Legislature(2021 - 2022)SENATE FINANCE 532

04/22/2022 01:00 PM Senate FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 99 PHYSICAL/OCCUPATIONAL THERAPY BD/PRACTICE TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
-- Public Testimony <Time Limit May Be Set> --
+ HB 111 DENTAL HYGIENIST ADVANCED PRAC PERMIT TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
-- Public Testimony <Time Limit May Be Set> --
+ HB 168 ELECTRONIC APPLICATION FOR STATE BENEFITS TELECONFERENCED
Heard & Held
-- Testimony <Time Limit May Be Set> --
-- Public Testimony <Time Limit May Be Set> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                 SENATE FINANCE COMMITTEE                                                                                       
                      April 22, 2022                                                                                            
                         1:03 p.m.                                                                                              
                                                                                                                                
                                                                                                                                
1:03:50 PM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Bishop called the  Senate Finance Committee meeting                                                                    
to order at 1:03 p.m.                                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Click Bishop, Co-Chair                                                                                                  
Senator Bert Stedman, Co-Chair                                                                                                  
Senator Lyman Hoffman                                                                                                           
Senator Donny Olson                                                                                                             
Senator David Wilson (via teleconference)                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Natasha von Imhof                                                                                                       
Senator Bill Wielechowski                                                                                                       
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Representative Matt  Claman, Sponsor; Lizzie  Kubitz, Staff,                                                                    
Representative  Matt  Claman;  Chelsea  Ward-Waller,  Staff,                                                                    
Representative  Ivy  Spohnholz; Representative  Liz  Snyder,                                                                    
Sponsor; Arielle Wiggin, Staff, Representative Liz Snyder.                                                                      
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Sara Chambers,  Director, Division of  Corporation, Business                                                                    
and   Professional   Licensing,  Department   of   Commerce,                                                                    
Community  and  Economic  Development;  LeeAnne  Carrothers,                                                                    
American  Physical  Therapy   Association,  Alaska  Chapter,                                                                    
Wasilla; Representative  Ivy Spohnholz,  Sponsor, Anchorage;                                                                    
Royann Royer, Alaska  Dental Hygiene Association, Anchorage;                                                                    
David  Nielson, Chair,  Alaska  Board  of Dental  Examiners,                                                                    
Anchorage;  John  Zasada,  Policy Director,  Alaska  Primary                                                                    
Care  Association,  Anchorage;  Ron  Meehan,  Food  Bank  of                                                                    
Alaska, Anchorage.                                                                                                              
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
HB 99     PHYSICAL/OCCUPATIONAL THERAPY BD/PRACTICE                                                                             
                                                                                                                                
          HB 99 was HEARD and HELD in committee for further                                                                     
          consideration.                                                                                                        
                                                                                                                                
CSHB 111(FIN)                                                                                                                   
          DENTAL HYGIENIST ADVANCED PRAC PERMIT                                                                                 
                                                                                                                                
          CSHB 111(FIN) was HEARD and HELD in committee for                                                                     
          further consideration.                                                                                                
                                                                                                                                
HB 168    ELECTRONIC APPLICATION FOR STATE BENEFITS                                                                             
                                                                                                                                
          HB 168 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
                                                                                                                                
HOUSE BILL NO. 99                                                                                                             
                                                                                                                                
     "An  Act relating  to the  State  Physical Therapy  and                                                                    
     Occupational  Therapy Board;  relating to  the practice                                                                    
     of physical  therapy; and relating  to the  practice of                                                                    
     occupational therapy."                                                                                                     
                                                                                                                                
1:05:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MATT CLAMAN, SPONSOR, introduced the                                                                             
legislation with prepared remarks:                                                                                              
                                                                                                                                
     First, I want  to thank you for hearing  House Bill 99.                                                                    
     We  often talk  of  making Alaska  open  and ready  for                                                                    
     business,  House  Bill 99  makes  sure  we're open  and                                                                    
     ready  for business  and specific  of  the business  of                                                                    
     providing physical and  occupational therapy. My office                                                                    
     introduced House Bill  99 at the request  of the Alaska                                                                    
     Physical and Occupational Therapy Associations.                                                                            
                                                                                                                                
     House  Bill  99  amends   the  governing  statutes  for                                                                    
     physical   therapists,  physical   therapy  assistants,                                                                    
     occupational   therapists,  and   occupational  therapy                                                                    
     assistants  practicing  in  Alaska. These  changes  are                                                                    
     designed  to   bring  Alaska  statutes  in   line  with                                                                    
     national  standards and  terminology  and overall  make                                                                    
     the administrative experience  of these professions and                                                                    
     professionals smoother and up to date.                                                                                     
                                                                                                                                
     House  Bill  99  is  supported by  the  state  Physical                                                                    
     Therapy and Occupational  Therapy Board, which believes                                                                    
     House  Bill 99  will help  the  board and  its work  to                                                                    
     protect the public. The letter  stating that support is                                                                    
     in  your bill  packet. Currently,  physical therapists,                                                                    
     physical  therapy assistants,  occupational therapists,                                                                    
     and occupational therapy  assistants are represented by                                                                    
     the  state Physical  Therapy  and Occupational  Therapy                                                                    
     Board. This  board is made  up of one  physician, three                                                                    
     physical therapists,  two occupational  therapists, and                                                                    
     one member  of the  public. House  Bill 99  removes the                                                                    
     physician  from  this  board  and  replaces  them  with                                                                    
     another occupational  therapist, thereby  balancing the                                                                    
     representation of  the professions on the  board. There                                                                    
     is  good  reason  for  this.   When  this  statute  was                                                                    
     originally   written,   the   work  of   physical   and                                                                    
     occupational   therapists   required  referral   by   a                                                                    
     physician. This  has not  been the  case in  Alaska for                                                                    
     more than 30 years.                                                                                                        
                                                                                                                                
     House Bill  99 also enables  the board to  discipline a                                                                    
     therapist  who commits  infractions under  AS 08.84.120                                                                    
     such as  conviction of a  felony, gross  negligence, or                                                                    
     abuse of alcohol. Currently, the  board has the ability                                                                    
     to revoke  or deny a  license based on  infractions but                                                                    
     has no ability to discipline.                                                                                              
                                                                                                                                
     Additionally, House Bill 99  clarifies the language and                                                                    
     the requirements for those  therapists to receive their                                                                    
     training outside  of the  United States,  ensuring that                                                                    
     their  training is  equivalent to  a U.S.  professional                                                                    
     physical therapy program  and also exempting therapists                                                                    
     trained in  an English language program  from having to                                                                    
     take an English proficiency test.                                                                                          
                                                                                                                                
     Furthermore,  this  bill  updates  language  in  Alaska                                                                    
     statute that  referenced an accrediting entity  that no                                                                    
     longer  exists and  makes  the  language more  general,                                                                    
     allowing the  state board to designate  the appropriate                                                                    
     accrediting entity as needed.  Several other updates to                                                                    
     terminology  are made  to  update  the language.  House                                                                    
     Bill  99 does  not  constitute a  restructuring of  the                                                                    
     relevant statute, but  it contains several long-awaited                                                                    
     changes that  will make it easier  for professionals to                                                                    
     do business in Alaska.                                                                                                     
                                                                                                                                
1:07:58 PM                                                                                                                    
                                                                                                                                
LIZZIE KUBITZ, STAFF, REPRESENTATIVE MATT CLAMAN, discussed                                                                     
the Sectional Analysis (copy on file):                                                                                          
                                                                                                                                
     Section 1                                                                                                                  
    AS 08.84.010. Creation and membership of the board.                                                                         
     Removes the seat  for a physician and  balances out the                                                                    
     board with  3 physical  therapists or  physical therapy                                                                    
     assistants   and    3   occupational    therapists   or                                                                    
     occupational therapy  assistants along with  one public                                                                    
     member, to make up the  7-member board. It also changes                                                                    
     the  term  "physical  therapy assistant"  to  "physical                                                                    
     therapist  assistant" in  this  section and  throughout                                                                    
     the entire  statute. This change  is to conform  to the                                                                    
     industry title used nationally.                                                                                            
                                                                                                                                
     Section 2                                                                                                                  
     AS 08.84.030. Qualifications for licensing.                                                                                
     Allows the  board to have  broader authority  over what                                                                    
     entities   will  have   accreditation  oversight   over                                                                    
     physical  therapy  &   occupational  therapy  education                                                                    
     programs. Some  of the  accrediting entities  listed in                                                                    
     statute  are now  either renamed  or  no longer  exist,                                                                    
     making that statute obsolete.                                                                                              
                                                                                                                                
     Section 2  removes language  from the  statute relating                                                                    
     to additional  supervised field work  that occupational                                                                    
     therapists  must  complete  as these  requirements  are                                                                    
     covered by the accrediting bodies.                                                                                         
                                                                                                                                
     Section 3                                                                                                                  
     AS 08.84.032. Foreign-educated applicants.                                                                                 
     Changes   the  section   headline  from   "trained"  to                                                                    
     "educated."  New   language  is  added   that  requires                                                                    
     foreign-educated   physical   therapist   or   physical                                                                    
     therapy   assistant  students   to   have  attended   a                                                                    
     "substantially" equivalent educational  program that is                                                                    
     accredited  by a  U.S.  accreditation  entity that  has                                                                    
     been  approved  by  the board.  Outdated  and  obsolete                                                                    
     language is removed that can  be found on page 4, lines                                                                    
     3 -9 of this bill.                                                                                                         
                                                                                                                                
     Added  to subsection  (3) of  this section  is language                                                                    
     that  would  require  that   a  physical  therapist  or                                                                    
     physical therapist assistant  pass a test demonstrating                                                                    
     competency  of  the  English  language  only  if  their                                                                    
     program was  taught in  a foreign  language. Subsection                                                                    
     (4)  requires that  a foreign-educated  applicant is  a                                                                    
     legal alien  or a U.S citizen.  Subsection (7) requires                                                                    
     them  to  pay  the  required fee  and  meet  any  other                                                                    
     qualifications  for licensure  set by  the board  under                                                                    
     08.84.010(b).                                                                                                              
                                                                                                                                
     All the above  changes in Section 3  are replicated for                                                                    
     occupational   therapists   or   occupational   therapy                                                                    
     assistants on page  4, lines 27-31 and over  to page 5,                                                                    
     lines 1-22.                                                                                                                
                                                                                                                                
     Section 4                                                                                                                  
     AS 08.84.060. Licensure by acceptance of credentials.                                                                      
     Makes conforming terminology changes.                                                                                      
                                                                                                                                
     Section 5                                                                                                                  
     AS 08.84.065(c). Temporary changes.                                                                                        
     Makes conforming terminology changes.                                                                                      
                                                                                                                                
     Section 6                                                                                                                  
     AS 08.84.075(b). Limited permit.                                                                                           
     Makes conforming terminology changes.                                                                                      
                                                                                                                                
     Section 7                                                                                                                  
     AS 08.84.075(c). Limited permit.                                                                                           
     Changes language that would now  require that a limited                                                                    
     permit is valid for 120 consecutive days.                                                                                  
                                                                                                                                
     Section 8                                                                                                                  
     AS 08.84.075(d). Limited permit.                                                                                           
    Allows only one limited permit per 12-month period.                                                                         
                                                                                                                                
     Section 9                                                                                                                  
     AS 08.84.090. Licensure.                                                                                                   
     Updates licensure terminology.                                                                                             
                                                                                                                                
     Section 10                                                                                                                 
     AS  08.84.120(a). Refusal,  revocation, and  suspension                                                                    
     of license.                                                                                                                
                                                                                                                                
     Adds disciplinary action as a  possibility to actions a                                                                    
     board  might  consider  for   an  infraction  of  their                                                                    
     licensure  and  updates  terminology in  item  (7)  and                                                                    
     states in  (9) that failure  to comply with the  law or                                                                    
     regulations  or  order of  the  board  might result  in                                                                    
     disciplinary action or suspension of a license.                                                                            
                                                                                                                                
     Section 11                                                                                                                 
    AS 08.04.130(a). False claim of license prohibited.                                                                         
     Adds updated credentialing and terminology.                                                                                
                                                                                                                                
     Section 12                                                                                                                 
    AS 08.84.130(b). False claim of license prohibited.                                                                         
     Updates terminology.                                                                                                       
                                                                                                                                
     Section 13                                                                                                                 
     AS 08.84.190. Definitions.                                                                                                 
     Adds  a   new  paragraph  defining  the   updated  term                                                                    
     "physical therapist assistant."                                                                                            
                                                                                                                                
     Section 14                                                                                                                 
     AS 11.41.470(1). Definitions.                                                                                              
     Updates  definitions  in  criminal  law/sexual  assault                                                                    
     statute.                                                                                                                   
                                                                                                                                
     Section 15                                                                                                                 
     AS 47.17.290(14). Definitions.                                                                                             
     Updates   terminology   under  definitions   in   child                                                                    
     protection statute.                                                                                                        
                                                                                                                                
     Section 16                                                                                                                 
     AS 08.84.190(7). Definitions.                                                                                              
     Repeals subsection  (7), which is the  definition using                                                                    
     outdated term of  physical therapy assistant; according                                                                    
     to  Leg. Legal,  when the  actual "term"  used for  the                                                                    
     definition is being changed, the  entire citing must be                                                                    
     repealed.  The new  definition is  set out  on page  8,                                                                    
     Section 13, lines 11-14.                                                                                                   
                                                                                                                                
     Section 17                                                                                                                 
     Applicability                                                                                                              
     Sets out  the applicability  clauses for  licensure for                                                                    
     sections 2 and 3 of this Act and for sections 7 and 8.                                                                     
                                                                                                                                
     Section 18                                                                                                                 
     Uncodified law                                                                                                             
     Transition   language  for   the   board  vacancy   and                                                                    
     appointments for  the PT/OT board, and  states that the                                                                    
     changes do not  apply to current licensees  until it is                                                                    
     time for  their licensure renewal and  then all changes                                                                    
     to the law will apply.                                                                                                     
                                                                                                                                
Ms. Kubitz listed individuals available for questions.                                                                          
                                                                                                                                
1:12:27 PM                                                                                                                    
                                                                                                                                
Senator  Olson asked  if state  medical associations  and/or                                                                    
the Medical Board supported  the legislation. He highlighted                                                                    
the  bill's  proposal  to  remove   a  physician  [from  the                                                                    
Physical Therapy and Occupational Therapy Board].                                                                               
                                                                                                                                
Representative  Claman  replied  that  he  had  spoken  with                                                                    
individual physicians.                                                                                                          
                                                                                                                                
Senator  Olson  interjected  that   there  were  letters  of                                                                    
support in the bill packets.                                                                                                    
                                                                                                                                
Representative  Claman replied  that the  physicians he  had                                                                    
spoken to did not have a problem with the bill.                                                                                 
                                                                                                                                
Senator Olson asked if there was anything from the boards.                                                                      
                                                                                                                                
Representative Claman replied in the negative.                                                                                  
                                                                                                                                
Senator Olson  asked for the  percentage of  foreign medical                                                                    
applicants  applying for  physical and  occupational therapy                                                                    
positions.                                                                                                                      
                                                                                                                                
1:13:15 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
1:13:35 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Senator Olson reiterated his previous question.                                                                                 
                                                                                                                                
Representative Claman deferred to Ms. Chambers.                                                                                 
                                                                                                                                
SARA CHAMBERS,  DIRECTOR, DIVISION OF  CORPORATION, BUSINESS                                                                    
AND   PROFESSIONAL   LICENSING,  DEPARTMENT   OF   COMMERCE,                                                                    
COMMUNITY  AND  ECONOMIC DEVELOPMENT  (via  teleconference),                                                                    
replied that she would follow up with the answer.                                                                               
                                                                                                                                
Co-Chair Bishop asked Ms. Chambers  to provide the answer to                                                                    
his office for distribution to committee members.                                                                               
                                                                                                                                
Co-Chair Bishop moved to invited testimony.                                                                                     
                                                                                                                                
LEEANNE CARROTHERS,  AMERICAN PHYSICAL  THERAPY ASSOCIATION,                                                                    
ALASKA  CHAPTER,  WASILLA  (via  teleconference),  spoke  in                                                                    
support  of  the  legislation. The  association  represented                                                                    
approximately 450 licensed  physical therapists and physical                                                                    
therapist  assistants in  Alaska. She  stated that  the bill                                                                    
provided  many  needed   language  changes  and  terminology                                                                    
changes to  the existing  statute, which would  bring Alaska                                                                    
in line  with current  national standards,  terminology, and                                                                    
practice.  She elaborated  that the  bill provided  balanced                                                                    
representation   by  physical   and  occupational   therapy.                                                                    
Additionally, the  bill removed  a position from  the board,                                                                    
which was a  relic of a time when  physical and occupational                                                                    
therapists   required   physician   supervision   and   were                                                                    
accredited  by the  American Medical  Association. The  bill                                                                    
reduced administrative burden and  costs for individuals who                                                                    
graduated  from schools  taught  in English  outside of  the                                                                    
United States  and provided  disciplinary capability  to the                                                                    
board.  She  summarized  that the  bill  provided  necessary                                                                    
updates, was noncontroversial, and long overdue.                                                                                
                                                                                                                                
