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