03/07/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) Commissioner Department of Health | |
| SB8 | |
| SB44 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 8 | TELECONFERENCED | |
| += | SB 44 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 7, 2023
3:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator James Kaufman, Vice Chair
Senator Löki Tobin
Senator Forrest Dunbar
Senator Cathy Giessel
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
Commissioner, Department of Health
Heidi Hedberg - Anchorage
- CONFIRMATION ADVANCED
SENATE BILL NO. 8
"An Act repealing the certificate of need program for health
care facilities; making conforming amendments; and providing for
an effective date."
- MOVED CSSB 8(HSS) OUT OF COMMITTEE
SENATE BILL NO. 44
"An Act relating to the practice of naturopathy; establishing
the Naturopathy Advisory Board; relating to the licensure of
naturopaths; relating to disciplinary sanctions for naturopaths;
relating to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
- MOVED CSSB 44(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 8
SHORT TITLE: REPEAL CERTIFICATE OF NEED PROGRAM
SPONSOR(s): SENATOR(s) WILSON
01/18/23 (S) PREFILE RELEASED 1/9/23
01/18/23 (S) READ THE FIRST TIME - REFERRALS
01/18/23 (S) HSS, L&C
02/16/23 (S) HSS AT 3:30 PM BUTROVICH 205
02/16/23 (S) Heard & Held
02/16/23 (S) MINUTE(HSS)
02/21/23 (S) HSS AT 3:30 PM BUTROVICH 205
02/21/23 (S) Heard & Held
02/21/23 (S) MINUTE(HSS)
03/02/23 (S) HSS AT 3:30 PM BUTROVICH 205
03/02/23 (S) <Above Item Removed from Agenda>
03/02/23 (S) MINUTE(HSS)
03/07/23 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 44
SHORT TITLE: NATUROPATHS: LICENSING; PRACTICE
SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST
01/25/23 (S) READ THE FIRST TIME - REFERRALS
01/25/23 (S) HSS, L&C, FIN
02/23/23 (S) HSS AT 3:30 PM BUTROVICH 205
02/23/23 (S) Heard & Held
02/23/23 (S) MINUTE(HSS)
03/07/23 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
HEIDI HEDBERG, Commissioner Designee
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Testified as the commissioner-designee for
the Department of Health.
JEANNIE MONK, Senior Vice President
Alaska Hospital and Healthcare Association
Juneau Alaska
POSITION STATEMENT: Testified in support of Commissioner-
Designee Heidi Hedberg.
VERNE BOERNER, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of Commissioner-
Designee Heidi Hedberg.
NANCY MERRIMAN, CEO
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of Commissioner-
Designee Heidi Hedberg.
NILS ANDREASSEN, Executive Director
Alaska Municipal League
Juneau, Alaska
POSITION STATEMENT: Testified in support of Commissioner-
Designee Heidi Hedberg.
GARY ZEPP, Staff
Senator David Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a summary of changes from version A
to version B of SB 8
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a summary of changes from version A
to version S of SB 44
CLYDE JENSEN, Ph.D.
Professor of Pharmacology
Rocky Vista University
Saint George, Utah
POSITION STATEMENT: Answered questions about SB 44.
ACTION NARRATIVE
3:32:25 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:32 p.m. Present at the
call to order were Senators Giessel, Dunbar, Kaufman, Tobin, and
Chair Wilson.
^CONFIRMATION HEARING(S) COMMISSIONER DEPARTMENT OF HEALTH
CONFIRMATION HEARING(S)
COMMISIONER, DEPARTMENT OF HEALTH
3:33:16 PM
CHAIR WILSON announced the consideration of Heidi Hedberg's
confirmation as Commissioner for the Department of Health (DOH).
3:33:34 PM
HEIDI HEDBERG, Commissioner-Designee, Department of Health,
Anchorage, Alaska, shared that she was born in Utah, raised in
Seattle, and moved to Alaska in 1995. She has a degree in
outdoor studies from Alaska Pacific University which taught her
leadership and other valuable skills. She is married with two
sons. She has worked in non-profit organizations which allowed
her to make connections and strengthen partnerships. She has
worked for the Girl Scout Council and a blood bank. She said she
has worked in the Division of Public Health for 13 years in
various positions, which has given her a unique perspective on
government operations. It also allowed her to build strong
partnerships with hospitals, tribal health organizations, and
federal agencies. She is aware of Alaska's challenges. She
served four years as the director of public health and in that
role, she represented the Department of Health and Social
Services in Unified Command. Unified Command was formed during
the COVID-19 pandemic under Homeland Security and Emergency
Management. She found it challenging to lead when resources were
scarce and the staff was burned out.