1:16:23 PM                                                                                                                    
                                                                                                                                
Co-Chair Bishop OPENED public testimony.                                                                                        
                                                                                                                                
1:16:37 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
1:17:03 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair  Stedman wondered  if  there was  an  error in  the                                                                    
printing of  the bill.  He observed  the version  before the                                                                    
committee was version A. He was being facetious.                                                                                
                                                                                                                                
Co-Chair Bishop CLOSED public testimony.                                                                                        
                                                                                                                                
Representative Claman  stressed that  the bill  had received                                                                    
no  amendments  in the  House  and  there was  no  committee                                                                    
substitute.                                                                                                                     
                                                                                                                                
SB  99  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
CS FOR HOUSE BILL NO. 111(FIN)                                                                                                
                                                                                                                                
     "An  Act relating  to the  practice of  dental hygiene;                                                                    
     relating  to  advanced   practice  permits  for  dental                                                                    
     hygienists; relating to  dental assistants; prohibiting                                                                    
     unfair  discrimination  under  group  health  insurance                                                                    
     against  a  dental  hygienist  who  holds  an  advanced                                                                    
     practice  permit; relating  to  medical assistance  for                                                                    
     dental   hygiene  services;   and   providing  for   an                                                                    
     effective date."                                                                                                           
                                                                                                                                
1:19:01 PM                                                                                                                    
                                                                                                                                
CHELSEA WARD-WALLER, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,                                                                       
introduced herself. She believed Representative Spohnholz                                                                       
was available online to introduce the legislation.                                                                              
                                                                                                                                
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, ANCHORAGE (via                                                                           
teleconference), introduced the legislation with prepared                                                                       
remarks:                                                                                                                        
                                                                                                                                
     House  Bill 111  creates an  advanced practice  permit,                                                                    
     which  would  allow  experienced  and  licensed  dental                                                                    
     hygienists to  provide preventative oral  healthcare to                                                                    
     underserved populations  at senior  centers, healthcare                                                                    
     facilities, daycares, and schools  for Alaskans who are                                                                    
     eligible for  public assistance, are homebound,  or who                                                                    
     live  in a  rural underserved  community. We  know that                                                                    
     oral  health  plays  a  really  critical  role  in  the                                                                    
     overall  health and  well-being  of  Alaskans and  poor                                                                    
     oral health  contributes to poor  health. In  fact, bad                                                                    
     oral  health  is   linked  to  cardiovascular  disease,                                                                    
     Alzheimer's,  osteoporosis, as  well as  poor nutrition                                                                    
     and other serious health issues  and this is more acute                                                                    
     for   low  income   individuals  and   those  who   are                                                                    
     physically immobile.                                                                                                       
                                                                                                                                
     Currently, dental hygienists can  practice in a dentist                                                                    
     office or they can  practice semi-independently if they                                                                    
     have a  collaborative agreement  with a  dentist, which                                                                    
     is similar  to what physician's assistants  do already.                                                                    
     An  advance practice  permit that's  proposed by  House                                                                    
     Bill  111 would  allow  dental hygienists  to care  for                                                                    
     these  underserved   populations  at   senior  centers,                                                                    
     healthcare  facilities,  daycare,  schools,  and  those                                                                    
     that   are   eligible   for  public   assistance,   are                                                                    
     homebound, or  live in underserved communities  if they                                                                    
     have a  minimum of  4,000 hours of  clinical experience                                                                    
     and  are approved  by the  board  of dental  examiners,                                                                    
     which  includes both  dentists  and dental  hygienists.                                                                    
     The bill  lays out specific services  allowed under the                                                                    
     permit and specific populations  that a licensed dental                                                                    
     hygienist  can provide  those services  to without  the                                                                    
     supervision  and   physical  presence  of   a  licensed                                                                    
     dentist. Unlike some licensing bills  in the past where                                                                    
     there was  competing license  types that  had different                                                                    
     perspectives,   this  bill   has   been  developed   in                                                                    
     consultation with the Alaska  Dental Society, the Board                                                                    
     of Dental  Examiners, and the Alaska  Dental Hygienists                                                                    
     Association. The  advanced practice permit  holder will                                                                    
     have   to  maintain   malpractice  insurance,   provide                                                                    
     written notice  of their service limitations,  and make                                                                    
     a referral  to a licensed dentist  if further treatment                                                                    
     is necessary.                                                                                                              
                                                                                                                                
     This  bill  would  allow   dental  hygienists  who  are                                                                    
     experienced  to practice  to the  full  scope of  their                                                                    
     training   credentials  and   professional  experience.                                                                    
     Importantly, Alaska  won't be  the first state  to make                                                                    
     these changes.  Dental hygienists are able  to practice                                                                    
     under advance  practice permits  or similar  permits in                                                                    
     six  other states  and 40  other states  are considered                                                                    
     direct  access  states  for  dental  hygienists,  which                                                                    
     means  that dental  hygienists  can initiate  treatment                                                                    
     based on their assessment  of a patient's needs without                                                                    
     the authorization or presence of a dentist.                                                                                
                                                                                                                                
     Finally,  I  will  note that  we  have  made  important                                                                    
     changes  to  this bill  at  the  recommendation of  the                                                                    
     Board  of  Dental  Examiners   and  the  Alaska  Dental                                                                    
     Society including requiring  permit holders to maintain                                                                    
     patient records  for at least seven  years, making sure                                                                    
     that  the Board  of Dental  Examiners has  a separately                                                                    
     certified  hygienist  to administer  local  anesthesia,                                                                    
     and  then  empowering  the  Department  of  Health  and                                                                    
     Social Services  (DHSS) to make regulations  related to                                                                    
     this bill. We  may need to update the  DHSS language to                                                                    
     confirm  with the  recent split  of  the Department  of                                                                    
     Health and Social Services.                                                                                                
                                                                                                                                
Representative Spohnholz listed individuals available to                                                                        
speak to the bill.                                                                                                              
                                                                                                                                
1:23:31 PM                                                                                                                    
                                                                                                                                
Senator Olson asked if the bill allowed prescriptive                                                                            
authority to the advanced dental hygienists.                                                                                    
                                                                                                                                
Representative  Spohnholz  replied  there  was  very  narrow                                                                    
prescriptive authority regarding  topical, preventative, and                                                                    
prophylactic  agents  that  dental hygienists  were  already                                                                    
allowed  to provide.  She deferred  the  question to  Royann                                                                    
Royer  [with  the  Alaska Dental  Hygiene  Association]  for                                                                    
further detail.                                                                                                                 
                                                                                                                                
Senator  Olson asked  if advanced  dental hygienists  had to                                                                    
participate  in  the  Prescription Drug  Monitoring  Program                                                                    
(PDMP) that  other prescriptive practitioners  were required                                                                    
to abide by.                                                                                                                    
                                                                                                                                
Representative Sponholz answered  that dental hygienists did                                                                    
not prescribe  controlled substances and therefore,  did not                                                                    
have  DEA  [Drug Enforcement  Administration]  certification                                                                    
and did not have to participate in the PDMP.                                                                                    
                                                                                                                                
Senator Olson  asked if the  permit enabled  advanced dental                                                                    
hygienists to perform advanced dental procedures.                                                                               
                                                                                                                                
Representative  Sponholz responded  that  the  bill did  not                                                                    
allow  dental hygienists  to practice  beyond  the scope  of                                                                    
their current practice  in any way. The  bill simply enabled                                                                    
dental hygienists  to do  what they  had already  been doing                                                                    
safely for a  very long time and without  the supervision of                                                                    
a dentist if they had  4,000 hours of experience in addition                                                                    
to a previous dental hygienist  license and were approved by                                                                    
the Board of Dental Examiners.                                                                                                  
                                                                                                                                
1:25:27 PM                                                                                                                    
                                                                                                                                
Ms. Ward-Waller  discussed the  Sectional Analysis  (copy on                                                                    
file):                                                                                                                          
                                                                                                                                
     Section 1                                                                                                                  
     Ability of practice of dental hygienists.                                                                                  
                                                                                                                                
     (e) Amends AS 08.32.110. to allow a licensed dental                                                                        
     hygienist who holds an advanced practice permit issued                                                                     
     by the board to perform duties allowed by the permit.                                                                      
                                                                                                                                
     Section 2                                                                                                                  
     Advanced practice permits.                                                                                                 
     Adds a new section under AS 08.32.125 creating the                                                                         
     advanced practice permit and providing requirements as                                                                     
     follows:                                                                                                                   
                                                                                                                                
     (a) The Board of Dental Examiners may issue an                                                                             
     advanced practice permit to a licensed dental                                                                              
     hygienist  with a  minimum  4,000  documented hours  of                                                                    
     clinical experience. This  subsection lists what duties                                                                    
     fall  under  advanced  practice permits:  general  oral                                                                    
     health   &   cleaning,   providing   treatment   plans,                                                                    
     screenings,  taking radiographs,  and/or delegating  to                                                                    
     dental assistants.                                                                                                         
                                                                                                                                
     (b)  A licensed  dental hygienist  holding an  advanced                                                                    
     practice permit  may provide services to  a patient who                                                                    
     is  not able  to  receive dental  treatment because  of                                                                    
     age,  infirmity, or  disability. The  patient may  be a                                                                    
     resident  of   a  senior  center,   residential  health                                                                    
     facility,  or held  in a  local correctional  facility.                                                                    
     The patient  may also be  enrolled in  certain schools,                                                                    
     receiving benefits under  the Special Supplemental Food                                                                    
     Program (WIC), homebound, or a  resident of a community                                                                    
    that has a shortage of dental health professionals.                                                                         
                                                                                                                                
     (c)  A licensed  dental hygienist  holding an  advanced                                                                    
     practice permit  can provide appropriate services  to a                                                                    
     patient  without   the  presence,   authorization,  and                                                                    
     supervision  of  a  licensed  dentist  and  without  an                                                                    
     examination from a licensed dentist.                                                                                       
                                                                                                                                
     (d)  A  licensed  dental  hygienist  with  an  advanced                                                                    
     practice  permit must  maintain professional  liability                                                                    
     insurance. They must also give  the patient, parent, or                                                                    
     legal  guardian  written   notice  that  the  treatment                                                                    
     provided  will  be  limited to  those  allowed  by  the                                                                    
     permit, a  written recommendation  that the  patient be                                                                    
     examined by  a licensed dentist for  comprehensive oral                                                                    
     care,  and  assistance in  receiving  a  referral to  a                                                                    
     licensed dentist for further oral treatment.                                                                               
                                                                                                                                
     (e)  An advanced  practice permit  is  valid until  the                                                                    
     license  of the  dental hygienist  expires. A  licensed                                                                    
     dental  hygienist  can  renew their  advanced  practice                                                                    
     permit at the same time they renew their license.                                                                          
                                                                                                                                
1:29:31 PM                                                                                                                    
                                                                                                                                
ROYANN ROYER,  ALASKA DENTAL HYGIENE  ASSOCIATION, ANCHORAGE                                                                    
(via teleconference),  spoke in support of  the legislation.                                                                    
She shared information about her  work in dentistry for many                                                                    
years  in Alaska.  She shared  that approximately  six years                                                                    
back  she had  seen a  significant need  that was  not being                                                                    
addressed   in  Alaska.   She   had   started  a   nonprofit                                                                    
organization  that   served  residents  in   long-term  care                                                                    
facilities. She spoke to the  importance of the legislation.                                                                    
She  currently  practiced  under  a  collaborative  practice                                                                    
agreement,  which  allowed   dental  hygienists  to  provide                                                                    
treatment under  the general supervision  of a  dentist. She                                                                    
was able  to see  a patient  prior to  the dentist.  She was                                                                    
lucky to  have several dentists  to collaborate with  on the                                                                    
project and would continue as  long as possible. However, if                                                                    
the bill  went through, it  would provide another  option to                                                                    
continue the program if needed.  For example, if she did not                                                                    
have a dentist  to work with, she would be  able to continue                                                                    
seeing  the  long-term  residents and  provide  assessments,                                                                    
radiographs,   preventative   services,  and   oral   health                                                                    
education. The patients  could then see a  dentist either in                                                                    
or outside the facility as needed.                                                                                              
                                                                                                                                
Ms. Royer  relayed that  many hygienists  wanted to  work in                                                                    
underserved areas,  but they  could not  find a  dentist who                                                                    
would  work in  a collaborative  agreement. The  legislation                                                                    
had been  brought forward  by a  hygienist in  Fairbanks who                                                                    
wanted to  find a way  to provide services. She  shared that                                                                    
assessment and treatment done  routinely were less expensive                                                                    
than  waiting  for  a  person   to  notice  problems,  which                                                                    
necessitated  more extensive  and expensive  procedures. She                                                                    
highlighted  that preventative  treatment helped  to prevent                                                                    
systemic    conditions   such    as   pneumonia,    diabetes                                                                    
complications,  and heart  disease. She  stated that  Alaska                                                                    
needed  more   providers  in   underserved  areas   and  the                                                                    
registered  dental  hygienist  advanced  practitioner  would                                                                    
help decrease the disparity.                                                                                                    
                                                                                                                                
1:32:54 PM                                                                                                                    
                                                                                                                                
DAVID  NIELSON, CHAIR,  ALASKA  BOARD  OF DENTAL  EXAMINERS,                                                                    
ANCHORAGE  (via  teleconference),   shared  that  discussion                                                                    
about  the  advanced  dental  hygiene  permit  had  come  up                                                                    
several times over the past  couple of years and the support                                                                    
had always  been good. He  shared that the bill  sponsor had                                                                    
been receptive  to board comments  and had made a  couple of                                                                    
changes  to the  original bill.  He relayed  that the  board                                                                    
supported the bill in its  current form. He highlighted that                                                                    
Section  4  specified  that the  dental  board  would  draft                                                                    
regulations to clarify what additional  tasks, if any, would                                                                    
be  delegated  dental  assistants by  the  advanced  hygiene                                                                    
permit holder and under what level of supervision.                                                                              
                                                                                                                                
Co-Chair Bishop  looked at  Section 2  (a) and  wondered how                                                                    
the  4,000 hours  was documented.  He asked  if students  or                                                                    
individuals had a logbook.                                                                                                      
                                                                                                                                
Mr. Nielson  replied that there  was typically  an affidavit                                                                    
where someone attested  to the fact that a  person had 4,000                                                                    
hours  of practice.  He stated  that  it would  likely be  a                                                                    
person's employer.                                                                                                              
                                                                                                                                
1:35:24 PM                                                                                                                    
                                                                                                                                
JOHN   ZASADA,   POLICY   DIRECTOR,  ALASKA   PRIMARY   CARE                                                                    
ASSOCIATION,  ANCHORAGE   (via  teleconference),   spoke  in                                                                    
support   of  the   legislation.   He   detailed  that   the                                                                    
association  supported  the  operations and  development  of                                                                    
Alaska's  29  non-tribal   and  tribal  federally  qualified                                                                    
health centers.  He provided  detail about  the association.                                                                    
He stressed that dental services  and oral health were vital                                                                    
components of  the whole person  care that  community health                                                                    
centers  provided patients.  He  detailed  that many  health                                                                    
centers offered  on-site dental  services provided  by staff                                                                    
or  contracts   with  other  dental   health  professionals.                                                                    
Smaller  sites  relied on  sending  patients  to larger  hub                                                                    
facilities or  neighboring urban  health centers  for dental                                                                    
care.  One  frequently  cited reason  for  the  shortage  of                                                                    
dental services  was the lack  of providers. He  stated that                                                                    
persistent  provider   shortages  at   all  levels   in  the                                                                    
community  healthcare dental  system  resulted in  providers                                                                    
not  working  at their  highest  level  of licensure,  which                                                                    
created  inefficiencies,  decreased  provider  satisfaction,                                                                    
and barriers to patient care.  The bill would add a valuable                                                                    
layer of  staffing between dentists and  other hygienists to                                                                    
provide   comprehensive  services.   He  spoke   to  further                                                                    
attributes of the program. The  new provider type would lead                                                                    
to an  adjustment of the  overall health  spend, potentially                                                                    
lessening  the reliance  on higher  cost  dentists to  lower                                                                    
cost hygiene. He urged the passage of the bill.                                                                                 
                                                                                                                                
1:37:44 PM                                                                                                                    
                                                                                                                                
Co-Chair Bishop OPENED and CLOSED public testimony.                                                                             
                                                                                                                                
1:38:03 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
1:38:43 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
CSHB 111(FIN)  was HEARD and  HELD in committee  for further                                                                    
consideration.                                                                                                                  
                                                                                                                                
HOUSE BILL NO. 168                                                                                                            
                                                                                                                                
     "An Act  requiring the Department of  Health and Social                                                                    
     Services  to   provide  and  allow  submission   of  an                                                                    
     electronic application for  certain state benefits; and                                                                    
     providing for an effective date."                                                                                          
                                                                                                                                
1:39:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   LIZ   SNYDER,   SPONSOR,   introduced   the                                                                    
legislation. She detailed that  the legislation required the                                                                    
Department  of Health  and  Social Services  or  soon to  be                                                                    
Department  of  Health  to   make  applications  for  public                                                                    
assistance available  for completion and  submission online.                                                                    
The  bill  would keep  all  other  existing paper-based  and                                                                    
email options  available as well. The  required deadline for                                                                    
the  action to  occur  was  July 1,  2022.  She stated  that                                                                    
online  forms could  increase accessibility  and efficiency,                                                                    
which would  be beneficial to  Alaskans and the  Division of                                                                    
Public  Assistance. Online  applications had  been supported                                                                    
by  past and  current administrations,  as evidenced  by the                                                                    
stated  goal to  do such  and by  ongoing efforts;  however,                                                                    
efforts had not been consistent  and had not been finalized.                                                                    
She relayed  that requiring  online availability  in statute                                                                    
protected  the department's  current work  to get  the forms                                                                    
online and  ensures the effort  would cross the  finish line                                                                    
after more than a decade of false starts.                                                                                       
                                                                                                                                
1:40:40 PM                                                                                                                    
                                                                                                                                
ARIELLE WIGGIN,  STAFF, REPRESENTATIVE LIZ  SNYDER, reviewed                                                                    
the Sectional Analysis (copy on file):                                                                                          
                                                                                                                                
     Sec.  1: Adds  a new  subsection (19)  to AS  47.05.010                                                                    
     Duties  of  Department   requiring  the  Department  of                                                                    
     Health  and Social  Services to  create and  provide an                                                                    
     entirely  online  application process  for  individuals                                                                    
     applying for  public assistance  and defines  an online                                                                    
     application.  Adds  language requiring  the  department                                                                    
     inform applicants  that making false statements  on the                                                                    
     application is  a punishable act.  It does  not mandate                                                                    
     applicants apply online or remove the written option.                                                                      
                                                                                                                                
     Sec. 2:  Amends AS 47.08.150(b) Assistance  For Chronic                                                                    
     or   Acute  Medical   Conditions  by   adding  language                                                                    
     requiring the Department of  Health and Social Services                                                                    
     to  establish an  entirely  online application  process                                                                    
     for  individuals applying  for  the  Chronic and  Acute                                                                    
     Medical  Assistance  program. Adds  language  requiring                                                                    
     the  department  inform  applicants that  making  false                                                                    
    statements on the application is a punishable act.                                                                          
                                                                                                                                
     Sec. 3:  Adds a new  subsection (6) to  AS 47.25.001(a)                                                                    
     Powers   and  Duties   that  requires   the  department                                                                    
     establish  an entirely  online application  process and                                                                    
     allows  applicants to  apply in  any  form required  by                                                                    
     state  and federal  law.  Adds  language requiring  the                                                                    
     department   inform   applicants  that   making   false                                                                    
    statements on the application is a punishable act.                                                                          
                                                                                                                                
     Sec.  4: Adds  a  new section  (7)  to AS  47.25.071(e)                                                                    
     Child Care  Grant Program that requires  the department                                                                    
     establish  an entirely  online application  process for                                                                    
     assistance  under the  Child Care  Grant Program.  Adds                                                                    
     language  requiring  the department  inform  applicants                                                                    
     that making  false statements on  the application  is a                                                                    
     punishable act.                                                                                                            
                                                                                                                                
     Sec. 5:  Amends AS  47.25.095 Definitions For  Day Care                                                                    
     Assistance  and Child  Care  Grant  Programs to  define                                                                    
     electronic application.                                                                                                    
                                                                                                                                
     Sec. 6: Amends AS  47.25.150 Application For Assistance                                                                    
     by  adding language  requiring the  Division of  Public                                                                    
     Assistance to establish  an entirely online application                                                                    
     process  for individuals  applying for  assistance from                                                                    
     the department and defines  an online application. Adds                                                                    
     language  requiring  the department  inform  applicants                                                                    
     that making  false statements on  the application  is a                                                                    
     punishable act.                                                                                                            
                                                                                                                                
     Sec. 7: Amends AS  47.25.440 Application For Assistance                                                                    
     by adding  language requiring the Department  of Health                                                                    
     and  Social Services  to establish  an entirely  online                                                                    
     application   process  for   individuals  applying   to                                                                    
     receive Adult  Public Assistance and defines  an online                                                                    
     application.  Adds  language requiring  the  department                                                                    
     inform applicants  that making false statements  on the                                                                    
     application is a punishable act.                                                                                           
                                                                                                                                
     Sec.  8: Adds  a  new subsection  (4)  to AS  47.25.622                                                                    
     Alaska   Affordable  Heating   Program  requiring   the                                                                    
     Department of Health and Social  Services to create and                                                                    
     provide   an  entirely   online  4.9.2021   application                                                                    
     process  for   individuals  applying  for   the  Alaska                                                                    
     Affordable  Heating  Program   and  defines  an  online                                                                    
     application.  Adds  language requiring  the  department                                                                    
     inform applicants  that making false statements  on the                                                                    
     application is a punishable act.                                                                                           
                                                                                                                                
     Sec. 9:  Adds a new  subsection (4) to  AS 47.25.980(a)                                                                    
     Duties of  Department requiring the Division  of Public                                                                    
     Assistance  to create  and provide  an entirely  online                                                                    
     application  process for  individuals applying  for the                                                                    
     Supplemental Nutrition  Assistance Program  and defines                                                                    
     an  online  application.  Adds language  requiring  the                                                                    
     department   inform   applicants  that   making   false                                                                    
    statements on the application is a punishable act.                                                                          
                                                                                                                                
     Sec.   10:    Amends   AS    47.27.020(a)   Application                                                                    
     Requirements by adding  language requiring the Division                                                                    
     of Public  Assistance to  establish an  entirely online                                                                    
     application  process for  individuals applying  for the                                                                    
     Alaska  Temporary  Assistance Program.  Defines  online                                                                    
     application.  Adds  language requiring  the  department                                                                    
     inform applicants  that making false statements  on the                                                                    
     application is a punishable act.                                                                                           
                                                                                                                                
     Sec.  11:   Amends  AS  47.45.302(a)   Cash  Assistance                                                                    
     Benefits  by adding  language requiring  the Department                                                                    
     of Health and Social  Services to establish an entirely                                                                    
     online  application  process for  individuals  applying                                                                    
     for  the   cash  assistance  program.   Defines  online                                                                    
     application.  Adds  language requiring  the  department                                                                    
     inform applicants  that making false statements  on the                                                                    
     application is a punishable act.                                                                                           
                                                                                                                                
     Sec. 12:  Adds a new  section to the uncodified  law of                                                                    
     the State  of Alaska allowing the  Department of Health                                                                    
     and  Social Services  to  adopt  regulations needed  to                                                                    
     create and implement online applications.                                                                                  
                                                                                                                                
     Sec.   13:  Requires   Section   12   to  take   effect                                                                    
     immediately under AS 01.10.070(c).                                                                                         
                                                                                                                                
     Sec. 14: Provides an effective date of July 1, 2022.                                                                       
                                                                                                                                
1:42:04 PM                                                                                                                    
                                                                                                                                
Senator  Olson   asked  how  the   bill  would   help  rural                                                                    
applicants with poor internet connections.                                                                                      
                                                                                                                                
Representative   Snyder   replied   that  in   areas   where                                                                    
connectivity  was  not  an  issue,   the  demand  for  paper                                                                    
services  and associate  assistance  should  go down,  which                                                                    
would free up  additional time for the division  to meet the                                                                    
needs of rural Alaskans.                                                                                                        
                                                                                                                                
Senator Olson asked how the  bill would help people in areas                                                                    
of his district like Diomede or St. Lawrence Island.                                                                            
                                                                                                                                
Representative  Snyder  responded  that  the  bill  was  not                                                                    
necessarily  designed  to  be  particularly  beneficial  for                                                                    
individuals without online access.  She pointed out that the                                                                    
division  had a  functional  phoneline where  it could  walk                                                                    
applicants  through the  forms. She  relayed the  demand for                                                                    
the phone  line had been very  high. The bill aimed  to free                                                                    
up  time for  the division  and  make it  faster to  receive                                                                    
service.                                                                                                                        
                                                                                                                                
Co-Chair Bishop hoped  it would be the  case. He highlighted                                                                    
that  some people  were  waiting 45  minutes  trying to  get                                                                    
services.                                                                                                                       
                                                                                                                                
Representative  Snyder   agreed.  She  shared  it   was  the                                                                    
motivation   of  the   legislation.  Stakeholders   reported                                                                    
repeatedly  on the  challenging wait  time. She  stated that                                                                    
the  longer the  delay, the  odds of  an eligible  applicant                                                                    
completing  the form  diminished.  She had  heard about  the                                                                    
issue  for  quite  some  time,  and  she  had  advocated  in                                                                    
subcommittees  for  additional  positions to  meet  the  gap                                                                    
until applications were online. She  hoped the bill would be                                                                    
part of the solution to a persistent problem.                                                                                   
                                                                                                                                
1:44:47 PM                                                                                                                    
                                                                                                                                
Co-Chair Bishop moved to invited testimony.                                                                                     
                                                                                                                                
RON   MEEHAN,   FOOD   BANK  OF   ALASKA,   ANCHORAGE   (via                                                                    
teleconference),  spoke in  support of  the bill.  He shared                                                                    
that the  Food Bank  of Alaska had  a robust  staff outreach                                                                    
team  that  was federally  funded  in  partnership with  the                                                                    
state. He  provided detail  about the  work provided  by the                                                                    
Food Bank. He  shared that almost one-quarter  of the people                                                                    
eligible   in  Alaska   for  SNAP   [Supplemental  Nutrition                                                                    
Assistance   Program]  benefits   were  not   accessing  the                                                                    
program. He stated that Alaskans  faced unique challenges in                                                                    
accessing benefits. One  of the major barriers  was the lack                                                                    
of  options for  how to  apply. He  stated the  creation and                                                                    
addition of an  online program would reduce  the problem. He                                                                    
elaborated that  Alaska currently used a  paper application.                                                                    
The  current online  option required  someone  to provide  a                                                                    
finger or  stylus signature, which  many people  were unable                                                                    
to  do. He  relayed that  not all  communities had  a public                                                                    
assistance  office, and  many offices  were still  currently                                                                    
closed. He  provided further  detail about  the difficulties                                                                    
associated  with  the current  system.  He  stated that  the                                                                    
current process  could take weeks  for individuals  in rural                                                                    
communities. He  highlighted high  wait times on  the phone.                                                                    
The bill  would streamline  the process and  the application                                                                    
could be  simplified. He reviewed  benefits of the  bill. He                                                                    
enthusiastically supported the legislation.                                                                                     
                                                                                                                                
1:48:25 PM                                                                                                                    
                                                                                                                                
Co-Chair Bishop OPENED and CLOSED public testimony.                                                                             
                                                                                                                                
HB  168  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
Co-Chair  Bishop discussed  the schedule  for the  following                                                                    
Monday.                                                                                                                         
                                                                                                                                
ADJOURNMENT                                                                                                                   
1:49:17 PM                                                                                                                    
                                                                                                                                
The meeting was adjourned at 1:49 p.m.                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects