Legislature(2015 - 2016)BUTROVICH 205

04/08/2015 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 53 ADVANCED PRACTICE REGISTERED NURSES TELECONFERENCED
Heard & Held
*+ SB 90 MEDICAID: USED DURABLE MEDICAL EQUIPMENT TELECONFERENCED
Heard & Held
+ HB 4 AUTOMATED EXTERNAL DEFIBRILLATOR TELECONFERENCED
Heard & Held
Bills Previously Heard/Scheduled:
+= SB 74 MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES TELECONFERENCED
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 8, 2015                                                                                          
                           1:30 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bert Stedman, Chair                                                                                                     
Senator Cathy Giessel, Vice Chair                                                                                               
Senator Pete Kelly                                                                                                              
Senator Johnny Ellis                                                                                                            
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Bill Stoltze                                                                                                            
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 74                                                                                                              
"An  Act relating  to  permanent  fund  dividends; relating  to  a                                                              
medical  assistance   reform  program;  establishing   a  personal                                                              
health   savings   account   program    for   medical   assistance                                                              
recipients;  relating to the  duties of  the Department  of Health                                                              
and    Social   Services;    establishing    medical    assistance                                                              
demonstration   projects;  and   relating  to   a  study   by  the                                                              
Department of Health and Social Services."                                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 53                                                                                                              
"An  Act  relating   to  advanced  practice   registered  nursing;                                                              
relating to  certified direct-entry  midwifery; and  providing for                                                              
an effective date."                                                                                                             
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 90                                                                                                              
"An  Act relating  to the  purchase of  durable medical  equipment                                                              
under Medicaid; and providing for an effective date."                                                                           
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 4                                                                                                                
"An Act relating to automated external defibrillators."                                                                         
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 74                                                                                                                   
SHORT TITLE: MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES                                                                            
SPONSOR(s): SENATOR(s) KELLY                                                                                                    
                                                                                                                                
03/13/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/13/15       (S)       HSS, STA, FIN                                                                                          
03/13/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/13/15       (S)       -- Testimony <Invitation Only> --                                                                      
03/23/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/23/15       (S)       Heard & Held                                                                                           
03/23/15       (S)       MINUTE(HSS)                                                                                            
04/01/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/01/15       (S)       Heard & Held                                                                                           
04/01/15       (S)       MINUTE(HSS)                                                                                            
04/02/15       (S)       STA AT 9:00 AM BUTROVICH 205                                                                           
04/02/15       (S)       <Pending Referral>                                                                                     
04/03/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/03/15       (S)       -- Testimony <Invitation Only> --                                                                      
                                                                                                                                
BILL: SB 53                                                                                                                   
SHORT TITLE: ADVANCED PRACTICE REGISTERED NURSES                                                                                
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
02/18/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/18/15       (S)       L&C, HSS                                                                                               
03/10/15       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/10/15       (S)       Heard & Held                                                                                           
03/10/15       (S)       MINUTE(L&C)                                                                                            
03/12/15       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/12/15       (S)       Moved SB 53 Out of Committee                                                                           
03/12/15       (S)       MINUTE(L&C)                                                                                            
03/13/15       (S)       L&C RPT 4DP 1NR                                                                                        
03/13/15       (S)       DP: COSTELLO, GIESSEL, MEYER, STEVENS                                                                  
03/13/15       (S)       NR: ELLIS                                                                                              
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 90                                                                                                                   
SHORT TITLE: MEDICAID:  USED DURABLE MEDICAL EQUIPMENT                                                                          
SPONSOR(s): SENATOR(s) STOLTZE                                                                                                  
                                                                                                                                
03/25/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/25/15       (S)       HSS, FIN                                                                                               
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: HB 4                                                                                                                    
SHORT TITLE: AUTOMATED EXTERNAL DEFIBRILLATOR                                                                                   
SPONSOR(s): REPRESENTATIVE(s) WILSON                                                                                            
                                                                                                                                
01/21/15       (H)       PREFILE RELEASED 1/9/15                                                                                
01/21/15       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/15       (H)       JUD                                                                                                    
02/04/15       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
02/04/15       (H)       Moved HB 4 Out of Committee                                                                            
02/04/15       (H)       MINUTE(JUD)                                                                                            
02/06/15       (H)       JUD RPT 4DP 1NR                                                                                        
02/06/15       (H)       DP: KELLER, MILLETT, CLAMAN, LEDOUX                                                                    
02/06/15       (H)       NR: GRUENBERG                                                                                          
02/11/15       (H)       TRANSMITTED TO (S)                                                                                     
02/11/15       (H)       VERSION: HB 4                                                                                          
02/13/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/13/15       (S)       HSS, JUD                                                                                               
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
RANDY RUARO, Staff                                                                                                              
Senator Bert Stedman                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Addressed the changes in version I of SB 74.                                                              
                                                                                                                                
JANE CONWAY, Staff                                                                                                              
Senator Cathy Giessel                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis of SB 53.                                                                
                                                                                                                                
DR. CARRIE DOYLE, Clinical Nurse Specialist                                                                                     
Alaska Clinical Nurse Specialist Association (ACNSA)                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 53.                                                                            
                                                                                                                                
LAURA SARCONE, Co-Chair                                                                                                         
Advanced Practice Registered Nurses (APRN) Alliance                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 53.                                                                            
                                                                                                                                
BRANDON BREFCZYNSKI, Staff                                                                                                      
Senator Bill Stoltze                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented SB 90 on behalf of the sponsor.                                                                 
                                                                                                                                
PATRICK REINHART, Director                                                                                                      
Governor's Council on Disability & Special Education                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 90.                                                                            
                                                                                                                                
JIM BECK, Executive Director                                                                                                    
Access Alaska                                                                                                                   
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 90.                                                                            
                                                                                                                                
JOHN CANNON, President                                                                                                          
Key Coalition of Alaska                                                                                                         
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 90.                                                                            
                                                                                                                                
KIM CHAMPNEY, Chief of Services                                                                                                 
REACH and Alaska Association on Developmental Disabilities                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 90.                                                                            
                                                                                                                                
REPRESENTATIVE TAMMIE WILSON                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of HB 4.                                                                                          
                                                                                                                                
DOUG SCHRAGE, Chief                                                                                                             
Alaska Fire Chiefs Association                                                                                                  
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of HB 4.                                                                             
                                                                                                                                
JIM FOSTER, Active Resuscitation Community Organizer                                                                            
Loren Marshall Foundation                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of HB 4.                                                                             
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:44 PM                                                                                                                    
CHAIR BERT  STEDMAN 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,  Kelly,  Ellis, and  Chair                                                              
Stedman. He  listed the order  of the four  bills to be  heard: SB                                                              
74, SB 53, SB 90, and HB 4.                                                                                                     
                                                                                                                                
         SB 74-MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES                                                                      
                                                                                                                                
1:31:12 PM                                                                                                                    
CHAIR  STEDMAN announced  the  consideration of  SB  74. He  noted                                                              
that his  staff, the sponsor's staff,  and the Departments  of Law                                                              
and Health and Social  Services have been working hard  on the new                                                              
CS for SB 74.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  KELLY moved  to adopt  the CS  for SB 74,  labeled                                                              
29-LS0692\I, as the working document.                                                                                           
                                                                                                                                
CHAIR STEDMAN objected for discussion.                                                                                          
                                                                                                                                
RANDY   RUARO,  Staff,   Senator   Bert  Stedman,   Alaska   State                                                              
Legislature,  addressed the  changes  in version  I of  SB 74.  He                                                              
read from the following:                                                                                                        
                                                                                                                                
The  committee  substitute  for   SB  74,  version  I,  makes  the                                                              
following substantive changes:                                                                                                  
                                                                                                                                
   · Deletes Sections 1 and 3 of SB 74 related to health savings                                                                
     accounts and funding the accounts with 10% of a recipients                                                                 
     permanent fund dividend.                                                                                                   
                                                                                                                                
   · As a conforming change, deletes language in Section 4 of SB                                                                
     74 that would have put a sunset date on the health savings                                                                 
     account provisions.                                                                                                        
                                                                                                                                
   · Adds a new Section 1 related to false claims for medical                                                                   
     assistance and providing for a civil penalty to be imposed                                                                 
     by either a court or an administrative agency and providing                                                                
     for enhanced damages to be awarded to the state.                                                                           
                                                                                                                                
   · Amends Section 2 of SB 74 to make a conforming change by                                                                   
     deleting subparagraph (1) which related to health savings                                                                  
     accounts and renumbering the remaining subparagraphs.                                                                      
                                                                                                                                
   · Amends Section 2, subparagraph (2) of SB 74 by adding                                                                      
     language requiring the DHSS reform program to include                                                                      
     referrals for career and education services.                                                                               
                                                                                                                                
   · Amends Section 2, subparagraph (4) of SB 74 by adding                                                                      
     "behavioral health" to the list of services that                                                                           
     telemedicine should be expanded to include.                                                                                
                                                                                                                                
   · Amends Section 2, subparagraph (9) of SB 74 by adding                                                                      
     language providing that the payment process should be                                                                      
     reformed by implementing fee agreements based on                                                                           
     performance measures that include premium payments for                                                                     
    centers of excellence and penalties for certain hospital                                                                    
    related outcomes, such as hospital acquired infections,                                                                     
     readmissions, and failures of outcomes.                                                                                    
                                                                                                                                
   · Amends Section 2, of SB 74 by adding a new section (b) that                                                                
    requires the identify areas where access to telemedicine                                                                    
     would be most effective and to coordinate with Indian                                                                      
     Health Services providers where appropriate to gain access                                                                 
     to telemedicine equipment.                                                                                                 
                                                                                                                                
   · Amends Section 2(b) of SB 74, the report section on reforms                                                                
     by changing the annual report due date from 10 days after                                                                  
     session starts to October 15 of each year, and adds a                                                                      
     number of subparagraphs in (4) - (13) that are designed to                                                                 
     provide information to the legislature on the progress of                                                                  
     reforms and other information relevant to management of the                                                                
     program.                                                                                                                   
                                                                                                                                
  · Amends Section 2 of SB 74 by adding a new section (d) that                                                                  
     is a definition of telemedicine.                                                                                           
                                                                                                                                
   · Section 3 of version I relates to direction to the                                                                         
     department on reducing use of emergency room services.                                                                     
     This was Section 6 in the original version of SB 74.  There                                                                
     was no change between the two sections other than                                                                          
     numbering.                                                                                                                 
                                                                                                                                
   · Section 4, the repeal section of SB 74 is deleted.  It                                                                     
     repealed the health savings account sections and the reform                                                                
     sections.  While reform provisions are included in version                                                                 
     I, they are not subject to sunset.                                                                                         
                                                                                                                                
  · It is replaced with a new Section 4 relating to efforts at                                                                  
     fighting fraud or waste of Medicaid funds and reporting the                                                                
     results to the Legislature.                                                                                                
                                                                                                                                
   · Section 5 of SB 75, the section on managed care and a                                                                      
     demonstration project using persons enrolled in Denali                                                                     
     KidCare has been amended to be broader in scope in terms of                                                                
     both the types of actions the Commissioner can take and the                                                                
     population groups in Medicaid that can be included.  This                                                                  
     provides flexibility to the department to obtain the                                                                       
     greatest possible coverage and savings.                                                                                    
                                                                                                                                
   · The rest of the sections in the CS are not substantively                                                                   
    different than SB 74 or are related to implementation of                                                                    
    the bill, Section 7 (Medicaid Choice Waiver); Section 8                                                                     
     (Transition Regulations); Section 9 (Conditional Effect),                                                                  
     and Sections 6, 7, 8 have an immediate effective date.                                                                     
                                                                                                                                
1:38:43 PM                                                                                                                    
CHAIR  STEDMAN withdrew  his  objection.  There being  no  further                                                              
objections, version I was adopted.                                                                                              
                                                                                                                                
SENATOR   GIESSEL  requested   clarification  of   Section  2   on                                                              
telemedicine  and  the  cooperation  with  Indian  Health  Service                                                              
(IHS)  providers.   She  understood   that  IHS  has   been  using                                                              
telemedicine  for several years.  She asked  if the bill  suggests                                                              
providing private sector  access to the IHS structure  and if non-                                                              
beneficiaries would be charged for the service.                                                                                 
                                                                                                                                
MR. RUARO  explained that  the intent is  more general  than that.                                                              
The IHS  facilities have  been building  up telemedicine  capacity                                                              
over the years,  whereas the state doesn't have it  in some areas.                                                              
The idea in Section  2 is to urge the department  to work with IHS                                                              
and  take advantage  of  opportunities  of sharing  equipment  and                                                              
working together.                                                                                                               
                                                                                                                                
1:40:41 PM                                                                                                                    
SENATOR  GIESSEL summarized  that it  is more  of a  philosophical                                                              
statement of working together, rather than a contract.                                                                          
                                                                                                                                
MR.  RUARO  said  that  is  correct;   they  anticipate  that  the                                                              
department and IHS will work together.                                                                                          
                                                                                                                                
SENATOR GIESSEL  thought that was  realistic. She  appreciated not                                                              
duplicating services and costs.                                                                                                 
                                                                                                                                
1:41:57 PM                                                                                                                    
SENATOR GIESSEL  asked about new  subsection (d) which  includes a                                                              
definition of telemedicine.  She asked about other  definitions of                                                              
telemedicine in statute.                                                                                                        
                                                                                                                                
MR. RUARO did not know of any other definitions of telemedicine.                                                                
                                                                                                                                
SENATOR GIESSEL said  there are other definitions  and she offered                                                              
to compare them so they coincide.                                                                                               
                                                                                                                                
CHAIR STEDMAN held SB 74 in committee.                                                                                          
                                                                                                                                
           SB 53-ADVANCED PRACTICE REGISTERED NURSES                                                                        
                                                                                                                                
1:43:24 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 53.                                                                             
                                                                                                                                
1:43:51 PM                                                                                                                    
SENATOR CATHY GIESSEL,  sponsor of SB 53, explained  that the bill                                                              
updates  Alaska's  34-year-old   statutory  title  from  "Advanced                                                              
Nurse Practitioner"  (ANP) and "Nurse Anesthetist" (NA)  to now be                                                              
called  "Advanced  Practice  Registered Nurse"  (APRN).  She  drew                                                              
attention to  a chart that  identifies the various  current titles                                                              
for practicing  nurses and  the new titles  proposed in  the bill.                                                              
She  said   the  statutes  have   not  kept  up  on   the  titles.                                                              
Nationally, the titles  are becoming more unified. The  use of the                                                              
APRN  title will  increase clarity  of  practice roles,  insurance                                                              
billing,  Medicare, and  Veterans  Administration procedures,  and                                                              
interaction with agencies.                                                                                                      
                                                                                                                                
She  concluded  that   nothing  in  the  bill   changes  scope  of                                                              
practice,  certification or  licensing  requirements, nor  changes                                                              
fee structures to the board.                                                                                                    
                                                                                                                                
1:48:06 PM                                                                                                                    
JANE   CONWAY,  Staff,   Senator  Cathy   Giessel,  Alaska   State                                                              
Legislature, presented  the sectional analysis of SB  53. She read                                                              
from the following:                                                                                                             
                                                                                                                                
     Section  1 amends  AS 08.02.010  and adds  APRNs to  the                                                                   
     list  of professions  that  are  required to  use  their                                                                   
     professional  titles  on  stationery,  signs,  or  other                                                                   
     advertising.                                                                                                               
                                                                                                                                
     Sections 2-4  are conforming amendments that  change the                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 5 amends  AS 08.68.100(a) by requiring  that the                                                                   
     Board  of   Nursing  regulations  pertaining   to  APRNs                                                                   
     include   the  practices  of   APRNs  who  practice   as                                                                   
     certified   registered  nurse  anesthetists,   certified                                                                   
     clinical    nurse    specialists,     certified    nurse                                                                   
     practitioners,  or certified  nurse  midwives and  makes                                                                   
     conforming amendments.                                                                                                     
                                                                                                                                
     Section  6  amends  AS  08.68.160   by  adding  advanced                                                                   
     practice  registered  nursing  to  the  licenses  issued                                                                   
     under  AS  08.68  and  changes  the  term  "professional                                                                   
     nursing" to "registered nursing."                                                                                          
                                                                                                                                
     Section  7 adds a  new subsection  to AS 08.68.170  that                                                                   
     sets  out the  qualifications for  an advanced  practice                                                                   
     registered nursing license.                                                                                                
                                                                                                                                
     Section 8  repeals and reenacts AS 08.68.190  concerning                                                                   
     license  examinations  and  adds  an  advanced  practice                                                                   
     registered   nursing   examination  to   the   licensing                                                                   
     examinations conducted under AS 08.68.                                                                                     
                                                                                                                                
     Section  9 is  a  conforming  amendment that  changes  a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to advance practice registered nurse."                                                                                     
                                                                                                                                
     Section  10  amends  AS  08.68  by  adding  a  paragraph                                                                   
     requiring  the  Department  of Commerce,  community  and                                                                   
     Economic  Development to  set fees  related to  advanced                                                                   
     practice  registered  nursing and  deletes  "vocational"                                                                   
     nursing.                                                                                                                   
                                                                                                                                
     Section   11   amends  AS   08.68.230(a)   by   removing                                                                   
     "licensed   professional    nurse"   from   the   titles                                                                   
     authorized for persons licensed under AS 08.68.                                                                            
                                                                                                                                
     Section   12  amends   AS   08.68.230   by  adding   new                                                                   
     subsections   authorizing   the   use  of   the   titles                                                                   
     "advanced   practice   registered   nurse",   "certified                                                                   
     registered   nurse  anesthetist",  "certified   clinical                                                                   
     nurse  specialist", "certified  nurse practitioner",  or                                                                   
     "certified nurse midwife" and associated initials.                                                                         
                                                                                                                                
     Section   13  amends  AS   08.65.265  to  add   advanced                                                                   
     practice  registered nurses  to  the persons  authorized                                                                   
     to supervise a practical nurse.                                                                                            
                                                                                                                                
     Section 14  adds impersonation  of an advanced  practice                                                                   
     registered  nurse as a  grounds for denial,  suspension,                                                                   
     or revocation of a nursing license.                                                                                        
                                                                                                                                
     Section 15  requires institutions that are  applying for                                                                   
     accreditation  of  advanced  practice  registered  nurse                                                                   
     training  to provide  certain information  to the  Board                                                                   
     of Nursing.                                                                                                                
                                                                                                                                
     Section 16  adds impersonation  of an advanced  practice                                                                   
     registered  nurse as a  grounds for denial,  suspension,                                                                   
     or revocation  of a certificate  to practice as  a nurse                                                                   
     aide.                                                                                                                      
                                                                                                                                
     Sections   17-19   add  advanced   practice   registered                                                                   
     nursing  to  the  licenses  issued  by  the  board,  and                                                                   
     change  the term "professional  nursing" to  "registered                                                                   
     nursing"  in AS  08.68.360  - 08.68.390,  which  declare                                                                   
     the  unlicensed practice  of nursing  a public  nuisance                                                                   
     and provide for injunctive relief.                                                                                         
                                                                                                                                
     Section 20  adds advanced practice registered  nurses to                                                                   
     the licensees who may delegate certain nursing duties.                                                                     
                                                                                                                                
     Section  21 is  a conforming  amendment  that changes  a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to  "advance  practice  registered nurse"  and  makes  a                                                                   
     related technical change.                                                                                                  
                                                                                                                                
     Section  22 defines  the practice  of advanced  practice                                                                   
     registered nursing.                                                                                                        
                                                                                                                                
     Section 23-25  are conforming  amendments that  change a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance  practice registered  nurse" and make  other                                                                   
     related technical amendments.                                                                                              
                                                                                                                                
     Section 26  adds advanced practice registered  nurses to                                                                   
     persons  who are  considered justified  in conduct  that                                                                   
     would  otherwise be  considered  the use  of force  when                                                                   
     delivering emergency medical care.                                                                                         
                                                                                                                                
     Sections 27-28  are conforming amendments that  change a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 29  adds advanced practice registered  nurses to                                                                   
     those licensees  immune from civil liability  for an act                                                                   
     or omission  in delivering  patient care services  while                                                                   
     escorting  an injured or  sick person  whose life  is in                                                                   
     danger in a conveyance that is not an ambulance.                                                                           
                                                                                                                                
     Section  30 is  a conforming  amendment  that changes  a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 31  adds advanced practice registered  nurses to                                                                   
     those practitioners  authorized to draw blood  for tests                                                                   
     of persons charged with sex offenses.                                                                                      
                                                                                                                                
     Sections 32-33  are conforming amendments that  change a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurses."                                                                                   
                                                                                                                                
     Section  34  clarifies that  nurse-midwives  and  direct                                                                   
     entry midwives are certified.                                                                                              
                                                                                                                                
     Sections 35-38  are conforming amendments that  change a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance  practice registered  nurse" and make  other                                                                   
     related technical amendments.                                                                                              
                                                                                                                                
     Section  39 changes  the term  "registered  professional                                                                   
     nursing" to "registered nursing."                                                                                          
                                                                                                                                
     Section  40   clarifies  that  nurse-midwives   must  be                                                                   
     certified to be a provider under AS 21.87.                                                                                 
                                                                                                                                
     Section  41 is  a conforming  amendment  that changes  a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Sections   42-43  clarifies   that  nurse-midwives   are                                                                   
     certified and makes other technical amendments.                                                                            
                                                                                                                                
     Sections 44-46  are conforming amendments that  change a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 47  adds advanced practice registered  nurses to                                                                   
     the  definition of  health  care provider  in  statutory                                                                   
     provisions concerning prisons.                                                                                             
                                                                                                                                
     Section  48 is  a conforming  amendment  that changes  a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 49  adds advanced practice registered  nurses to                                                                   
     licensees  with particular  training  who  may assess  a                                                                   
     child  with  respect to  the  waiver under  a  statutory                                                                   
     provision  concerning home  and community based  medical                                                                   
     assistance.                                                                                                                
                                                                                                                                
     Section  50 is  a conforming  amendment  that changes  a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to  "advance  practice  registered nurse"  and  makes  a                                                                   
     related technical change.                                                                                                  
                                                                                                                                
     Section 51  adds advanced practice registered  nurses to                                                                   
     practitioners   who  are   not   liable  for   providing                                                                   
     information  to  the  Department of  Health  and  Social                                                                   
     Services  for  the  purpose  of  providing  services  to                                                                   
     certain children and makes a related technical change.                                                                     
                                                                                                                                
     Sections 52-54  add advanced practice  registered nurses                                                                   
     to  practitioners  who may  under  statutory  provisions                                                                   
     concerning  mental  health  commitment, determine  if  a                                                                   
     person  may  be  administered   psychotropic  medication                                                                   
     without   the  person's   consent,   and  add   advanced                                                                   
     practice registered  nurses with particular  training to                                                                   
     the  definition  of  mental   health  professionals  for                                                                   
     those statutory provisions.                                                                                                
                                                                                                                                
     Section 55  adds advanced practice registered  nurses to                                                                   
     practitioners who  may review a health care  plan for an                                                                   
     assisted living home resident.                                                                                             
                                                                                                                                
     Sections 56-59  are conforming amendments that  change a                                                                   
     statutory reference  from "advanced nurse  practitioner"                                                                   
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 60 repeals specific statutes.                                                                                      
                                                                                                                                
     Section 61 sets  July 1, 2015 as the effective  date for                                                                   
     the bill.                                                                                                                  
                                                                                                                                
1:54:08 PM                                                                                                                    
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
DR.  CARRIE  DOYLE, Clinical  Nurse  Specialist,  Alaska  Clinical                                                              
Nurse Specialist  Association (ACNSA), testified in  support of SB                                                              
53.  She  said  she  is also  a  member  of  the  Alaska  Advanced                                                              
Practice  Registered Nurses  (APRN) Alliance,  which is  comprised                                                              
of all  four APRN specialties,  University of Alaska  - Anchorage,                                                              
and the Board  of Nursing. She related that nationwide,  there are                                                              
four types  of APRN.  This bill will  bring Alaska into  alignment                                                              
with a national  move called the APRN Consensus  Model. She listed                                                              
the types of nurse practitioners contained in the bill.                                                                         
                                                                                                                                
She  related  that  the  Consensus  Model  was  developed  by  the                                                              
National Council  of State Boards  of Nursing in  conjunction with                                                              
an APRN work  group. The Consensus Model seeks  uniformity in APRN                                                              
licensure, accreditation, certification, and education.                                                                         
                                                                                                                                
1:56:25 PM                                                                                                                    
LAURA  SARCONE,  Co-Chair,  Advanced  Practice  Registered  Nurses                                                              
(APRN)  Alliance, testified  in  support of  SB  53. She  repeated                                                              
much of  the previous testimony.  She said that eleven  states are                                                              
already in  full compliance with  the Consensus Model  and another                                                              
eleven  states  are  three-quarters  of  the  way  to  compliance.                                                              
Alaska is  half-way there  and SB  53 "brings  us over  the finish                                                              
line" by  updating old titles. She  thanked the sponsor  and urged                                                              
the passage of the bill.                                                                                                        
                                                                                                                                
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
SENATOR  GIESSEL  stated that  the  fiscal note  contains  receipt                                                              
services; three professional  groups will pay for  the expenses of                                                              
enacting the bill.                                                                                                              
                                                                                                                                
CHAIR STEDMAN held SB 53 in committee.                                                                                          
                                                                                                                                
         SB 90-MEDICAID: USED DURABLE MEDICAL EQUIPMENT                                                                     
                                                                                                                                
1:58:49 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 90.                                                                             
                                                                                                                                
1:59:31 PM                                                                                                                    
BRANDON  BREFCZYNSKI, Staff,  Senator Bill  Stoltze, Alaska  State                                                              
Legislature,  presented  SB  90  on  behalf  of  the  sponsor.  He                                                              
summarized  that SB  90 will grant  the Department  of Health  and                                                              
Social Services  (DHSS) the  authority to  use Medicaid  funds for                                                              
the  purchase  of  durable  medical   equipment.  Durable  medical                                                              
equipment includes  things like wheel chairs, walkers,  bed lifts,                                                              
and shower  curtains. Currently,  the state Medicaid  program does                                                              
not allow  for reimbursement  of used  durable medical  equipment,                                                              
even  though  it  is allowed  under  federal  law.  Several  other                                                              
states have  created durable medical  equipment programs  and have                                                              
seen real cost savings. SB 90 will not cost the state anything.                                                                 
                                                                                                                                
2:00:00 PM                                                                                                                    
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:00:10 PM                                                                                                                    
PATRICK  REINHART, Director,  Governor's Council  on Disability  &                                                              
Special  Education, testified  in support  of SB  90. He shared  a                                                              
story  about a  visit to  a durable  medical  equipment store.  He                                                              
said he would like  to see this type of store  in Alaska. He noted                                                              
that the store's help were people with disabilities.                                                                            
                                                                                                                                
2:02:59 PM                                                                                                                    
JIM  BECK,  Executive   Director,  Access  Alaska,   testified  in                                                              
support of  SB 90. He described  the equipment that  Access Alaska                                                              
carries, how  they operate,  and how much  equipment is  lent out.                                                              
He said there are substantial benefits to the state from SB 90.                                                                 
                                                                                                                                
2:05:02 PM                                                                                                                    
JOHN  CANNON, President,  Key Coalition  of  Alaska, testified  in                                                              
support  of  SB  90.  He  said  that  this  bill  is  one  of  Key                                                              
Coalition's  top priorities.  Currently, the  state prohibits  the                                                              
purchase  of  used  medical  equipment.  He  noted  other  states'                                                              
experiences of cost  savings from their durable  medical equipment                                                              
reuse  programs.  He  made  a  suggestion  to  offer  re-ownership                                                              
policies.  He  cautioned  about  the  impact  on  durable  medical                                                              
equipment industry and providers. He urged passage of the bill.                                                                 
                                                                                                                                
2:09:21 PM                                                                                                                    
KIM CHAMPNEY, Chief  of Services, REACH and Alaska  Association on                                                              
Developmental  Disabilities, testified  in support  of SB  90. She                                                              
shared a  story about one of  her clients, the process  of working                                                              
with  an  equipment  vendor, and  the  difficulties  and  expenses                                                              
involved. If  Medicaid dollars  are involved  many issues  will be                                                              
solved.  She   concluded  that  Access  Alaska   has  successfully                                                              
developed  and  implemented  a  pilot  program  for  used  durable                                                              
medical equipment.                                                                                                              
                                                                                                                                
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
CHAIR STEDMAN held SB 90 in committee.                                                                                          
                                                                                                                                
             HB 4-AUTOMATED EXTERNAL DEFIBRILLATOR                                                                          
                                                                                                                              
2:12:33 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of HB 4.                                                                              
                                                                                                                                
REPRESENTATIVE  TAMMIE WILSON, Alaska  State Legislature,  sponsor                                                              
of HB 4. She read the sponsor statement:                                                                                        
                                                                                                                                
     On behalf of the Alaska Fire Chiefs Association I am                                                                       
     pleased to introduce HB 4. The purpose of this bill is                                                                     
     to reduce impediments in state law to allow for more                                                                       
     public access to Automated External Defibrillators                                                                         
     (AEDs).                                                                                                                    
                                                                                                                                
     AEDs are automated medical devices that can be safely                                                                      
     used by an untrained bystander to restore a normal                                                                         
     cardia rhythm in a person experiencing sudden cardiac                                                                      
     arrest. The device provides both verbal and written                                                                        
     instructions to the user.                                                                                                  
                                                                                                                                
     The use of AEDs are currently covered by Alaska's Good                                                                     
     Samaritan Law (AS 09.65.090), which is designed to                                                                         
     encourage would-be rescuers to take action without                                                                         
     fear of litigation However, Alaska's Good Samaritan                                                                        
     attaches conditions to building owners and                                                                                 
     institutions that provide AEDs (AS 09.65.087). These                                                                       
     conditions include requirements to provide training,                                                                       
     maintenance, a means to notify 911, and registering                                                                        
     the device(s) with emergency medical services (EMS).                                                                       
                                                                                                                                
     Large  companies  and  institutions  cannot  confidently                                                                   
     assure  that  each of  the  conditions can  be  reliably                                                                   
     met;   therefore,  exposing   them   to  liability   and                                                                   
     discouraging access  to AEDs. Removing  these conditions                                                                   
     would encourage  the increased  availability of  AEDs in                                                                   
     our communities.                                                                                                           
                                                                                                                                
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:14:30 PM                                                                                                                    
DOUG  SCHRAGE, Chief,  Alaska Fire  Chiefs Association,  testified                                                              
in  support of  HB  4. He  described  how the  automated  external                                                              
defibrillator  (AED)  works.  He   said  the  bill  is  not  about                                                              
discontinuing CPR  and AED training and maintenance  programs, nor                                                              
is  it  about  de-emphasizing  device  registration  or  emergency                                                              
notification;  it is  only about  making more  AED's available  to                                                              
the  public.   He  pointed   out  that  the   goal  of   Good  Sam                                                              
legislation,  such as HB  4, is to  offer liability  protection to                                                              
all AED program  constituents and to encourage  more organizations                                                              
to  provide  AED's.   It  does  not  include  program   design  or                                                              
operational requirements  and should  not condition  immunity upon                                                              
compliance with such requirements.                                                                                              
                                                                                                                                
