Legislature(2019 - 2020)BUTROVICH 205
02/28/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB120 | |
| SB179 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 120 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | SB 179 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 28, 2020
1:30 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Tom Begich
MEMBERS ABSENT
Senator Mike Shower
COMMITTEE CALENDAR
SENATE BILL NO. 120
"An Act relating to administration of psychotropic medication to
a patient without the patient's informed consent; and providing
for an effective date."
- HEARD & HELD
SENATE BILL NO. 179
"An Act relating to the licensure of nursing professionals;
relating to a multistate nurse licensure compact; and providing
for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 120
SHORT TITLE: ADMINISTRATION OF PSYCHOTROPIC MEDICATION
SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST
05/06/19 (S) READ THE FIRST TIME - REFERRALS
05/06/19 (S) HSS
02/28/20 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 179
SHORT TITLE: NURSING: LICENSURE; MULTISTATE COMPACT
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/05/20 (S) READ THE FIRST TIME - REFERRALS
02/05/20 (S) HSS, L&C, FIN
02/24/20 (S) HSS AT 1:30 PM BUTROVICH 205
02/24/20 (S) -- MEETING CANCELED --
02/28/20 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 120.
ALBERT WALL, Deputy Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 120.
CYNTHIA MONTGOMERY, Psychiatric Nurse Practitioner
Alaska Psychiatric Institute
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 120.
MICHAEL ALEXANDER, M.D., Chief Psychiatrist
Alaska Psychiatric Institute
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 120.
MARIEKE HEATWOLE, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 120.
SARA CHAMBERS, Division Director
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Presented an overview of SB 179.
JULIE ANDERSON, Commissioner
Department of Commerce, Community, and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Presented an overview of SB 179.
DANETTE SCHLOEDER, Chair
Alaska Board of Nursing
Anchorage, Alaska
POSITION STATEMENT: Presented an overview of SB 179.
MARIANNE MURRAY, D.N.P., Executive Administrator
Alaska Board of Nursing
Anchorage, Alaska
POSITION STATEMENT: Presented an overview of SB 179.
ACTION NARRATIVE
1:30:26 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:30 p.m. Present at the
call to order were Senators Giessel, von Imhof, Begich, and
Chair Wilson.
SB 120-ADMINISTRATION OF PSYCHOTROPIC MEDICATION
1:30:45 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 120,
"An Act relating to administration of psychotropic medication to
a patient without the patient's informed consent; and providing
for an effective date."
He noted that the committee would hear an overview of the bill
and take invited and public testimony.
1:31:35 PM
SENATOR GIESSEL, speaking as sponsor of SB 120, said the bill
addresses the administration of psychotropic drugs. She said
Alaska Psychiatric Institute (API) has gone through some recent
challenges and the bill addresses one of those challenges, the
ongoing psychiatrist shortage in Alaska. Currently, API has one
fulltime year round psychiatrist. Under current statute, a
psychiatrist is the only person who can conduct an initial
assessment of a patient in a behavioral health crisis and decide
whether to prescribe a psychotropic medication.
SENATOR GIESSEL explained that psychotropic medications help
calm patients down to make them safe and to ensure the safety of
the staff and other patients. A psychiatric crisis or emergency
situation is an acute disturbance in a person's behavior,
thought, or mood. If left untreated, it may lead to harm to the
individual or to others. A psychotropic drug includes
olanzapine, chlorpromazine, and haloperidol to treat psychosis,
bipolar disorder, and severe behavioral health disorders and
lorazepam, a valium-type medication used to treat anxiety
reactions.
SENATOR GIESSEL said API's mission is to provide the best
possible care for its patients and the state needs to help so
they can better meet those needs. An Advanced Practice
Registered Nurse (APRN) or Physician Assistant (PA) is present
when the psychiatrist is not available, observing any patient
crisis, breakdown, or the buildup that leads to that crisis
situation. These professionals can make an educated judgment
about the use of one of these psychotropic drugs, but currently
must call the psychiatrist if he is not at the institute.
SB 120 would allow the APRN or PA observing the patient with
escalating behavior to make the assessment, diagnosis, and
decision about whether to prescribe and administer the
medication without any delay. It would remove an obsolete
statute that requires that only a psychiatrist can order the use
of psychotropic medication. The use of de-escalation techniques
and the medications will help keep patients in a safe hospital
setting where these patients can be cared for appropriately
rather than being sent to a jail when their out of control
behavior leads to assault.
SENATOR GIESSEL said these medications are already approved for
APRNs and PA.
1:37:36 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, gave the sectional analysis for SB
120. She noted that Amendment 1, in members' packets, would
address an oversight in the drafting of the bill. It adds
physician assistant in Section 1, line 12. Allowing a physician
assistant to assess and prescribe psychotropic medications is a
crucial part of the bill, she said.
1:38:36 PM
At ease
1:38:57 PM
CHAIR WILSON reconvened the meeting.
MS. CONWAY said that after an assessment is made, the patient's
behavior must be documented to explain why other remedies were
not successful and the necessity to prescribe the drug.
Subsection 2 removes the word "licensed" since physicians are
already licensed. It adds Advanced Practice Registered Nurses
and Physician Assistants to the list of those who can prescribe
psychotropic medication and outlines how that must be done.
MS. CONWAY said subsection (c) on page 2, line 15, would outline
the time period, 72 hours, the medication can be prescribed. AS
47.30.839 requires a court order to go beyond prescribing three
days, which is not addressed in this bill. Section 2 also adds
transition language and an immediate effective date.
1:41:08 PM
ALBERT WALL, Deputy Commissioner, Department of Health and
Social Services, Anchorage, Alaska, said SB 120 arose from
discussions with Senator Giessel on ways to improve care and
reduce stress on API's psychiatrists, who are on call 24/7, 365
days a year.
1:42:17 PM
CYNTHIA MONTGOMERY, Psychiatric Nurse Practitioner, Alaska
Psychiatric Institute, Anchorage, Alaska, said SB 120 is in the
best interest of patients. Alaska has many psychiatric
providers, but API is required to use contractors and locum
tenens providers to provide care to the most seriously mentally
ill patients in Alaska. These temporary psychiatrists are often
from the Lower 48 and are not familiar with Alaska's unique laws
surrounding mental health. Even when the patient's primary care
provider is present, if the provider is an APRN or PA, the
registered nurses on duty must call API's psychiatrist to
prescribe any psychotropic medications.
MS. MONTGOMERY said that because the psychiatrist may not be
immediately available, the medication cannot be given to
patients in a timely manner. The psychiatrist may not be
familiar with the patient and may be unwilling to prescribe
crisis medication. She has observed registered nurses call a
locum tenens psychiatrist and the psychiatrist does not
understand the statutory necessity. Often, patients are out of
control and refuse to take the offered medications. Allowing the
patient's own provider to prescribe the medication is in the
best interest of the patients and the facility. Besides
preventing potential harm to themselves or others, the
medication can mitigate damage to the brain during psychotic
agitation and aggression. The Joint Commission Standards require
that a licensed, independent practitioner who is most familiar
with the patient be responsible for that patient's care.
1:45:52 PM
MICHAEL ALEXANDER, M.D., Chief Psychiatrist, Alaska Psychiatric
Institute, Anchorage, Alaska, said SB 120, the crisis medication
bill, is imperative. He is the only psychiatrist at API and is
on call for 20 to 25 days per month. When API began to provide
services, there were only psychiatrists on staff and not
psychiatric nurse practitioners or physician assistants. In the
last 10 years, nurse practitioners and physician assistants were
added to the medical staff. These professionals previously
prescribed psychotropic medications, but about a year ago it was
discovered that only psychiatrists could do so. He said these
professionals are capable of prescribing and administering
psychotropic drugs and should be given the opportunity to care
for their patients.
1:47:49 PM
CHAIR WILSON opened public testimony on SB 120.
1:48:01 PM
MARIEKE HEATWOLE, representing self, Anchorage, Alaska, said she
previously worked as a nurse at Anchorage Psychiatric Institute,
but is currently pursuing a degree as a psychiatrist nurse
practitioner. She echoed the previous testimony in support of SB
120. It resolves a statutory discrepancy and ensures patient-
centered care.
1:49:04 PM
CHAIR WILSON closed public testimony on SB 120 and solicited a
motion.
1:49:17 PM
SENATOR VON IMHOF moved to adopt Amendment 1:
31-LS0866\S.1
Marx
2/25/20
AMENDMENT 1
OFFERED IN THE SENATE
TO: SB 120
Page 1, line 12:
Delete "or a registered"
Insert ", physician assistant, [OR A REGISTERED]"
1:49:25 PM
There being no objection, Amendment 1 was adopted.
CHAIR WILSON held SB 120 in committee.
SB 179-NURSING: LICENSURE; MULTISTATE COMPACT
1:49:54 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 179,
"An Act relating to the licensure of nursing professionals;
relating to a multistate nurse licensure compact; and providing
for an effective date."
He said Senate Rules Committee introduced SB 179 at the request
of the governor. He stated his intention to have an overview of
the bill, take invited testimony and public testimony.
1:50:53 PM
SARA CHAMBERS, Division Director, Division of Corporations,
Business and Professional Licensing, Department of Commerce,
Community and Economic Development (DCCED), Juneau, Alaska,
introduced herself.
1:51:27 PM
JULIE ANDERSON, Commissioner, Department of Commerce, Community,
and Economic Development, Anchorage, Alaska, said SB 179 allows
Alaska to join the Nurse Licensure Compact (NLC). This is a
multistate compact that allows nurses to practice in all
participating states. The Nurse Licensing Compact would help
address the registered nurse shortage across the state with
increased flexibility of health care emergency preparedness and
still allow the state to maintain its autonomy. Currently, 34
states have joined the NLC and 11 states have pending
legislation to join. The NLC is supported in Alaska. In a recent
survey of Alaska licensees, 87 percent of Alaska resident nurses
indicated their support for Alaska joining the compact. The
Alaska Board of Nursing voted to support joining the NLC last
year.
1:52:44 PM
DANETTE SCHLOEDER, Chair, Alaska Board of Nursing, Anchorage,
Alaska, began a PowerPoint "Nurse Licensure Compact, SB 179."
She reviewed slide 2:
Mission: Actively promote and protect the health of
the citizens of Alaska through the safe and effective
practice of nursing as defined by law.
License Numbers for FY2019
*Registered Nurses: 14,697
*Licensed Practical Nurses: 805
Advanced Practice Registered Nurses: 1,388
Certified Nurse Aides: 3,416
Total licensees: 20,306
MS. SCHLOEDER reviewed slide 3, What is Licensure?
Minimum qualifications to practice.
Age and experience are not a factor of licensure.
Licensure requirements for NLC are more comprehensive
than Alaska.
MS. SCHLOEDER said all nurses graduate from accredited programs
and sit for the same licensing examination. Licensing and
competency are not synonymous. The Alaska Board of Nursing voted
to support the compact after listening to nurses and employers.
The board examined the evidence-based literature and nursing
practice trends in Alaska and throughout the nation. The board
also considered the experiences of the other 34 state nursing
boards that have joined the compact. The Alaska Board of Nursing
recognizes that while the original version of the NLC may not
have been a good fit for Alaska, the enhanced NLC with its
rigorous requirements for multistate licensure is a good fit.
She offered the Board of Nursing's support for SB 179.
1:56:31 PM
MARIANNE MURRAY, D.N.P., Executive Administrator, Alaska Board
of Nursing, Anchorage, Alaska, asked what problem the board is
trying to fix.
DR. MURRY reviewed slide 4, Nursing Facts in Alaska That Impact
Healthcare:
• The average time for nursing licensure.
• Nurse licensure application completion rate.
• Loss of income for the nurse.
• Loss of patient contact hours.
• Amount of nursing graduates
She said it currently takes 12 to 16 weeks for a nurse to obtain
initial licensure, primarily because the application requires
primary source documents. These documents include college
transcripts and employment verification. Further, background
checks must be completed. Once the application is complete, the
board's licensing examiners can start the approval process. She
said that 97 percent of applications submitted are initially
incomplete, so licensing examiners work with the applicants to
identify the needed documentation. Since source documents are
verified or provided by other states or colleges, it can take
weeks or sometimes months to arrive. She said staff is currently
working on applications submitted in early November 2019.
CHAIR WILSON asked if there is a process for nurses to obtain
temporary licensure.
DR. MURRAY answered yes, but licensees must complete an
application. With the four-month delay in getting licensure,
there is a loss of income for a nurse coming to Alaska. The
average wage for Alaskan nurses is $85,000 per year, so nurses
could potentially lose about $20,000 while awaiting their
licenses. Most important is the loss of patient contact hours.
DR. MURRAY said Alaska has two nursing schools. As the previous
director of the University of Alaska Anchorage (UAA) School of
Nursing, she offered her view that Alaska has great schools, but
not enough nursing graduates. UAA graduates about 250 nurses
each year and Charter College graduates about 75. Ninety-five
percent of those graduates have jobs within six months. She
pointed to the chart on the bottom of slide 4 from the U.S.
Health Resources and Services Administration (HRSA) from January
2020 showing that by 2030, the expected need is 5,400. Alaska
ranks as number one in the nation for needing registered nurses.
2:00:11 PM
SENATOR BEGICH asked what the unmet needs are today in order to
compare that to the projection for 2030.
DR. MURRAY replied she had the HRSA information for 2030.
SENATOR BEGICH explained that the largest growth area in Alaska
has been the health care industry, which is driven by the rapid
increase in Medicaid expansion. He asked if the projections took
into account that the need may level off.
DR. MURRAY replied it might, but the average age of nurses is 50
or 55, so in ten years many nurses will retire. The Alaska
population over age 65 is anticipated to double in the next 20
years, so Alaska will still have a significant need.
