04/02/2015 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB44 | |
| SB69 | |
| SB18 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 18 | TELECONFERENCED | |
| * | SB 69 | ||
| + | TELECONFERENCED | ||
| + | SB 44 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
April 2, 2015
1:30 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Cathy Giessel, Vice Chair
Senator Kevin Meyer
Senator Gary Stevens
Senator Johnny Ellis
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 44
"An Act relating to the religious exemptions in the Public
Employment Relations Act and the Alaska Railroad Corporation
Act."
- MOVED SB 44 OUT OF COMMITTEE
SENATE BILL NO. 69
"An Act relating to the Board of Chiropractic Examiners and the
practice of chiropractic."
- HEARD & HELD
SENATE BILL NO. 18
"An Act exempting a health care sharing ministry from regulation
as an insurer."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 18
SHORT TITLE: HEALTH CARE SHARE MINISTRY NOT INSURANCE
SPONSOR(s): SENATOR(s) COGHILL
01/21/15 (S) PREFILE RELEASED 1/16/15
01/21/15 (S) READ THE FIRST TIME - REFERRALS
01/21/15 (S) HSS, L&C
02/18/15 (S) HSS AT 1:30 PM BUTROVICH 205
02/18/15 (S) Heard & Held
02/18/15 (S) MINUTE(HSS)
03/11/15 (S) HSS AT 1:30 PM BUTROVICH 205
03/11/15 (S) Moved SB 18 Out of Committee
03/11/15 (S) MINUTE(HSS)
03/13/15 (S) HSS RPT 4DP 1NR
03/13/15 (S) DP: STEDMAN, GIESSEL, KELLY, STOLTZE
03/13/15 (S) NR: ELLIS
04/02/15 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 69
SHORT TITLE: BD OF CHIROPRACTIC EXAMINERS; PRACTICE
SPONSOR(s): SENATOR(s) STOLTZE
03/06/15 (S) READ THE FIRST TIME - REFERRALS
03/06/15 (S) L&C, FIN
04/02/15 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 44
SHORT TITLE: RELIGIOUS UNION EXEMPTION: PERA & AKRR
SPONSOR(s): SENATOR(s) GIESSEL
02/09/15 (S) READ THE FIRST TIME - REFERRALS
02/09/15 (S) L&C, JUD
03/10/15 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/10/15 (S) Heard & Held
03/10/15 (S) MINUTE(L&C)
04/02/15 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
FORREST WOLFE, Staff
Senator Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions related to SB 44.
SENATOR BILL STOLTZE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 69.
BRANDON BREFCZYNSKI, Staff
Senator Bill Stoltze
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a sectional analysis for SB 69:
FRED PARADY, Deputy Commissioner
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Explained the DCCED fiscal note for SB 69.
SHARI RYAN, Executive Administrator
Alaska Chiropractic Society
Anchorage, Alaska
POSITION STATEMENT: introduced herself.
PATRICIA CONNERS ALLEN, D.C., Chair
Board of Trustees
University of Western States
Portland, Oregon
POSITION STATEMENT: Testified in support of SB 69.
EDWARD J. BARRINGTON, D.C., Member
Board of Chiropractic Examiners
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 69.
JAMES F. HESTON, Member
Board of Chiropractic Examiners
Homer, Alaska
POSITION STATEMENT: Provided supporting testimony for SB 69.
TODD CURZIE D.C., President
Alaska Chiropractic Society
Homer, Alaska
POSITION STATEMENT: Testified in support of SB 69 on behalf of
the ACS.
JORDAN SHILLING, Staff
Senator John Coghill
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 18 on behalf of the sponsor.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community and Economic Development
POSITION STATEMENT: Answered questions and explained the fiscal
note for SB 18.
JOEL NOBLE
Alliance of Health Care Sharing Ministries and Samaritan
Ministries,
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 18.
JENNIFER MEYHOFF
Alaska Association of Health Underwriters
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to SB 18.
ACTION NARRATIVE
1:30:19 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:30 p.m. Present at the call to
order were Senators Meyer, Ellis, Stevens, Giessel, and Chair
Costello.
SB 44-RELIGIOUS UNION EXEMPTION: PERA & AKRR
1:30:53 PM
CHAIR COSTELLO announced the consideration of SB 44. "An Act
relating to the religious exemptions in the Public Employment
Relations Act and the Alaska Railroad Corporation Act." She
noted that this was the second hearing and public testimony was
closed.
1:31:50 PM
FORREST WOLFE, Staff, Senator Cathy Giessel offered to answer
questions related to SB 44.
SENATOR STEVENS summarized his understanding that the bill
allows an employee to select the charity to which his/her union
dues equivalent will be contributed.
MR. WOLFE agreed with the description. Currently the union
collects the fees and in lieu of them going to the union they
are contributed to a charitable organization of the union's
choosing. The bill allows the employee to select where the funds
are contributed.
SENATOR STEVENS offered his understanding that under this
exemption the employee would pay dues but not be a member of the
bargaining unit.
MR. WOLFE confirmed that was correct.
1:33:36 PM
SENATOR COSTELLO found no further questions and asked the will
of the committee.
1:33:46 PM
SENATOR GIESSEL motioned to report SB 44, labeled 29-LS0061\W,
from committee with individual recommendations and attached
fiscal note(s).
CHAIR COSTELLO announced that without objection, SB 44 is
reported from the Senate Labor and Commerce Standing Committee.
1:34:09 PM
At ease
SB 69-BD OF CHIROPRACTIC EXAMINERS; PRACTICE
1:35:57 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SB 69. "An Act relating to the Board of
Chiropractic Examiners and the practice of chiropractic." She
noted that this was the first hearing.
1:36:25 PM
SENATOR BILL STOLTZE, sponsor of SB 69, introduced SB 69
speaking to the following sponsor statement:
Healthcare and wellness have developed and progressed
over the years, and patient preferences have changed
along with them. In some cases, state laws have not
kept up with this progress. Senate Bill 69 endeavors
to update and clarify the statutes guiding
chiropractic care in Alaska.
SB 69 addresses training and utilization of
chiropractic clinical assistants and interns;
strengthens current law allowing chiropractors to
perform school physicals; revises penalties for
fraudulent practices; and updates definitions and
modernizes terminology.
SB 69 makes timely changes to our statutes guiding
chiropractic care, resulting in chiropractic
physicians being able to treat patients more
efficiently and affordably.
1:41:57 PM
SENATOR GIESSEL pointed out that in addition to physicians,
nurse practitioners and physician assistants are qualified to
perform pre-participation sports physicals. She questioned
whether the education statutes needed to be updated to include
chiropractors for performing those physicals.
SENATOR STOLTZE admitted he didn't know.
1:43:36 PM
CHAIR COSTELLO asked for a sectional analysis.
1:43:48 PM
BRANDON BREFCZYNSKI, Staff, Senator Bill Stoltze, provided the
following sectional analysis for SB 69:
Section 1: Amends AS 08.20.055 by adding new language
allowing the board to adopt regulations for
chiropractic interns and preceptors, chiropractic
clinical assistants, and performance of patient
examinations.
Section 2: Amends AS 08.20.100(b) clarifying how
chiropractors can accept referrals, allowing
chiropractors to perform school physicals, and
allowing the employment of certified chiropractic
clinical assistants, interns, and preceptors.
Section 3: Adds new subsection to AS 08.20.100
exempting from this section chiropractic interns under
certain conditions.
Section 4: Amends AS 08.20.160 regarding the
requirements for temporary permits.
Section 5: Adds new section to AS 08.20 regarding
chiropractic clinical assistants.
Section 6: Amends 08.20.185 to modernize terminology.
Section 7: Amends AS 08.20.200 by updating penalties
for unlicensed practice.
1:46:31 PM
SENATOR GIESSEL noted that her question was answered; AS
14.30.070 and 14.30.120 identify chiropractors as being able to
perform physical examinations for students and education
programs.
CHAIR COSTELLO asked what chiropractors are not qualified to
diagnose.
SENATOR STOLTZE deferred the question.
SENATOR COSTELLO asked if the bill provides further
clarification that chiropractors are able to perform pre-
participation physicals because that's not universally
understood.
SENATOR STOLTZE replied that's one reason, and he hopes to hear
from one of the organizations.
CHAIR COSTELLO requested a general statewide overview of which
schools districts do and do not accept physicals from
chiropractors.
SENATOR STOLTZE agreed to provide the information.
CHAIR COSTELLO asked Mr. Parady to review the fiscal note.
1:50:09 PM
FRED PARADY, Deputy Commissioner, Department of Commerce,
Community and Economic Development (DCCED), said SB 69 adds new
licensure requirements for chiropractic assistants and will
require additional administrative procedures to authorize
chiropractic interns and preceptors. The fiscal note requests
one part time licensing examiner for up to 14 hours per week to
manage the estimated additional 200 plus chiropractic assistants
and new intern preceptor approval processes.
Professional licensing programs within the Division of
Corporations, Business and Professional Licensing are entirely
receipt supported so the fiscal note includes no undesignated
general funds. He noted that the estimated cost of $750 per
license likely will be lower based on FY2014 data that shows the
314 licensees paid $450 per license.
Responding to an earlier question, he relayed that when he
worked for the North Slope Borough School District,
chiropractors performed pre-performance sports physicals.
CHAIR COSTELLO asked if public health nurses are able to do
sports physicals.
SENATOR GIESSEL answered no.
1:53:10 PM
CHAIR COSTELLO opened public testimony.
1:53:40 PM
SHARI RYAN, Executive Administrator, Alaska Chiropractic
Society, introduced herself.
CHAIR COSTELLO asked about the difference in training for a
medical doctor and a chiropractic doctor.
MS. RYAN replied the educational requirements are comparable and
she would follow up with specifics.
SENATOR STEVENS asked about chiropractic clinical assistants and
interns.
MS. RYAN explained that a chiropractic clinical assistant does
therapy and assists the chiropractor. Their training ranges from
a two year program at the Palmer College of Chiropractic to
online programs. A chiropractic intern has completed the
required training and education and wants on-the-job training
supervised by a preceptor.
1:56:08 PM
CHAIR COSTELLO asked how many chiropractors are performing
school physicals across the state.
MS. RYAN offered to follow up with the information.
CHAIR COSTELLO asked what a physical costs.
MS. RYAN offered to follow up with the information.
SENATOR MEYER asked if other states allow chiropractors to
perform pre-participation sports physicals.
MS. RYAN replied 35 states allow that.
1:57:47 PM
PATRICIA CONNERS ALLEN, D.C., Chair, Board of Trustees,
University of Western States, said she has practiced
chiropractic medicine in Juneau since 1984 and previously served
on the Board of Chiropractic Examiners. She explained that the
bill allows the Board of Examiners to establish a process so
that chiropractic interns can come to Alaska and be supervised
by a preceptor doctor.
1:59:23 PM
EDWARD J. BARRINGTON, D.C., representing himself, reported that
he serves on the Board of Chiropractic Examiners and is chair of
two committees in the Alaska Chiropractic Society. He explained
that chiropractors practice in primary care and their training
and diagnostic capabilities exceeds their practice statute. SB
69 will update the statutes to bring the law closer to the
current training and education of chiropractic physicians. It
also clarifies that chiropractic physicians are able to perform
pre-participation sports physicals. The Alaska School Athletic
Association (ASAA) has requested that the statute specifically
include the pre-participation language. Chiropractors are
currently authorized to perform physicals on children before
they enter school and to keep them out of sports activities. It
makes sense that they should also be authorized to perform pre-
participation sports physicals.
SB 69 will also help regulate the training and certification of
chiropractic clinical assistants. Medical assistants are trained
and often work in chiropractic offices but they are not under
the auspices of the Board of Chiropractic Examiners. The bill
also provides a name change for the peer review committee.
2:05:39 PM
JAMES F. HESTON, member, Board of Chiropractic Examiners,
described SB 69 as basic housekeeping that has been discussed
for years. However, the $700 licensing fee described in the
fiscal note misrepresents the intention, which was simply to get
statutory authority to adopt regulations to regulate
chiropractic assistants. The board would like to use a national
certification program provided through an organization such as
the Federation of Chiropractic Licensing Boards for training,
testing, and two-year certification. He noted that the board had
yet to vote to support this in a resolution but it was likely.
CHAIR COSTELLO said she didn't intend to move the bill today so
there was time for the resolution to pass before the committee
took any action.
2:07:37 PM
TODD CURZIE D.C., President, Alaska Chiropractic Society (ACS),
stated that ACS coordinates continuing education and training
for its members, many of whom are also active in other national
organizations. ACS supports SB 69 as a responsible way to
modernize chiropractic practices and protect the public.
2:09:06 PM
CHAIR COSTELLO announced that she would keep public testimony
open and hold SB 69 for further consideration.
SB 18-HEALTH CARE SHARE MINISTRY NOT INSURANCE
2:09:43 PM
CHAIR COSTELLO announced the consideration of SB 18. "An Act
exempting a health care sharing ministry from regulation as an
insurer." She noted this was the first hearing.
2:10:05 PM
JORDAN SHILLING, Staff, Senator John Coghill stated that SB 18
has two main purposes: 1) to define health care sharing
ministries and 2) to exempt them from insurance statutes because
they are charitable organizations. Health care sharing is a
payment arrangement for health care among persons of similar
beliefs. It is administered by a nonprofit corporation.
He noted the three largest sharing ministries are Christian
Health Care Ministries, which was established in 1990,
MediShare, established in 1993, and Samaritan Ministries,
established in 1994. All three are biblically based and have
membership requirements, such as living a Christian lifestyle
and abstaining from tobacco.
MR. SHILLING continued to explain that health care sharing
ministries are different from regular insurance. Insurance is
the transfer of risk from one entity to another in exchange for
a guaranteed payment. The sharing ministries are 501(c)(3)s and
no member is required by law to pay anyone's medical bills. They
don't assume or transfer risk, pool money or use actuaries, and
they don't purchase reinsurance policies. They are a group of
people who come together voluntarily and agree to share costs.
He stated that most states do not consider sharing ministries a
form of insurance, including the Alaska Division of Insurance.
There are about 3,400 Alaskans in sharing ministries. He noted
30 states have passed laws similar to SB 18. If the state were
to regulate these sharing ministries as insurance companies,
they would likely cease to exist.
SENATOR MEYER asked Ms. Wing-Heier her opinion of the bill and
what it attempts to do from an insurance perspective.
2:13:57 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), said the
decision to join a health care sharing ministry is a personal
commitment by an individual who trusts an organization to assume
the responsibility to pay their medical bills. About 3,500
people participate in health care sharing ministries in Alaska.
She explained that sharing ministries were specifically carved-
out of the Affordable Care Act (ACA) as long as they were in
existence in 1999. The bill codifies that this is ongoing in the
state and that previous administrations have not taken exception
to it.
CHAIR COSTELLO asked for an explanation of the DCCED fiscal
note.
2:16:30 PM
MS. WING-HEIER said the Division of Insurance submitted a zero
fiscal note because the bill maintains the status quo. It will
not impact the current organization or work load of the
division; health care ministries are not taxed currently and
won't be in the future.
SENATOR MEYER asked how a group qualifies for this exemption.
MS. WING-HEIER replied the organization is set up as a 501(c)(3)
nonprofit. She deferred further explanation to the sponsor.
2:18:11 PM
JOEL NOBLE, Alliance of Health Care Sharing Ministries and
Samaritan Ministries, explained that this is one of the accepted
exemptions within the Affordable Care Act for not having
individual insurance. Some of the qualifying standards include
being in existence before December 31, 1999 and providing an
annual audit upon request.
SENATOR MEYER asked the significance of the 1999 date.
MR. NOBLE surmised that it was to keep false actors from
starting for the sake of getting out from under the individual
mandate of the AFA. The date was set based on the starting dates
of the three national ministries. About 50 Mennonite churches
also qualify.
SENATOR MEYER continued to question the date since the
Affordable Care Act passed in 2010.
MR. NOBLE said the date came from the U.S. Senate Committee on
Finance and he wasn't sure what the thinking was.
CHAIR COSTELLO asked how health care sharing ministries work.
MR. NOBLE explained that they are member-to-member sharing
entities based on the Amish model of community help, but applied
to medical needs. He used his membership in Samaritan Ministries
as an example. Each month the ministry newsletter includes the
name and address of a member along with their medical need.
Depending on the need, other members are assigned the same name.
He and the other members each send a check to the injured party
that is equivalent to the monthly cost of membership. Those
checks total the amount of the bill and the injured party uses
them to pay their medical costs. He also related that when his
kids were born, he received a number of checks from ministry
members and he cashed them to pay the hospital and doctors.
2:23:04 PM
JENNIFER MEYHOFF, Alaska Association of Health Underwriters
(AHU), said this professional organization represents over 100
licensed health insurance brokers, agents, consultants, and
benefits specialists. They help individuals and employers
purchase, administer and utilize their individual and group
health insurance coverage. She said AHU is concerned with
consumer protection and integrity of the health care and
insurance markets in Alaska. As such, the lack of Division of
Insurance oversight of the exemption under SB 18 is very
troubling. AHU understands that this is not insurance, but it
looks and feels like insurance to the 3,500 consumers in Alaska.
She questioned what would happen in the event of a $1 million
claim or a prescription drug need in excess of $30 thousand per
month. The bill doesn't address this and other important
consumer protections, which is why the Alaska Association of
Health Underwriters opposes SB 18.
2:26:37 PM
SENATOR COSTELLO closed public testimony and held SB 18 in
committee for further consideration.
2:26:58 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor and Commerce Standing
Committee meeting at 2:26 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 69 - Version A.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Sponsor Statement.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Fiscal Note.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Hearing Request.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Sectional Analysis.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Support Letter Dr. Campbell.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Support Letter Logan University.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Support Letter Palmer College.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 69 - Support Letter Univ. Western States.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| SB 18 - Version H.PDF |
SL&C 4/2/2015 1:30:00 PM |
SB 18 |
| SB 18 - Sponsor Statement.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 18 |
| SB 18 - Fiscal Note.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 18 |
| SB 18 - HCSM Summary.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 18 |
| SB 18 - Catholic Anchor Article.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 18 |
| SB 18 - ACA Exemption.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 18 |
| AG Opinion - Occupational Licensing 1991.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| ASBCE Newsletter Excerpt - 2003.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |
| 2015.04.08 Alaska State Medical Association Letter.pdf |
SL&C 4/2/2015 1:30:00 PM |
SB 69 |