00 CS FOR HOUSE BILL NO. 293(L&C) 01 "An Act relating to the practice of genetic counseling; relating to the licensure of genetic 02 counselors; establishing the Genetic Counseling Advisory Council; relating to the duties 03 of the State Medical Board; relating to telehealth by licensed genetic counselors; relating 04 to medical malpractice liability of licensed genetic counselors; relating to immunity from 05 civil liability for a licensed genetic counselor providing free health care services; and 06 prohibiting unfair discrimination under group health insurance against genetic 07 counselors." 08 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 09  * Section 1. AS 08.02.110(a) is amended to read: 10 (a) An acupuncturist licensed under AS 08.06, an audiologist or speech- 11 language pathologist licensed under AS 08.11, a behavior analyst licensed under 12 AS 08.15, a person licensed in the state as a chiropractor under AS 08.20, a 13 professional or associate counselor licensed under AS 08.29, a dentist under AS 08.36, 01 a dietitian or nutritionist licensed under AS 08.38, a genetic counselor licensed  02 under AS 08.53, a massage therapist licensed under AS 08.61, a marital and family 03 therapist licensed under AS 08.63, a medical practitioner or osteopath under AS 08.64, 04 a direct-entry midwife certified under AS 08.65, a registered or advanced practice 05 registered nurse under AS 08.68, an optometrist under AS 08.72, a licensed 06 pharmacist under AS 08.80, a physical therapist or occupational therapist licensed 07 under AS 08.84, a psychologist under AS 08.86, or a clinical social worker licensed 08 under AS 08.95, shall use as professional identification appropriate letters or a title 09 after that person's name that represents the person's specific field of practice. The 10 letters or title shall appear on all signs, stationery, or other advertising in which the 11 person offers or displays personal professional services to the public. In addition, a 12 person engaged in the practice of medicine or osteopathy as defined in AS 08.64.380, 13 or a person engaged in any manner in the healing arts who diagnoses, treats, tests, or 14 counsels other persons in relation to human health or disease and uses the letters 15 "M.D." or the title "doctor" or "physician" or another title that tends to show that the 16 person is willing or qualified to diagnose, treat, test, or counsel another person, shall 17 clarify the letters or title by adding the appropriate specialist designation, if any, such 18 as "dermatologist," "radiologist," "audiologist," "naturopath," or the like. 19  * Sec. 2. AS 08.02.130(j)(1) is amended to read: 20 (1) "health care provider" means 21 (A) an audiologist or speech-language pathologist licensed 22 under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor 23 licensed under AS 08.20; a professional or associate counselor licensed under 24 AS 08.29; a dental hygienist licensed under AS 08.32; a dentist licensed under 25 AS 08.36; a dietitian or nutritionist licensed under AS 08.38; a naturopath 26 licensed under AS 08.45; a genetic counselor licensed under AS 08.53; a 27 marital and family therapist licensed under AS 08.63; a physician licensed 28 under AS 08.64; a podiatrist, osteopath, or physician assistant licensed under 29 AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse licensed 30 under AS 08.68; a dispensing optician licensed under AS 08.71; an optometrist 31 licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical 01 therapist or occupational therapist licensed under AS 08.84; a psychologist or 02 psychological associate licensed under AS 08.86; or a social worker licensed 03 under AS 08.95; or 04 (B) a physician licensed in another state; or 05 (C) a member of a multidisciplinary care team who is licensed 06 in another state; 07  * Sec. 3. AS 08.02.130(j)(4) is amended to read: 08 (4) "member of a multidisciplinary care team" means an audiologist, 09 speech-language pathologist, behavior analyst, professional counselor, dietitian, 10 genetic counselor, nutritionist, naturopath, marital and family therapist, podiatrist, 11 osteopath, physician assistant, nurse, pharmacist, physical therapist, occupational 12 therapist, psychologist or psychological associate, advanced nurse practitioner, or 13 social worker who is a member of a team coordinated by a physician licensed in 14 another state who meets the requirements of (b)(3) of this section; 15  * Sec. 4. AS 08 is amended by adding a new chapter to read: 16 Chapter 53. Genetic Counselors.  17 Article 1. Licensing of Genetic Counselors.  18 Sec. 08.53.100. License required; title. (a) Except as provided in 19 AS 08.53.150 and 08.53.210, a person may not practice, offer or attempt to practice, or 20 advertise or announce as being prepared or qualified to practice as a genetic counselor 21 without a license. 22 (b) Unless licensed under this chapter or excepted from licensure under 23 AS 08.53.210(a), a person may not use or publicly display a title in connection with 24 the person's name, including "genetic counselor," "licensed genetic counselor," "gene 25 counselor," "genetic consultant," "genetic associate," or a similar title or associated 26 letters, abbreviations, or insignia indicating that the person holds a genetic counseling 27 license. 28 Sec. 08.53.110. Qualifications for license. The board shall issue a license to 29 practice genetic counseling to an applicant who 30 (1) pays the required fees and applies on a form prescribed by the 31 board; and 01 (2) provides evidence satisfactory to the board that the applicant 02 (A) has successfully completed a certification program in 03 genetic counseling or medical genetics that, at the time of graduation, is 04 accredited by a nationally recognized certifying organization for genetic 05 counseling or medical genetics and approved by the board in regulation; 06 (B) has passed a certified genetic counselor examination 07 provided by a nationally recognized certifying organization for genetic 08 counseling or medical genetics approved by the board in regulation; 09 (C) unless the license was later reinstated, has not had a license 10 to practice genetic counseling revoked, suspended, or, while under 11 investigation, has not voluntarily surrendered a license, in this state or another; 12 and 13 (D) is not the subject of an unresolved or adverse decision 14 based on a complaint, investigation, review procedure, or other disciplinary 15 proceeding undertaken by a state, territorial, local, or federal genetic 16 counseling licensing jurisdiction or law enforcement agency that relates to 17 criminal or fraudulent activity, genetic counseling malpractice, or negligent 18 genetic counseling and that adversely reflects on the applicant's ability or 19 competence to practice as a genetic counselor or on the safety or well-being of 20 a patient or client. 21 Sec. 08.53.120. Temporary license. The board shall issue a temporary license 22 to practice genetic counseling for up to one year to an applicant who meets the 23 requirements of AS 08.53.110(1), (2)(A), (2)(C), and (2)(D), and has met the 24 requirement to take the examination required under AS 08.53.110(2)(B), but has either 25 not taken the examination or has not received examination results. A genetic counselor 26 working under a temporary license shall work under the general supervision of a 27 licensed genetic counselor or a licensed physician. A temporary license terminates 30 28 days after the holder of the temporary license fails to pass the examination. 29 Sec. 08.53.130. Licensure by credentials. The board may issue a license to 30 practice genetic counseling to an applicant who pays the required fees and provides 31 satisfactory evidence to the board that the applicant holds an equivalent valid license 01 issued by another state, territory, or jurisdiction of the United States. 02 Sec. 08.53.140. Renewal of license; continuing education. (a) The board 03 shall renew the license of a licensee who applies for renewal on a form provided by 04 the board, pays the required fee, provides evidence of continued competency in 05 accordance with regulations adopted by the board, and provides evidence satisfactory 06 to the board that the licensee meets the requirements of either (b) or (c) of this section. 07 (b) A licensee shall provide with an application to renew the license evidence 08 satisfactory to the board demonstrating the licensee has completed, within two years 09 immediately preceding the application, 50 continuing education units provided by a 10 nationally recognized certifying organization for genetic counseling or medical 11 genetics that is approved by the board in regulation. 12 (c) A licensee may submit a written request to the board to waive or reduce 13 the continuing education requirements under (b) of this section or grant an extension 14 of time in which the continuing education requirements must be completed. The board 15 may grant the request if the licensee was unable to complete the continuing education 16 requirements because 17 (1) of an illness of the licensee or of a family member for whom the 18 licensee provides care; 19 (2) the licensee experienced another demonstrated hardship that 20 substantially interfered with the licensee's ability to complete the continuing education 21 requirements; or 22 (3) approved continuing education units were not reasonably available 23 to the licensee.  24 Sec. 08.53.150. Genetic counseling intern. (a) A person enrolled as a student 25 in a certification program in genetic counseling or medical genetics that is accredited 26 by a nationally recognized certifying organization for genetic counseling or medical 27 genetics and approved by the board in regulation may perform genetic counseling 28 services using the title of genetic counseling intern if the services 29 (1) performed are an integral part of the student's course of study; and 30 (2) are performed under the direct supervision of a licensed genetic 31 counselor who is assigned to supervise the student. 01 (b) In this section, "direct supervision" means supervision that is on-site or 02 available by visual or real-time electronic means through which a supervising licensed 03 genetic counselor guides the genetic counseling intern while the genetic counseling 04 intern performs a clinical activity; "direct supervision" may include demonstration, 05 coaching, and observation to the extent that the demonstration, coaching, or 06 observation otherwise meets the requirements of this subsection. 