HB 103-OPTOMETRY & OPTOMETRISTS  3:23:22 PM CHAIR SPOHNHOLZ announced that the first order of business would be HOUSE BILL NO. 103, "An Act relating to the practice of optometry." 3:23:37 PM CHAIR SPOHNHOLZ, as the sponsor of the proposed bill, offered some insights for the purpose and intent of HB 103. She explained that the bill gave authority to the Board of Optometry to regulate the practice of optometry and assured that the Board would have the opportunity to update its educational standards, continuing education standards, and scope of practice based on the best practices and available evidence. She emphasized that the proposed bill would not allow optometrists to provide services outside their scope of practice, which included performance of surgeries. The proposed bill would allow for the Board of Optometry to utilize the regulatory process to manage themselves, similar to doctors, nurses, and midwives. She declared that a robust process existed which ensured thoughtful consideration and opportunity for public testimony for any proposed changes. She declared her desire to "get the legislature out of the business of managing optometry in the State of Alaska." 3:25:48 PM REPRESENTATIVE EDGMON moved to adopt the proposed committee substitute (CS) for HB 103, labeled 30-LS0459\D, Bruce, 2/21/17, as the working document. CHAIR SPOHNHOLZ objected for discussion. 3:26:23 PM BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska State Legislature, paraphrased from the sponsor statement [included in members' packets], which read as follows [original punctuation provided]: HB 103 modernizes and updates the Alaska Optometry Statute, as many parts are over 50 years old. It allows the optometry board the authority to regulate its practice the same as other prescribing health professions such as dentistry, medicine and nursing. This bill also allows the board to continue to adopt regulations, updated to current practice and moves the continuing education (CE) requirements back into regulations. Continuing education is still required by current statute, but the hours and subjects will be determined by the board as with other professions. This change allows the board flexibility to control CE requirements and is recommended by the Department of Commerce, Community and Economic Development. The current regulations require more CE hours than the statute subsection deleted by this bill. HB 103 allows the optometry board to determine prescribed drug schedules, including standards and limitations on practice determined by the board. The bill ensures that no licensee may perform any procedure beyond the scope of the licensee's education, training, and experience as established by the board. This allows for future new and improved diagnostic and therapeutic procedures as determined by the board, while not having to return to the legislature for every new technological advance, which is currently the case and unnecessarily burdensome. The optometry definition in this bill is updated to reflect current and modern-day practice. MS. NISBETT paraphrased from the Sectional Analysis of the bill [included in members' packets], which read as follows [original punctuation provided]: Section 1 AS.08.72.050 (4)(6) updates very old statutes to indicate that regulations shall be adopted to govern the current prescription and use of pharmaceutical agents; and develop uniform standards for the practice of optometry. Section 2 AS.08.72.060 (c)(4) the board shall publish advisory opinions regarding standards for the practice of optometry. Section 3 AS 08.72.181(d) moves the continuing education (CE) requirements back into regulation, as desired by the Department of Commerce, Community and Economic Development. Continuing education is still required by current statute, but the hours and subjects will be determined by the board. Section 4 AS 08.72.272(a) clarifies the current statute for the board to regulate pharmaceutical agent prescription including standards and limitations on practice determined by the board. Section 5 AS 08.72.278 Limitation on practice adds a new section that sets limitations on services, ensuring that the board may not authorize any procedure beyond the scope of the licensee's education and experience. Section 6 AS 08.72.300(3) updates the optometry definition to reflect current practice. Section 7 Effective date for Section 2. This is because (3) of Section 2 was added to statute in 2016 via Senate Bill 74, the Medicaid Reform bill, and it had the effective date of July 2017, so (4) is written to comply with that date as well. (per Legislative Drafting) REPRESENTATIVE EASTMAN asked what the biggest problem was which the proposed bill would address. CHAIR SPOHNHOLZ said that the discussion was still for distinguishing the proposed committee substitute from the original bill. MS. NISBETT, in response to Representative Eastman, offered her belief that the biggest issue was for definitions of ophthalmic surgery and non-invasive procedures, which had been removed. CHAIR SPOHNHOLZ removed her objection. There being no further objection, the proposed committee substitute (CS) for HB 103, labeled 30-LS0459\D, Bruce, 2/21/17, was adopted as the working document. 3:31:16 PM PAUL BARNEY, OD, Chair, Alaska Board of Optometry, shared his background, including his past presidency of the Alaska Optometric Association, and stated his support for the proposed bill as it would allow the Board of Optometry to regulate the details of the practice of optometry, similar to the regulation of advanced practice nurses, dentists, and medical doctors. He stated that this would not set new precedence in health care as other health care providers were regulated in this same way in the state. The proposed bill would give optometrists a better opportunity to practice at the highest level of education by allowing the Board of Optometry to write regulations commensurate with educational advances. He pointed out that the current optometry statute was written more than 40 years ago, and it required that optometry pursue a statute change whenever there were advances in education and technology. He noted that statute changes were costly and time consuming. He added that the board could not promulgate regulations, practices, or procedures that were beyond the education of optometrists, and that the board was overseen by the Department of Law, similar to other health care boards, which would ensure that the regulations were within the scope of optometric education. He stated that the medical legal system and the insurance system also ensured safeguards, as any health care provider providing care outside their education was subject to disciplinary action by the board as well as serious medical legal ramifications. He noted that, as insurance providers did not pay providers for care outside the scope of education, there was not any incentive for any health care provider to provide care outside their education. He added that there were serious consequences. He assured that the primary concern of the board was for the safety of the public. He declared that optometrists were conservative and cautious practitioners, which would not change with passage of the proposed bill. He stated that the proposed bill would put the regulatory details for the practice of optometry in the Board of Optometry, as they could incorporate new technologies and advances in eye care as they occur. He reported that optometry provided about 70 percent of the eye care in the United States, and often in rural areas, optometrists were the only eye care providers in the community. REPRESENTATIVE SULLIVAN-LEONARD referred to page 2, line 15, of the committee substitute regarding the deletion of the continuing education concerning the injection of nontopical therapeutic pharmaceutical agents and asked for Dr. Barney to expand on this. DR. BARNEY explained that optometrists did minor procedures which could require injectable anesthetics or steroids. He said that the proposed bill would clean up the statutes and allow the Board of Optometry to decide the educational requirements. 3:37:47 PM JEFF GONNASON, OD, Legislative Chair, Alaska Optometric Association, offered some of his background. He reported that the optometry doctorate degree was brought to the same level of education as medicine and dentistry more than 45 years ago. He detailed that this included four years of undergraduate school, followed by a four year graduate professional doctoral program, and then one to two years of residency or advanced education, which exactly followed the model for dental school. He added that 66 percent of optometry students were women. He pointed out that advanced practice nursing, dentistry, medicine, and optometry were all independent, with their own regulatory boards, and were all currently authorized to prescribe drugs, including controlled narcotics, in Alaska. He stated that optometrists were defined as physicians by the Centers for Medicare and Medicaid Services and were held to the same standard of care as other medical professions in the treatment of Medicare and Medicaid patients. He reported that the optometry malpractice insurance fee was low, about $485 per year for $4 million of coverage. He relayed that about 150 optometrists practiced in Alaska, providing the vast majority of eye care in the state, and serving more than 80 remote locations. He declared that optometrists were the primary care physicians for eye care in Alaska. He said that antiquated state statutes were a barrier to attracting the best new doctors. He declared that proposed HB 103 did not authorize optometrists to do anything, it only updated the antiquated statutes and gave the State Board of Optometry authority to regulate the profession with the sworn duty to protect the public. He said that licensing included professional judgement for when to refer patients for specialty care. He emphasized that the proposed bill did not compare optometry with ophthalmology. He offered a comparison of a family doctor with a neurosurgeon. He reiterated that the board would not authorize any optometrist to perform a treatment for which they were not qualified. He declared that risk of harm to the public had never been an issue. He declared that the Board of Optometry deserved the same level of respect as the other professions. He stated his support for proposed HB 103. REPRESENTATIVE JOHNSTON asked about the low cost for malpractice insurance. DR. GONNASON replied that optometrists were very conservative and were sued less often. He relayed that this was based on the actuarial tables, although the rates were a bit higher in states with more lawyers. 3:44:31 PM HARRIET MILKS, Assistant Attorney General, Commercial and Fair Business Section, Civil Division (Juneau), Department of Law, directed attention to page 4 of the administrative regulations drafting manual [Included in members' packets] and spoke about the flow chart which detailed the steps taken by boards for proposals to adopt regulations governing each profession. She noted that the Department of Law (DOL) was always available to advise and assist with the process, but DOL did not tell the boards how to regulate their professions or get involved in policy issues. The department ensured that the proposed regulations were constitutional, and consistent with the administrative procedure act. She called attention to the transparency of the process to the public, as every Alaskan could see what the licensing boards proposed to adopt as regulations. She reported that DOL ensured that the proposed regulations went out for public comment and that public questions could be submitted. Once the regulation was put out for public notice and the public comments were received, the board would meet in a noticed public meeting, and discuss the public comments. If the regulations were adopted, they were sent to DOL for review to ensure constitutionality, and not beyond the scope of the authority of the board. She explained that advisory opinions were observations about the way a practice might happen in a licensed program consistent with the regulations. These advisory opinions were not law, and were not brought to DOL for vetting. She reminded the committee that things changed, such as new treatment modalities and daily issues that could not be anticipated. She said that boards could also ask the DOL to look at advisory opinions. 3:50:33 PM CHAIR SPOHNHOLZ said that HB 103 would be held over.