SENATOR BEGICH asked how UAA's budget cuts have impacted nurse
recruitment and graduation. He asked if there is a shortage
because people are not interested or that resources have
diminished.
DR. MURRAY responded that one key issue at UAA was hiring
faculty to teach nursing. She opined that a number of people in
Alaska want to go to nursing school, but it makes people nervous
to think about becoming faculty at a university that is
financially unstable.
2:03:18 PM
SENATOR GIESSEL highlighted that nursing applications went
online in July 2019, but it is still taking 12 to 16 weeks to
process. She asked her to identify the issues.
DR. MURRAY replied the application volume of up to 350 per month
is one issue. There is also a backlog because applications are
incomplete due to a lack of primary source documentation. Source
documents must be submitted and verified by the universities or
employers. Thus, the applicants and agency staff must wait for
other people to submit information. She acknowledged that some
of the inefficiencies are related to the process.
SENATOR GIESSEL asked how many temporary licenses are issued.
MS. CHAMBERS offered to follow up with the information.
SENATOR GIESSEL recalled that these figures were in the most
recent sunset audit. She asked how long it takes to process and
issue temporary licenses.
DR. MURRAY answered that temporary licenses can take time
because an application must be completed and the applicant must
meet certain criteria for a temporary license.
SENATOR GIESSEL asked why someone would apply for a temporary
license.
DR. MURRAY cited the example of a recent graduate who applied
for a temporary license while waiting to take the NCLEX
(National Council Licensure Exam).
2:05:47 PM
SENATOR GIESSEL summarized that there is an opportunity to
become licensed while waiting for results and then go through a
fuller licensing process. She asked if the board would be able
to issue temporary licenses in an emergency, such as an outbreak
of coronavirus.
MS. CHAMBERS cited the 2018 earthquake as an example. Some Lower
48 states wanted to send nurses to Alaska to help and it took
over a week to issue temporary licenses for each of about a
dozen nurses. The board had to mobilize people to prioritize and
expedite those applications. In an emergency situation that
might require several hundred nurses in rural areas, the process
of obtaining a temporary license could take time because
applicants must still make an application and go through the
vetting process.
MS CHAMBERS said this bill will help diminish or eliminate the
impact of waiting weeks for documents to trickle in. The compact
eliminates that for applicants who want multiple licenses in
compact states because the home state completes the primary
source verification. Her staff can usually issue a completed
application within 10 days.
SENATOR GIESSEL expressed concern that the process has
deteriorated. In the past, Alaska has had outbreaks of RSV
(respiratory syncytial virus) affecting newborns, primarily in
rural Alaska. Thus, Alaska has had a need for specialized
neonatal nurses. The board expeditiously executed those
temporary licenses and worked hard to put that process in place.
She recalled that the board had a very efficient process. She
noted that the board has gone to online applications.
MS. CHAMBERS replied that the division has worked on the
inefficiencies it can control. However, it cannot control the
time it takes for documentation to arrive. During the 2018
earthquake, the board waited for the health care manger at the
facility to gather the documentation for its nurses. Once the
board receives the documentation, temporary licenses can be
processed quickly. She acknowledged that processing temporary
licenses for a dozen nurses took up to a week. In a situation
where more nurses were needed, it would have taken longer
because the board must follow current laws.
2:11:14 PM
SENATOR VON IMHOF related her understanding that nurses go
through the rigorous process of qualifying for a license in
their home state. If Alaska is part of the compact or modified
compact, nurses would have 60 days to provide documentation
during the licensure process. She understood Ms. Chambers
identified bottlenecks out of the division's control. She
related her understanding that the bill suspends an application
after 60 days if the documentation is not received and it
remains suspended until it is completed.
MS. CHAMBERS said the compact is a uniform agreement among
participating states that agree to all of the terms and
requirements. This particular compact cannot be modified or
altered. She pointed out that SB 157, a professional licensing
reform bill, would give the division and boards the tools to
offer modified or increased temporary licensure similar to what
Senator von Imhof described. SB 157 would provide the solution
since it would apply to all professions, including nurses.
SENATOR VON IMHOF asked whether it makes sense to pull nursing
out of the reform bill or think about how to enhance SB 179 due
to the nursing shortage, the aging population, and the
geographic location of Alaska. She said any number of illnesses
or pandemics could come to the state at any given time.
SENATOR GIESSEL asked for the duration of a temporary license.
DR. MURRAY answered six months.
SENATOR GIESSEL noted that temporary licenses are covered under
AS 08.68.210. She asked Dr. Murray to describe what licensure by
endorsement means.
DR. MURRAY responded that licensure by endorsement involves
licensing an applicant in Alaska who holds a license in another
jurisdiction.
2:15:30 PM
SENATOR GIESSEL said licensure by endorsement is covered under
AS 08.68.200, which seems like an expeditious process for
someone who is licensed in another state.
DR. MURRAY replied that applicants seeking licensure by
endorsement still must apply for licensure and be vetted, which
takes time.
2:16:21 PM
DR. MURRAY reviewed slide 6, What is the Nurse Licensure
Compact?:
It is an agreement among states to offer an optional
multistate license to nurses who have met eleven high
standards of education, training, and discipline-free
practice.
AS 28.37.010. Compact Enacted. The Driver License
Compact is enacted into law and entered into with all
other jurisdictions legally joining in it in the form
substantially contained in AS 28.37.110 - 28.37.190.
Alaska joined the Driver License Compact in 1986.
She reported that Alaska participates in over 25 different
compacts.
DR. MURRAY reviewed slide 7, What is the Nurse License Compact?
The Alaska Board of Nursing retains full authority to:
• Ensure all nurses practicing in Alaska follow its
standards, laws, and rules
• Offer multistate licensure or single state
licensure as an option
• Remove the ability of a nurse with a multistate
license to practice in our state.
The Interstate Compact Commission agreement is in
statute and can only be changed when all participating
states agree to new laws.
DR. MURRAY reviewed slide 8, Benefits to Alaska:
Reduces cost/burden on nurses.
Reduces cost/burden on employers.
Expedites disaster relief.
Adds options to keep Alaska-trained nurses in state.
She said the board held townhall stakeholder meetings in Juneau,
Anchorage, and Fairbanks. The board met many nurses who hold
licenses in many other states.
DR. MURRAY reviewed slide 9, Benefits to Alaska:
Increases access to care.
Increases telehealth solutions for Alaskans.
Eases burden on military families.
Expands employment opportunities for Alaska nurses:
• Facilities online education.
• Telehealth work.
• Seasonal employment flexibility.
2:19:05 PM
DR. MURRAY reviewed slide 10, NLC Requirements vs Alaska
Requirements. She said that Alaska licensees do not have to pass
an English language proficiency exam. Alaska licensees are not
required to be free of a felony or misdemeanor convictions
related to the practice of nursing nor do applicants in Alaska
need to have a social security number.
DR. MURRAY reviewed slide 11, Nurse Licensure Compact in 34
states. The slide depicted a map of the 34 states in the NLC.
She noted that Indiana and New Jersey were joining and 10 states
have pending legislation.
DR. MURRAY reviewed slide 12, Nurse Licensure Survey Results.
She noted that when she joined the board in September, it had
just voted to move forward with the compact. The board conducted
a survey about the Nurse Licensure Compact in December 2019 and
over 3,527 licensees responded, the majority of which reside in
Alaska.
CHAIR WILSON asked what type of nurses were included in that
number.
DR. MURRAY said the survey was sent to anyone who had an RN or
LPN [licensed practice nurse] license. Advanced Practice
Registered Nurses hold an APRN and an RN license, so APRNs would
have received the survey.
SENATOR VON IMHOF asked if traveling nurses are paid the same as
Alaska nurses and if using traveling nurses is less expensive
for hospitals.
MS. CHAMBERS replied those are questions to ask employers; nurse
salaries are not regulated by licensure. She noted that the
Alaska State Hospital and Nursing Home Association (ASHNA)
supports the bill.
2:22:44 PM
DR. MURRAY reviewed slide 13, Survey Results, which read:
3,573 nurse completed the 2019 Alaska Compact Survey!
92 [percent] of all respondents are in favor of
joining the Nurse Licensure Compact
89 [percent] of Alaskan resident nurses are in favor
of joining the compact
87 [percent] of the nurses would apply for a compact
nurse license if available.
DR. MURRAY reviewed slide 14, Nurse Licensure Compact SB 179.
The table in this slide shows overwhelming support by residents,
union and nonunion members, and respondents who hold a license
solely in Alaska as well as other jurisdictions.
SENATOR GIESSEL related her understanding that about 40 percent
of nurses with an Alaska license have their primary residence
outside of the state, so nurses living in Oregon were asked
whether Alaska should be a compact state.
DR. MURRAY confirmed that the board polled all of the Alaskan
nurse licensees.
SENATOR GIESSEL pointed out that an estimated 40 percent of
those are out-of-state residents.
SENATOR VON IMHOF asked how much the licensing fee for nurses
is.
DR. MURRAY replied a new application costs $375.
SENATOR VON IMHOF asked if fees will change with the compact.
DR. MURRAY said the board believes fees for compact licensure
would probably be more since the nurse will not pay extra fees
in other states.
SENATOR VON IMHOF asked if nurses coming to Alaska will pay $375
to get an Alaskan endorsement, if Alaska is in the compact.
2:26:17 PM
MS. CHAMBERS said that under the compact, nurses could select
either a single state license or a multistate license, which
would allow them to work in any of the other 34 compact states.
Nurses with a multistate license would not have to apply for or
pay for licensure because they already have the multistate
privilege. The multistate compact is tied to the home state, so
anytime a nurse moves from Alaska to another compact state or
from a compact state to Alaska, they would need to transfer
their home state status within the compact. Everyone renews
their license in their home state, which is the way licenses are
currently renewed. She said the division anticipates being able
to charge more for the multistate licenses and the board will
continue to adjust fees annually. The board has committed that
the multistate license will not cost single-state licensees
additional fees. The board wants to make sure that Alaskan
nurses who do not want to enter the compact will not pay for
compact activities.
SENATOR VON IMHOF said $375 is not a large fee but multiplied by
500 people it is substantial. She asked what out of state nurses
are paid and said she wants to make sure that this bill will not
displace Alaskan nurses.
CHAIR WILSON added that licensure fees go to investigations of
bad actors and complaints. He does not want to short fund
investigative services that provide safety of residents. He
asked if there would be a way to add an additional fee, if
necessary, for nurses who come to Alaska under the compact.
MS. CHAMBERS replied the division is considering setting the
multistate compact fee higher. The compact does not allow states
to assess an additional fee for visiting nurses since it will
circumvent the purpose of the compact. However, every state has
its own fee-setting process. She pointed out that Alaska nurses
currently absorb the investigative costs. The division wants to
make sure that when investigating multistate nurses, the costs
are allocated to those nurses who are in the compact. The 34
states in the compact have not seen an overwhelming increase in
investigative activity. Currently, 650 nursing jobs are
available in the state. There is quite a difference between the
available nurses and the available jobs.
SENATOR BEGICH said residents want jobs in Alaska, but the state
cannot provide the training and recruit for faculty. He related
his understanding that Alaskan residents would pay more, but
out-of-state residents would not pay any fees to work in Alaska.
MS. CHAMBERS confirmed that is how the compact works. If a
flight nurse works in the Lower 48, the nurse must have a
license to care for that patient once the flight lands. There
are plenty of opportunities for Alaskan residents to benefit
from not having to pay when these residents want to utilize
additional economic opportunities, for example, in telehealth.
SENATOR BEGICH said that sounds almost like a disincentive to
keep people in the state. The state does not want to trap people
in Alaska, but if the state has a shortage of 670 nurses and
adds an additional incentive to leave the state, this could be a
potential disincentive to fill the nursing gap, not an
incentive. Twenty-one percent of the workforce today are not in-
state residents. These non-residents get services and pay
nothing for them. This seems to be an example of increasing
that. He asked for some reassurance.
CHAIR WILSON suggested that some employers could speak to that.
2:35:31 PM
MS. SCHLOEDER said she has always had a primary Alaskan license.
Three years ago she answered the call to help train new nurses
through online education. She has to have licenses in Washington
and Montana in order to teach online. She is lucky that she only
needs three licenses. She met a nurse educator who has 37. She
has to have a license for every state where she has a student
because teaching nursing is practicing nursing. There are highly
trained nurses in Alaska who would like to teach online, and
online education is very popular in advanced practice, in
doctorate programs, and others, but these nurses do not want to
get a license in every state where they have students.
CHAIR WILSON noted the interest in the bill and reminded people
that they could send written testimony to shss@akleg.gov.
SENATOR BEGICH said Ms. Schloeder indicated that it is a
disadvantage to APRNs, but according to slide 2, these nurses
are not eligible to enter the compact.
MS. SCHLOEDER said an online instructor who is teaching Advanced
Practice Registered Nurses would still need to hold licenses in
those states.
SENATOR BEGICH asked what government regulates the nurse
licensure compact.
MS. CHAMBERS said the Alaska Board of Nursing has full control
and sovereignty over nursing practice in Alaska.
2:38:32 PM
SENATOR BEGICH said he was asking a slightly different question.
The NLC has structures and processes that can be changed and the
state would be under those processes if it signs the compact. He
asked which government is in charge of that.
MS. CHAMBERS said that like the other 27 compacts, including the
driving, mining, and children placement compacts, there is a
body made up of member states who facilitate the conversation.
That is the Interstate Commission. If Alaska joins, there will
be 35 board chairs who represent each state. Each state has an
equal voice. The terms of what the commission can and cannot do
is in the bill. All legislatures adopting the compact say that
state boards retain sovereignty over practice and set the
priorities for licensure. The commission has nothing to do with
the day-to-day evaluation of nurses. It is about how to
facilitate the conversation about how the compact is going to
operate.
