SB 86-TEMPORARY PERMITS & LICENSES  1:57:10 PM CHAIR COSTELLO reconvened the meeting and announced the consideration of SENATE BILL NO. 86, "An Act relating to occupational licensing; relating to temporary licenses, permits, and certificates; and providing for an effective date." 1:57:51 PM KATIE MCCALL, staff, Senator Mia Costello, Alaska State Legislature, Juneau, Alaska, introduced SB 86 on behalf of the Senate Labor and Commerce Committee, reading the sponsor statement into the record: Senate Bill 86 adapts language originally found in Senate Bill 56, the Governor's public health disaster emergency bill, by providing a means to issue temporary licenses, permits, and certificates under statutory law. The distinction between Senate Bill 86 and Senate Bill 56 is that the Governor's bill only amended uncodified law to allow for expedited licensing during the novel coronavirus disease public health disaster emergency. By placing a temporary licensing process in statute, our state laws become more COVID-19-aware and the state has the means to maintain operations during times of unprecedented need, even when a disaster emergency declaration is not in place. MS. MCCALL explained that SB 86 highlights whether or not the legislature wants to put a provision like this in statute rather than in uncodified law. SENATOR STEVENS asked why the legislature would address temporary licenses in uncodified law when a disaster declaration would be much simpler and do the same thing. CHAIR COSTELLO explained that SB 86 is one of several bills that have been introduced in the absence of a new disaster declaration that target some of the topics that the governor's SB 56 encompassed. She said this this may or may not be the best approach but it does provide a more deliberative process. 2:04:34 PM SENATOR STEVENS said his concern was the potential to miss some issue that could have been addressed by the disaster declaration. He noted that he learned just yesterday that 15 rules covered under the disaster declaration for education need to be put into uncodified law. For example, many districts have been hiring teachers without certification and that needs to be in some bill. CHAIR COSTELLO said the governor chose not to declare a disaster and he oversees all the executive branch departments. "We're willing to work with the administration on a path forward," she said. 2:05:43 PM MS. MCCALL read the sectional analysis for SB 86 into the record: Sec. 1 AS 08.01.062 Page 1, Lines 4-14 & Page 2,  Line 1  Repeals current statutory language establishing temporary courtesy licenses for nonresidents. Subsection (a) contains new language establishing that the Department of Commerce, Community, and Economic Development has the ability to issue a temporary license, permit, or certificate to an individual who holds a corresponding license, permit, or certificate in another jurisdiction. Subsection (b) establishes that a temporary license, permit, or certificate is valid for one year and allows the license, permit, or certificate holder to temporarily practice the occupation for which it was granted. Sec. 2 AS 08.11.050 Page 2, Lines 2-14 Removes "temporary license" from this section. Renumbers subsections accordingly. Sec. 3 AS 08.13.070 Page 2, Lines 15-31 & Page 3,  Lines 1-11    Amends subsections (1) (6) (7) and (8) by removing "temporary permit" from each subsection. Amends these same subsections by adding language specifying that a temporary license is issued under AS 08.01.062. Adds "temporary supervised practice license" to these same subsections.   MS. MCCALL quoted from a legal memo [from Legislative Counsel Sandon M. Fisher dated February 11, 2021] that explained the rationale for the change. The excerpt read as follows: 3. Under current law, a person who have applied to take the examination for a license to practice as a barber or a hairdresser is eligible to receive a temporary license under AS 08.13.175 so long as the person works under the supervision of a licensee. Similarly, veterinary applicants awaiting examination results are eligible to receive a temporary license under AS 08.98.180 if they practice under supervision. The draft bill changes the name of these license to "temporary supervised practice license." AS 08.63.130 also authorizes a temporary license while waiting to take the examination, but without the supervision requirement. MS. MCCALL explained that "temporary permit" is replaced with "temporary supervised practice license" throughout the bill. Sec. 4 AS 08.13.130(a) Page 3, Lines 12-21  Is amended by removing "or temporary permit" from this section. Adds language specifying that a temporary license is issued under AS 08.01.062. Adds "temporary supervised practice license" to this section. Sec. 5 AS 08.13.150 Page 3, Lines 22-29  Is amended by removing "or temporary permit" from this section. Adds language specifying that a temporary license is issued under AS 08.01.062. Adds "temporary supervised practice license" to this section. Sec. 6 AS 08.13.175 Page 3, Lines 30-31 & Page 4,  Lines 1-11  Changes the title of this section from "temporary license" to "temporary supervised practice license." Removes "be temporarily licensed" from this section and replaces it with "receive a temporary supervised practice license." Inserts language to specify that each temporary license listed in this section is a temporary "supervised practice" license. Sec. 7 AS 08.13.185(a) Page 4, Lines 12-31 & Page 5,  Line 1  Removes "temporary permit" from subsection (a)(12) and renumbers subsections accordingly. Inserts language to specify that a temporary license listed under this section is a temporary "supervised practice" license. 2:10:21 PM Sec. 8 AS 08.13.190 Page 5, Lines 2-15  Amends subsections (a) and (b) by removing "temporary permit" from those subsections. Adds language to subsections (a) and (b) specifying that a temporary license is issued under AS 08.01.062. Adds "temporary supervised practice license" to those subsections. Sec. 9 AS 08.20.180(a) Page 5, Lines 16-22  Is amended by removing language pertaining to the issuance of a temporary permit and a locum tenens permit under this section. Sec. 10 AS 08.36.100 Page 5, Lines 23-26  Removes AS 08.36.254 as an exception to the provision that a person may not practice, or attempt to practice, dentistry without a license. Sec. 11 AS 08.63.130 Page 5, Lines 27-31 & Page 6,  Lines 1-7  Changes the title of this subsection by inserting the word "practice." Inserts language to specify that a temporary license listed under this section is a temporary "practice" license. Sec. 12 AS 08.64.279 Page 6, Lines 8-12 Is amended by removing language pertaining to a temporary permit for locum tenens practice. Sec. 13 AS 08.64.315 Page 6, Lines 13-23  Removes subsection (4) "temporary permit" and subsection (5) "locum tenens permit." Renumbers subsections accordingly. Sec. 14 AS 08.68.220 Page 6, Lines 24-31 & Page 7,  Lines 1-13 Removes "temporary permit" from subsections (1) (2) and (3). Sec. 15 AS 08.80.160 Page 7, Lines 14-27  Removes subsection (5) "temporary license" and subsection (8) "emergency permit." Renumbers subsections accordingly. Sec. 16 AS 08.84.010(b) Page 7, Lines 28-31 & Page 8,  Lines 1-12  Is amended by removing the issuance of "temporary permits" from the State Physical Therapy and Occupational Therapy Board. 2:12:08 PM Sec. 17 AS 08.84.050 Page 8, Lines 13-21 Is amended to remove subsection (5) "temporary permit" and subsection (6) "limited permit." Sec. 18 AS 08.84.150 Page 8, Lines 22-31 & Page 9,  Lines 1-25  Is amended by replacing the word "limited" in subsections (a)(3) and (b)(4) with the word "temporary." The statute referenced in those same subsections is replaced with AS 08.01.062. Sec. 19 AS 08.98.120(a) Page 9, Lines 26-31 & Page 10,  Lines 1-3 Is amended by replacing the statute referenced in subsection (a) with AS 08.01.062. Sec. 20 AS 08.98.180 Page 10, Lines 4-13  Changes the title of this section from "temporary license" to "temporary supervised practice license." Removes "be temporarily licensed" from this section and replaces it with "receive a temporary supervised practice license." Inserts language to specify that a temporary license described in this section is a temporary "supervised practice" license. Sec. 21 AS 08.98.190 Page 10, Lines 14-23  Inserts language specifying that a temporary license listed in this section is a temporary "supervised practice" license. Removes subsection (7) "temporary permit." Sec. 22 Page 10, Lines 24-28 Lists the sections that will be repealed as a result of this Act. Sec. 23 Page 10, Line 29  Establishes an effective date of January 1, 2022. 2:13:39 PM SENATOR GRAY-JACKSON asked for the definition of a locum tenens permit. CHAIR COSTELLO asked Sara Chambers to answer the question. She also asked her to discuss which professions had the most regulations set aside to expedite temporary licensure and whether or not there was already an expedited process in statute for certain professions to receive a temporary license. She noted that the legislature had passed legislation to expedite licenses for military spouses and wondered whether the statutes offered a similar accommodation to nurses or any other profession. 2:15:41 PM SARA CHAMBERS, Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Juneau, Alaska, responded to Senator Gray-Jackson explaining that a locum tenens license is a very specific temporary license that allows someone from out of state to work for a limited and fixed period for a profession, typically in the medical field. She noted that these professionals are sometimes referred to as "travelers." Responding to the chair's question, she offered to follow up with the information. She explained that the division has a variety of types of licenses ranging from a permanent two-year license to a locum tenens temporary license to an emergency curtesy license. All of these licenses differ according to the licensing program and the decisions of the board that oversees the profession. MS. CHAMBERS said she wanted to clarify that while the term "expediting" means moving forward quickly, it should not be interpreted to mean