He noted no opposition  to the bill and the following  support it:                                                              
the American  Red Cross and  American Heart Association.  The bill                                                              
has no fiscal impact. He requested support for the bill.                                                                        
                                                                                                                                
2:17:42 PM                                                                                                                    
JIM  FOSTER,  Active  Resuscitation   Community  Organizer,  Loren                                                              
Marshall  Foundation, testified  in  support of  HB  4. He  agreed                                                              
with Chief Schrage's  comments about the best practices.  He noted                                                              
the bill does not  include training or maintenance  of the AED. He                                                              
opined that  it does not  belong in the  bill. He said  the intent                                                              
is to  help businesses  and organizations  to be comfortable  with                                                              
using AED's and to save lives.                                                                                                  
                                                                                                                                
2:19:54 PM                                                                                                                    
SENATOR  ELLIS thanked  the  testifier  for mentioning  the  Loren                                                              
Marshall  Foundation.  He  said  he  is  happy  his  constituent's                                                              
legacy lives on.                                                                                                                
                                                                                                                                
2:21:02 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
REPRESENTATIVE WILSON  noted that there  are AED's in  the capital                                                              
building.                                                                                                                       
                                                                                                                                
CHAIR STEDMAN held HB 4 in committee.                                                                                           
                                                                                                                                
2:21:45 PM                                                                                                                    
There  being  nothing  further   to  come  before  the  committee,                                                              
Chair  Stedman adjourned  the Senate  Health  and Social  Services                                                              
Standing Committee at 2:21 p.m.                                                                                                 

Document Name Date/Time Subjects
APRN bill_diagram_for core message.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
APRN bill_core message 09_07_2014.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
AaNA Letter of Support for SB53 to Senator Stedman.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
APRN Info page.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
Letter re SB 53_Stedman_APRN-A_Juneau.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Fiscal Note APRN vsn N.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Hearing Request SEN HSS.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Sectional Analysis vsn N.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Sponsor Statement vsn N.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support AaNA 3-9-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support AARP 3-3-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support AK Affiliate ACNM 2-23-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support AK Pharmacists 3-6-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support AKANA 2-22-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support ANPA 2-24-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support APRN Alliance 2-22-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support ASHNHA 3-5-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support Bd of Nursing 3-9-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support Dooley 3-6-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support FASDx Services 2-26-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support Hartz 2-26-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support Hiles 3-16-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support Myers 2-24-2015.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Support Rader 2-22-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Version N.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
HB 4 Information Services Request.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB 04 Hearing Request Senate HSS.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB 4 Fiscal Note.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB 4 Testimony.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 AED Bill Power Point Presentation.pptx SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Letter of Support for AED's AFCA.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Letter of Support for AEDs Michael Levy MD.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Supporting Document 1 - Heart Rhythm Society Sudden Cardiac Arrest Fact Sheet.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Supporting Document 2 - What Is an Automated External Defibrillator.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Supporting Document 3 - Research report_ Effects of AED device features on performance by untrained laypersons.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Supporting Document 4 - Research report_ Automated external defibrillator use by untrained bystanders can the public use model work.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Letter of Support - AHA.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Letter of Support - Dr BradleyAlaskaLtr2-4-15.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Sectional Analysis.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Sponsor Statement.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
HB04 Ver. A.pdf SHSS 4/8/2015 1:30:00 PM
HB 4
SB90 Support Material.pdf SHSS 4/8/2015 1:30:00 PM
SB 90
SB90 Sponsor Statement.pdf SHSS 4/8/2015 1:30:00 PM
SB 90
SB90 Hearing Request.pdf SHSS 4/8/2015 1:30:00 PM
SB 90
SB90 ver A.pdf SHSS 4/8/2015 1:30:00 PM
SB 90
SB53 Backup States Adopting APRN Consensus Model.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Backup Benefits of APRN model.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB53 Fiscal Note DCCED 4-7-15.pdf SHSS 4/8/2015 1:30:00 PM
SB 53
SB 90 Letter from AK PT Association.pdf SHSS 4/8/2015 1:30:00 PM
SB 90
CS SB 74 Version I.pdf SHSS 4/8/2015 1:30:00 PM
SB 74