02/18/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Alaska Primary Care Association (apca) | |
| SB89 | |
| SB76 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 89 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 76 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 18, 2025
3:31 p.m.
MEMBERS PRESENT
Senator Forrest Dunbar, Chair
Senator Cathy Giessel, Vice Chair
Senator Matt Claman
Senator Löki Tobin
Senator Shelley Hughes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION(S): ALASKA PRIMARY CARE ASSOCIATION (APCA)
- HEARD
SENATE BILL NO. 89
"An Act relating to physician assistants; relating to
collaborative agreements between physicians and physician
assistants; relating to the practice of medicine; relating to
health care providers; and relating to provisions regarding
physician assistants in contracts between certain health care
providers and health care insurers."
- HEARD & HELD
SENATE BILL NO. 76
"An Act relating to complex care residential homes; and
providing for an effective date."
- MOVED SB 76 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 89
SHORT TITLE: PHYSICIAN ASSISTANT SCOPE OF PRACTICE
SPONSOR(s): SENATOR(s) TOBIN
02/07/25 (S) READ THE FIRST TIME - REFERRALS
02/07/25 (S) HSS, L&C
02/18/25 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 76
SHORT TITLE: COMPLEX CARE RESIDENTIAL HOMES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/27/25 (S) READ THE FIRST TIME - REFERRALS
01/27/25 (S) HSS, FIN
02/06/25 (S) HSS AT 3:30 PM BUTROVICH 205
02/06/25 (S) Heard & Held
02/06/25 (S) MINUTE(HSS)
02/13/25 (S) HSS AT 3:30 PM BUTROVICH 205
02/13/25 (S) Heard & Held
02/13/25 (S) MINUTE(HSS)
02/18/25 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
NANCY MERRIMAN, Chief Executive Officer (CEO)
Alaska Primary Care Association
Anchorage Alaska
POSITION STATEMENT: Co-presented Alaska Primary Care
Association.
MS. AQUINO, Chief Executive Officer (CEO)
Anchorage Neighborhood Health Center
Anchorage, Alaska
POSITION STATEMENT: Co-presented Alaska Primary Care Association
and answered questions.
CASEY GOKEY, Chief Medical Officer
Anchorage Neighborhood Health Center
Anchorage, Alaska
POSITION STATEMENT: Answered questions on the presentation
Alaska Primary Care Association.
JOSHUA GILMORE, Board Chair
Alaska Primary Care Association
Talkeetna, Alaska
POSITION STATEMENT: Co-presented Alaska Primary Care Association
and answered questions.
SENATOR LÖKI TOBIN, District I
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 89.
MACKENZIE POPE, Staff
Senator Löki Tobin
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis for SB 89.
DR. BOB LAWRENCE, Chief Medical Officer
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Presented SB 76 on behalf of the Senate
Rules Committee, sponsor by request.
ACTION NARRATIVE
3:31:10 PM
CHAIR DUNBAR called the Senate Health and Social Services
Standing Committee meeting to order at 3:31 p.m. Present at the
call to order were Senators Giessel, Tobin, Hughes, and Chair
Dunbar. Senator Claman arrived thereafter.
^PRESENTATION(S): ALASKA PRIMARY CARE ASSOCIATION (APCA)
PRESENTATION(S): ALASKA PRIMARY CARE ASSOCIATION (APCA)
3:32:03 PM
CHAIR DUNBAR announced the presentation Alaska Primary Care
Association (APCA).
3:32:46 PM
NANCY MERRIMAN, Chief Executive Officer (CEO), Alaska Primary
Care Association, Anchorage Alaska, co-presented Alaska Primary
Care Association. She introduced Ms. Aquino and Mr. Gilmore and
mentioned there were others in attendance who together represent
27 health centers with two look-alike centers and serve more
than 112,000 patients in Alaska.
MS. MERRIMAN moved to slides 1-4 and stated that health centers
provide a range of services, including primary care, dental,
vision, behavioral health, and substance use disorder treatment.
She noted that when a patient enters a local health center, they
are served regardless of their ability to pay. When health
centers serve Medicaid patients, all the services they receive
are included within one Medicaid encounter rate.
3:34:36 PM
MS. MERRIMAN stated that much of the testimony would focus on
Medicaid payments to Federally Qualified Health Centers (FQHCs).
She explained that these centers rely on a unique,
congressionally directed Medicaid payment structure, which
mandates states to provide bundled, cost-related per-visit
payments compliant with federal regulations. She noted that
during invited testimony before the Senate Finance Committee
last year, her organization raised concerns after legal and
policy experts found several points on which the [Department of
Health] had been paying FQHCs out of compliance with the state
plan, state regulations, and federal law.
3:35:41 PM
CHAIR DUNBAR acknowledged Senator Claman joined the meeting.
3:36:22 PM
MS. MERRIMAN moved to slide 5, Health Centers Serve the Primary
Care Needs of All Alaskans, three pie charts that show
percentages of patients receiving serves by type of insurance
coverage, age, and ethnicity/race. She reported that the Alaska
Primary Care Association (APCA) appreciated the Department of
Health's response following last year's hearing, including the
scheduling of work sessions to address issues identified by
APCA, its legal team, and its accounting firm. She stated that
after more than 18 months of meetings, some agreements had been
reached, while other issues remained under discussion. APCA
submitted recent correspondence with the Department for the
Committee's review. She noted that progress appeared to be
shifting from agreement toward actual changes in payment
structure and meaningful relief for Alaska's health centers.
3:37:35 PM
MS. MERRIMAN introduced three key points for the Committee's
consideration. First, she acknowledged APCA's collaborative
relationship with the Department of Health and expressed
appreciation for Deputy Commissioner Ricci and her team's
engagement in understanding Alaska's FQHC Medicaid payment
obligations. Second, she stressed that health centers cannot
sustain further delays and urged the Department to expedite
resolution efforts so that rates can be set and adjusted based
on mutually agreed definitions and solutions. Third, she
mentioned the Department's recognition of the lengthy regulatory
process required for corrections and underscored the need to
accelerate that work by any available means.
3:38:39 PM
MS. MERRIMAN moved to slide 7, showing pictures of three health
centers in Alaska, and provided background on a key issue
involving Department of Health payment errors to FQHCs. She
explained that federal law requires cost-related encounter rates
to be adjusted when a health center undergoes a "change of scope
of services," meaning a clinically significant change in how
services are delivered. She stated that the Department currently
lacks a functioning system to process these adjustments. APCA
has requested that the Department issue clear guidance and
procedures, including definitions and examples, to allow health
centers to submit change in scope rate adjustment requests.
3:39:53 PM
CHAIR DUNBAR asked what "change in scope" means in practical
terms.
3:40:05 PM
MS. MERRIMAN replied that a change in scope occurs when a health
center experiences a significant shift in the duration, type, or
intensity of services provided. She explained that such changes
warrant a reassessment of the existing payment rate.
3:40:36 PM
CHAIR DUNBAR asked for a real-world example.
3:40:47 PM
[LISA AQUINO, Chief Executive Officer (CEO), Anchorage
Neighborhood Health Center, Anchorage, Alaska, co-presented
Alaska Primary Care Association and answered questions.] She
replied that when Anchorage Neighborhood Health Center first
opened, it did not have an OB case manager, but providers now
deliver babies and serve patients who benefit from that added
support. She explained that the center operates using a care
team model, and while the team has expanded to provide deeper
services and improved outcomes, there is currently no mechanism
to classify that as a change of scope. She emphasized that these
enhancements lead to healthier newborns and better maternal
outcomes, which ultimately benefit the payer, yet there is no
way to seek payment adjustments for such changes.
3:41:54 PM
MS. MERRIMAN concluded by stating that Alaska health centers and
APCA look forward to resolving the outstanding issues and
advancing efforts to better support the healthcare needs of
communities across the state.
3:42:25 PM
SENATOR CLAMAN stated that the discussion primarily involves
changes to scope of practice within Medicaid regulations, which
fall under state control, unlike Medicare which is federally
regulated. He noted that the current effort does not appear to
require legislative action. He clarified that the testimony
served to inform the Committee about ongoing efforts to improve
Medicaid coverage for individuals receiving care in Alaska.
3:42:59 PM
MS. MERRIMAN replied that is correct.
SENATOR HUGHES clarified that the Centers for Medicare &
Medicaid Services (CMS) oversee both Medicare, which serves
seniors, and Medicaid, which serves individuals who meet income
eligibility requirements. She thanked the presenters and noted
she had experience working with Alaska Primary Care Association
and community health centers statewide. She asked for
clarification on the term "look-alikes," recalling that APCA
reported having 27 community health centers and two look-alikes.
She also commented that health centers are well distributed
across Alaska, offering access even in small or remote villages,
though some patients may need to travel. She requested the
number of individual clinic sites, noting that one health center
may operate multiple locations.
3:44:25 PM
MS. MERRIMAN explained that the term "look-alike" was coined by
the Health Resources and Services Administration (HRSA) to
describe an organization that meets all the same compliance
standards as a health center program grantee but does not
receive federal grant funding. She noted that the grant helps
cover the gap between the cost of care and what is collected
from patients. Alaska has two look-alike organizations that are
prepared to apply for full health center grantee status when new
access point grant opportunities arise; one such opportunity was
offered last year, but no awards have been made yet. She also
pointed to a map showing over 200 clinic locations in Alaska,
confirming that health center organizations often operate
multiple sites, including about eight mobile or school-based
clinics, though that number may be undercounted.
3:46:16 PM
SENATOR HUGHES said it was exciting to hear how access to
clinics has expanded since her last involvement in 2012. She
reflected on living in villages before the establishment of
FQHCs, when non-Alaska Native residents had to fly to urban
centers for care and noted the benefit of today's inclusive
access. She recalled efforts to allow veterans to be seen at
community health centers rather than traveling to Anchorage or
Fairbanks, describing Alaska as a national leader in that area.
She complimented the payer mix shown in the presentation and
shared her personal experience receiving high-quality care at
Mat-Su Health Center, stating it was indistinguishable from
other healthcare facilities. She thanked the presenters for
providing accessible care to underserved populations and
emphasized the value of health centers for seniors who struggle
to find providers accepting Medicare.
3:48:11 PM
MS. MERRIMAN clarified that of the 29 health center
organizations in Alaska, including the two look-alikes, 15 are
part of the tribal health system and play a critical role in
serving communities across the state. She agreed that the
comprehensive, integrated care provided at health centers stands
out compared to other clinics. She highlighted that this model
of care contributes to significant cost savings, noting that
Medicaid patients seen in the health center system cost 24
percent less than those seen elsewhere.
3:49:08 PM
MS. AQUINO remained on slide 7 and said she also serves as chair
of the Alaska Primary Care Association's FQHC Medicaid Payment
Task Force. She said ANHC is Alaska's largest non-tribal and
oldest community health center. She noted that ANHC has
delivered comprehensive care in Anchorage for over 50 years,
offering integrated services including behavioral health,
clinical pharmacy, on-site lab, x-ray, mammogram, pharmacy, and
dental care. In the past year, ANHC served over 15,000
individuals, a number expected to grow. The center accepts all
patients regardless of ability to pay, with a payer mix of 35
percent Medicaid, 27 percent Medicare, 26 percent private
insurance, and 12 percent uninsured or self-pay. ANHC offers a
sliding fee scale, transportation assistance, and interpreter
services in more than 50 languages.
3:50:47 PM
MS. AQUINO moved to slide 8 and reported that patient visits at
ANHC have increased 37 percent over the past three years,
reflecting growing demand. She described APCA's creation of a
Medicaid payment task force that includes health center leaders,
CFOs, and policy, legal, and financial advisors to support
discussions with the Department of Health. She thanked the
department for their collaboration and highlighted the change in
scope issue as a key focus. She explained that a health center's
Prospective Payment System (PPS) rate is based on the services
it offered when the rate was established, but as community needs
evolve, services often expand beyond that original scope.
3:52:27 PM
MS. AQUINO moved to slide 9 and cited the example of ANHC's
early operations, which lacked a lab, x-ray, and OB case
manager. Today, ANHC serves high-risk OB patients and offers
case management to ensure maternal and infant health. These
services are not reflected in the original PPS rate. She also
noted a demographic shift, stating that ANHC's senior population
increased from 23 percent to over 27 percent of the patient base
in the past year, with continued growth expected. She stated
that senior patients have different needs, with a higher
percentage experiencing chronic diseases and requiring more
supportive services as part of their healthcare. She explained
that the challenge is there is no easy way and well-defined
process to describe to the State of Alaska the change in scope
that Anchorage Neighborhood Health Center makes to meet the
needs of senior Alaskans. Without that process, the center is
not ensured fair reimbursement as outlined in the regulations.
3:54:16 PM
MS. AQUINO expressed appreciation for the ongoing conversations
with the State and stated that health centers look forward to a
time when they can clearly describe the many ways they are
evolving to meet patient needs and receive fair reimbursement.
She shared optimism about the prospect of meaningful changes.
She emphasized the importance of DOH's correction efforts and
called for immediate relief through interim guidance and
procedures that health centers can use while regulatory updates
are completed.
3:55:22 PM
SENATOR GIESSEL stated that Anchorage Neighborhood Health serves
as a significant safety net for Anchorage. She asked about the
provider mix at the clinic, specifically inquiring whether it
includes physicians, nurse practitioners, or physician
assistants.
MS. AQUINO deferred the question.
3:55:46 PM
CASEY GOKEY, Chief Medical Officer (CMO), Anchorage Neighborhood
Health Center, Anchorage, Alaska, answered questions on the
presentation Alaska Primary Care Association. She said she is
also a family doctor at the clinic. She reported that most
providers at the clinic are either a Doctor of Medicine (MDs)
and Doctor of Osteopathic Medicine (DOs), with about 25 percent
being advanced practice providers. She noted high burnout and
turnover among advanced practice providers due to the complexity
of the clinic's patient population, which includes both chronic
medical and psychosocial challenges. She explained the clinic
created a training program that pairs new advanced practice
providers with experienced doctors for one-on-one mentorship to
support long-term retention.
SENATOR GIESSEL asked about the behavioral health provider mix,
specifically whether it includes social workers, professional
counselors, or other types of professionals.
3:57:02 PM
MS. GOKEY stated that the behavioral health team consists of
approximately half PhD psychologists and half Licensed Clinical
Social Workers (LCSWs). She explained that providers work in a
team-based, integrated care model within the clinic. While PhD
psychologists may have additional training for neuropsychiatric
testing, all behavioral health staff offer a full range of
services. She added that during a medical visit, if behavioral
health needs are identified, a provider can be called in for a
same-day brief intervention and to initiate follow-up care.
SENATOR GIESSEL said also integrated care.
MS. GOKEY replied yes.
3:58:08 PM
JOSHUA GILMORE, CEO, Sunshine Health Center; Board Chair, Alaska
Primary Care Association, Talkeetna, Alaska, Co-presented Alaska
Primary Care Association and answered questions. He moved to
slide 10 and described numerous challenges Federally Qualified
Health Centers (FQHCs) face in maintaining sustainability and
quality care amid evolving healthcare reimbursement systems. He
emphasized the importance of partnering with the Alaska Medicaid
program to achieve parity in reimbursement while reducing costs
and improving outcomes. He praised the Medicaid department,
particularly Ms. Ricci and her team, for engaging with providers
and working collaboratively to address concerns, including the
longstanding issue of the change in scope process and capturing
additional costs. He highlighted the broader community impact of
FQHCs, noting that sustainability through Medicaid enables
support for interconnected services such as daycare, food
pantries, and transportation, and stressed the critical role of
community partnerships in meeting
4:02:08 PM
CHAIR DUNBAR asked about the practical impact on FQHCs across
the state if a solution is not reached regarding the change in
scope process and ongoing funding challenges.
4:02:27 PM
MR. GILMORE stated that without a solution to the change in
scope and funding challenges, FQHCs would be unable to expand
services and would likely face a reduction in services. He
emphasized that this would ultimately lead to decreased access
to care.
CHAIR DUNBAR asked how many people are impacted if change
doesn't occur.
MR. GILMORE replied that failure to change would affect
thousands of Alaskans.
4:02:56 PM
SENATOR GIESSEL noted that medication-assisted treatment for
substance use is a critical service provided by clinics. She
emphasized that without these clinics, such treatment would be
largely inaccessible. She added that this service is especially
important given the severity of the substance abuse problem in
Alaska.
4:03:16 PM
MS. MERRIMAN expressed appreciation for the opportunity to speak
and thanked the committee for holding the hearing. She
emphasized that health centers are vital to Alaska's healthcare
system, providing high-quality, low-cost care statewide. She
noted the Department of Health would also be speaking and
welcomed continued collaboration to ensure FQHC payment
compliance.
CHAIR DUNBAR found not further questions and thanked the
presenters.
4:04:40 PM
At ease.
SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
4:05:55 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 89 "An Act relating to
physician assistants; relating to collaborative agreements
between physicians and physician assistants; relating to the
practice of medicine; relating to health care providers; and
relating to provisions regarding physician assistants in
contracts between certain health care providers and health care
insurers."
4:06:12 PM
SENATOR LÖKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 89 introduced herself.
4:06:20 PM
MACKENZIE POPE, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, provided the sectional analysis for
SB 89. She introduced herself.
4:06:24 PM
SENATOR TOBIN explained that the legislation was reintroduced to
address barriers to care in Alaska, particularly through a
pathway to independent licensure for physician assistants (PAs).
She shared that she is currently studying public policy and
recently researched U.S. healthcare policy, noting it has
historically been ad hoc and shaped by competing interest groups
since the 1942 Stabilization Act. She emphasized that Alaska
faces the highest healthcare costs in the nation, and while SB
89 will not fix all systemic issues, it is a necessary step
toward increasing access to care.
4:08:00 PM
SENATOR TOBIN stated that SB 89 aims to establish a pathway to
independent licensure for physician assistants. She emphasized
that Alaskans face difficulty accessing preventative care and
basic medical support for common ailments. She explained that
physician assistants play a key role in patient care by
assessing conditions and consulting their networks for complex
cases outside their scope. She underscored the importance of
recognizing and elevating the professional experience of
physician assistants.
4:08:31 PM
SENATOR TOBIN explained that many may be unaware of the rigorous
education and training required for physician assistants. She
noted that the profession began in the 1970s on battlefields,
evolving into a formal education system for PAs. She stated that
applicants to accredited physician assistant programs typically
have over 3,000 patient contact hours prior to entering a 27-
month graduate-level program, which includes 2,000 hours of
clinical rotations alongside medical students. She added that
Alaska requires continuing medical education every two years and
a comprehensive exam every ten years for physician assistants to
maintain licensure.
4:09:38 PM
SENATOR TOBIN stated that SB 89 differs from previous iterations
due to stakeholder input and reflects a compromise addressing
their concerns. She explained that SB 89 permits physician
assistants to pursue independent licensure after completing
4,000 hours under a collaborative agreement, in addition to the
initial 2,000 clinical hours. She added that if a physician
assistant changes specialties, the State Medical Board may
require up to 4,000 more contact hours, totaling up to 10,000
hours before independent licensure when there is a change in
specialty. She acknowledged that this differs from the process
for nurse practitioners but emphasized that the bill seeks to
balance professional advancement with stakeholder concerns.
4:10:47 PM
SENATOR TOBIN stated that maintaining collaborative agreements
has proven burdensome for physician assistants. She noted that
last year 12 percent of collaborating physicians lived outside
Alaska, a number that has since increased to 14.5 percent. She
emphasized that physician assistants often must pay to maintain
these agreements despite providing quality care under remote
supervision. She concluded by stating that SB 89 preserves State
Medical Board oversight, restricts independent surgery,
maintains care standards, and creates a pathway to independent
licensure to expand access to affordable, community-based
preventative care.
4:12:40 PM
SENATOR HUGHES stated she had no conflict of interest, although
her husband is a retired physician assistant who served on the
Vietnam battlefield, where the profession originated. She shared
that her husband often worked remotely in villages with minimal
contact from the collaborating physician. She said when her
husband's rural patients went to Anchorage and Fairbanks for
care, often physicians consulted with her husband because he was
familiar with the patient. She expressed support for SB 89 but
asked for clarification on the required hours, summarizing 3,000
clinical hours before program entry, 2,000 during clinical
rotations, and 4,000 under a collaborative agreement before
independent licensure. She asked whether any additional hour
requirements apply.
4:13:50 PM
SENATOR TOBIN clarified that the 3,000 clinical hours mentioned
prior to entering a physician assistant program are not a formal
requirement but reflect the average experience of individuals
pursuing a graduate-level degree in the field.
4:14:34 PM
MS. POPE provided the sectional analysis for SB 89:
[Original punctuation provided.]
Senate Bill 89: Sectional Analysis
Section 1. Removes state medical board (SMB) reference
to AS 08.64.107 Regulation of Physician Assistants
which is repealed and reenacted in a later section.
Section 2. Repeals and reenacts 08.64.107 to
restructure the physician assistant authorizing
statutes.
Subsection (a) directs the SMB to adopt regulations
related to the acts within the practice of medicine
that physician assistants (PAs) may perform, which
must allow for PA practice of acts they are
generally educated and trained to perform. This
subsection specifically prevents PAs from
performing surgery without supervision. This
subsection also directs the SMB to promulgate
regulations for PAs who switch specialty, and the
methods by which a collaborating physician will
assess a PA.
Subsection (b) establishes that a PA with less than
4,000 postgraduate clinical hours may only practice
under a collaborating agreement. These
collaborative agreements must be in writing and
describe the specialty the hours are completed
within, as well as the oversight methods.
Subsection (c) outlines that assessment for PAs
practicing in rural areas can be done
telephonically or via video.
Subsection (d) outlines the process for a PA to
notify the SMB if they begin to practice a new
specialty.
Subsection (e) requires a copy of the collaborative
agreement be provided to the SMB. At such a time as
the PA reaches the required postgraduate hours,
they shall notify the SMB and complete an
attestation provided by the SMB.
Subsection (f) directs the SMB to assess whether
that specialty will require additional requirements
or hours. For specialty change, or in other
regulation change, the requirements are not to
exceed the clinical hours required in subsection
(b).
4:16:23 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 3. Amends 08.64 to add a new section laying
out the qualifications for physician assistant
qualifications for licensure.
Section 4. Amends 08.64.230 to add an additional
section directing the SMB or it's executive secretary
to grant a license to qualified applicants.
Section 5. Amends the existing statute to include
physician assistants in the list of medical
practitioners whose licensure we recognize from other
states and provinces of Canada.
Section 6. This amends 08.64.250 to include PAs in the
existing temporary licensure process and reference the
new applicable section 08.64.206.
4:16:48 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 7. This section amends the existing statute to
include physician assistants alongside the other
medical practitioners in the list of temporary
licensure and substitute roles in different medical
facilities.
Section 8: Adds a subsection to include PAs in the fee
requirement when applying for a license.
Section 9: Amends the section to include PAs in the
existing statute regarding the SMBs parameters for
evaluating any extenuating circumstances to waive
certain requirements for meeting licensure
qualifications.
Section 10. This section amends AS 08.64.326
subsection (a) to include PAs in the existing statutes
regarding the process for being sanctioned for crime,
misrepresentation, and failure to pay fees, to name a
few of the examples given in the statute.
Section 11. This amends the existing statute to
include PAs in the existing voluntary surrender
provisions in AS 08.64.334.
Section 12. This amends the existing statute to
include PAs in the process for medical practitioners
who treat fellow licensed medical practitioners for
alcoholism, drug addiction, and mental/emotional
disorders who might constitute a danger to their
patients or themselves, to report to the SMB.
4:17:56 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 13. Grants immunity in civil liability for PAs
who submit a report in good faith to the SMB relating
to addictive substances abuse.
Section 14. Amends statute so that PAs cannot refuse
to submit a report to the SMB or withhold evidence on
the grounds that it is under doctor-patient
confidentiality.
Section 15. Updates the statute covering all state
licensees under this chapter, including PAs, to
specify that if they practice without a valid license,
they are guilty of a class A misdemeanor.