that the requirements for licensure are changed. The applicant still needs to meet all the requirements in statute and regulation. For example, several years ago the legislature required expedited handling of military spouse licenses and the division does move those applications to the front of the line, but there is no special pathway in most of the professions. She said the overseeing boards have not made a concerted effort to adopt the temporary licensing provisions that are allowed under AS 08.010.62. However, the language in SB 86 is similar to Senate Bill 157 that the Governor introduced in 2020. That bill spoke to the need to allow people who are qualified in other jurisdictions to start working in Alaska while they finish the Alaska requirements. If that bill had passed last year, it would have been a useful tool. She said the division is looking at this bill and other options to amend licensing practices to be responsive to the healthcare system and the military. 2:20:07 PM SENATOR REVAK related that the number one issue that he hears from the military is licensure. He noted that he spoke with people from the Department of Defense (DoD) earlier today who said that the average wait nationally for an expedited license is 10 months and Alaska is not one of the better states for expedited licensing. He asked if a temporary license and an expedited full state license were different. MS. CHAMBERS replied that expedited licensure means the application is moved to front of line whereas a temporary license or another type of license allowed in statute or regulation to change the license requirements to offer a license, as SB 86 does, to someone who meets standards that may be slightly different than what is currently in statute. She advised that the division has been working closely with DoD and the military communities for several years to try to change the statute. She said the Governor had several bills last year on this topic, there is the nurse licensure compact this year, and SB 86 would also give the division tools to legally allow this type of license to be issued. The Department of Commerce, Community and Economic Development (DCCED) cannot do this without legislative authority. The overseeing boards may have the ability but they have not moved forward. SB 86 would shift the ability from the boards to the department, which could save weeks to months compared to the time it takes the boards to analyze, review, and vote on a license, which they are required to do. SENATOR REVAK highlighted the concern he heard from DoD about the number of families that have opted not to move to Alaska. Licensure was one of the reasons that has been mentioned. SENATOR REVAK asked the average time to process out of state occupational licenses when they are and are not expedited and the time it takes to receive a temporary license. 2:24:08 PM MS. CHAMBERS answered that each license type takes a different amount of time because each is governed separately in statute and regulation. The problem is not with the agency review but with the number and level of statutory and regulatory requirements the applicant must fulfill. Some applicants have hundreds of documents they must supply from educational institutions and previous employers. This bogs them down and it is beyond the division's control. Once the applicant has sent all the required documentation, which can take weeks or months depending on the sophistication of the license requirements, the division conducts the internal staff review and sends the application to the relevant board for its review, which takes several additional weeks. When an applicant is moved to the front of the line, the review can be shortened from six weeks to two weeks, but that is on top of the time it takes to supply all the documentation that statute and regulation require. MS. CHAMBERS said expediting the process after the statutory and regulatory documentation has been supplied is different than looking at the structure of the law and making a decision to do things differently, which is what SB 86 does. Right now, military spouses can have their application moved to the front of the line but they still have to meet all the same requirements as other applicants. The speed with which they pull the requirements together is in their hands for part of it but some of it is outside their control. MS. CHAMBERS said putting temporary licensure in the department's hands and helping to change the structure to give military spouses the chance to work while they finish the requirements for full licensure is a fundamental structure change that also transfers to health care and all the other professions that have to go through her office. 2:27:46 PM SENATOR REVAK indicated his wish to see closure on the issue and committed to continue to work to that end. 2:28:25 PM CHAIR COSTELLO asked Ms. Chambers how many of the 14 pages of regulations waived by the disaster declaration affected the division and which ones were people asking for now that the legislature might be able to accommodate without a disaster declaration. 