CHAIR WILSON asked if the Department of Law reviewed this
compact.
MS. CHAMBERS replied it is the governor's bill, so the
Department of Law wrote it. The division worked with the
Department of Law many months in drafting the bill.
SENATOR GIESSEL recapped that nurses with a multistate license
who come to Alaska will not be charged anything. She expressed
concern about the potential loss of revenue for the Board of
Nursing under the compact.
MS. CHAMBERS responded that not all those licensees are in
compact states. There is a percentage of licensees outside of
Alaska who would still be required to obtain an Alaskan license
because these licensees are not part of a compact. The board
anticipates that there may be a loss of revenue for the board
from up to 4,000 nurses. Conversely, the workload on the board
will decrease because it will not be processing all those
licenses. The division held conversations internally and with
the staff to answer questions about whether the expenses of the
board will decrease. If the board does not need as much staff to
process applications, it will lose staff through attrition or
the division will assign staff members to other programs. The
division is not only keen on tracking those expenses to have
transparent conversations with the board and stakeholders but
also so that the board and licensees know that the costs of
multistate licenses might go up.
SENATOR GIESSEL questioned whether that makes sense. She said
there are currently 6,000 licensed nurses and it takes about 10
minutes to renew a license, so there should not be staff costs
to process. She acknowledged that renewal fees allow the board
to stay solvent.
DR. MURRAY said the board loses 3,000 licensees each biennial
renewal. The board has a steady rate of nurse licensees along
with considerable fluctuation in the number of other licensees.
CHAIR WILSON invited Ms. Chambers to present the sectional
analysis for the bill.
2:44:45 PM
MS. CHAMBERS noted that much of the bill is adding the compact
license where nursing licenses already exists. She presented the
following sectional analysis for SB 179:
Section 1: Amends AS 08.02.010 (Professional
Designation Requirements) to add AS 08.69 (the
Multistate Nurse Licensure Compact chapter, created by
Section 23 of this Act) as a qualification designation
requirement for registered nurses.
Section 2: Adds AS 08.69 (created by Section 23 of
this Act) to AS 08.11.120 (Audiology Exemptions), to
allow a nurse that holds a multistate license to
perform hearing sensitivity evaluations.
Section 3: Extends the Board of Nursing's existing
authority to govern AS 08.69 (created by Section 23 of
this Act), and identifies the executive director of
the board as the interstate commission licensure
compact administrator
Section 4: Exempts AS 08.69 (created by Section 23 of
this Act) from the Administrative Procedures Act, as
nurses licensed under this chapter are subject to the
due process provided in the Nurse Licensure Compact.
Section 5: Requires the Registered Nurse (RN) or
Licensed Practical Nurse (LPN) offering to practice in
this state to submit evidence of qualification to
practice and to be licensed under this chapter (AS
08.68) or AS 08.69 (created by Section 23 of this
Act).
2:47:04 PM
Section 6: Extends the existing required
qualifications in AS 08.68.170 (Qualifications of
Registered or Practical Nurse Applicants) to nurse
applicants under AS 08.69 (created by Section 23 of
this Act).
Section 7: Clarifies that AS 08.68.190(b) (under
License by Examination) pertains only to Alaska state
nursing licensure.
Section 8: Creates a new subsection (c) under AS
08.68.190 (under License by Examination), which
explains that if the qualifications are met for both
AS 08.69 (created by Section 23 of this Act) and AS
08.68.170, the Board of Nursing shall issue a
multistate license.
Section 9: Amends AS 08.68.200 (Licensure by
Endorsement) to pertain only to single state licensure
in Alaska.
Section 10: Amends AS 08.68.220 (Fees) to authorize
the Department of Commerce Community and Economic
Development to set fees for multistate licenses issued
by the board.
Section 11: Amends AS 08.68.230(a) (under Use of Title
and Abbreviation) to authorize a multistate license
holder under AS 08.69 (created by Section 23 of this
Act) to use the title Registered Nurse and the
abbreviation R.N.
Section 12: Amends AS 08.68.230(b) (under Use of Title
and Abbreviation) to authorize a multistate license
holder under AS 08.69 (created by Section 23 of this
Act) to use the title Licensed Practical Nurse and the
abbreviation L.P.N.
Section 13: Amends AS 08.68.230(d) (under Use of Title
and Abbreviation) to add single state language to
temporary permits and to note that an LPN that holds a
temporary permit in the state can use the title
Temporary Licensed Practical Nurse and the
abbreviation TLPN.
Section 14: Clarifies in AS 08.68.251 (Lapsed
Licenses) that single state or multistate nursing
licenses may be reinstated if lapsed for fewer than
five years.