Section 16. Amends the statute to include PAs in the
list of medical providers who can support a licensed
physician in another state, in the support of the
regular medical service of the United States Public
Health Service, or volunteering services to the armed
services of the US among other unique medical support
situations.
Section 17. Amends the statute to allow physicians
assistants to show their PA credentials to communicate
their qualifications.
Section 18. Amends 08.64.380 to include PAs as
providers who can accept concurrent referrals for
systemic disease treatment.
Section 19: Amends the definition of practitioner to
include physician assistant in the statute.
4:19:10 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 20: Puts in statute the definition of
physician assistant. Section 21: Amends the statute
referenced to be in line with the repealed statutes
removed by previous sections. Section 22: Adds a
section under AS 21.07.010 to prevent any requirements
within a health care insurance policy from being more
restrictive than or inconsistent with the practice,
education, or collaboration provisions outlined in AS
08.64.
4:19:32 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 23: Updates the definition of licensed
physician assistants to remove the supervision
requirement allowing for PAs who have completed their
postgraduate clinical requirements and are no longer
subject to a collaborating physician agreement to
continue their practice. Section 24: Amends the
statute to include physician assistant in the
definition of health care provider in statute.
4:19:52 PM
CHAIR DUNBAR stated that he initially believed the 4,000 hours
mentioned in SB 89, Section 2(f), were required for a new
specialty. He sought clarification, asking whether the State
Medical Board has discretion to set additional hours up to
4,000. He asked if the Board could reduce the hours depending on
the specialty.
4:20:40 PM
MS. POPE replied that an initial 4,000 hours are required. She
explained that if a physician assistant chooses to switch to a
different specialty, the State Medical Board may require
additional hours, not to exceed 4,000.
4:21:07 PM
SENATOR HUGHES noted that definitions for surgery vary widely.
She observed that some definitions include minor procedures like
stitching a wound, which physician assistants commonly perform
without direct supervision. She contrasted this with major
procedures such as heart surgery. She asked if "surgery" is
defined elsewhere in statute or if clarification is needed.
4:21:42 PM
SENATOR TOBIN responded that her office would follow up on the
definition of "surgery." She stated that the current language
was recommended by Legislative Legal Services, based on her
intent to align physician assistants' scope of practice with
standards accepted across all 50 states.
4:22:07 PM
CHAIR DUNBAR stated that [surgery] was a point of contention
last year with some groups interested in the bill and emphasized
that it is an issue that needs to be clearly defined.
4:22:21 PM
SENATOR TOBIN thanked the committee for hearing SB 89 and
reiterated the goal of addressing concerns from stakeholders,
associations, and groups. She emphasized the importance of
creating a pathway to independent licensure, noting that an
unfair system arbitrarily limits the ability of qualified
individuals to provide quality care. She stated that
reintroducing the bill reflects a policy decision she believes
is the right course of action.
4:22:57 PM
CHAIR DUNBAR held SB 89 in committee.
4:23:04 PM
At ease.
SB 76-COMPLEX CARE RESIDENTIAL HOMES
4:24:36 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 76 "An Act relating to complex
care residential homes; and providing for an effective date."
4:25:10 PM
DR. BOB LAWRENCE, Chief Medical Officer, Department of Health,
Anchorage, Alaska, presented SB 76 on behalf of the Senate Rules
Committee, sponsor by request. He said Senate Bill 76
establishes a new residential license type for Complex Care
Residential Homes (CCRHs) to improve Alaska's system of care for
individuals with complex behavioral health needs. CCRHs will
provide long-term, supportive care in a residential setting for
individuals with complex behavioral, and co-occurring medical,
or disability-related needs.
4:26:02 PM
CHAIR DUNBAR found no questions and solicited the will of the
committee.
4:26:06 PM
SENATOR GIESSEL moved to report SB 76, work order 34-GS1493\A,
from committee with individual recommendations and attached
fiscal note(s).
4:26:08 PM
CHAIR DUNBAR found no objection and SB 76 was reported from the
Senate Health and Social Services Standing Committee.
4:26:44 PM
There being no further business to come before the committee,
Chair Dunbar adjourned the Senate Health and Social Services
Standing Committee meeting at 4:26 p.m.