03/21/2022 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB19 | |
| HB111 | |
| SB193 | |
| SB197 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 111 | TELECONFERENCED | |
| += | SB 193 | TELECONFERENCED | |
| *+ | SB 197 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 19 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
March 21, 2022
1:32 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Peter Micciche
Senator Gary Stevens
Senator Elvi Gray-Jackson
MEMBERS ABSENT
Senator Joshua Revak, Vice Chair
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 19(EDC)
"An Act relating to instruction in a language other than
English; and establishing limited language immersion teacher
certificates."
- MOVED CSHB 19(EDC) OUT OF COMMITTEE
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 111(FIN)
"An Act relating to the practice of dental hygiene; relating to
advanced practice permits for dental hygienists; relating to
dental assistants; prohibiting unfair discrimination under group
health insurance against a dental hygienist who holds an
advanced practice permit; relating to medical assistance for
dental hygiene services; and providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 193
"An Act extending the termination date of the Board of
Chiropractic Examiners; and providing for an effective date."
- MOVED CSSB 193(L&C) OUT OF COMMITTEE
SENATE BILL NO. 197
"An Act relating to direct health care agreements; and relating
to unfair trade practices."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 19
SHORT TITLE: LIMITED TEACHER CERTIFICATES; LANGUAGES
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS
02/18/21 (H) PREFILE RELEASED 1/8/21
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) EDC, L&C
04/09/21 (H) EDC AT 8:00 AM DAVIS 106
04/09/21 (H) Heard & Held
04/09/21 (H) MINUTE(EDC)
04/12/21 (H) FIN REPLACES L&C REFERRAL
04/12/21 (H) BILL REPRINTED
04/12/21 (H) EDC AT 8:00 AM DAVIS 106
04/12/21 (H) Heard & Held
04/12/21 (H) MINUTE(EDC)
04/14/21 (H) EDC AT 8:00 AM DAVIS 106
04/14/21 (H) <Bill Hearing Canceled>
04/16/21 (H) EDC AT 8:00 AM DAVIS 106
04/16/21 (H) Moved CSHB 19(EDC) Out of Committee
04/16/21 (H) MINUTE(EDC)
04/19/21 (H) EDC RPT CS(EDC) 5DP 2NR
04/19/21 (H) DP: ZULKOSKY, CRONK, PRAX, STORY,
DRUMMOND
04/19/21 (H) NR: HOPKINS, GILLHAM
05/03/21 (H) FIN AT 1:30 PM ADAMS 519
05/03/21 (H) Heard & Held
05/03/21 (H) MINUTE(FIN)
05/06/21 (H) FIN AT 1:30 PM ADAMS 519
05/06/21 (H) Moved CSHB 19(EDC) Out of Committee
05/06/21 (H) MINUTE(FIN)
05/07/21 (H) FIN RPT CS(EDC) 5DP 4NR
05/07/21 (H) DP: EDGMON, LEBON, CARPENTER, THOMPSON,
MERRICK
05/07/21 (H) NR: RASMUSSEN, JOSEPHSON, WOOL, ORTIZ
05/14/21 (H) TRANSMITTED TO (S)
05/14/21 (H) VERSION: CSHB 19(EDC)
05/17/21 (S) READ THE FIRST TIME - REFERRALS
05/17/21 (S) EDC, L&C, FIN
01/21/22 (S) EDC AT 9:00 AM BUTROVICH 205
01/21/22 (S) Heard & Held
01/21/22 (S) MINUTE(EDC)
01/26/22 (S) EDC RPT 5DP
01/26/22 (S) DP: HOLLAND, HUGHES, STEVENS, MICCICHE,
BEGICH
01/26/22 (S) EDC AT 9:00 AM BUTROVICH 205
01/26/22 (S) Moved CSHB 19(EDC) Out of Committee
01/26/22 (S) MINUTE(EDC)
01/31/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
01/31/22 (S) Scheduled but Not Heard
02/02/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/02/22 (S) Heard & Held
02/02/22 (S) MINUTE(L&C)
BILL: HB 111
SHORT TITLE: DENTAL HYGIENIST ADVANCED PRAC PERMIT
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/24/21 (H) READ THE FIRST TIME - REFERRALS
02/24/21 (H) L&C, FIN
03/29/21 (H) L&C AT 3:15 PM BARNES 124
03/29/21 (H) Heard & Held
03/29/21 (H) MINUTE(L&C)
03/31/21 (H) L&C AT 3:15 PM BARNES 124
03/31/21 (H) Moved CSHB 111(L&C) Out of Committee
03/31/21 (H) MINUTE(L&C)
04/05/21 (H) L&C RPT CS(L&C) 7DP
04/05/21 (H) DP: KAUFMAN, SCHRAGE, MCCARTY, NELSON,
SNYDER, FIELDS, SPOHNHOLZ
05/11/21 (H) FIN AT 1:30 PM ADAMS 519
05/11/21 (H) -- MEETING CANCELED --
05/15/21 (H) FIN AT 10:00 AM ADAMS 519
05/15/21 (H) Heard & Held
05/15/21 (H) MINUTE(FIN)
05/19/21 (H) FIN AT 1:30 PM ADAMS 519
05/19/21 (H) <Bill Hearing Canceled>
02/02/22 (H) FIN AT 9:00 AM ADAMS 519
02/02/22 (H) Moved CSHB 111(FIN) Out of Committee
02/02/22 (H) MINUTE(FIN)
02/04/22 (H) FIN RPT CS(FIN) 6DP 1NR
02/04/22 (H) DP: ORTIZ, EDGMON, THOMPSON, WOOL,
JOSEPHSON, FOSTER
02/04/22 (H) NR: MERRICK
02/17/22 (H) TRANSMITTED TO (S)
02/17/22 (H) VERSION: CSHB 111(FIN)
02/22/22 (S) READ THE FIRST TIME - REFERRALS
02/22/22 (S) L&C, FIN
03/21/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 193
SHORT TITLE: EXTEND BOARD OF CHIROPRACTIC EXAMINERS
SPONSOR(s): SENATOR(s) MICCICHE
02/15/22 (S) READ THE FIRST TIME - REFERRALS
02/15/22 (S) L&C, FIN
02/28/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/28/22 (S) Heard & Held
02/28/22 (S) MINUTE(L&C)
03/21/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 197
SHORT TITLE: DIRECT HEALTH CARE AGREEMENTS
SPONSOR(s): SENATOR(s) HUGHES
02/16/22 (S) READ THE FIRST TIME - REFERRALS
02/16/22 (S) L&C
03/21/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
REPRESENTATIVE JONATHAN KREISS-TOMKINS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 19.
REPRESENTATIVE IVY SPOHNHOLZ
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 111.
CHELSEA WARD-WALLER, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB 111
on behalf of the sponsor.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community, and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions and provided information
during the hearing on HB 111.
ROAYANN ROYER, CDA, RDH, MPH, Member
Alaska Dental Hygiene Association
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
111.
DR. DAVID NIELSON, Chair
Board of Dental Examiners
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
111.
JOHN ZASADA, Policy Director
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
111.
KATIE MCCALL, Staff
Senator Mia Costello
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the explanation of changes from
version B to version I for SB 193.
KRIS CURTIS, Legislative Auditor
Legislative Audit Division
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions and provided information
during the hearing on SB 193.
SENATOR SHELLEY HUGHES
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 197.
BUDDY WHITT, Staff
Senator Shelley Hughes
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 197
on behalf of the sponsor.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community, and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions and provided information
during the hearing on SB 197.
ACTION NARRATIVE
1:32:59 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:32 p.m. Present at the call to
order were Senators Gray-Jackson, Stevens, Micciche, and Chair
Costello.
HB 19-LIMITED TEACHER CERTIFICATES; LANGUAGES
1:33:34 PM
CHAIR COSTELLO announced the consideration of CS FOR HOUSE BILL
NO. 19(EDC) "An Act relating to instruction in a language other
than English; and establishing limited language immersion
teacher certificates."
She stated her intention to hear from the sponsor and look to
the will of the committee.
1:34:00 PM
REPRESENTATIVE JONATHAN KREISS-TOMKINS, Alaska State
Legislature, Juneau, Alaska, sponsor of HB 19, stated
appreciation for the committee's consideration of the bill. He
also thanked the agencies for their work in striking the right
balance.
CHAIR COSTELLO noted who was available to answer questions.
CHAIR COSTELLO found no questions and solicited a motion.
1:35:04 PM
SENATOR STEVENS moved to report the Committee Substitute for HB
19, work order 32-LS0169\I, from committee with individual
recommendations and attached fiscal note(s).
1:35:33 PM
CHAIR COSTELLO found no objection and CSHB 19(EDC) was reported
from the Senate Labor and Commerce Standing Committee.
1:35:46 PM
At ease
HB 111-DENTAL HYGIENIST ADVANCED PRAC PERMIT
1:37:56 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of CS FOR HOUSE BILL NO. 111(FIN) "An Act relating
to the practice of dental hygiene; relating to advanced practice
permits for dental hygienists; relating to dental assistants;
prohibiting unfair discrimination under group health insurance
against a dental hygienist who holds an advanced practice
permit; relating to medical assistance for dental hygiene
services; and providing for an effective date."
She noted that this was the first hearing and the intention was
to hear the introduction and take invited and public testimony.
1:38:23 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 111, introduced the legislation
paraphrasing the following:
HB 111 creates an Advanced Practice Permit, which will
allow experienced, licensed dental hygienists to
provide preventative oral health care to underserved
populations at senior centers, health care facilities,
day cares, and schools, and for Alaskans who are
eligible for public assistance, are homebound, or who
live in underserved rural communities.
Oral health care plays a crucial role in the overall
health and well-being of Alaskans. Poor oral health
care contributes to poor overall health. This problem
is worst amongst our state's most vulnerable
populations. Many low income individuals and families
in Alaska don't regularly seek oral healthcare due to
cost, apprehension of dental work, access, and trouble
finding a provider. Bad oral health is linked to
cardiovascular disease, Alzheimer's, osteoporosis, as
well as poor nutrition and other serious health
issues. So, increasing access to preventative dental
health care through dental hygienists will save and
improve Alaskan's health and well-being.
Currently, dental hygienists can practice in a
dentist's practice or practice semi-independently if
they have a collaborative agreement with a dentist,
similar to what Physicians Assistants do.
An Advanced Practice Permit will allow dental
hygienists to care for underserved populations at
senior centers, health care facilities, day cares, and
schools, and for Alaskans who are eligible for public
assistance, are homebound, or who live in an
underserved community if they have the following:
1. minimum of 4,000 hours of clinical experience,
and
2. are approved by the Alaska Board of Dental
Examiners.
The bill lays out the specific services allowed under
the permit and the specific populations that a
licensed dental hygienist can provide services to
without the supervision or physical presence of a
licensed dentist. This list has been developed in
consultation with the Alaska Dental Society, Board of
Dental Examiners, and Alaska Dental Hygienists
Association (Section 2 (a) services and Section 2 (b)
populations).
The Advanced Practice Permit-holder will have to
maintain malpractice insurance, provide a written
notice of their service limitations, and make a
referral to a licensed dentist nearby if further
dental treatment is needed (Section 2 (d)). This will
allow dental hygienists to practice to the full scope
of their training, credentials, and professional
experience.
Alaska won't be the first state to make these changes.
Dental hygienists are able to practice under advance
practice permits or similar permits in six other
states (Colorado, Washington, Montana, Maine,
Connecticut, and California) and 40 other states are
considered "direct access" states, meaning that dental
hygienists can initiate treatment based on their
assessment of a patient's needs without the
authorization or presence of a dentist
Lastly, I'll note that we have already made important
changes to this bill at the recommendation of the
Board of Dental Examiners and the Alaska Dental
Society, including
• requiring permit-holders to maintain patient records
for at least 7 years,
• making sure that the Board of Dental Examiners has
separately certified a dental hygienist to administer
local anesthesia, and
• empowering DHSS to make regulations related to the
bill.
CHAIR COSTELLO requested the sectional analysis for HB 111.
1:42:49 PM
CHELSEA WARD-WALLER, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, Juneau, Alaska, presented the sectional
analysis for HB 111 on behalf of the sponsor.
Section 1
Ability of practice of dental hygienists.
(e) Amends AS 08.32.110. to allow a licensed dental
hygienist who holds an advanced practice permit
issued by the board to perform duties allowed by the
permit.
Section 2
Advanced practice permits.
Adds a new section under AS 08.32.125 creating the
advanced practice permit and providing requirements as
follows:
(a) The Board of Dental Examiners may issue an
advanced practice permit to a licensed dental
hygienist with a minimum 4,000 documented hours of
clinical experience. This subsection lists what
duties fall under advanced practice permits: general
oral health & cleaning, providing treatment plans,
screenings, taking radiographs, and/or delegating to
dental assistants.
(b) A licensed dental hygienist holding an advanced
practice permit may provide services to a patient
who is not able to receive dental treatment because
of age, infirmity, or disability. The patient may be
a resident of a senior center, residential health
facility, or held in a local correctional facility.
The patient may also be enrolled in certain schools,
receiving benefits under the Special Supplemental
Food Program (WIC), homebound, or a resident of a
community that has a shortage of dental health
professionals.
(c) A licensed dental hygienist holding an advanced
practice permit can provide appropriate services to
a patient without the presence, authorization, and
supervision of a licensed dentist and without an
examination from a licensed dentist.
(d) A licensed dental hygienist with an advanced
practice permit must maintain professional liability
insurance. They must also give the patient, parent,
or legal guardian written notice that the treatment
provided will be limited to those allowed by the
permit, a written recommendation that the patient be
examined by a licensed dentist for comprehensive
oral care, and assistance in receiving a referral to
a licensed dentist for further oral treatment.
(e) An advanced practice permit is valid until the
license of the dental hygienist expires. A licensed
dental hygienist can renew their advanced practice
permit at the same time they renew their license.
Section 3
Grounds for discipline, suspension, or revocation of
license.
Amends AS 08.32.160 to exempt a licensed dental
hygienist as permitted under an advanced practice
permit from supervision requirements for clinical
procedures. Licenses may be revoked if a dental
hygienist allows a dental assistant to perform a
prohibited procedure, or if the licensee falsified,
destroyed, or failed to maintain a patient or facility
record for the last seven years.
1:45:39 PM
Section 4
Allows a dental hygienist holding an advance practice
permit to delegate to a dental assistant the
exposure/development of radiographs, the application
of preventative agents, and other tasks as specified
by the board in regulations. Section 5
Section 5
Prohibits insurance providers from discriminating
against dental hygienists holding advanced practice
permits.
Section 6
This section is amended to include dental hygienist
services in the optional services provided by the
Department of Health and Social Services.
Section 7
Allows the Department of Commerce, Community, and
Economic Development, the Department of Health and
Social Services, and the Board of Dental Examiners to
adopt regulations necessary to implement the changes
made in this bill. The regulations may not take
effect before the effective date of this bill.
Section 8
Section 7 on regulations takes effect immediately.
Section 9
Effective date for sections 1-6 is January 1, 2023.
1:46:42 PM
CHAIR COSTELLO asked why two departments are involved in
licensing, not just the Department of Commerce, Community and
Economic Development (DCCED).
1:47:04 PM
REPRESENTATIVE SPOHNHOLZ explained that regulations are needed
in both Medicaid and in professional licensing to ensure there
is clear guidance on implementation for dental hygienists who
will provide services to those eligible for public services.
CHAIR COSTELLO noted that Section 6 provides the option to offer
these services through Medicaid.
REPRESENTATIVE SPOHNHOLZ replied the bill does not change the
services that are available through Medicaid, but it does allow
advanced practice dental hygienists (APDN) who practice
independently to offer those services. She clarified that DHSS
regulations would need to be changed to reflect this.
CHAIR COSTELLO asked her to talk about why the provision in
Section 5 that prohibits insurance providers from discriminating
against APDNs is in the bill, and whether she anticipated that
sort of discrimination.
REPRESENTATIVE SPOHNHOLZ explained that in the past insurance
companies have used a change in statute as an opportunity to
compensate a provider at a different rate. HB 111 seeks to
ensure that dental hygienists holding an advanced practice
permit who are practicing autonomously continue to be reimbursed
at the same rate as though they were practicing under a dental
office. The training is the same, but they hold an advanced
practice permit and operate an independent practice.
She added that there is a shortage of both dentists and dental
hygienists in the state. Because most of the problems in dental
health care are associated with preventative work, supporting
the market for APDHs actually will save money in the long term.
1:49:40 PM
SENATOR STEVENS said he assumes the bill will need some changes
to reflect the Governor's Executive Order to divide the
Department of Health and Social Services (DHSS).
REPRESENTATIVE SPOHNHOLZ agreed that changes would be needed
because the bill was drafted prior to that Executive Order.
1:50:13 PM
SENATOR GRAY-JACKSON said she was pleased to see the provision
in Section 5 to prevent discrimination in reimbursement for
APDHs practicing independently. She offered her belief that
insurance companies will need to be educated.
SENATOR STEVENS said he assumes that the eight villages in his
district that do not have dentists will not experience a
reduction in the quality of care they currently receive.
REPRESENTATIVE SPOHNHOLZ replied the expectation is that access
to care will improve dramatically with this advanced practice
permit for dental hygienists. These experienced professionals
have been providing preventative dental care for a very long
time and the bill does not change that standard of care.
SENATOR STEVENS commented on past battles and said he was
pleased that there is continuing progress to help the people in
small communities.
REPRESENTATIVE SPOHNHOLZ relayed that her office had worked
carefully with the Dental Society, the Board of Dental
Examiners, and the Alaska Dental Hygienists' Association to
craft the bill. The bill was changed to accommodate concerns and
she was pleased to see the alignment among all stakeholders.
1:53:32 PM
At ease
1:53:53 PM
CHAIR COSTELLO reconvened the meeting and asked Ms. Wing-Heier
to talk about Section 5 and how the Division of Insurance would
help educate insurance companies to prevent discrimination in
reimbursement practices.
1:54:26 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community, and Economic Development, Anchorage,
Alaska, explained that insurance companies may discriminate, but
not unfairly. For example, it is acceptable for an insurance
company to file to offer homeowners insurance in Kodiak, but not
Barrow. In the case of this bill, insurance companies would be
expected to reimburse advanced practice dental hygienists who
are active under their own license in a separate clinic.
However, it may not be at the same rate as a dentist because
dental hygienists currently are not reimbursed at the same rate
as dentists.
SENATOR GRAY-JACKSON restated her concern that insurance
companies may not know about this new law and reject a claim
that comes from an APDH because it is not from a dentist. She
asked how the division will educate insurance companies so this
issue doesn't arise.
MS. WING-HEIER responded that once the bill is signed and there
is an effective date, the division will notify insurance
companies of this change. Consumers are encouraged to contact
the division if they have a claim that is not paid the way it
should be so the matter can be resolved.
CHAIR COSTELLO turned to invited testimony.
1:56:26 PM
ROAYANN ROYER, CDA, RDH, MPH, Member, Alaska Dental Hygiene
Association, Anchorage, Alaska, testified by invitation in
support of HB 111. She gave her credentials and related that she
currently practices under a collaborative agreement that allows
a hygienist to provide treatment under the general supervision
of a dentist, prior to the dentist seeing a patient.
MS. ROYER clarified that a dental hygienist holding an advanced
practice permit would still provide treatment as a member of a
comprehensive oral health care team. She stressed that allowing
a hygienist to provide services prior to the diagnosis and
treatment planning of a dentist does not compromise the health
and safety of a patient or the quality of service they receive.
HB 111 offers an opportunity to provide efficient, cost-saving
services to the under-served population. Citing her own
situation, she said that if she did not have an agreement with a
dentist, HB 111 would allow her to continue to provide the
current hygienist scope of practice services to the long-term
care residents and refer to a dentist as needed. She said she
intends to continue her collaborative agreement, but HB 111
provides another option. She noted that the bill also addresses
Senator Steven's concern about access to dental care services in
villages. Many hygienists who want to work in under-served
communities cannot find a dentist with whom to collaborate.
Because routine assessment and preventative treatment clearly is
less expensive in the long term, dental professionals throughout
the state support HB 111.
2:00:40 PM
SENATOR STEVENS asked if hygienists who work for Native health
organizations are part of the Alaska Dental Hygiene Association.
MS. ROYER replied many of them are part of ADHA. She noted that
Southcentral Foundation is a member and when she worked for that
organization she went to the villages.
SENATOR STEVENS asked if non-Natives are able to receive care
from Native health care organizations that serve a village.
MS. ROYER answered yes.
2:02:01 PM
DR. DAVID NIELSON, Chair, Board of Dental Examiners, Anchorage,
Alaska, testified by invitation in support of HB 111. Stated
that the Board of Dental Examiners supports HB 111 in its
current form. The board appreciates that the sponsors of the
bill have been receptive to board comments and suggestions for
changes. As stipulated in Section 4, he said the dental board
will draft regulations stating what additional tasks, if any, a
dental hygienist holding an advanced practice permit may
delegate to a dental assistant and under what level of
supervision. He expressed optimism that the extended effective
date would allow time to write those regulations.
2:03:51 PM
JOHN ZASADA, Policy Director, Alaska Primary Care Association,
Anchorage, Alaska, testified by invitation in support of HB 111.
On behalf of APCA, he stated support for the operation and
development of Alaska's 29 tribal and non-tribal federally
qualified health centers. He relayed that APCA partners with the
Alaska Dental Hygiene Association and the Alaska Dental Society.
He stated that overall oral health is a vital component of the
whole person care that community health centers provide their
patients. A frequently cited reason for the shortage of dental
services is the lack of providers. Persistent shortages of
providers results in providers not working at their highest
level of licensure, which creates inefficiencies and decreases
provider satisfaction. APCA believes the advanced practice
permit will be a valuable addition.
2:06:06 PM
CHAIR COSTELLO opened public testimony on HB 111; finding none,
she closed public testimony.
CHAIR COSTELLO held HB 111 in committee for future
consideration.
2:06:35 PM
At ease
SB 193-EXTEND BOARD OF CHIROPRACTIC EXAMINERS
2:08:01 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SENATE BILL NO. 193 "An Act extending the
termination date of the Board of Chiropractic Examiners; and
providing for an effective date."
She solicited a motion to adopt the proposed committee
substitute (CS).
2:08:21 PM
SENATOR STEVENS moved to adopt the committee substitute (CS) for
SB 193, work order 32-LS1486\I, as the working document.
2:08:35 PM
CHAIR COSTELLO objected for an explanation of the changes.
2:08:42 PM
KATIE MCCALL, Staff, Senator Mia Costello, Alaska State
Legislature, Juneau, Alaska, presented the explanation of
changes from version B to version I for SB 193.
Page 1, Line 2
Inserts into the title "requiring a report on audit
compliance by the Board of Chiropractic Examiners."
Sec. 1 - AS 08.03.010(c)(5) Page 1, Line 6
Reduces the board extension from five years to two
years.
Sec. 2 - Page 1, Lines 8-14
Adds a requirement for the legislative audit division
to prepare and submit to the Legislative Budget and
Audit Committee a report on the compliance of the
Board of Chiropractic Examiners with the
recommendations of the June 22, 2021 audit of the
board.
2:09:46 PM
CHAIR COSTELLO withdrew her objection; finding no further
objection, version I was adopted.
2:10:21 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
Alaska State Legislature, Juneau, Alaska, introduced herself.
SENATOR MICCICHE observed that the audit report on the Board of
Chiropractic Examiners clearly stated that the statutory duty to
investigate occupational licensing complaints is assigned to the
Division of Corporations, Business, and Professional Licensing.
He offered his belief that the problems the audit identified
rest with the division; they seem beyond the board's control. He
asked if the Audit Division sees this in other boards and
commissions.
MS. CURTIS replied she does hear that complaint from time to
time. She explained that the sunset review process is a holistic
legislative oversight mechanism that provides an opportunity to
look at the board and the support it has. She reminded the
committee that what led to the recommendation to extend the
board just five years was an issue that could affect the board's
ability to protect the public. That information is not in the
audit report because the investigation is ongoing.
MS. CURTIS said the Division of Audit reporting on the status of
the recommendations is important but she believes that what the
committee really wants the Audit Division to do is ensure that
the public safety issue is addressed. She cautioned that as
currently drafted, she would be focused on the progress of the
recommendations even though those are not directly related to
the reduced extension.
She offered to suggest alternate wording once the investigation
she referenced is finished. She characterized the current draft
as missing a piece.
2:13:11 PM
SENATOR MICCICHE countered that the legislature is looking at
board compliance more than at any individual case. The new
section in uncodified law points out that regardless of what the
board did in that case, it was beyond the board's control.
2:14:05 PM
MS. CURTIS directed attention to Appendix A on page 19 that
lists the criteria the Audit Division uses in a sunset audit,
one of which is the degree to which complaints to the board have
been efficiently addressed. Part of the legislative oversight
sunset process involves looking at the division and sometimes
the recommendations have to do with the division, which is the
case in this audit.
2:14:45 PM
CHAIR COSTELLO agreed with Senator Micciche that the language in
the committee substitute would address the issue, because the
legislature has oversight and the audit provides information
about more than just the board.
MS. CURTIS stated that an audit after just two years does not
start from scratch, so the process takes less time and is less
expensive.
CHAIR COSTELLO said that information is helpful as the committee
continues to look at this particular board and the issues it
faces.
SENATOR STEVENS asked when the last audit was done.
2:16:12 PM
At ease
2:16:16 PM
CHAIR COSTELLO reconvened the meeting.
MS CURTIS replied the last audit was done in 2013; the board
received the full eight-year extension in the prior audit.
SENATOR STEVENS expressed satisfaction with the answer.
CHAIR COSTELLO found no further questions and solicited a
motion.
2:16:43 PM
SENATOR STEVENS moved to report CSSB 193, work order 32-
LS1486\I, from committee with individual recommendations and
attached fiscal note(s).
2:17:06 PM
CHAIR COSTELLO found no objection and CSSB 193(L&C) was reported
from the Senate Labor and Commerce Standing Committee.
2:17:17 PM
At ease
SB 197-DIRECT HEALTH CARE AGREEMENTS
2:19:06 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SENATE BILL NO. 197 "An Act relating to direct
health care agreements; and relating to unfair trade practices."
She noted that this was the first hearing and the intention was
to hear both invited and public testimony.
2:19:29 PM
SENATOR SHELLEY HUGHES, Alaska State Legislature, Juneau,
Alaska, sponsor of SB 197, introduced the legislation. The
sponsor statement read as follows:
Senate Bill 197 establishes guidelines for direct
health care agreements between medical providers and
patients. Direct Health Care (DHC) is a subscription
for health care services in which patients, employers,
or health plans pay primary care providers a flat,
simple periodic fee in exchange for access to a
clearly established broad range of health care
services.
DHC removes some of the financial barriers patients
encounter in accessing routine primary care, including
preventive, wellness, and chronic care services. With
a DHC plan, health care providers aren't burdened with
time-consuming insurance paperwork, leaving more time
to spend with patients. Under DHC agreements (there
are currently over 1,400 direct primary care practices
in 48 states), patients typically get same day access
or next day visits and the option to call or text
their clinic 24/7.
Health outcomes for patients improve under direct
health as there is a focus on routine and preventative
health care. Patients also feel less restrained from
interacting with their provider and typically seek
care before their symptoms become serious.
Consequently, visits to the emergency room are also
reduced.
Senate Bill 197 clearly spells out the elements of a
DHC agreement and emphasizes consumer protections.
Further, the bill clearly defines that Direct Health
Care agreements are not insurance. They do, however,
lower the hurdles to access for many Alaskans.
Alaskans spend more on health care per capita than any
other state in the union. At a time when many Alaskans
fear the uncertainties of the economy, pandemic, and
global instability, direct health care agreements can
provide an option for low-cost, stable access to
quality healthcare.
SENATOR HUGHES reported that 32 states had adopted similar
agreements and Alaska was one of 12 states with pending
legislation. She expressed hope that the committee would agree
that it was time for the legislature to make this sensible
option available to Alaskans.
CHAIR COSTELLO asked Mr. Whitt to provide the sectional
analysis.
2:22:45 PM
BUDDY WHITT, Staff, Senator Shelley Hughes, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 197 on behalf of the sponsor. It read as follows:
Section 1 18.23.500 Page 1, Line 4 through Page 4,
Line 14
Adds new section “Direct Health Care Agreements” to
Chapter 23 of Title 18.
Section (a), page 1, line 6 through page 2, line 20 –
Defines a Direct Health Care Agreement as a written
agreement between patient, government entity or private
business and a provider for specific services in
exchange for an annual fee, that services provided for
the fee must be specified, and that the patient may
submit an insurance claim for services rendered beyond
those specified in the agreement.
Section (b), page 2, lines 21 through 27 – Directs that
providers must allow a patient to terminate the
agreement within 30 days and that if the agreement is
terminated, the provider shall provide a refund of the
payments made under the agreement, less payments made
for services already provided.
Section (c), page 2, line 28 through page 3, line1 – An
agreement between provider and patient may be terminated
in writing after thirty days, and the provider may give
a refund, charge a termination penalty or termination
fee.
Section (d), page 3, lines 2 through 5 – An agreement
between provider and employer or government entity may
be terminated in writing after thirty days, and the
provider may give a refund, charge a termination penalty
or termination fee.
Section (e), page 3, lines 6 through 10 – Modifications
or renewal to an existing agreement can be made upon
written agreement between both parties. A provider may
not make a change to the annual fee more than once a
year and a 45-day written notice must be given prior to
a change in fee.
Section (f), page 3, lines 11 through 14 – Specifies
that a direct health care agreement is not subject to
the consumer protections in Title 21 (Insurance) but are
subject to other consumer protections including AS
45.45.915 (Section 2 of the bill).
Section (g), page 3, lines 15 through 24 – A Direct
Health Care Agreement provider may not misrepresent
themselves or the services that they provide in a direct
health care agreement.
Section (h), page 3, line 25 through page 4, line 14 –
Specifies that a direct health care agreement is not
health insurance or underwriting, that direct health
care agreement services are exempt from regulation by
the Division of Insurance, and that a certificate of
authority or license to market is not required to offer
or execute such an agreement. The definitions of “health
care provider” and “health care service” are given in
subsections 1 and 2 of this section.
Section 2 AS 45.45.915 Page 4, line 16 through page
5, line 5
Adds new section “Direct Health Care Agreements” to
Chapter 45 of Title 45
Section (a), page 4, lines 16 through 22 – A health care
provider may not refuse to enter into a Direct Health
Care Agreement based upon any characteristic of a class
of persons protected by federal and state laws that
prohibit discrimination.
Section (b), page 4, line 23 through page 5, line 5 – A
health care provider may only decline to enter an
agreement or cancel an existing agreement if the
patients care needs are beyond that which the health
care provider can provide. An existing agreement may
only be terminated once the provider has transferred the
patient to a health care provider that can provide the
needed level of care and has agreed to provide the
patient with that needed level of care. The definitions
of “direct health care agreement” and “health care
provider” are the same as those found in section [1,
page 4, lines 6-14].
Section 3, Page 5, Lines 6 through 8
Adds violations of sections 1 and 2 of the bill to the
list of unlawful acts under the unfair trade practices
and consumer protections clause of the AS 45.50.471(b).
2:27:14 PM
MR. WHITT advised that the sponsor asked him to draft a response
to the analysis of the fiscal note from the Department of
Health, OMB Component Number 242. He offered to speak to that
now if that was the chair's wish.
2:28:10 PM
CHAIR COSTELLO expressed her preference to wait until a
subsequent hearing.
She asked if this would be a limitation for providers because
they are essentially committing to be available on short notice
to the individuals that paid for the service.
SENATOR HUGHES replied that she was aware of clinics that were
merging the models of insurance and direct-pay healthcare
agreements so in those settings it would be the provider's
choice. The model clearly defines the set of services so
subscribers that need services outside the list would have to
pay for the extra items.
CHAIR COSTELLO observed that the bill indicates that insurance
is not involved until the patient goes outside the list of
preapproved services. She asked if that means that the monthly
fee does not count toward the insurance deductible.
SENATOR HUGHES replied that's correct. She added that she
neglected to mention during the introduction that this is a good
option for small employers. They could offer health insurance
for catastrophic events and a direct-pay healthcare agreement
would cover primary care and preventative treatment. Nationwide,
it is generally primary care providers that are using these
direct-pay healthcare agreements, but the option is available
for specialists as well.
2:30:55 PM
SENATOR GRAY-JACKSON asked who determines the monthly fee.
SENATOR HUGHES replied it is an agreement between the provider
and the patient, but the model is that each patient would pay
the same fee.
SENATOR GRAY-JACKSON asked for an estimate of what the fee might
be.
MR. WHITT replied the fees vary from state to state but his
research has found fees ranging from $100 to $250 per month. The
demographic makes a difference but it's based on the number of
items on that list that are covered under the agreement.
CHAIR COSTELLO asked Ms. Wing-Heier to come forward.
2:33:17 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community, and Economic Development, Anchorage,
Alaska, introduced herself.
SENATOR STEVENS asked if there would be an advantage for
insurance companies to cover the fee [for direct-pay healthcare
agreements].
MS. WING-HEIER replied insurance companies will stay out of
direct-pay healthcare agreements. She posed a hypothetical to
demonstrate that a $100 per month direct-pay healthcare
agreement could make good, cost-saving sense for a family that
had a $15,000 deductible health insurance plan.
SENATOR STEVENS asked for confirmation that Medicare would not
pay the fee for a direct-pay healthcare agreement.
MS. WING-HEIER replied Medicare won't touch direct-pay
healthcare agreements but the division believes that Alaskans on
Medicare will find them beneficial because it can be so
difficult to find primary care physicians who treat Medicare
patients.
2:35:04 PM
SENATOR GRAY-JACKSON asked if the fee for a family of four would
be different than for an individual.
MS. WING-HEIER replied she would assume so.
CHAIR COSTELLO offered her understanding that individuals within
a group would be paying the same fee and this could include a
small business. This is an option that encourages preventative
care.
2:36:29 PM
SENATOR STEVENS asked Ms. Wing-Heier if she had any concerns
about these agreements.
MS. WING-HEIER replied the division supports the bill, but to
avoid confusion, AS 21.03 would need to be amended to list the
other types of practices that are not insurance. She added that
the division is fairly sure these agreements are already in use
in Alaska, but because they are not allowed right now, she did
not want to hear testimony about this practice here in the
state.
SENATOR MICCICHE asked why they aren't already allowed.
MS. WING-HEIER explained that the definition of direct-care
health care sounds very much like insurance but the specific
definition has not been added to AS 21.03, which is the scope of
code for insurance. Until that's done, there is a problem
because it sounds as though the doctor is the insurance company.
SENATOR MICCICHE pointed to paragraph (3) on page 2, lines 7-9
that says these agreements must clearly state they are not
health insurance and they don't meet any federal mandate for
health insurance. He asked why one of these agreements wouldn't
fulfill the mandated insurance coverage under federal law if it
provided those services and care.
MS. WING-HEIER replied the federal law only recognizes insurance
companies and self-insured plans, not doctors providing the care
under these agreements. The agreement could list all the
essential benefits and provide the same services, but still not
be a qualified health plan.
SENATOR MICCICHE asked if that was a gap in the Affordable Care
Act. If ACA's goal was to provide adequate health care for all
Americans, he said these agreements are a more creative
solution.
MS. WING-HEIER replied they are creative but they do not cover
catastrophic losses because there would be too few people to
spread the risk for such things as a million dollar baby or
someone with hemophilia. A private practice could not support
that kind of risk.
CHAIR COSTELLO listed the individuals available to answer
questions.
2:40:58 PM
At ease
2:42:10 PM
CHAIR COSTELLO reconvened the meeting.
2:42:23 PM
CHAIR COSTLLO found no one who wished to comment and she closed
public testimony on SB 197.
She held SB 197 in committee for future consideration.
2:42:50 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor and Commerce Standing
Committee meeting at 2:42 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 19 Letters of Support Received as of 3.21.22.pdf |
SL&C 3/21/2022 1:30:00 PM |
HB 19 |
| HB 111 v. I Sponsor Statement 2.10.2022.pdf |
SL&C 3/21/2022 1:30:00 PM |
HB 111 |
| HB 111 v. I Sectional Analysis 2.10.2022.pdf |
SL&C 3/21/2022 1:30:00 PM |
HB 111 |
| HB 111 Supporting Document - FAQs 2.16.22.pdf |
SFIN 4/21/2022 9:00:00 AM SL&C 3/21/2022 1:30:00 PM |
HB 111 |
| SB 193 Version I.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 193 |
| SB 193 Explanation of Changes, version B to I.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 193 |
| SB 197 Sponsor Statement.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |
| SB 197 Sectional Analysis.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |
| SB 197 Fiscal Note 242 - DOH.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |
| SB 197 Supporting Document - Pioneer Health DHCA White Paper.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |