03/02/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB21 | |
| SB78 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 21 | TELECONFERENCED | |
| *+ | SB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 2, 2021
1:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
State Medical Board
David Boswell - Fairbanks
Larry Daugherty - Eagle River
- CONFIRMATIONS ADVANCED
SENATE BILL NO. 21
"An Act relating to mobile intensive care paramedics; relating
to duties of the State Medical Board and the Department of
Health and Social Services; and providing for an effective
date."
- HEARD & HELD
SENATE BILL NO. 78
"An Act relating to telehealth."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 21
SHORT TITLE: LICENSE MOBILE INTENSIVE CARE PARAMEDICS
SPONSOR(s): SENATOR(s) REVAK
01/22/21 (S) PREFILE RELEASED 1/8/21
01/22/21 (S) READ THE FIRST TIME - REFERRALS
01/22/21 (S) HSS, L&C
03/02/21 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 78
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH
SPONSOR(s): LABOR & COMMERCE
02/10/21 (S) READ THE FIRST TIME - REFERRALS
02/10/21 (S) HSS, L&C
03/02/21 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
DAVID BOSWELL, Appointee
Fairbanks, Alaska
POSITION STATEMENT: Testified as the governor's appointee to the
State Medical Board.
LARRY DAUGHERTY, M.D., Appointee
Eagle River, Alaska
POSITION STATEMENT: Testified as the governor's appointee to the
State Medical Board.
DIRK CRAFT, Staff
Senator Josh Revak
Alaska State Legislature
POSITION STATEMENT: Presented SB 21 on behalf of the bill
sponsor.
SETH DUGGAN, Staff
Senator Josh Revak
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional for SB 21 on behalf
of the bill sponsor.
CLINT FARR, Deputy Director
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about SB 21.
TODD MCDOWELL, EMS Program Manager
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about SB 21.
BRIAN WEBB, representing self
Anchorage, Alaska
POSITION STATEMENT: Explained the background of SB 21.
WILMA VINTON, representing self
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SB 21.
RICHARD ETHERIDGE, Alaska Fire Chiefs Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 21.
MICHAEL LEVY, M.D., EMA Medical Director
Anchorage, Alaska
POSITION STATEMENT: Inaudible testimony.
KATIE MCCALL, Staff
Senator Mia Costello
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 78 on behalf of the Senate
Labor and Commerce Standing Committee.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community and Economic Development
(DCCED)
Juneau, Alaska
POSITION STATEMENT: Answered questions about SB 78.
SARAH HETEMI, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 78.
PORTIA NOBLE, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 78.
RYAN MCKEE, Americans for Prosperity
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 78.
ACTION NARRATIVE
1:32:10 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Costello, Hughes, Begich, Reinbold,
and Chair Wilson.
^Confirmation Hearing(s)
CONFIRMATION HEARING(S)
State Medical Board
1:33:02 PM
CHAIR WILSON announced the consideration of the governor's
appointees to the State Medical Board. He called on appointee
David Boswell.
1:33:25 PM
DAVID BOSWELL, Appointee, Fairbanks, Alaska, said he is a father
of eight. He is the senior minister of the Northern Lights
Church of Christ in downtown Fairbanks. He has volunteered in
numerous capacities. He has been a foster parent for five years
for nine children, four of whom he adopted. He was a member of
the Governor's Council on Disabilities and Special Education. He
is the public member of the Alaska State Medical Board. He has
been an active and interested member in his community. He was
appointed to the medical board at a unique time for the state,
nation, and world. He has participated in the Alaska Medical
Board since last March as the secretary. He probably has had
more opportunities than normal to meet with the board over the
last 12 months because of the needs of the emergency.
MR. BOSWELL said the board met weekly to prepare for the
necessity of creating regulations for the pandemic. He has been
through incredible training the past year. He attended the
Federation of State Medical Boards Zoom conference. He gained
access to numerous resources. Although he didn't realize the
vast quantity of time that would be asked of him when he began
this position a year ago, it was worthwhile and rewarding.
1:36:42 PM
SENATOR REINBOLD asked him what exact role he has been playing
in the disaster response and his take on the executive disaster
response.
At ease due to technical difficulties.
1:38:09 PM
CHAIR WILSON reconvened the meeting and asked Mr. Boswell to
restart his response to Senator Reinbold's question.
MR. BOSWELL said at the beginning of his term, the board learned
how to do emergency regulations even before they learned how to
do typical regulations. That was helpful because the board
appropriately dealt with the needs for telehealth during the
pandemic. They worked with the current and changing needs of the
Prescription Drug Monitoring Program (PDMP). As the secretary,
he chaired one of the meetings. He had incredible guidance from
the executive administrator and from the trainings provided.
SENATOR REINBOLD said she understands the administrative work.
She wants to know overall what he thinks of the response and the
global impacts to schools and the economy. etc. In particular,
she asked if the Medical Board had access to hydroxychloroquine
and ivermectin or had heard of any issues with those
MR. BOSWELL said he was struggling to hear the audio.
SENATOR REINBOLD asked what his general feeling is about the
administrative response to the disaster.
1:41:19 PM
At ease because of technical issues
1:45:37 PM
CHAIR WILSON reconvened the meeting.
1:46:09 PM
CHAIR WILSON asked Mr. Boswell to continue.
MR. BOSWELL said that the State Medical Board has done an
excellent job of responding to the emergency declaration.
SENATOR REINBOLD said that is good to hear because she has not
received any feedback about the medical board. She asked if
there had been any issues with hydroxychloroquine and ivermectin
or getting any medications that have been proven to be effective
against COVID-19.MR. BOSWELL replied that acquiring medications
was not under the purview of the board.
SENATOR REINBOLD clarified that the pharmacy board would deal
with medication and clarified that the medical board deals with
licensure and had not heard of any issues with those
medications.
MR. BOSWELL agreed.
1:47:33 PM
SENATOR BEGICH said he recalled that when they spoke last year
the position of the executive secretary, which is a paid
position, was vacant. The vacancy required that board members
exam each physical license for each physician. He asked if that
position was still vacant and if it were vacant, how has that
impacted the work of the board.
MR. BOSWELL answered that when he began, Miss Alicia Jones was
executive administrator. She stepped down this past fall and the
position was then filled by Ms. Zinn who prepared the transition
to Natalie Norberg, the current administrator. The board worked
seamlessly during the transition. It was beyond what he could
have hoped for. Everything was taken care of behind the scenes
by the staff.
SENATOR BEGICH said the governor's disaster declaration expired
a few weeks ago. Under that disaster declaration, there were
emergency powers for the board to issue emergency medical
licenses. For the PDMP, there is a requirement that doctors sign
up for that program, but that doesn't always happen. Under the
emergency powers, the board had powers to deal with both of
those issues. He asked if that has been affected by the
expiration of the emergency powers.
MR. BOSWELL said the at the last board meeting, they spoke to
the compliance issue with the PDMP. This current year the
compliance has increased significantly. The board has discussed
ways to make it more efficient and to make all physicians
registering with the PDMP aware of the expectations. One of the
board members has drafted a letter to speak to that. The
executive administrator has drafted a letter to send to
physicians to explain the two-step process to improve
compliance.
SENATOR BEGICH asked what the percentage is for compliance. He
asked again about the impacts of the expiration of the emergency
order.
MR. BOSWELL replied that emergency licenses are still good until
the license finishes, and there is time to transition to a
regular license. That was a useful tool during the emergency
declaration. Those who want to keep a license can go through the
normal licensure process.
SENATOR BEGICH asked about the compliance percentage for the
PDMP.
MR. BOSWELL said he doesn't have that number, but it was
presented to the board.
CHAIR WILSON added he has already requested that data from
Director Sara Chambers because of an issue with another bill. He
called on appointee Larry Daugherty.
1:53:16 PM
LARRY DAUGHERTY, M.D., Appointee, Eagle River, Alaska, said he
came to Alaska in 2014. It is a privilege to serve his community
as a radiation oncologist. He also has a background as a
paramedic and firefighter. As a radiation oncologist at the
Anchorage Radiation Oncology Center, he has difficult
conversations with patients. His job is to help people navigate
during a time of crisis and to offer help. The state has faced
its own type of nightmare this past year in confronting the
challenges of the COVID-19 pandemic. As a result, the
legislative body at times has been paralyzed, as evidenced by
the delay in confirmations of the State Medical Board
appointees. He has been working on the board for over a year.
The board has worked to expedite emergency licensure. The board
has crafted and approved guidelines for telemedicine. The board
has worked to optimize the workflow and skills of physician
assistants and paramedics. All has been done as a service to the
state. The State Medical Board exists to protect the public and
ensure the state has safe, competent, licensed healthcare
professionals practicing in Alaska. The board grants licenses
and investigates complaints.
DR. DAUGHERTY said that serving on the board is a service. These
are unpaid positions that can take a lot of time away from
family, medical practice, and other pursuits. He does not enjoy
the regular meetings and bureaucracy and being in a position to
take disciplinary action against his peers, but he can make a
difference. Instead of being a critical voice on the sidelines,
he is doing what he can to take action and provide solutions. He
wants to change some of the things that drive him crazy about
the current system. The state is among the slowest in processing
applications for licensure. Much of the system is antiquated and
expensive and needs to be modernized. Some well-intended laws
are flawed, namely the PDMP. He hopes that his can be a voice to
convince the legislative body to fix these laws. Despite these
annoyances, in his opinion, Alaska is the best place on earth to
practice medicine. Alaska needs to keep it great by continuing
to maintain high standards for licensure and maintaining high
expectations for how healthcare professionals conduct
themselves.
1:57:44 PM
SENATOR REINBOLD thanked him for his willingness to serve and
bringing issues to the table he wants solved. She wants to hear
if the committee can do anything to help process applications
faster and improve the PDMP.
DR. DAUGHERTY replied that the board over the last year has
shown it can process applications quickly when it needs to with
emergency licensure. He sees no reason why the process can't be
improved in significant ways. He has crafted a resolution about
the PDMP with another board member. The resolution passed the
board unanimously. It should be coming to the committee. The
board is asking for a simple change in the law which would
increase compliance and utilization of the PDMP.
SENATOR BEGICH asked why the licensing process takes so much
time. He asked Dr. Daugherty to briefly walk the committee
through that process. He also asked Dr. Daugherty to explain the
proposed change to the PDMP.
DR. DAUGHERTY answered that when an applicant applies for
licensure, the state is a comprehensive and thorough, as it
should be, in vetting candidates in order to verify education
and training and to make sure there are no adverse actions from
other states. Other than seeing inefficiencies in the software
process, he doesn't yet know why it takes six to eight months to
receive a license. It other states it takes weeks. That may have
to do with Alaska law and the policy of every application being
reviewed by board members, but he thinks it is an antiquated
system. Every month he gets a dozen or so applications in one
giant PDF. It is cumbersome to analyze and review the data. He
is confident that other states have better processes. There is a
federation of state medical boards with a centralized system. He
doesn't know the answer, but other states do it better.
DR. DAUGHERTY said the PDMP is a wonderful program and tool with
great potential for solving the opioid crisis. Prescriptions for
these drugs have decreased, but with the way the law is written,
physicians can delegate others to access the PDMP on their
behalf. The law stipulates that the delegate must hold a formal
license. In Alaska, medical assistants don't hold a license. On
a daily base the medical board gets complaints from anonymous
sources that well-intended physicians don't understand that they
cannot assign a medical assistant as a delegate. Then they have
committed a felony. The board's hands are tied because of the
way the law is written. The board resolution is that a physician
should have delegates they trust at whatever level of training.
SENATOR BEGICH said that he appreciates his candor. To be clear,
Dr. Daugherty and other members are reviewing the applications.
DR. DAUGHERTY replied that the board members do a final review
of the entire application.
2:05:18 PM
SENATOR COSTELLO said that the Senate Labor and Commerce
Committee has taken portions of the governor's disaster
declaration, and as a courtesy to the process, is reviewing his
administration's request for changes in statute to determine
whether to make certain statutes COVID-aware or provide
temporary changes that are needed as the state works its way
through the vaccination process. Several bills are running
through the process. She would be happy to work with him through
Senator Reinbold's office on a licensure bill. As chair of the
Labor and Commerce Committee, her intention is to ferret through
why the process is taking so long and to find ways to expedite
the licensure process. She would welcome his suggestions on how
to speed up that process. The state is so lucky to have talented
Alaskans like himself who are willing to provide the expertise
and donate the time to make the state a better place to live and
work.
DR. DOUGHERTY thanked her and said he looks forward to working
with her on that.
2:07:21 PM
CHAIR WILSON entertained a motion.
2:07:27 PM
SENATOR HUGHES stated that in accordance with AS 39.05.080, the
Senate Health and Social Services Standing Committee reviewed
the following and recommends the appointments be forwarded to a
joint session for consideration:
State Medical Board
David Boswell - Fairbanks
Larry Daugherty - Eagle River
She reminded members that signing the reports regarding
appointments to boards and commissions in no way reflects
individual members' approval or disapproval of the appointees;
the nominations are merely forwarded to the full legislature for
confirmation or rejection.
2:07:51 PM
At ease
SB 21-LICENSE MOBILE INTENSIVE CARE PARAMEDICS
2:09:44 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 21 "An Act relating to mobile
intensive care paramedics; relating to duties of the State
Medical Board and the Department of Health and Social Services;
and providing for an effective date." He states his intent to
hear an overview of the bill and take invited testimony. He
asked the staff of bill sponsor Senator Revak to introduce the
bill. He noted a number of people available online to answer
questions.
2:10:43 PM
DIRK CRAFT, Staff, Senator Josh Revak, Alaska State Legislature,
said that SB 21 seeks to consolidate oversight of the Emergency
Medical Services (EMS) system under a single agency to better
provide better peer and professional oversight. This has been
years in the making through a deliberative process that involved
hundreds of stakeholders throughout the EMS community. It has
been unanimously supported by the State Medical Board and has
broad support from paramedics around the state. Currently EMS
oversight is split between the State Medical Board within the
Department of Commerce and the EMS section of the Department of
Health and Social Services (DHSS). This bill will transfer all
paramedic licensure to the Alaska Emergency Medical Services in
DHSS, which currently is responsible for certifying EMTs
(Emergency Medical Technicians), EMT instructors, EMT training,
ground ambulance and medevac services, paramedic instructors,
and paramedic training. The split arose because paramedics did
not exist in Alaska before 1974. After 1974, the term mobile
intensive care paramedic was created for the new scope of
practice in the Anchorage and Fairbanks fire departments. EMS
within DHSS did not exist in Alaska code until 1981 when the
responsibility to license and credential paramedics was placed
under the State Medical Board. In 1984 the EMS section became
fully functional; however, the paramedic licensure still stayed
under the State Medical Board.
MR. CRAFT said that SB 21 will not change the scope of practice,
license requirements, or fee structure for the approximately 600
paramedic licenses in Alaska. Medical direction will be provided
by the existing DHSS chief medical officer and the EMS medical
director's committee comprised of 11 members specializing in
emergency medicine, five of whom are required to have paramedic
experience. The EMS existing data systems are able to
incorporate paramedic licensure, making the move a seamless
transition. Transferring oversight and licensure of mobile
intensive care paramedics from the State Medical Board to DHSS
will fully integrate the EMS system and ensure it is robust,
sustainable, and resilient. Aligning all EMS services under a
single agency better promotes public health and safety while
also providing efficiencies through peer and professional
oversight.
2:13:11 PM
SETH DUGGAN, Staff, Senator Josh Revak, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis:
Sec. 1 amends 08.64.107, State Medical
Board/Regulation of physician assistants and intensive
care paramedics, to remove regulation of paramedic
licensure from the Medical Board. (See also Sec. 8.)
Sec. 2 amends 08.64.170(a), License to practice
medicine, podiatry, or osteopathy, allowing paramedics
to practice medicine to render emergency lifesaving
service under "another law" instead of under the
Medical Board's authority. (See also Sec. 6)
Sec. 3 amends 08.64.360, Penalty for practicing
without a license or in violation of chapter, to
remove paramedics. (See also Sec. 10)
Sec. 4 amends 08.64.369(d), Health care professionals
to report certain injuries, to change paramedics
licensed under the Medical Board to those licensed
under DHSS, for health care providers who must report
certain injuries to the Department of Public Safety.
Sec. 5 amends 12.55.185(11), Sentencing and Probation,
to change paramedics licensed under the Medical Board
to those licensed under DHSS.
Sec. 6 amends 18.08.075, Authority of emergency
medical technician, to allow paramedics to provide
emergency medical care. (See also Sec. 2.)
Sec. 7 amends 18.08.080, Emergency Medical
Services/Regulation, to require DHSS to adopt
regulations establishing standards for paramedic
licenses.
Sec. 8 adds a new subsection 18.08.082(a)(5), Issuance
of certificates; designations, to add regulation of
paramedic licensure to DHSS. (See also Sec. 1.)
2:14:40 PM
Sec. 9 amends 18.08.082(b), Issuance of certificates;
designations, to clarify that DHSS is the central
certifying and licensing agency for all emergency
medical services.
Sec. 10 amends 18.08.084(a), Certificate required, to
prohibit a person from practicing as a paramedic
without a license. (See also Sec. 3.)
Sec. 11 amends 18.08.086(a), Immunity from liability,
adding license because they are certified. This means
it provides immunity in 08.02, which includes
paramedics. They are not liable for civil damages
unless it's gross negligence.
Sec. 12 18.08.089(a) is amended to allow a paramedic
to pronounce someone's death if the paramedic falls
under one of the three categories.
Sec. 13 adds a new paragraph (14) to 18.08.200,
Emergency Medical Services/Definitions, to add the
definition of "mobile intensive care paramedic". (See
also Sec. 14.)
Sec. 14 Amends 29.45.050(r) to include mobile
intensive care paramedics in a municipal property tax
exemption. Emergency Medical Services are already
under this, this section just clarifies Mobile
Intensive Care Paramedics.
MR. DUGGAN noted that Section 14 is only for voluntary EMS
staff.
Sec. 15 amends 37.05.146(c)(77)(F), Definition of
program receipts and non-general fund program
receipts, to add fees for licensure of paramedics to
the list of fees collected by DHSS.
Sec. 16 repeals 08.64.366, Liability for services
rendered by a mobile intensive care paramedic (See
18.08.086, Immunity from liability, under DHSS).
Repeals 08.64.380, Medicine/Definitions to remove (3)
"emergency lifesaving service" and (4) "mobile
intensive care paramedic" (See also Sec. 12).
Sec. 17 amends the uncodified law to provide
transitional authorities: (a) A current paramedic
license issued before January 1, 2021 remains valid
until it expires under the Medical Board, is suspended
or revoked, or is converted to a license under DHSS.
(b) The Department of Commerce, Community and Economic
Development and the Medical Board will transfer to
DHSS on January 1, 2021, files of all pending
paramedic-related records and proceedings,
applications, and disciplinary actions. (c) Authority
for DHSS to adopt regulations which shall include the
conversion of unexpired paramedic licenses issued
under the Medical Board.
Sec. 18 provides an immediate effective date for DHSS
to adopt regulations.
Sec. 19 provides an effective date of January 1, 2022.
2:16:55 PM
SENATOR BEGICH said that anecdotally he has heard that the
process for EMT licensure takes a long time. He asked if this
will this speed up that process. He noted the blank pages in the
fiscal notes and asked if the bill would lead to any cost
savings.
MR. CRAFT replied that speeding up the process was one of the
primary reasons for introducing the legislation, as well to
house all these emergency medical personnel under one
professional licensing statute. The fiscal notes are zero
because the department can absorb any potential change in cost
but he would defer to the department.
2:18:24 PM
CLINT FARR, Deputy Director, Division of Public Health,
Department of Health and Social Services (DHSS), Juneau, Alaska,
said that DHSS can absorb any costs associated with the transfer
of paramedics to his division. The division already has
certification/licensure processes in place and licenses
thousands of EMTs annually, so with the number of paramedics,
the office can absorb that with current staffing and processes.
SENATOR BEGICH asked when jurisdiction transfers from the State
Medical Board, if there is a provision for public comment about
any issues with EMS services.
MR. FARR replied that the public has a way to comment through
the regulatory process. He deferred to Todd McDowell.
2:20:11 PM
TODD MCDOWELL, EMS Program Manager, Division of Public Health,
Department of Health and Social Services (DHSS), Juneau, Alaska,
answered that the medical director's committee has biannual
meetings open to the public for comment.
SENATOR REINBOLD asked if the governor's executive order to
split DHSS into two departments takes effective, which
commissioner would EMS be under.
CHAIR WILSON answered the Division of Public Health. He
clarified with Mr. Farr.
MR. FARR replied that is correct.
SENATOR REINBOLD suggested that if DHSS is bifurcated, the bill
should have conforming language. She shared that the Chugiak
Fire Department is so important to her community and asked that
they be allowed to weigh in. She would love to hear from them
and their views on the bill.
SENATOR HUGHES said that when the classification was first
created, the only place to put it was under the State Medical
Board. She asked why the change has taken so long.
MR. CRAFT replied there is a long history. Brian Webb who was a
paramedic around that time can explain.
2:23:57 PM
BRIAN WEBB, representing self, Anchorage, Alaska, said he was a
former regional EMS training coordinator. He has been involved
with this for many years. One of the issues with his generation
of medics was a feeling if they switched from licensure to
certification that would somehow diminish their stature and them
as a medical practice as a whole. His era has retired or died
off. The newer generation is looking at streamlined and easier
ways of doing things because the paramedic licensure process in
Alaska is a dramatic affair. He has been working on this for the
past 20 years. He started this process with Senator Birch over
three years ago. The paramedics have tried to do this in
different ways over the years and finally the nexus came to be
to do it legislatively.
SENATOR HUGHES said she will try to help them get it across the
finish line. Her husband was in Vietnam as a medic and was an
EMT and then a paramedic. She asked what the difference is
between an EMT and a paramedic. She observed the fiscal note
that moving the paramedics over will create a smoother pathway
for career advancement for EMTs.
MR. WEBB said that the Office of EMS is already staffed by
paramedics who already manage the training and certification as
mentioned. That will streamline process, especially for people
from out of state. It will simplify a lot of things. The subject
matter experts are already at the Office of EMS who know the
process and can streamline it for folks in the future.
SENATOR HUGHES asked him to explain an EMT vs a paramedic.
MR. WEBB said that an EMT I requires 110-160 hours of training
with no clinical experience required before certification. An
EMT I can become an EMT II with another 50-80 hours of training,
plus some additional skills and patient care verification. To
become an EMT III requires 50-80 hours of additional training
and a test. Paramedics are in classrooms for over 1,000 hours
and then after graduating from a paramedic program they spend
about 650 hours in the lower 48 riding along with an advanced
life support ambulance service. Then they take the national
registry test and apply for state licensure. It is a much longer
road with advanced skill sets compared to EMTs.
2:29:03 PM
CHAIR WILSON opened public testimony.
2:29:14 PM
WILMA VINTON, representing self, Fairbanks, Alaska, said that
she is a mobile intensive care paramedic (MICP) since 2007 and
an EMT since 1979. She is an assistant chief of EMS for Steese
Volunteer Fire Department. She is an EMS instructor and past
adjunct faculty for the University of Alaska Fairbanks paramedic
program. She assists EMTs and MICPs with acquiring and
maintaining their certifications and licenses. She has
personally gone through both processes. This move from the
Medical Board to EMS in DHSS is an excellent way to streamline
the licensing process. EMTs and MICPs work side by side, but
when she is assisting members with certifying and recertifying,
she is working with two different agencies and processes. The
state Office of EMS is already providing certification to EMTs
in an efficient and effective manner. EMTs are regularly
certified within a week of testing but definitely within 20
days. She sees no problems with MICPs being licensed in that
same timeline. The licensing under the State Medical Board can
take several months. The board only meets four times a year. The
Office of EMS has staff who work on this on a daily process.
This shortened timeframe is especially important for someone
trying to get job in Alaska as a paramedic. It will be a
seamless move and will align the MICPs with EMS as they are in
many states. This will benefit students, military leaving the
service, and those in the lower 48 seeking jobs in Alaska as
paramedics.
2:32:06 PM
RICHARD ETHERIDGE, Alaska Fire Chiefs Association, Juneau,
Alaska, said the Fire Chiefs Association supports SB 21.
Paramedics often have to be hired from out of state. It often
takes several months to get licensed in Alaska because of
licensure through the Medical Board. The delay places a burden
on a community trying to get paramedics to serve. Sometimes it
takes six to eight months. Transitioning paramedics to EMS will
shorten the timeframe of getting licenses or certificates. There
will be no decrease in quality control. It is beneficial for
fire chiefs to have one state agency to work with for continuing
education and certification. The State Medical Board voted to
support this transition and the Office of EMS is wiling to
accept the program.
2:33:56 PM
MICHAEL LEVY, M.D., EMA Medical Director, Anchorage, Alaska, was
not able to testify because of sound problems.
CHAIR WILSON asked him to submit his testimony to
[email protected].
2:35:53 PM
CHAIR WILSON closed public testimony.
SENATOR REINBOLD noted that the next committee of referral is
Labor and Commerce and asked that the chair to get the feedback
of the Chugiak Fire Department.
CHAIR WILSON replied that the bill is not moving out of
committee today. The bill sponsor will try to get in touch with
the fire department before the bill moves out of committee.
SENATOR COSTELLO added that her staff has been in touch with the
fire department and will work to make sure their concerns are
heard.
2:36:49 PM
CHAIR WILSON held SB 21 in committee.
SB 78-HEALTH CARE SERVICES BY TELEHEALTH
2:37:07 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 78
"An Act relating to telehealth." He asked Senator Costello and
her staff to the table.
2:37:40 PM
KATIE MCCALL, Staff, Senator Mia Costello, Alaska State
Legislature, Juneau, Alaska, said that in January 2021, Governor
Dunleavy asked the legislature to extend the public health
disaster emergency with the passage of SB 56, a comprehensive
bill with numerous provisions. The legislature instead passed a
resolution asking the governor to issue a new emergency disaster
declaration as there was not enough time for SB 56 to go through
the legislative process before the expiration of the emergency
disaster declaration in effect at the time. In the meantime, the
legislature has taken individual sections from the governor's
bill and created separate legislation to address different
provisions. SB 78 was taken directly from Section 6 of the
governor's bill to address telehealth expansion. The purpose of
introducing this bill is to give the legislative branch the
opportunity to determine whether statutes should be more COVID
aware rather than rely on an emergency disaster declaration in
order to keep the state operational. The Senate Labor and
Commerce Committee intends to rely heavily on the administration
to explain why certain sections in the disaster extension bill,
such as the provisions now found in SB 78, are necessary. The
Senate Labor and Commerce Committee has no position on this
bill. The committee is introducing it as a courtesy to the
administration due to the expiration of the disaster declaration
and provisions in the bill have no way to continue.
2:39:52 PM
SENATOR COSTELLO explained that this is one of several pieces
moving through the process and that her office has been working
with the committee chair, administration, and Director Sara
Chambers in the Department of Commerce, Community and Economic
Development (DCCED,) in addition to stakeholders. Changes can be
made to the bill to address temporary needs of the state and
long-term changes to make statutes more COVID aware. The
committee will probably hear testimony today in opposition to
this version of the bill, but she is hopeful that based on her
conversations with the stakeholders and the administration that
the bill can be crafted to meet the needs of the state as it
moves into the recovery stage of the pandemic. The chair has
also introduced a measure that has passed the Senate that makes
some laws more COVID aware.
2:41:17 PM
SENATOR BEGICH noted that the bill has no effective date or
expiration. He asked if that is intentional.
MS. MCCALL replied that the chair of this committee and of the
Senate Labor and Commerce Committee, [Senator Costello],
discussed adding a sunset date to the bill. If providers from
out of state never become licensed in the state, they can
continue to practice telehealth as long as the bill is in
effect. A sunset date would not allow those services to continue
indefinitely.
SENATOR BEGICH said that without an effective date, the bill
would take effect 90 days after the end of the session.
MS. MCCALL replied that is something to look at changing.
SENATOR BEGICH pointed out that without an expiration date,
there will be a loss of professional licensing fees for the
state of Alaska. He asked if there had an analysis of that and
any other impact that it would have on licensed Alaskan
residents.
2:43:17 PM
SENATOR COSTELLO replied that the governor's disaster
declaration stated that there would be no changes to licensing
fees. The administration intention would be no changes or
impacts to the fees with the disaster declaration, but the fees
are directly related to activities that have to be pursued by
the licensing board. She had a concern about that. This is a
good opportunity for the administration to explain its rationale
for that. She understands that some Alaskans who have traveled
outside the state for care. For example, one person's daughter
has cancer. With the ability to travel curtailed by COVID, the
parent wants to continue to see that provider who is out of
state. Not many Alaskans are affected by this provision, but
enough Alaskans are that it is necessary to allow that continuum
of care to continue. It would make sense for the bill to become
effective immediately with a sunset date so that it can be
reviewed. She does not know what the impact will be on
licensure, but perhaps Sara Chambers does.
2:44:55 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, said her agency
submitted an indeterminate fiscal note because the bill as
written would change policy permanently and has no sunset date.
Her agency could not determine the loss of revenue to self-
funded boards. This is potentially a short-term bill in this
season of COVID, so there is less concern about the fiscal
impact. It is focused on a smaller constituency and not a long-
term change to do away with licensing for all telemedicine. As
the bill is written now, the fiscal note is indeterminate, but
it would create a loss of revenue.
SENATOR REINBOLD said that SB 56 is a big bill. It is amazing
that Senator Costello pulled this section out to work on
independently. She thanked Senator Costello for that. The
legislature has worked on telehealth in the past and worked hard
with physicians on Alaskan preference for telehealth. That is
important. She supports telehealth but there is nothing like
meeting someone in person. She wants sidebars on that. She wants
to review the committee discussion on SB 56 and work on
amendments.
SENATOR HUGHES asked if this applies to behavioral health as
there are a lot of mental health needs right now. Telehealth has
been the platform for that during the pandemic. For some
families in rural areas, it could still be helpful even when
there is not a pandemic. She asked if the bill covers a variety
of provider types, including behavioral health providers.
2:48:38 PM
MS. MCCALL replied that the bill does not specifically address
behavioral health providers, but the topic came up in a meeting
with the administration. Department of Health and Social
Services (DHSS) mentioned that federal public health addresses
that issue.
CHAIR WILSON said that through federal regulations, behavioral
health is covered in the federal disaster declaration, so their
guidance for telehealth and some of the waivers will continue.
The department has assurance from the Biden administration that
that will continue through the end of calendar year 2021. His
office has been working on that. It is clear that behavioral
health is covered.
SENATOR HUGHES thanked the chair for looking into that. Because
of Alaska's geography and how spread out the state is, it is
important that behavioral health providers continue to provide
services through telehealth. She asked if anyone is working on
that for once the federal disaster declaration ends.
CHAIR WILSON said that his office is looking to continue that as
an end-state license process. Through working with the bill
sponsor, his understanding is that an end date is being looked
out for the out-of-state licensees. Regular boards and
commissions will still have jurisdiction over those medical
providers in the state and they follow the same process to
become licensed medical providers.
SENATOR HUGHES clarified that she is asking specifically about
behavioral health.
CHAIR WILSON replied all health practitioners of healthcare and
behavioral health and dental would be covered. They are looking
at any licensed person obligated to provide telehealth.
SENATOR BEGICH said that federal behavioral health waivers will
go away at the end of the calendar year. He clarified that the
chair is looking at something more comprehensive that would
apply to any provider. He is in agreement with Senator Reinbold.
Parameters or sideboards are important to protect the Alaska
workforce. He knows the chair will be looking at that in terms
of expiration dates and licensing issues. That is the issue in
all his questions. He asked who is going to enforce and monitor
the healthcare practitioners who are not licensed and residing
in the state and who ensures they are in good standing. The bill
doesn't seem to address that. He doesn't know what will cover
that or to ensure practitioners are acting within the scope of
their expertise. The committee has discussed the Prescription
Drug Monitoring Program with the State Medical Board. He asked
what the prescribing process is. There could be different laws
around prescriptions. These are the issues he wants to see
addressed. Those monitoring costs have to be reflected in the
fiscal note at some point.
MS. MCCALL said that for prescribing, the bill mentions the
services provided have to be within the scope of practice within
the jurisdiction that providers are licensed. Based on
conversations she has had with Legislative Legal, licenses tend
to be fairly uniform. Her office hasn't had a chance to reach
out to Legislative Research to look at different licensing
provisions and where there might be discrepancies. Legislative
Legal was not concerned that there would be major differences,
but that will be looked at more.
SENATOR BEGICH said that an easier answer might be to simply
require providers to meet Alaska's own standards.
2:54:38 PM
CHAIR WILSON opened public testimony.
2:54:46 PM
SARAH HETEMI, representing self, Anchorage, Alaska, said that
she was happy that Governor Dunleavy asked the legislature to
extend the public health disaster emergency with the passage of
SB 56. She was especially happy about Section 6 of the bill,
which related to the issue of telehealth expansion. Telemedicine
is a big part of the future. COVID-19 showed that more than
ever. The state needs to empower its healthcare providers to
deliver telemedicine as it is a crucial component of healthcare
reform that will increase access to all. It could be
lifechanging in terms of cost savings. Individuals who reside in
underserved rural and urban communities have to wait longer,
travel further, and ultimate pay more for healthcare. The state
has the ability and opportunity to significantly improve service
to these individuals. This bill should have bipartisan support.
It is an opportunity to make statutes more up to date and more
COVID-19 aware instead of relying on the emergency declaration
alone.
2:56:53 PM
PORTIA NOBLE, representing self, Anchorage, Alaska, said that
Alaskans need more accessibility and convenience, not just
during a pandemic. In December of 2020, over 30 policy think
tanks and grassroots organizations united to urge policy makers
across the country to permanently enact and enhance telehealth
capabilities and remove as many barriers as possible. Healthcare
groups, clinics, and hospitals in the last two years have
innovated and invested in telehealth capabilities. Pandemic or
not, there is a great opportunity to embrace and expand the free
market in healthcare. Alaska has seen barriers eliminated
specifically because of telemedicine. She agrees with Senator
Reinbold about the in-person relationship with a doctor, but she
sees interesting statistics that providers increased the number
of weekly telehealth consultations for Medicare enrollees from
13,000 to 1.7 million. That statistic should be embraced to
support elders in Alaska and across the country. She encouraged
the committee to move forward with SB 78 and other free market
health bills to improve accessibility and convenience for all
Alaskans.
2:58:47 PM
RYAN MCKEE, Americans for Prosperity, Wasilla, Alaska, said this
is a great step in giving the public an easier way to connect
with doctors. Some may choose to go out of state, but Senator
Reinbold is a big supporter of choice. Individuals should have
this choice in healthcare of whether to seek healthcare in state
or out of state. Across the nation more states are moving to
allow telemedicine to be used more widely. Alaska has many rural
communities where access to healthcare is often a struggle.
Telehealth can help. Many cancer patients are doing telemedicine
appointments right now. That is especially a benefit during the
pandemic. Telehealth offers important alternative to some
services. Alaska will gain from having it.
3:01:16 PM
CHAIR WILSON closed public testimony and held SB 78 in
committee.
3:02:02 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee at meeting 3:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HSS_Dave Boswell Board Application_Redacted.pdf |
SHSS 3/2/2021 1:30:00 PM |
SHSS Medical Board Confirmation Hearing |
| HSS_Larry Daugherty Board Application_Redacted.pdf |
SHSS 3/2/2021 1:30:00 PM |
SHSS Medical Board Confirmation Hearing |
| SB 78 v. A.PDF |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 78 Sponsor Statement.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 78 v. A Sectional Analysis.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 78 Fiscal Note DCCED.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 21 version B.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sponsor Statement.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sectional Analysis.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sectional Analysis 3.2.21.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DHSS.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DCCED.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Point Paper.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 State Medical Board Letter of Support (3.2.21).pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 21 |