already higher than the statutory requirement.
4:07:02 PM
Ms. Cramer continued to discuss the Summary of Changes:
Page 23, lines 13-14: Amends the Board of Examiners in
Optometry - Grounds for imposition of disciplinary
sanctions (08.72.240) stating that the Board may
impose disciplinary sanctions when the board finds
after a hearing that the licensee (10) prescribed or
dispensed an opioid in excess of the maximum dosage
authorized under Maximum dosage for opioid
prescriptions (Sec. 28).
Page 23, line 18 - Page 24, line 12: Section 28 -
Amends the Board of Examiners in Optometry
(1) A licensee may not issue an initial prescription
for an opioid that exceeds a four-day supply to an
adult
(2) For a prescription that exceeds a four day supply
to a minor, requires the licensee to discuss with the
parent of legal guardian why the prescription is
necessary and the risks associated with opioid use
(b) Allows the Optometrist to exceed the four-day
supply if the Optometrist determines it is necessary
(1) Requires the Optometrist to document the
patient's medical condition or chronic pain
triggering the need for the opioid in excess of
four-days
(2) Allows the Optometrist to take into
consideration logistical of travel barriers when
writing an opioid prescription.
Page 27, lines 20-21: Amends the Board of Veterinary
Examiners - Grounds for imposition of disciplinary
sanctions (08.98.235) stating that the Board may
impose disciplinary sanctions when the board finds
after a hearing that the person (9) prescribed or
dispensed an opioid in excess of the maximum dosage
authorized under Maximum dosage for opioid
prescriptions (Sec. 33).
Page 27, line 24 - Page 28 line 13: Section 33 -
Amends the Board of Veterinary Examiners
(a) A veterinarian may not issue an initial
prescription for an opioid that exceeds a seven-day
supply to the owner of an animal for outpatient use
(b) Allows the veterinarian to exceed the seven-day
supply if the veterinarian determines it is necessary
(1) Requires the veterinarian to document the
animals condition or chronic pain triggering the
need for the opioid in excess of seven-days
(2) Allows the veterinarian to take into
consideration logistical or travel barriers when
writing a prescription.
4:10:14 PM
Ms. Cramer continued to discuss the Summary of Changes:
Page 28, lines 16-17: Amends statute to add advance
practice registered nurse and optometrist to the
definition of practitioner.
Page 30, line 22: Conforming change for the inclusion
of Schedule IIIA controlled substances (11.71.160) to
the definition of opioid.
Page 35, line 13: Conforming change for the inclusion
of Schedule IIIA controlled substances (11.71.160) to
the definition of opioid.
Page 38 lines 1-5: Section 49 - Conditional effect
The intent is that Optometrists would continue to have
a four-day prescribing limit for opioids and other
controlled substances as they currently do.
Page 38, lines 6-8: Section 50
Immediate effective date for sections 27 and 28
relating to optometrists per Section 49 - conditional
effect.
4:12:00 PM
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
further OBJECTION, Work Draft 30-GH1021\N was ADOPTED.
4:12:41 PM
AT EASE
4:13:29 PM
RECONVENED
Co-Chair MacKinnon relayed that the public hearing for the
Senate version of the bill had been opened and closed on an
earlier date. She relayed that there were several members
of different boards online to testify. The CS tried to
address issues brought forward to the committee. She noted
there were answers to committee member questions by the
Department of Health and Social Services dated May 26, 2016
(copy on file).
4:14:09 PM
RICHARD HOLT, VICE CHAIR, ALASKA BOARD OF PHARMACY,
DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT
(via teleconference), introduced himself.
Co-Chair MacKinnon mentioned a prior inquiry by Mr. Holt
pertaining to businesses needing to report. She detailed
Mr. Holt had asked whether an entity had to report its
database or to the Prescription Drug Monitoring Program
(PDMP) if its facility was closed. She asked Ms. Chambers
to address the issue.
Ms. Chambers affirmed that the law required PMDP database
entry when certain schedules of controlled substances were
dispensed. The board already had a system for a waiver in
the case that a pharmacy did not ever prescribe opioids.
The next step, if the bill became law, was for the board to
consider the exception in regulation mentioned by Co-Chair
MacKinnon. She furthered it stood to reason that if a
pharmacy was closed, it would not be dispensing scheduled
substances. It was not the goal of the legislation to
create any illogical bureaucracy. She encouraged the board
to outline the issue in regulation or policy. She concluded
that if a business was closed it would not need to enter
information into the database that day.
Mr. Holt expressed appreciation for the follow up.
4:16:40 PM
Co-Chair MacKinnon referred to testimony by Senator Cathy
Giessel concerning dosage versus the duration of time. She
believed the committee had chosen to follow best practices
in other states. She asked Dr. Butler to address the
duration versus the dosage and why the administration had
chosen a seven-day period.
Dr. Butler stated that the administration had based its
recommendations on best practices in other states and on
determining what was pragmatic and workable. He believed
the duration was the easier way to go than trying to
convert to the BTU equivalent of the morphine milligram
equivalence. To his knowledge, only one state had gone that
route. He elaborated that the dosage would be over a set
timeframe. The options provided different ways to
accomplish the same goal. The administration had pursued
what it believed to be the more pragmatic and simple way to
communicate the law.
4:18:04 PM
Co-Chair MacKinnon asked Ms. Chambers if an issue with
software had been addressed, or whether the Board of
Pharmacy needed to address the issue in regulation. The
committee had inquired whether internet speed would prevent
a pharmacy from uploading the appropriate information to
the PDMP and whether it would be a violation.
Ms. Chambers stated that the Board of Pharmacy would
continue deliberating and enumerating in regulation and
policy ways to assist pharmacies in reporting and
circumventing some of those elements beyond their control.
The goal was to be compliant and not penalize pharmacies
for spotty internet access. The board already had a
precedent in doing so.
Co-Chair MacKinnon asked if Ms. Chambers could relay the
administration's commitment to work with the Alaska State
Medical Board for concerns registered about the Board of
Pharmacy's potential adoption and imposition of standards
of safe prescribing.
Ms. Chambers recounted that the medical board had presented
in its letter some concerns about pharmacies or individual
pharmacists red flagging prescribers and potentially
setting their own arbitrary standards. The PDMP was housed
within the Board of Pharmacy by law and the board already
set the notification standards in policy. The board would
continue to set notification standards through a public
process either in policy or regulation; it would not be up
to the individual pharmacist or pharmacy to make the
determination. She continued that as safe prescribing
guidelines were developed by the boards it was the
administration's hope and encouragement that the boards
that were impacted and had convened the previous year on
the Joint Committee on Prescriptive Guidelines would
continue to work together on consensus building. The group
had worked together quite easily the previous year in
making sure all prescribers were at the table when and if
prescribing guidelines were put into regulation.
4:20:51 PM
Senator Olson asked if the medical board was in favor of
plan that had been put in place and was currently in
writing.
Ms. Chambers answered that all the members (including the
medical board) were in consensus that the guidelines they
wanted to recommend would be the State of Washington
prescribing guidelines with a lower maximum morphine
equivalent dosage than what Washington prescribed.
Senator Olson asked for verification that the medical board
had unanimously approved the guidelines.
Ms. Chambers stated that the previous year each board had
elected a representative to come to the table for the
purpose of making the recommendation to the legislature as
required by law. The committee had not gone further, so
there was no official guideline. However, all the boards
with prescribing authority (except for veterinarians) had
agreed with the thresholds. She reiterated that the
agreement was not codified or in regulation and was not
disciplinable. The boards understood that their
representative was speaking for them in making the
recommendation to the legislature.
Senator Olson asked what it meant that the guideline
recommendation was not disciplinable.
Ms. Chambers stated that the boards were unable to
discipline a license if there were standards that were
unwritten or uncodified. She continued that a
recommendation had been made to the legislature and none of
the boards had adopted the guideline as its own practice.
Senator Olson asked if the Alaska State Medical Association
had weighed in on the issue.
Ms. Chambers responded that the meetings were publicly
noticed and made available. She did not recall that a
member of the medical association had participated.
4:23:23 PM
Senator von Imhof highlighted Section 16 of the bill,
pertaining to a physician's flexibility to exceed the
seven-day limit if it was thought to be justified. Under
the circumstance the physician would be required to notate
the amount prescribed in the patient's file. She remarked
that a doctor had been concerned about having to write six
separate prescriptions if they wanted a prescription to
exceed the seven-day limit. She surmised that the section
would allow a physician to write one prescription with the
notation that a patient may exceed the seven-day limit for
a specified reason.
Dr. Butler answered in the affirmative.
Senator Olson referred to Section 9, pertaining to
osteopaths. He asked if there was a significant difference
between osteopathic doctors versus MDs in their
requirements for prescriptions.
Dr. Butler replied that there was no difference. Doctors of
osteopathy and medical doctors were under the Alaska
Medical Board.
Senator Olson agreed that it was much less cumbersome and
more acceptable to write one prescription versus six for a
patient.
4:25:47 PM
Senator Hughes discussed the bill's exemption for
correctional facilities from requiring a prescriber to deal
with the PDMP. She referred to the problem with drugs
circulating in the prison system. She wondered about the
rationale behind the exemption and asked if the Department
of Corrections (DOC) had weighed in on the issue.
Dr. Butler affirmed that DOC had weighed in on the matter.
The rationale was that someone who is incarcerated is
similar to someone who is hospitalized or in any other type
of institution. The PDMP focus was on outpatient use of
controlled substances. For example, a person who was one
year into a 20-year term would not be out on the streets.
The administration believed it would be an excessive
administrative burden and it would be up to DOC to
determine how to avoid potential for drug diversion within
its institutions. The statute specified that the
requirement to use the PDMP would be maintained for an
individual receiving a prescription at the time of their
release from incarceration.
4:27:35 PM
Co-Chair MacKinnon thought it might appear as if the
committee was moving quickly on the bill, however the
administration had access to the Senate's version of the
bill since the previous Friday. She asked for verification
that the administration had been given time to thoroughly
review the CS.
Ms. Chambers answered in the affirmative.
Co-Chair MacKinnon relayed that the bill used the term
palliative care. She wanted to ensure that individuals
suffering life-limiting illnesses and qualifying for end-
of-life care through different medical programs would be
treated with respect (as under palliative care) and would
be allowed to access prescriptions for pain management.
Ms. Chambers responded that palliative care included end-
of-life care, but it did not exclusively deal with end-of-
life care. Palliative care was a broader pain management
specialty or type of care, which end-of-life care may fall
under.
4:29:06 PM
Vice-Chair Bishop reviewed the two fiscal notes. The first
zero fiscal note was from the Department of Health and
Social Services for Public Health Administrative Services.
The bill would require the adoption of regulations, but the
analysis stated that no additional appropriation would be
required. The second note was from the Department of
Commerce, Community and Economic Development for the
Division of Corporations, Business and Professional
Licensing (CBPL). The cost for FY 18 was $27,500. Passage
of the bill meant the division would require the funds to
cover legal costs to amend regulations and printing and
postage in the first year to the referenced professional
licensing programs. There was no anticipated cost to change
the database from weekly to daily. Professional licensing
programs within the division were funded by receipt
supported services. He continued that licensing fees for
each occupation were set in AS 08.01.065. The total revenue
collected approximately equaled the occupation's actual
regulatory cost.
Co-Chair MacKinnon restated that the $27,500 was out of
designated receipts covered by the professions. She added
that the administration had received the R version of the
bill. The committee had made a small amendment dealing with
an issue brought forward by the Board of Optometry. She
detailed the issue dealt with a two-year educational
lookback.
PAUL BARNEY, CHAIR, ALASKA BOARD OF EXAMINERS IN OPTOMETRY,
DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT
(via teleconference), stated that he had reviewed the
changes the committee had made to the bill, which addressed
the issue he had previously communicated to Ms. Chambers.
He was in support of the bill as written.
Co-Chair MacKinnon relayed that two references in prior
versions of the bill to specific years had been removed
from the CS. The two-year lookback had created clunky
language for the Board of Examiners in Optometry.
4:32:29 PM
Vice-Chair Bishop MOVED to report SCS CSHB 159(FIN) out of
Committee with individual recommendations and the
accompanying fiscal notes. There being NO OBJECTION, it was
so ordered.
SCS CSHB 159(FIN) was REPORTED out of committee with a "do
pass" recommendation and with two previously published
fiscal notes: FN2(DHS), FN3(CED).
4:33:05 PM
AT EASE
4:35:17 PM
RECONVENED
Co-Chair MacKinnon relayed that the committee had no other
scheduled meetings at present.
ADJOURNMENT
4:35:40 PM
The meeting was adjourned at 4:35 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 159 Sectional Analysis Version U.A 5.24.17.pdf |
SFIN 5/30/2017 3:30:00 PM |
HB 159 |
| HB 159 Comparison of HB 159 and SB 79 - 5.22.17.pdf |
SFIN 5/30/2017 3:30:00 PM |
HB 159 SB 79 |
| HB 159 Work Draft version N.pdf |
SFIN 5/30/2017 3:30:00 PM |
HB 159 |
| HB159 Changes to include from SB 79.pdf |
SFIN 5/30/2017 3:30:00 PM |
HB 159 SB 79 |
| HB159 Sponsor Statement - Governor Transmittal Letter 3.6.17.pdf |
SFIN 5/30/2017 3:30:00 PM |
HB 159 |
| HB 159 (FIN) v N Summary of Changes.pdf |
SFIN 5/30/2017 3:30:00 PM |
HB 159 |