3:37:36 PM
COMMISSIONER-DESIGNEE HEDBERG said that governing required
strong connections, the ability to collect and assess
information quickly, and triage priorities. Optimism and
teamwork were the key to success during the pandemic. Being the
director of public health was a career highlight; it grew her
ability to govern. She credited the staff and partners for
Alaska having fewer deaths and hospitalizations compared to
other rural states. Working with tribal health partners, Alaska
was ranked number one for vaccines per capita for the first four
months of the pandemic.
She stated that her vision for the Department of Health is to
increase the health, well-being, and self-sufficiency of
Alaskans. This vision can be accomplished by leveraging public
health to be the chief health strategist to address the gaps in
the continuum of care and the inefficient systems within public
assistance. She said she would focus on elders aging in place
and timely reimbursement for Medicaid providers. The desired
outcomes will be healthier Alaskans, the economy will be more
vibrant, and the health care system will be more accessible and
affordable. Prevention is cheaper than treatment. It is also a
cost-containment tool over time. Healthy Alaskans 2030 is a
state health improvement plan that will improve the health
challenges Alaska faces to date.
COMMISSIONER-DESIGNEE HEDBERG said the Division of Public
Assistance output is at a low point due to the ineffective
systems that are in place. She conveyed that she was willing to
take responsibility for the problems of the past and was
committed to be a better steward of resources. The bifurcation
of the Department of Health and Social Services places her in a
better position to deal with problems than her predecessors. IT
systems need to be integrated and she has a plan. A workflow
management system is also being implemented. A request for more
staff and resources was submitted for the Governor's amended
budget. Staff needs to feel seen, heard, valued, and safe. They
are passionate about their work but they are not always
recognized for their efforts. Gaps in the continuum of care have
come a long way but there are still gaps that need to be closed.
She committed to ensuring that Alaskans have the right resources
at the right time.
3:42:07 PM
COMMISSIONER-DESIGNEE HEDBERG stated that she appreciates the
legislature passing legislation on crisis stabilization centers.
Now time needs to be spent making sure these services are
implemented. Aging in place is another key to healthy families.
Advocacy groups for individuals with disabilities want updates
to the rate-setting methodologies, an increase in the workforce,
and the ability for individuals with disabilities to choose
their direct services. Healthcare services touch every aspect of
the Medicaid program. The staff at DOH have saved over $370
million dollars through tribal reclaiming. She stated she is
committed to expanding tribal reclaiming and other cost-saving
ideas about pharmacy rebates. The governor's Health Family
Initiative should be fully realized. Strong families are the
foundation of a vibrant economy and community. Agencies and
departments will need to work together so that policies can be
updated and funding sources leveraged. She said that over the
next four years, the health, wellness, and self-sufficiency of
Alaskans will be addressed.
COMMISSIONER-DESIGNEE HEDBERG stated that what she brings to
this role is organizational leadership, stability, innovation,
and a team approach.
3:45:36 PM
CHAIR WILSON asked if there were any questions.
3:45:44 PM
SENATOR DUNBAR requested more detail on the progress in
eliminating the backlog in the food stamp program.
COMMISSIONER-DESIGNEE HEDBERG responded that she anticipates
that the backlog will be eliminated in two months. Last week the
eligibility technicians processed 5,000 SNAP recertification
applications and this week they've processed a little more than
4,000. The IT staff programmed the eligibility information
system (EIS) which stopped the backlog from continuing, and now
they're working on programing to move from a six-month
recertification period to a 12-month recertification period. The
go-live date will be in July. A team has also been working on an
online SNAP application that will go live this December. The
department is also working to improve communication and have
timelier follow-up with constituents.
3:48:39 PM
SENATOR DUNBAR asked what the expected wait time is for somebody
who is not in the backlog and is filing an application right
now.
3:48:56 PM
COMMISSIONER-DESIGNEE HEDBERG answered that all the public
assistance programs are experiencing various levels of delay, so
she can't tell somebody who applies today whether it will take a
week, a month, or longer to receive the benefits because it
depends on the individual's income and the program for which
they're applying.
3:50:41 PM
CHAIR WILSON opened public testimony on the appointment of Heidi
Hedberg as commissioner of the Department of Health.
3:50:56 PM
JEANNIE MONK, Senior Vice President, Alaska Hospital and
Healthcare Association, Juneau Alaska, stated that on behalf of
AHHA, she was pleased to offer support for Commissioner-Designee
Heidi Hedberg. She has worked hard, is willing to take on
challenges, and she works to find solutions. Part of her success
is her willingness to build relationships and strong
partnerships. She will bring a deep understanding of the
challenges of rural Alaska. She understands rural health and is
willing to work with communities to address their needs.
Commissioner-Designee Hedberg has been and will continue to be a
great partner with hospitals and nursing homes. She will be fair
and involve stakeholders in decisions whenever possible, and she
will focus on providing the best for Alaskans. She reiterated
unwavering support for the appointment.
3:53:08 PM
VERNE BOERNER, representing self, Anchorage, Alaska, stated that
she was honored to speak in support of Heidi Hedberg's
confirmation as commissioner for the Department of Health. She
said she was the president and CEO of the Alaska Native Health
Board when she worked with Ms. Hedberg during the very
challenging COVID-19 pandemic and she demonstrated exceptional
leadership skills and great insight. She worked countless hours
around the clock to form partnerships and make them work. She
collaborated to develop new guidelines and developed a pandemic
response that supported communication and integrated responses
between state, tribal, and local partners. Her priority was to
protect all Alaskans. She reiterated strong support for the
appointment.
3:55:16 PM
NANCY MERRIMAN, CEO, Alaska Primary Care Association (APCA),
Anchorage, Alaska, stated that APCA supports the development and
operation of Alaska's 29 Federally Qualified Health Centers
(FQHA). She said it was her pleasure to express APCA's support
for Heidi Hedberg as commissioner of the Department of Health.
APCA has appreciated her partnership on emergency preparedness
and management, response to COVID-19, fostering collaboration
between public health and FQHC, and identifying ways to
strengthen Alaska's health care safety net. She has a wealth of
knowledge and experience and is results-oriented. Decades of
research support the value of primary care that meets patients
where they are. This is the kind of health care that FQHCs are
committed to providing and this is the kind of health care
Commissioner-Designee Hedberg believes in. The perspective she
has gained through the years will inform her leadership and
strategic planning for the Department of Health. Commissioner-
Designee Hedberg is a strong public health and community leader
and APCA supports her appointment as commissioner.
3:57:48 PM
NILS ANDREASSEN, Executive Director, Alaska Municipal League
(AML), Juneau, Alaska, stated that AML doesn't typically comment
on governor appointments, but he wanted to express how grateful
he was for Commissioner-Designee Hedberg's work the last few
years as the director of the Division of Public Health. Her work
to foster and maintain collaboration and partnership in response
to and during the Covid-19 public health emergency was
impressive. She forged partnerships that will benefit local
governments and communities in the future. For the first time,
AML is looking at social determinants of health in supporting
communities and that is entirely due to Commissioner-Designee
Hedberg's leadership. He reiterated his appreciation for the
work she has done and has the potential to do as commissioner of
the Department of Health.
3:59:54 PM
CHAIR WILSON closed public testimony and solicited a motion.
SENATOR KAUFMAN moved to forward the following name to a joint
session for consideration:
Commissioner, Department of Health
Heidi Hedberg - Anchorage
Signing the reports regarding appointments to boards and
commissions in no way reflects individual members' approval or
disapproval of the appointees; the nominations are merely
forwarded to the full legislature for confirmation or rejection.
CHAIR WILSON stated that without objection, the name will be
forwarded.
4:00:52 PM
At ease.
SB 8-REPEAL CERTIFICATE OF NEED PROGRAM
4:02:20 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 8 "An Act repealing the
certificate of need program for health care facilities; making
conforming amendments; and providing for an effective date."
He related that this was the second hearing, public testimony
was heard, and there was a committee substitute (CS) for the
committee to consider. He solicited a motion.
4:02:57 PM
SENATOR KAUFMAN moved to adopt the committee substitute (CS) for
SB 8, work order 33-LS0135\B, as the working document.
4:03:07 PM
CHAIR WILSON objected for purposes of discussion.
4:03:14 PM
GARY ZEPP, Staff, Senator David Wilson, Alaska State
Legislature, Juneau, Alaska, provided the following summary of
changes from version A to version B of SB 8.
Page 4, line 14
Replace "Department of Family and Community Services" with
"Department of Health."
Page 6, lines 4 and 10
Replace "Department of Family and Community Services" with
"Department of Health."
Page 6, line 15
Change the effective date from July 1, 2026 to July 1, 2028
CHAIR WILSON asked whether there were any questions.
4:04:29 PM
SENATOR DUNBAR asked the reason for delaying the effective date
until 2028.
CHAIR WILSON replied that was a compromise to help hospitals
recoup costs and plan for an end date of the Certificate of Need
(CON) Program. The additional time also provides an opportunity
for the department to develop additional regulations that may be
needed for hospital accreditations.
SENATOR DUNBAR asked what costs were anticipated from this
change.
CHAIR WILSON answered that the extra time allows hospitals that
may have made significant investments into equipment to recoup
some of that cost by continuing to have no competition for two
additional years.
4:05:40 PM
CHAIR WILSON removed his objection; he found no further
objection and version B was adopted.
4:06:16 PM
SENATOR DUNBAR said he'd like to see the data from states that
have repealed CON that shows the degree to which costs have
fallen since the repeal. Repealing CON sounds like a good idea
in theory but his concern was about the unintended consequences
it may have. He cited the testimony the committee heard that
repealing CON would result in the most profitable procedures no
longer being offered in hospitals, which would not lead to lower
costs.
CHAIR WILSON responded that he'd had conversations with the
Primera Blue Cross representative for this region who said his
experience was that a healthcare consolidation of services only
increases the cost of health care. His office has asked
healthcare organizations that have said they were having
financial trouble to produce their financial records that show
the actual cost to provide a service, but many hospitals and
agencies won't disclose the true cost of a service.
4:09:14 PM
SENATOR TOBIN observed that the two letters in the bill packets
from the Pacific Health Coalition were somewhat confusing.
4:09:28 PM
At ease.
4:10:17 PM
CHAIR WILSON reconvened the meeting. He suggested the committee
members who wanted further dialog should contact the individual
from Pacific Health Coalition who wrote that he was rescinding
his previous testimony without comment.
4:10:49
CHAIR WILSON found no further comments or questions and he
solicited a motion.
4:10:51 PM
SENATOR KAUFMAN moved to report the CS for SB 8, work order 33-
LS0135\B, from committee with individual recommendations and
attached fiscal note(s).
4:11:04 PM
CHAIR WILSON found no objection and CSSB 8(HSS) was reported
from the Senate Health and Social Services Standing Committee.
4:11:15 PM
At ease.
SB 44-NATUROPATHS: LICENSING; PRACTICE
4:13:09 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 44 "An Act relating to the
practice of naturopathy; establishing the Naturopathy Advisory
Board; relating to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to the
Department of Commerce, Community, and Economic Development; and
providing for an effective date."
4:13:26 PM
CHAIR WILSON noted that there was a committee substitute (CS)
for the committee to consider. He solicited a motion.
4:13:29 PM
SENATOR KAUFMAN moved to adopt the committee substitute (CS) for
SB 44, work order 33-LS0297\S, as the working document.
4:13:40 PM
CHAIR WILSON objected for purposes of discussion.
4:13:53 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, provided the following summary of
changes for SB 44 from version B to version S:
Page 2, lines 23-24: re: Advisory Board composition
The Advisory Board composition was changed to be
comprised of 2 NDs, 1 pharmacist, 1 MD or OD and
1 public member. (Reduced public members from 2
to 1, reduced NDs from 3 to 2, and added 1
pharmacist and 1 MD or OD.)
Page 4, line 4: re: externship
Removes the externship program requirement for
Naturopath licensure. The term is confusing and
unnecessary. Other medical providers with the
level of authority the NDs are requesting are
not required to match or emulate the MD and OD
internship process. The training for NPs is most
commensurate with that of NDs having similar
clinical hours, and neither have a required
residency.
Page 6, line 13: re: vaccines
Added vaccines to the list of services that a
licensed naturopath may provide.
Page 6, line 19:
Deletion of the word "surgical" to clarify this
sentence which only means that a licensed
naturopath may treat superficial lacerations,
abrasions and lesions. The word "surgical" can
be mistaken to infer procedures that they are
not seeking to perform.
Page 6, line 26:
Replaces the word "ultrasound" with the word
"imaging." There are several types of imaging
that a naturopath may wish to order if
necessary. Other types of imaging could be an
X-ray, MRI, CT scan, ultrasound, EKG, and other
tests to assist with correct patient diagnosis.
Page 6, line 30:
Replaces the word "ultrasound" with the word
"imaging." There are several types of imaging
that a naturopath may wish to order if
necessary to assist with correct patient
diagnosis.
CHAIR WILSON discerned there were no questions or comments.
4:16:55 PM
CHAIR WILSON removed his objection; he found no further
objection and version S was adopted. He noted that Senator
Dunbar had an amendment.
4:17:21 PM
At ease
4:18:19 PM
CHAIR WILSON reconvened the meeting.
4:18:25 PM
SENATOR DUNBAR moved to adopt Amendment 1 for SB 44. He noted
that the amendment was drafted based on the original bill, but
the following reflects the proposed changes to version S.
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR DUNBAR
TO: SB 44, version S
Page 4, lines 5 - 6:
Delete all material.
Renumber the following paragraphs accordingly.
Page 6, line 24:
Delete "and"
Page 6, line 27, following "test":
Insert "; and
(5) write prescriptions if the person has
passed a pharmaceutical examination approved by the
department that is equivalent to any examination of
pharmaceutical knowledge required under AS 08.64.210
or 08.64.220"
4:18:28 PM
CHAIR WILSON objected for purposes of an explanation.
SENATOR DUNBAR explained that naturopaths in Alaska are not
required to have prescriptive authority to practice, but SB 44
would require an individual who applies for a license to
practice naturopathy in the state to have passed a
pharmaceutical examination before they apply. The intent of the
amendment is to delete the requirement for naturopaths to pass a
pharmaceutical examination. Then on page 6, line 27 a new
paragraph (5) adds the ability for naturopaths to write
prescriptions if they have passed an approved pharmaceutical
examination. Naturopaths may obtain prescriptive authority but
they aren't required to do so.
4:20:15 PM
SENATOR GIESSEL advised that Dr. Clyde Jensen, who is a
professor of pharmacology, may wish to comment on Amendment 1.
4:20:41 PM
CLYDE JENSEN, Ph.D., MS, Professor of Pharmacology, Rocky Vista
University, Saint George, Utah stated his belief that a
naturopath who does not wish to prescribe should not be required
to do so. He then cautioned the committee to be mindful of any
amendment that creates unnecessary obstacles.
4:22:08 PM
CHAIR WILSON asked Senator Dunbar for confirmation that the
amendment would remove the requirement for a naturopath to pass
a pharmaceutical examination.
4:22:26 PM
SENATOR DUNBAR clarified that Amendment 1 removes the
requirement for a naturopath to pass a pharmaceutical
examination to practice naturopathy. It also adds a new
paragraph (5) on page 6 that clarifies that a licensed
naturopath who wants to write prescriptions may do so once they
have passed an approved pharmaceutical examination.
4:22:47 PM
CHAIR WILSON asked Dr. Jensen if there would be a benefit for a
naturopath to take the pharmaceutical examination even if they
do not intend to prescribe.
4:23:04 PM
DR. JENSEN said he was not aware of a benefit to taking the
examination if a naturopath chooses not to prescribe.
4:23:23 PM
SENATOR GIESSEL stated that the purpose of the state's
regulatory boards is to protect the public. She posited that
when a naturopath is providing health care services, they are
not confining their services to individuals who are not
consuming pharmaceuticals. She opined that the vitamins,
minerals, and herbal preparations that naturopaths recommend
have the potential to create side effects when they interact
with pharmaceuticals an individual has taken. She said that's
the reason to require naturopaths to demonstrate pharmaceutical
knowledge even if they don't prescribe them. The requirement for
naturopaths to pass a pharmaceutical examination provides
documentation that the state has examined an individual and
asserts that they have equivalent pharmaceutical knowledge to
others who are licensed under medical statutes. She noted that
Dr. Jenson testified in the past that the pharmacological
education that naturopaths receive is equivalent to medical
physicians.
4:26:18 PM
SENATOR TOBIN asked if the amendment would create two types of
licenses for naturopaths, one with an endorsement and one
without. She asked who would be checking to ensure that a
naturopath was practicing within their scope of licensure.
4:26:50 PM
SENATOR DUNBAR stated his belief that it would be the same
regulatory agency that currently oversees naturopaths. He
continued to say that if a naturopath were to exercise
prescriptive authority without taking the pharmaceutical
examination, that same regulatory body would take action. He
noted that Senator Giessel has evidence that most naturopaths
would take the examination and seek prescriptive authority, but
some members of the public expressed a desire to not force
prescriptive authority on naturopaths.
4:28:05 PM
SENATOR DUNBAR said he appreciates the changes in the CS and
Senator Giessel's reasoned argument for public safety. He
withdrew Amendment 1 and said he appreciated that the discussion
was on the record.
4:28:22 PM
CHAIR WILSON found no further amendments, questions, or comments
and he solicited a motion.
4:28:39 PM
SENATOR KAUFMAN moved to report the CS for SB 44, work order 33-
LS0297\S, from committee with individual recommendations and
attached fiscal note(s).
4:28:48 PM
CHAIR WILSON found no objection and CSSB 44(HSS) was reported
from the Senate Health and Social Services Standing Committee.
4:28:56 PM
At ease.
4:30:55 PM
CHAIR WILSON reconvened the meeting and made committee
announcements.
4:31:39 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 4:31 p.m.