Legislature(2023 - 2024)BUTROVICH 205
01/23/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| SB115 | |
| Presentation: State of Alaska Department of Health Overview | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 115 | TELECONFERENCED | |
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| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 23, 2024
3:30 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator James Kaufman, Vice Chair
Senator Löki Tobin
Senator Forrest Dunbar
Senator Cathy Giessel
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 115
"An Act relating to physician assistants; relating to
physicians; and relating to health care insurance policies."
- HEARD & HELD
PRESENTATION: STATE OF ALASKA DEPARTMENT OF HEALTH OVERVIEW
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 115
SHORT TITLE: PHYSICIAN ASSISTANT SCOPE OF PRACTICE
SPONSOR(s): SENATOR(s) TOBIN BY REQUEST
03/27/23 (S) READ THE FIRST TIME - REFERRALS
03/27/23 (S) HSS, L&C
01/23/24 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
SENATOR LÖKI TOBIN, District I
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as the sponsor of SB 115.
MACKENZIE POPE, Staff
Senator Löki Tobin
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a sectional analysis for SB 115.
CHRISTI FROILAND, MD
Alaska Academy of Physicians Assistants
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation on SB 115.
HAROLD JOHNSTON, MD
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation on SB 115.
WENDY SMITH, PA
Alaska Academy of Physicians Assistants
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 115.
CHRIS DIETRICH, PA
Orion Behavioral Health Network
Eagle River, Alaska
POSITION STATEMENT: Testified in support of SB 115.
BETSY DOUDS-PACZAN, PA, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 115.
JOHN HALL, MD, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 115 with
concerns.
JENNIFER FAYETTE, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 115.
MARY SWAIN, Executive Director
Cama'i Community Health Center
Naknek, Alaska
POSITION STATEMENT: Testified in support of SB 115.
KATHERINE VAN ATTA, representing self
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 115.
PAM VENTGEN, Executive Director
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to SB 115.
SYLVAN ROBB, Division Director
Corporations, Business and Professional Licensing
Department of Commerce, Community and
Economic Development (DCCED)
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 115.
EMILY RICCI, Deputy Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Co-presented the State of Alaska Department
of Health Overview.
HEIDI HEDBERG, Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Co-presented the State of Alaska Department
of Health Overview.
ACTION NARRATIVE
3:30:13 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:30 p.m. Present at the
call to order were Senators Tobin, Giessel, Dunbar, Kaufman, and
Chair Wilson.
SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
3:30:42 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 115
"An Act relating to physician assistants; relating to
physicians; and relating to health care insurance policies."
3:31:11 PM
SENATOR LÖKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, as the sponsor of SB 115, stated that the
purpose of the bill is to improve patient outcomes. Alaska has
long wait times, and it is difficult to access care across the
state. SB 115 will help reduce wait times and improve the
quality of care for Alaskans. SB 115 would allow physician
assistants (PAs) to provide care to patients without direct
oversight from collaborating physicians. She acknowledged that
no one operates alone, and that PAs could still consult with
physicians for complex and unusual issues. However, SB 115 would
allow experienced PAs to operate independently.
SENATOR TOBIN noted that there is an inadequate number of
physicians to meet the care demands of Alaskans. Over 69 percent
of primary care providers are in the urban Mat-Su and Anchorage
areas. Most PAs operate in rural areas and attempt to meet
people's basic medical needs. SB 115 would allow PAs with more
than 2,000 hours of professional experience to operate
independently. PAs with less than 2,000 hours would need to
maintain a collaborative agreement with a physician.
SENATOR TOBIN said healthcare needs and costs are high in
Alaska. The state also has some of the most limiting regulations
for PAs. SB 115 would help to improve patient outcomes by
creating a more equitable space for PAs to operate
independently. SB 115 would require PAs to:
• Be subject to the prescription drug monitoring program.
• Register with the Alaska Drug Enforcement Agency.
• Comply with all regulations while working under a
collaborating physician.
3:35:20 PM
MACKENZIE POPE, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, gave the sectional analysis for SB
115. READ sectional insert.
[Original punctuation provided.]
Senate Bill 115: Sectional Analysis
Section 1. Amends AS 08.64.107 by changing the term
"regulation" to "licensure and scope of practice."