2:30:41 PM MS. CHAMBERS said she appreciated the tools the legislature provided in 2020 through Senate Bill 241 that made it possible for the department to respond quickly to the changing healthcare and economic needs during the COVID-19 pandemic. She reported that all the statutory and regulatory suspensions pertaining to her division were elements to assist with the economic downturn that all states faced. She explained that the first element was the ability for the division's professional boards and the department to issue curtesy licenses on an expedited basis. That provided an opportunity for all professions to get people licensed who needed to continue to care for Alaskans who could no longer travel. The curtesy licensing opened an opportunity for mental health boards to help students who returned to Alaska from college but still needed professional psychological care. Curtesy licenses were moved quickly for those providers. She said another area that was in Senate Bill 241 that the Governor continued was a provision to allow physicians, physician assistants (PAs), and nurses who were licensed in other states to be able to provide limited telehealth to Alaskans without getting a license in Alaska. This was important to help the Alaskans who cannot travel to see specialty providers that may not be available in Alaska. She noted that out of state specialty providers who are not licensed in Alaska are not able to deliver telehealth care to their patients while they are in Alaska. That is what the telehealth provision under the emergency disaster declaration accomplished. MS. CHAMBERS said another provision in licensing that affected the division was finger printing. During the early stages of the COVID-19 pandemic in 2020, finger printers would not see people in person so the department worked with the Department of Public Safety through a federal compact to pause fingerprinting until people were able to get those done in person. She said the Governor also continued the provision in Senate Bill 241 to give nonprofits, corporations, and Native corporations the ability to meet virtually as long as the entity had rules for that. She said this continuing need is under the purview of the division. 2:37:25 PM CHAIR COSTELLO highlighted SB 24 that addresses the issue of corporations meeting virtually and SB 78 that relates to telehealth as examples of the legislature trying to be responsive to changing needs as well as making the statutes more COVID aware. She asked if more nurses and locum tenens came to Alaska during the pandemic. MS. CHAMBERS replied there was already a shortage of nurses and other providers before the pandemic. She said the division issued more than 300 expedited emergency curtesy licenses to nurses and several 100 more licenses for physicians and mental health providers. She reminded members that the issue with licensing is that it is a passthrough; applicants must meet the legal requirements to obtain the document that allows them to work legally. She said the nurse licensure compact is not before the committee but the foregoing speaks to the need for statutory streamlining. SB 86 works toward that and the Governor proposed this legislation last year to get ahead of it. 2:42:17 PM CHAIR COSTELLO asked if she believes that it would be helpful for the department to have the authority to pass regulations to issue temporary licenses for those professions that the boards currently administer. MS. CHAMBERS replied it would help the department to have that final authority. She clarified that the department would continue to work in partnership with their boards and commissions to ensure continued high public safety standards and review so this administrative streamlining would not degrade the process. CHAIR COSTELLO asked for an explanation of the changes throughout the bill from "temporary license" to "temporary supervised practice license." 2:46:14 PM MS. CHAMBERS replied she did not know the intent but in practice it means that the department would be able to issue a temporary license and the board would retain the ability to issue a supervised practice license. She noted that boards often use this authority to allow somebody who is in a student or journey phase to work under a person who is fully licensed. She offered to work with the chair's staff to learn more about the intent of the change. SENATOR GRAY-JACKSON asked for the number of certified nursing assistant (CNA) vacancies statewide. MS. CHAMBERS replied she would follow up with the data point but the department has known for a long time that there is a shortage in Alaska. She noted that the Board of Nursing, which oversees CNA licenses, just adopted emergency regulations to help CNA programs bolster their ability to recruit and retain faculty for those programs. The intention is to make those regulations permanent. SENATOR GRAY-JACKSON asked for the number of hours required for CNA certification. MS. CHAMBERS replied she would follow up with the information. 2:48:43 PM CHAIR COSTELLO held SB 86 in committee for future consideration.