07 Article 2. Regulation of Genetic Counselors.  08 Sec. 08.53.160. Scope of practice of genetic counselors. A licensed genetic 09 counselor may 10 (1) obtain and evaluate individual, family, and medical histories to 11 determine genetic risk for medical conditions and diseases in a patient or client or a 12 patient's or client's family members, including future potential children of the patient 13 or client; 14 (2) discuss the features, natural history, means of diagnosis, genetic 15 and environmental factors, and management of risk for genetic or medical conditions 16 or diseases with a patient or client; 17 (3) identify, order, and coordinate genetic laboratory tests and other 18 diagnostic studies as appropriate for the genetic assessment of a patient or client; 19 (4) integrate genetic laboratory test results and other diagnostic studies 20 with a patient's or client's personal and family medical history to assess and 21 communicate risk factors for genetic or medical conditions and diseases; 22 (5) explain the results and clinical implications of genetic laboratory 23 tests and other diagnostic studies to a patient or client; 24 (6) evaluate a patient's or client's or the patient's or client's family's 25 responses to, risk of, or risk of the recurrence of a medical condition or disease, and 26 provide related counseling and anticipatory guidance centered on the patient or client; 27 (7) use and provide referrals for community and online resources for 28 medical, educational, financial, and psychosocial support and advocacy to patients, 29 clients, families, and health care professionals; and 30 (8) provide written clinical documentation of medical, genetic, and 31 counseling information to patients, clients, families, and health care professionals. 01 Sec. 08.53.170. Disciplinary sanctions. (a) In addition to the board's powers 02 under AS 08.01.075, the board may revoke or suspend the license of a genetic 03 counselor, or may reprimand, censure, or discipline a licensee, if, after a hearing, the 04 board finds that the licensee 05 (1) used or knowingly cooperated in deceit, fraud, or intentional 06 misrepresentation to obtain a license; 07 (2) engaged in unprofessional conduct in the course of providing 08 professional services; 09 (3) violated the code of ethics adopted by the board; 10 (4) violated any provision of this chapter, a regulation adopted under 11 this chapter, or an order issued by the board; or 12 (5) has been convicted of a felony or a crime that involves moral 13 turpitude. 14 (b) The board may reinstate a revoked license if the licensee applies for 15 reinstatement of the revoked license at least one year after the revocation and, after a 16 hearing, the board finds that the licensee is able to practice the profession with skill 17 and safety. 18 Article 3. Genetic Counseling Advisory Council.  19 Sec. 08.53.180. Genetic Counseling Advisory Council. (a) The board shall 20 establish the Genetic Counseling Advisory Council for the purpose of advising the 21 board on matters relating to administering this chapter. 22 (b) The council consists of at least three and not more than five members 23 appointed by the board. A majority membership of the council must be licensed 24 genetic counselors. The council must include at least one licensed physician. If the 25 council has five members, the council may include one public member. A public 26 member of the council may not 27 (1) be engaged in the occupation that the board regulates; 28 (2) be associated by legal contract with a member of the occupation 29 that the board regulates except as a consumer of the services provided by a practitioner 30 of the occupation; or 31 (3) have a direct financial interest in the occupation that the board 01 regulates. 02 (c) The council shall meet at least annually or as necessary to conduct 03 business. The council may meet at the call of the chair, by the written request of a 04 majority of the council members, or at the request of the board. 05 (d) At the first meeting of the council, and annually thereafter, the council 06 shall elect from its membership a chair, vice chair, and secretary. An officer shall 07 serve until a successor is elected. 08 (e) A majority of the members of the council constitute a quorum. 09 (f) Members of the council serve staggered terms of three years. A council 10 member may not be appointed for more than three consecutive full terms. If a vacancy 11 occurs, the board shall appoint a qualified person to fill the unexpired portion of the 12 term. The board may remove a council member if the council member 13 (1) during the term of service, no longer meets the qualifications 14 required for appointment to the council; 15 (2) fails to attend council meetings for a period of one year; 16 (3) is found by the board to be in violation of a provision of this 17 chapter. 18 (g) Members of the council are not entitled to per diem and travel expenses 19 authorized for boards and commissions under AS 39.20.180. 20 Article 4. General Provisions.  21 Sec. 08.53.200. Application of Administrative Procedure Act. AS 44.62 22 (Administrative Procedure Act) applies to any action taken by the board under this 23 chapter. 24 Sec. 08.53.210. Exceptions to application of chapter. (a) This chapter does 25 not apply to a genetic counselor who is 26 (1) in the miliary service in the discharge of official duties; 27 (2) in the employ of the United States Public Health Service, United 28 States Department of Veterans Affairs, United States Indian Health Service, or another 29 agency of the federal government, in the discharge of official duties; 30 (3) licensed in another state or jurisdiction who is teaching or 31 demonstrating clinical techniques at a meeting, seminar, or limited course of 01 instruction sponsored by a genetic counseling society or association or by an 02 accredited genetic counseling or medical genetics educational institution; 03 (4) employed in the state by an Indian health program, as that term is 04 defined in 25 U.S.C. 1603, while providing genetic counseling services to a person the 05 Indian health program is entitled to serve under 25 U.S.C. 5301 - 5332 (Indian Self- 06 Determination and Education Assistance Act), as amended, and 25 U.S.C. 1601 et seq. 07 (Indian Health Care Improvement Act), as amended. 08 (b) A health care provider licensed in the state who is not a licensed genetic 09 counselor may provide genetic information, education, and support consistent with the 10 scope of the health care provider's practice, education, and training. 11 (c) A person excepted from this chapter under (a) of this section is held to the 12 same standard of care as a person covered by this chapter. 13 Sec. 08.53.220. Penalty. A person who violates a provision of this chapter or a 14 regulation adopted under this chapter for which a penalty is not otherwise provided is 15 guilty of a class B misdemeanor. 16 Sec. 08.53.230. Regulation of genetic counselors; powers of the board. (a) 17 In consultation with the Genetic Counseling Advisory Council established under 18 AS 08.53.180, the board shall adopt regulations necessary to carry out the purposes of 19 AS 08.53 regarding the licensure of genetic counselors and regulation of services a 20 genetic counselor may perform. The regulations must include the adoption of a code 21 of ethics for genetic counselors based on nationally recognized ethical standards for 22 genetic counselors. 23 (b) The board shall have the power to administer oaths, subpoena witnesses, 24 and compel the production of documents pertinent to carrying out duties imposed by 25 this chapter. 26 Sec. 08.53.300. Definitions. In this chapter, 27 (1) "board" means the State Medical Board; 28 (2) "licensed genetic counselor" means a genetic counselor licensed 29 under this chapter. 30  * Sec. 5. AS 08.64.101(a) is amended to read: 31 (a) The board shall 01 (1) except as provided in regulations adopted by the board under (b) of 02 this section, examine and issue licenses to applicants; 03 (2) develop written guidelines to ensure that licensing requirements are 04 not unreasonably burdensome and the issuance of licenses is not unreasonably 05 withheld or delayed; 06 (3) after a hearing, impose disciplinary sanctions on persons who 07 violate this chapter, AS 08.53, or the regulations or orders of the board; 08 (4) adopt regulations ensuring that renewal of licenses is contingent on 09 proof of continued competency on the part of the licensee; 10 (5) under regulations adopted by the board, contract with private 11 professional organizations to establish an impaired medical professionals program to 12 identify, confront, evaluate, and treat persons licensed under this chapter who abuse 13 alcohol, other drugs, or other substances or are mentally ill or cognitively impaired; 14 (6) adopt regulations that establish guidelines for a physician or 15 physician assistant who is rendering a diagnosis, providing treatment, or prescribing, 16 dispensing, or administering a prescription drug to a person without conducting a 17 physical examination under AS 08.64.364; the guidelines must include a nationally 18 recognized model policy for standards of care of a patient who is at a different location 19 than the physician or physician assistant; 20 (7) require that a licensee who has a federal Drug Enforcement 21 Administration registration number register with the controlled substance prescription 22 database under AS 17.30.200(n). 23  * Sec. 6. AS 08.64.103(a) is amended to read: 24 (a) After consulting with the board, the department shall employ two persons 25 who are not members of the board; one shall be assigned as the investigator for the 26 board; the other shall be assigned as the executive secretary for the board. The 27 investigator shall 28 (1) conduct investigations into alleged violations of this chapter,  29 violations of AS 08.53, and into alleged violations of regulations and orders of the 30 board; 31 (2) at the request of the board, conduct investigations based on 01 complaints filed with the department or with the board; [AND] 02 (3) be directly responsible and accountable to the board, except that 03 only the department has authority to terminate the investigator's employment and the 04 department shall provide day-to-day [DAY TO DAY] and administrative supervision 05 of the investigator; and  06 (4) in consultation with the Genetic Counseling Advisory Council,  07 ensure that applicants for a license or renewal meet the applicable requirements  08 under AS 08.53 and established by the board. 09  * Sec. 7. AS 08.64.130(a) is amended to read: 10 (a) The board shall preserve a record of its proceedings, which must contain 11 the name, age, residence, and duration of residence of each applicant for a license 12 under this chapter, the time spent by the applicant in medical study, the place of 13 medical study, and the year and school from which degrees were granted. The record 14 must also show whether the applicant was granted a license or rejected. 15  * Sec. 8. AS 09.55.560(2) is amended to read: 16 (2) "health care provider" means an acupuncturist licensed under 17 AS 08.06; an audiologist or speech-language pathologist licensed under AS 08.11; a 18 chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a 19 dentist licensed under AS 08.36; a genetic counselor licensed under AS 08.53; a 20 nurse licensed under AS 08.68; a dispensing optician licensed under AS 08.71; a 21 naturopath licensed under AS 08.45; an optometrist licensed under AS 08.72; a 22 pharmacist licensed under AS 08.80; a physical therapist or occupational therapist 23 licensed under AS 08.84; a physician or physician assistant licensed under AS 08.64; a 24 podiatrist; a psychologist and a psychological associate licensed under AS 08.86; a 25 hospital as defined in AS 47.32.900, including a governmentally owned or operated 26 hospital; an employee of a health care provider acting within the course and scope of 27 employment; an ambulatory surgical facility and other organizations whose primary 28 purpose is the delivery of health care, including a health maintenance organization, 29 individual practice association, integrated delivery system, preferred provider 30 organization or arrangement, and a physical hospital organization; 31  * Sec. 9. AS 09.65.300(c)(1) is amended to read: 01 (1) "health care provider" means a physician, physician assistant, 02 dentist, dental hygienist, osteopath, optometrist, chiropractor, registered nurse, 03 practical nurse, advanced practice registered nurse, naturopath, physical therapist, 04 occupational therapist, marital and family therapist, psychologist, psychological 05 associate, behavior analyst, assistant behavior analyst, licensed clinical social worker, 06 athletic trainer, certified direct-entry midwife, genetic counselor, licensed 07 professional counselor, or licensed associate counselor; 08  * Sec. 10. AS 21.36.090(d) is amended to read: 09 (d) Except to the extent necessary to comply with AS 21.42.365 and 10 AS 21.56, a person may not practice or permit unfair discrimination against a person 11 who provides a service covered under a group health insurance policy that extends 12 coverage on an expense incurred basis, or under a group service or indemnity type 13 contract issued by a health maintenance organization or a nonprofit corporation, if the 14 service is within the scope of the provider's occupational license. In this subsection, 15 "provider" means a state licensed physician, physician assistant, dentist, osteopath, 16 optometrist, chiropractor, advanced practice registered nurse, pharmacist, naturopath, 17 physical therapist, occupational therapist, marital and family therapist, psychologist, 18 psychological associate, licensed clinical social worker, licensed professional 19 counselor, licensed associate counselor, certified direct-entry midwife, genetic  20 counselor, or dental hygienist holding an advanced practice permit. 21  * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to 22 read: 23 TRANSITION: CURRENT GENETIC COUNSELORS. Notwithstanding the 24 licensing requirement of AS 08.53.100, enacted by sec. 4 of this Act, a person who, on the 25 day before the effective date of this Act, is engaged in the practice of genetic counseling, may 26 continue to practice genetic counseling without a license issued under AS 08.53 by the State 27 Medical Board until July 1, 2027. 28  * Sec. 12. The uncodified law of the State of Alaska is amended by adding a new section to 29 read: 30 TRANSITION: INITIAL MEMBERS OF THE GENETIC COUNSELING 31 ADVISORY COUNCIL. (a) The State Medical Board shall appoint the initial members of the 01 Genetic Counseling Advisory Council established in sec. 4 of this Act during the first meeting 02 of the board following the effective date of this Act. 03 (b) Notwithstanding AS 08.53.180(b), enacted by sec. 4 of this Act, a person who is 04 engaged in the practice of genetic counseling on the day before the effective date of this Act 05 may be appointed by the State Medical Board as an initial member of the Genetic Counseling 06 Advisory Council without a license issued under AS 08.53 by the State Medical Board. A 07 person appointed under this subsection may only continue to serve on the Genetic Counseling 08 Advisory Council after July 1, 2027, if the person obtains a license issued under AS 08.53 by 09 the State Medical Board on or before July 1, 2027.