Section 2. Amends AS 08.64.107 by adding four new
subsections:
Subsection (b) describes the procedures and
evaluations physician assistants can perform,
including their ability to: perform comprehensive
health histories and physical examinations of
patients; treat disease and injury; and prescribe,
dispense, order, and administer schedule II, III, IV,
or V controlled substance under federal law if the
physician assistant has a valid federal Drug
Enforcement Administration registration number.
Subsection (c) establishes that a physician assistant
with less than 2,000 hours of practice may practice
only under collaborative agreement with one (or more)
physician to provide care in a hospital, clinic, or
other clinical setting. These collaborative agreements
must be in writing and describe how the collaboration
will be executed between the physician and physician
assistant.
Subsection (d) requires that a physician assistant in
a collaborative agreement or the collaborating
physician shall provide a copy of their collaborative
agreement and relevant documentation to the State
Medical Board upon request.
Subsection (e) defines collaborative agreement.
Section 3. Amends 08.64.170 to authorize a physician
assistant to practice medicine independently, with
those practicing with less than 2000 hours required to
operate under a collaborative agreement as authorized
in the previous section. 33-LS0542\B | 12.22.2023 | 2
Section 4. Amends AS 11.71.900 to include physician
assistants under the definition of "practitioner."
Section 5. Amends AS 21.07.010 to disallow a contract
between a participating health care provider and
health care insurer from including a provision that
imposes a practice, education, or collaboration
requirement on physician assistants which is
inconsistent with or more restrictive than the
requirements stipulated under AS 08.64.107.
Section 6. Removes the direct supervision requirement
for physician assistants under the definition of
"attending physician" as stated in AS 23.30.395, which
allows employees to designate physician assistants as
responsible for their care under the Alaska Workers
Compensation Act.
Section 7. Removes the direct supervision requirement
for physician assistants under the definition of
"health care provider" as stated in AS 33.30.901,
which allows physician assistants to provide medical
services as a health care provider within the
Department of Corrections statute definition.
3:38:40 PM
CHAIR WILSON announced invited testimony on SB 115.
3:38:54 PM
CHRISTI FROILAND, MD, Alaska Academy of Physicians Assistants,
Anchorage, Alaska, said she is a dermatology-trained PA with
over 16 years of direct clinical experience in Alaska. She
emphasized the importance of SB 115, noting Alaska's challenging
PA licensing and collaboration process, which delays access to
care. SB 115 aims to allow PAs to practice to the full extent of
their training, aligning statutes with how PAs currently
practice in Alaska to better utilize the healthcare workforce.
MS. FROILAND explained that current statutes were enacted in
1974. The goal of SB 115 is to enhance collaboration, not
diminish it. Medicine is a team sport, and SB 115 would allow
experienced PAs to practice independently, providing quality and
timely care. She provided examples of how SB 115 would help
specialty PAs in smaller communities.
First, she pointed out that initially as a dermatology PA, she
was mentored by a dermatologist, but 16 years later, they
function like teammates. Without SB 115, if the dermatologist
retires, she will need a new collaborating physician to continue
seeing patients. This is impractical given her experience.
Medicine is a team sport, and SB 115 strengthens the team by
creating a level playing field.
Second, Fairbanks is a dermatology desert, with only one
dermatologist and a nine-month waitlist. An experienced medical
dermatologist like her could help alleviate this by serving the
community a few days a month. Currently, residents face
significant expenses traveling to Anchorage for care, leading to
delayed diagnoses of serious conditions. She stated that
allowing experienced PAs to serve more broadly could change
lives.
Third, a local PA, embedded in her tribal corporation, was told
by Copper River Native Association they would no longer hire PAs
due to burdensome regulations, opting for physicians and nurse
practitioners instead. This PA was a crucial part of her
community for over four years. Rural communities are dropping
PAs not because of quality issues, but due to regulatory
burdens, threatening access to specialty care.
MS. FROILAND concluded by asking for support in serving the
greater Alaska community. Many PAs have been trained by
nationally recognized experts in critical specialties that
Alaska lacks. These specialists are needed but underrepresented.
3:44:17 PM
SENATOR GIESSEL stated that as an advanced nurse practitioner
(NP), she was eager to co-sponsor SB 115 because it is absurd
that PAs do not have plenary practice. She asked how many states
offer non-collaborative whole scope of practice for PAs.
3:44:45 PM
MS. FROILAND replied five or six states.
SENATOR GIESSEL responded that Alaska would be leading the way
if SB 115 passed and asked for clarification that the statutes
on PA practice were written in 1974. She pointed out that NPs
have had plenary practice since 1980 and no one has died.
3:45:15 PM
CHAIR WILSON asked how many states have similar practices for
PAs.
3:45:36 PM
HAROLD JOHNSTON, MD, Alaska Primary Care Association, Anchorage,
Alaska, replied he did not know the answer. He said he is a
retired family physician and lifelong Alaskan who is speaking on
behalf of the Alaska Primary Care Association (APCA). He
highlighted his role as the architect and director of the Alaska
Family Medicine Residency for 19 years. The APCA represents 29
community health centers across Alaska, serving over 100 sites,
including both large urban areas and small rural practices.
These centers provide comprehensive care regardless of patients'
ability to pay. In 2022, APCA member clinics employed 83 PAs,
accounting for about a third of healthcare providers in these
centers, with 80,000 patient visits statewide.
DR. JOHNSTON emphasized that SB 115 modernizes the role of
PAs, reflecting how healthcare is practiced, especially in rural
Alaska. He noted that the bill would eliminate the need for
experienced PAs to have a formal collaborative relationship with
a specific physician, thereby reducing administrative burdens
and costs. He stated that SB 115 would improve provider
recruitment and allow funds to be redirected to enhance access
to care in rural communities. The bill also recognizes that
while newly trained PAs need close support, experienced PAs can
tailor their support to their individual needs. Dr. Johnston
concluded by expressing strong support for the passage of SB 115
on behalf of the APCA.
3:50:18 PM
SENATOR TOBIN stated that as of June 2023, six states allow PAs
to practice independently. Iowa was the most recent state to
adopt similar legislation.
CHAIR WILSON stated the other states are Arizona, Wyoming, Utah,
Montana, and North Dakota.
3:50:41 PM
CHAIR WILSON opened public testimony on SB 115.
3:51:11 PM
WENDY SMITH, PA, Alaska Academy of Physicians Assistants,
Juneau, Alaska, testified in support of SB 115. She stated that
as a physician assistant and lifelong resident of Juneau she has
practiced primary care for the last 20 years. She pointed out
that while working in a group clinic with many physicians, she
always had collaborators. However, after moving to a smaller
practice with only one physician, the task of finding a second
collaborator was onerous. The administration had to pay a silent
partner, whom she contacts only if necessary. She emphasized
that in her daily practice of seeing 20 patients, she
collaborates with multiple providers, including emergency room
providers, primary care providers, and specialists in oncology
and cardiology from various locations, including Texas and
Anchorage.
MS. SMITH stated that the requirement of being responsible for
all the care a PA provides can cause apprehension for physicians
to sign a PA as a collaborator. She stated her belief that SB
115 would allow experienced PAs to officially take
responsibility for the care they provide within their scope of
practice. Addressing concerns about safety and rogue independent
PAs, she noted that accountability issues exist among all
healthcare providers, whether they are physicians, NPs, or PAs,
and that everyone is ultimately responsible for their decisions.
She expressed that as a professional, she should not have to
depend on another professional to practice medicine. Currently,
if she lost her second collaborating physician, she wouldn't be
able to see patients, which is a significant fear. She concluded
by expressing her support for SB 115 and her optimism for the
future of medicine in Alaska.
3:53:33 PM
SENATOR GIESSEL asked how much her administrators pay the second
collaborating physician.
MS. SMITH replied that the average amount paid to a collaborator
is around $1,000 - $1,500 per month. She stated that her
collaborating physician works for free for the other doctor
certain weeks out of the year.
3:54:36 PM
CHRIS DIETRICH, Medical Director, Orion Behavioral Health
Network, Eagle River, Alaska, testified in support of SB 115. He
highlighted that SB 115 offers significant hiring benefits and
aids in the retention and promotion of mental health providers.
He shared a recent challenge at Banyan Treatment Center in
Wasilla, a 24-bed facility for veterans. Due to delays in
securing licensure for a second collaborator, veterans lost
access to the facility for 30 days. The clinic had to pay $1,500
for a second collaborator who did nothing more than sign off,
delaying patient care during a critical time. He emphasized that
SB 115 would greatly benefit behavioral health and substance use
treatment by extending access to experienced PAs, thus meeting
healthcare needs more effectively.
3:57:01 PM
SENATOR GIESSEL asked where Mr. Dietrich's clinic is located.
MR. DIETRICH replied that Banyan Treatment Center is a
nationwide organization that opened a clinic in Wasilla.
3:57:39 PM
SENATOR GIESSEL asked where he lives.
MR. DIETRICH replied that he lives in Palmer.
3:57:55 PM
BETSY DOUDS-PACZAN, PA, representing self, Anchorage, Alaska,
testified in support of SB 115. She said she is a practicing
licensed physician assistant (PA) in Alaska who provides care to
those with substance use issues and behavioral health needs. She
advocated for the passage of SB 115 to protect and expand the
ability of PAs to provide excellent care. SB 115 will remove
outdated licensing obstacles, making it easier to hire PAs and
allowing them to work to their full potential within their scope
of practice as part of a collaborative team. Modernizing the
statutes will ensure that PAs can perform duties according to
their training and experience, rather than being limited by
outdated guidelines. She urged the committee to move SB 115
forward.
3:59:46 PM
JOHN HALL, MD, representing self, Anchorage, Alaska, testified
in support of SB 115 with concerns. He said he is a retired
emergency physician who practiced at Providence Hospital for
over four years and has sponsored more than 200 physician
assistants (PAs) over the past 30 years. He spoke in favor of SB
115, despite snide remarks from others that the path to
independence for PAs should be medical school. After reviewing
SB 115 and speaking with five trusted PAs, he agrees some
changes to the regulations are needed, though the bill may
require amendments.
DR. HALL stated his belief that PAs should practice medicine
according to their training, even when they possess skills their
collaborating physician does not. For example, he sponsored PAs
performing prolotherapy and SI joint injections, skills he did
not personally have. He argued that PAs should bill insurance
under their own names, be paid in their names, and be able to
prescribe scheduled medications if they have a DEA license, even
if their collaborating physician does not. He also stated that
PAs should sign off on tasks they perform, such as physical
exams and necessary paperwork, without requiring a physician's
signature. While he thinks Alaska has good regulations for
licensing PAs, there is room for improvement to allow more
independence. He suggested that 2,000 hours of experience is not
sufficient for full independence, advocating for a higher
threshold, like the 8,000 hours required in Tucson.
DR. HALL said he supports SB 115 and the idea of moving the bill
to another committee for potential amendments to ensure
appropriate training before PAs gain full independence.
4:03:25 PM
JENNIFER FAYETTE, representing self, Anchorage, Alaska,
testified in support of SB 115 and said she is a lifelong
Alaskan and a practicing PA in Alaska for the last 10 years, as
well as a past president of the Alaska Academy of Physician
Assistants. She said she supports the passage of SB 115, having
spent the last two years working with the State Medical Board to
update current PA regulations. She emphasized that the current
regulations can quickly and drastically affect care for
Alaskans, highlighting the need to update the statutes.
MS. FAYETTE said PAs have been providing solid care for over 50
years, and it is time to reflect that in state statutes.
Medicine is inherently independent and collaborative, and
Alaskan PAs independently make diagnoses, formulate care plans,
prescribe medications, order tests, and interpret results. When
a patient's needs fall outside a PA's expertise or require
surgical treatment, they collaborate with colleaguesnot because
state regulations mandate it, but because this is how PAs are
trained and how modern medicine is practiced.
MS. FAYETTE said SB 115, would greatly increase access to care
across Alaska by allowing PAs to practice to the full extent of
their education, training, and experience, on par with other
medical providers. She fully supports and encourages the passing
of SB 115.
4:05:27 PM
MARY SWAIN, Executive Director, Cama'i Community Health Center
Naknek, Alaska, testified in support of SB 115. She stated that
Cama'i Health Center is a federally qualified health center
(FQHC) that provides comprehensive whole-person care, including
medical, behavioral, pharmacy, urgent and emergent care, and
care coordination services. She emphasized Cama'i's support for
SB 115 due to the increased access to care it would create for
Bristol Bay and the entire state. SB 115 would enable PAs to
practice independently to the fullest extent of their licenses
while maintaining collaborative agreement structures for less
experienced physician assistants.
MS. SWAIN said Cama'i Health Center has employed over 14 PAs and
core providers over the past five years. SB 115 is crucial for
FQHCs like Cama'i, which struggle to recruit and retain adequate
providers. The current collaborative agreements impose
unnecessary burdens on rural clinics that cannot support full-
time staff positions. Cama'i contracts with two physicians, one
out of state and the other semi-retired in southeast Alaska,
paying nearly $60,000 a year for collaborative plans.
MS. SWAIN highlighted that it is Cama'i's policy for PAs to
maintain strong collaborative relationships with a range of
urgent and specialty providers in real time to address patients'
specific needs. She concluded by reiterating the importance of
SB 115 for improving access to care and reducing administrative
burdens on rural health clinics.
4:07:29 PM
KATHERINE VAN ATTA, representing self, Wasilla, Alaska,
testified in support of SB 115. She said she has been a PA for
18 years and a certified nurse midwife for five years. She has
worked in rural Alaska in various full-time and intermittent
roles for 14 years, including three years full-time in Adak as
the sole licensed healthcare provider.
MS. VAN ATTA noted that a recent effort by the State Medical
Board to modernize PA regulations resulted in proposed changes
that were alarming. The new regulations would have made it
nearly impossible for PAs to work in rural areas, defined as
over 30 miles from a collaborating physician or tertiary health
center, which was alarmingly not defined. This would have
significantly decreased access to care for rural Alaskans.
MS. VAN ATTA pointed out that as a certified nurse midwife, she
is licensed independently and collaborates with physicians as
needed. She emphasized that being licensed to practice
independently does not diminish her ability to collaborate. She
expressed strong support for SB 115, believing it offers a
reasonable approach to maintaining and improving healthcare
access in rural Alaska.
4:09:27 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, Anchorage, Alaska, testified in opposition to SB
115. She stated that the association represents physicians and
physician assistants (PAs) across Alaska, with a primary focus
on the health of all Alaskans. She stated that the association
opposes SB 115, supporting PAs working collaboratively with
physicians as part of a healthcare team. She mentioned that the
association will participate in a new workgroup established by
the medical board to update PA regulations, acknowledging that
the current regulations are burdensome and need modernization.
MS. VENTGEN expressed concern over the proposed 2000-hour
requirement for independent practice, highlighting those
physicians, who have significantly more formal medical
education, must complete at least two years of additional
residency training before licensing. She noted that some
physician specialists undergo up to seven years of residency
training and family practice physicians average between 12,000
and 16,000 hours of clinical patient training before licensure.
MS. VENTGEN emphasized that the association believes revisions
to current regulations can be achieved without granting
independent practice to PAs. She also pointed out that SB 115
leaves several areas undefined, particularly regarding how a PA
might change or add a medical specialty. She questioned whether
a PA could do so independently or would need a new collaboration
with a physician. She concluded by stating that, as written, SB
115 does not adequately protect Alaskans.
4:11:49 PM
SENATOR TOBIN asked when the state last undertook a review of
the regulations for physician assistants and when that process
began.
MS. VENTGEN replied that the State Medical Association worked
with a group of PAs about three years ago to review the
regulations. However, no action was taken from that review. The
Medical Board reviewed those PA regulations somewhat and there
were weekly meetings with the State Medical Board. The Medical
Board then initiated a regulatory project which the Medical
Association did not support. While there were some areas of
agreement, most of the recently proposed regulatory changes were
considered very draconian and nonsensical. As a result, the
Medical Board agreed to form a workgroup to revisit the
regulations.
MS. VENTGEN emphasized that the supervision and licensure of PAs
should be addressed through regulation rather than statute. The
Medical Association is participating in the workgroup, which has
not yet set a first meeting date but is considering dates in
February. She expressed hope that this workgroup, without the
involvement of the medical board chairperson, would be able to
make significant changes.
4:14:16 PM
SENATOR DUNBAR asked if the association would change its
position and support SB 115 if the minimum hours requirement was
increased.
MS. VENTGEN replied that at this point, the State Medical
Association does not support independent practice for physician
assistants. However, they are willing to look at ways to make
employment for physician assistants easier and to make
supervision requirements less burdensome. She noted that some
regulation changes, such as the requirement for a second
collaborating physician, lack clear logic. She emphasized that
experienced physician assistants, like those with 16 years in
dermatology, are in a different situation than new PAs.
Therefore, licensing laws need to account for the range of
experience and training to protect citizens effectively.
SENATOR DUNBAR asked if there is evidence of worse patient
outcomes or decreased quality of healthcare in the six states
that have already implemented PA independent practice compared
to states that have not made the change.
MS. VENTGEN replied that a study was submitted to the committee
yesterday, conducted by the Hattiesburg Clinic in Mississippi.
This large clinic, which has employed PAs, nurse practitioners,
certified registered nurse anesthetists, and optometrists as
advanced practice providers since 2005, performed a
retrospective study on patient outcomes and the value of care
after expanding the scope of these providers. The study
concluded that collaborative practice between physicians and
advanced practice providers resulted in better patient outcomes
and care value. However, when mid-level providers saw patients
independently, it cost the clinic more, and patient outcomes
were reduced. She recommended committee members read the
insightful three-page report.
4:18:51 PM
SENATOR GIESSEL commented that she is a nurse practitioner (NP)
and in Alaska NPs have had independent practice for 44 years.
She referenced another study, 27 pages long, that includes 34
studies and data from Northern Arizona and the Netherlands,
showing that PAs deliver the same or better care outcomes as
physicians at the same or lower cost. She pointed out that the
study cited by Ms. Ventgen, involving 186 clinicians, is
relatively small. She asked if there are any other studies
showing negative outcomes for PAs in independent practice.
4:20:07 PM
MS. VENTGEN replied that a study conducted a year or two ago,
involving multiple veteran clinics, showed similar results, but
she did not have the study details in front of her.
4:20:40 PM
SYLVAN ROBB, Division Director, Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED) Juneau, Alaska, testified that she
recalled Senator Tobin's question about the regulations
affecting physician assistants. She stated that the Alaska
Physician Assistant Association approached the board about
modernizing the PA regulations. A workgroup was formed in late
2021 to address this issue and met several times throughout
2022. In February 2023, regulations were adopted by the board
after the drafting and review process by the division and the
Department of Law. The regulations went out for public comment,
and after considering the feedback, the board decided to
postpone adopting the changes and form a new workgroup. The
first meeting of this new workgroup is scheduled for February
2024.
4:22:05 PM
SENATOR TOBIN asked why the regulations were postponed,
suggesting that public comments might not have been positive.
She requested an explanation of the reasons behind the
postponement.
4:22:28 PM
MS. ROBB replied she did not want to speak for the board, but
there was a lot of public comment opposing the regulations.
4:22:50 PM
SENATOR DUNBAR asked how the 2000-hour requirement, equivalent
to approximately one year, was determined.
SENATOR TOBIN deferred to Ms. Pope.
4:23:36 PM
MS. POPE replied that the 2000-hour requirement was a starting
point for discussing the necessary hours a PA would need before
practicing independently. She mentioned the sponsor is open to
considering a different number if it benefits Alaskans.
4:24:09 PM
SENATOR DUNBAR asked whether a similar number of hours is
required for NPs and could any PAs present speak their thoughts
regarding the 2000 hours of experience requirement.
4:24:47 PM
MS. SMITH stated that the concept of collaboration does not mean
that the physician and PA are always in the same room, but
rather that the physician is accessible for questions. She
shared her experience as a new graduate PA who frequently
consulted with her collaborating physician. She emphasized that
comfort levels with collaboration vary among individuals.
MS. SMITH expressed her belief that, like NPs, specific
collaboration hours should not be required for PAs. She
mentioned that the proposed hours were included to make the bill
more acceptable to physicians, asserting that PAs will
collaborate regardless of their experience level. She suggested
that the hours could be increased to 4000 but stressed that
collaboration should not necessitate physical proximity, as PAs
in remote areas need to be able to consult with physicians via
phone or Skype.
MS. POPE interjected that the 2000 hours are in addition to the
formal education PAs receive.
MS. SMITH stated that PAs receive three semesters of didactic
training and three semesters of rotations, slightly less than
physicians' training. She acknowledged the rigorous training of
both PAs and nurse practitioners, noting that PAs graduate with
2000 hours of clinical experience, which combined with the
additional 2000 hours, totals 4000 hoursapproaching the level
of a physician's residency. She reiterated her pride in being a
PA and emphasized the intensity of their training while
distinguishing it from that of physicians.
4:28:09 PM
SENATOR TOBIN expressed her appreciation to the committee for
hearing SB 115. She highlighted the widespread healthcare
shortages in Alaska and the nation, noting the impending need
for more quality care providers as the population ages. She
emphasized the importance of "aging in place" and shared a
personal story about her father's challenges with physician
retention. She said she supported the legislation because PAs
live in and serve rural Alaska, providing high-quality care to
their communities. She hoped to continue working on the
legislation to find common ground and avoid a prolonged
regulatory process filled with distrust and frustration.
4:29:45 PM
CHAIR WILSON closed public testimony on SB 115.
4:29:52 PM
CHAIR WILSON [held SB 115 in committee.]
4:30:06 PM
At ease
^Presentation: State of Alaska Department of Health Overview
PRESENTATION: STATE OF ALASKA DEPARTMENT OF HEALTH OVERVIEW
4:32:38 PM
CHAIR WILSON reconvened the meeting and announced the
continuation of a presentation by the Department of Health that
began on January 18, 2024.
4:33:04 PM
EMILY RICCI, Deputy Commissioner, Department of Health,
Anchorage, Alaska, co-presenting the State of Alaska Department
of Health Overview, resumed the presentation on slide 13. She
stated that the behavioral health continuum of care falls into
seven buckets:
• Prevention and Early Intervention
• Outpatient Treatment
• Crisis Response and Stabilization
• Inpatient Services
• Step-down Services
• Care Coordination and Navigation
• Data Systems
How the department thinks about the continuum was informed by
the ongoing work of multiple populations:
Comprehensive Integrated Mental Health Program Plan
• All Alaskans
Behavioral Health Roadmap for Alaska Youth
• All Alaska youth
DOJ Report
• Medicaid-eligible Alaska youth
Complex Care
• Alaskans with complex cooccurring needs (medical,
behavioral, social, disabilities)
MS. RICCI said the department has spent the last eight months
visiting five regions of the state and hearing from individuals
and providers impacted by behavioral health issues. It is clear
to the Department of Health (DOH) that the core system of
Medicaid needs strengthening and flexibility to meet the needs
of different regions, hubs, and communities. She emphasized the
need to transition from an administrative services organization
to a Medicaid management information system. She explained that
this transition is integral to the core payment system for
behavioral health services. She noted that, through this effort,
DOH has identified several action items that are already being
addressed. These actions include conducting a methodology study,
transitioning to a consolidated Medicaid payment system, and
implementing other measures. She stated her belief that these
efforts, expected to be fully developed over the next one to
three years, will significantly address gaps in the behavioral
health continuum identified by DOH.
4:36:30 PM
CHAIR WILSON said the department had six meetings including a
kickoff that involved the entire state. He commended DOH
personnel for their work.
4:36:40 PM
SENATOR DUNBAR asked if the department could discuss behavioral
health providers advocating for a parity law in medical billing
with traditional physical medicine, as they feel the regulatory
burden for behavioral health payments in Alaska is significantly
higher than in many other states.
4:37:18 PM
CHAIR WILSON clarified that behavioral health providers are not
only seeking parity for payment but also for documentation and
access standards.
4:37:28 PM
MS. RICCI acknowledged the need to streamline administration and
reduce regulatory burdens for behavioral health providers. She
mentioned leveraging the regulatory process to identify ways to
ease these burdens while maintaining accountability. She noted
ongoing communication with stakeholder organizations and efforts
to stabilize leadership within the Division of Behavioral
Health. She highlighted the importance of claims payment work,
the 1115 Waiver renewal, and setting regulatory priorities to
quickly address the most impactful administrative barriers. She
emphasized the necessity of reviewing regulations and manuals to
determine what is essential for improving the continuum of care,
particularly in outpatient treatment.
4:39:17 PM
SENATOR GIESSEL said DOH's talking points are great but urged
the department to not lower standards in the process.
4:39:55 PM
CHAIR WILSON commented that Senate Bill 74, that was passed
around 2016, addressed the Medicaid redesign program and may
need updating to accommodate flexibility and 1115 Waiver
changes. He asked if the department has any recommendations on
how to fix existing laws to achieve compliance.
4:40:37 PM
MS. RICCI emphasized the importance of a functional claims
payment system for providers to ensure consistent revenue and
service stability. She noted that the department is focused on
identifying and addressing service gaps while renewing its
waiver with the federal government, aiming for completion by the
end of March. She acknowledged the need for future discussions
on waiver amendments, with public input and committee
involvement. She highlighted the balance between reducing
administrative burdens and maintaining care quality and
accountability, using the example of service authorizations for
outpatient behavioral health services, which the department is
currently reassessing to streamline.
SENATOR GIESSEL expressed concern that without basing outpatient
care on best practices, there is a risk of funding ineffective
clinical treatments. She emphasized that requiring a care plan
is not burdensome. She stated that a well-thought-out care plan
is essential and should be mandated, given the long-term nature
of behavioral health relationships. She urged caution in making
changes.
4:44:55 PM
CHAIR WILSON said he echoed Senator Giessel's concern, noting
that providers have employed various strategies to meet the need
for care plans. He mentioned that providers do initial plans and
later add addendums. He said there are ways that systems can
ensure both immediate patient stabilization and ongoing care
planning.
4:45:23 PM
MS. RICCI moved to slide 14 and highlighted the focus of Senior
and Disability Services on moving towards person-centered care
using the International Resident Assessment Instrument
(InterRAI). She noted that the division began implementation of
this tool about a year ago. The benefits of the InterRAI include
establishing a budget based on individual needs, allowing
individuals to choose services within that budget, fostering
self-determination, and enhancing flexibility. This approach
also provides budgetary predictability for both the division and
individuals. She credited the Division of Senior and Disability
Services for their collaboration with stakeholder groups in
developing the implementation for this tool. She mentioned that
the process of finalizing federal approval to access matching
funds to hire a contractor for technical assistance is underway.
She said this effort is expected to continue over the next three
years and aims to be a positive and collaborative approach.
4:47:22 PM
CHAIR WILSON thanked Mr. Newman for his work as the director of
Senior and Disability Services. He mentioned the possibility of
future presentations and asked for clarification on what is
occurring with the Supplemental Nutrition Assistance Program
(SNAP) backlog and its impact on receiving federal funds for
summer benefit programs. He asked why the Department of Commerce
couldn't handle funds for the foodbank.
4:50:06 PM
HEIDI HEDBERG, Commissioner, Department of Health, Anchorage,
Alaska, explained that the Summer Electronic Benefit Transfer
(EBT) program is administered by the Department of Education and
Early Development (DEED), which lacks the resources to manage
the program alone and thus seeks assistance from the Department
of Health (DOH). She clarified that the Public Information
Office's (PIO) comment likely stemmed from DOH's focus on the
Supplemental Nutrition Assistance Program (SNAP) EBT program.
She emphasized that the Summer EBT program is a collaborative
effort between the two departments. The Division of Public
Assistance is currently prioritizing the elimination of the SNAP
backlog and preventing future backlogs. DOH and DEED are working
together to evaluate and improve the administration process,
especially considering the manual nature of the pandemic EBT
program. The department is exploring the necessary IT systems
and efficient methods for communication with school districts.
She said due to these ongoing discussions, DOH was not prepared
for the 2024 program and is focusing on planning for 2025.
4:51:50 PM
CHAIR WILSON asked when the decision needs to be made so Alaska
can have a Summer EBT program.
4:51:59 PM
MS. HEDBERG said the deadline for 2024 was January and stated
her belief that the deadline for 2025 is rolling. She said she
would get back to the committee.
4:52:19 PM
SENATOR TOBIN expressed her appreciation for the insight
provided. She noted that she and Senator Dunbar have struggled
with ensuring that low-income communities they serve have access
to the Summer EBT program. She mentioned that the rural Summer
Food Program will serve her home community and expressed hope
that DOH can apply for the 2025 program.
4:52:48 PM
MS. HEDBERG mentioned that the Department of Commerce, upon
legislative approval, will focus on distributing funds to food
banks and pantries statewide. The Department of Health's funding
for food security, included in the proposed 2025 budget, is
intended as a buffer to implement recommendations from the Food
Security Task Force. As a member of the task force, she
highlighted that factors such as SNAP issues and inflation have
contributed to increased food bank visits. The funding will
support food security while these recommendations are put into
action.
4:54:23 PM
CHAIR WILSON asked why DOH wants to take on an additional burden
when it is struggling, especially since the Department of
Commerce Community and Economic Development has successfully
handled the food bank grant for the past two years.
4:54:43 PM
MS. HEDBERG stated DOH has a grants team, so the handling of the
food bank grant does not burden public assistance.
4:54:59 PM
CHAIR WILSON thanked the presenters for returning to conclude
the department overview.
4:55:43 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 4:55 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 115 Version B.PDF |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB115 Sponsor Statement 5.8.2023.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| DOH Department Overview 1.18.24.pdf |
SHSS 1/23/2024 3:30:00 PM |
Depattment of Health Update 1.18.24 |
| SB 115 DCCED CBPL FN.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB115 - Letter of Support Dietrich.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB115 Letter of Support - Evans.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB115 Sectional Analysis.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB 115 ANTHC Support 2024.01.22.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB 115 -AK State Medical Assoc - Hattiesburg Clinic Article.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |
| SB115 Hearing Follow Up Information 1.25.2024.pdf |
SHSS 1/23/2024 3:30:00 PM |
SB 115 |