Sections 15-19: Amend AS 08.68.270 (Grounds for
Denial, Suspension, or Revocation) and 08.68.275
(Disciplinary Sanctions) to add the multistate license
to the existing types of licenses that may be
disciplined by the board.
2:49:59 PM
SENATOR BEGICH asked, if the board invalidates someone with a
multistate license, is that person affected in every state.
MS. CHAMBERS answered yes. If someone is in violation of a
statute or regulation in a state where these licensees are
authorized to practice, that Board of Nursing can determine that
someone is guilty under the state's administrative procedure and
not welcome to practice in the state any longer. That is
reported through the nursing database, which the state currently
uses. The other states are notified and can take action on that
license. No nurse with active discipline can hold a multistate
license. A state would have to convert the license to a single
state license for the nurse to practice.
Section 20: Maintains exemptions in AS 08.68.800
(Exceptions to Application of Chapter) for nurses who
are working in limited circumstances under a license
issued in another state.
Section 21: Amends AS 08.68.805 (Delegation of Nursing
Functions) to include nurses who hold a multistate
license under 08.69 (created by Section 23 of this
Act).
Section 22: Amends AS 08.68.850(1) (Definition of
"advanced practice registered nurse) to include
registered nurses licensed under AS 08.69 (created by
Section 23 of this Act).
Section 23: Creates AS 08.69, Multistate Nurse
Licensure Compact. It includes the purpose,
definitions, provisions, jurisdiction, licensing
provisions, authority of state boards, information-
sharing, governance and rulemaking authority, due
process, enforcement, dispute resolution, withdrawal,
severability, and amendment. These articles are
uniform to all 34 other states within the compact and
are mandatory for participation.
Sections 24-36: Amend statutes to add AS 08.69
(created by Section 23 of this Act) to the definitions
of nursing as found throughout state law:
Section 37: Allows the department to adopt regulations
necessary to implement the changes made by this Act,
to take effect under AS 44.62 on the effective date as
noted in Section 38.
Section 38: Makes Section 37 (Transition Regulations)
effective immediately once the bill is signed.
Section 39: Makes Sections 1-36 of this Act effective
as of July 1, 2021.
2:52:48 PM
SENATOR VON IMHOF offered her belief that each state has unique
statutes. She asked if a nurse comes to Alaska as part of the
compact and violates a unique statute that is different from the
other states, would they lose the privilege to practice in other
states for violating one unique thing in Alaska.
DR. MURRAY replied the board would investigate and if necessary,
would work with the licensee's home state to have his/her
license revoked so that nurse would not be eligible for a
multistate license.
SENATOR VON IMHOF noted that Dr. Murray spoke about 11 things
that were similar or standard between Alaska and the NLC. She
asked if each traveling nurse who works in Alaska is responsible
for identifying the unique laws in Alaska.
2:54:30 PM
MS. SCHLOEDER answered that nurses are responsible for knowing
the Nurse Practice Act in their home state. Nurses holding a
multistate license must be familiar with the Nurse Practice Act
in each state in which the nurses practices.
MS. CHAMBERS said employers have a fiduciary responsibility to
make sure visiting nurses are knowledgeable to limit their own
liability, but the state does work with traveling nurses to make
sure they are familiar with Alaska's laws. This bill will not
change the state's current practice.
SENATOR GIESSEL asked how the board will know if nurses from
other states are in Alaska.
MS. CHAMBERS said Alaska currently licenses nurses who reside in
other states, but the board does not know when these licensees
are practicing in Alaska. The board also does not know when
nurses are practicing at military bases or for Alaska Native
organizations since these organizations are exempt from Alaska
licensure. The Board of Nursing and the division do not
currently keep tabs on those nurses.
SENATOR GIESSEL pointed out one difference. If a person violates
the Nurse Practices Act, the division will have collected a
licensing fee to help offset the cost of adjudication of the
violation. Under this compact, the division would not have that
same financial availability.
2:57:10 PM
SENATOR BEGICH said the board knows that a total of 20,306
licenses were issued to nurses in various categories. Under the
compact, the state would no longer know the number of licensed
nurses in Alaska. He said he didn't know if that was an issue.
MS. CHAMBERS said the division has access to the nursing
database so it would have information if someone filed a
complaint against a nurse. The division would use the same
disciplinary process it currently uses. She said knowing how
many licensed nurses are practicing in the state is important
for certain data collection points and to estimate fees.
Employers are responsible for day-to-day management of their
nurses, whether it is in a private clinic under a doctor or in a
large facility under a chief nursing officer.
3:00:08 PM
CHAIR WILSON asked the division to provide more information
about the fees, noting that he does not want to shortchange the
investigative practice of the board.
CHAIR WILSON held SB 179 in committee.
3:01:51 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee at 3:01 p.m.