Legislature(2021 - 2022)BARNES 124
03/31/2021 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB126 | |
| HB111 | |
| HB151 | |
| HB111 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 111 | TELECONFERENCED | |
| *+ | HB 126 | TELECONFERENCED | |
| += | HB 151 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 111-DENTAL HYGIENIST ADVANCED PRAC PERMIT
3:43:16 PM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 111, "An Act relating to the practice of
dental hygiene; relating to advanced practice permits for dental
hygienists; relating to dental assistants; prohibiting unfair
discrimination under group health insurance against a dental
hygienist who holds an advanced practice permit; relating to
medical assistance for dental hygiene services; and providing
for an effective date."
3:43:40 PM
REPRESENTATIVE SPOHNHOLZ explained that HB 111 would create an
advanced practice permit allowing experienced, licensed dental
hygienists to provide preventative oral health care to
underserved populations, as well as to those who are eligible
for public assistance, are homebound, or who live in an
underserved community. She said that the permit would be
available to dental hygienists who have a minimum of 4,000 hours
of applied clinical experience and are approved by the Alaska
Board of Dental Examiners.
3:44:30 PM
REPRESENTATIVE MCCARTY recalled that the last time HB 111 was
presented, he had asked for clarification on the 4,000 hours.
REPRESENTATIVE SPOHNHOLZ expressed that there was a
miscommunication. She said that a dental hygienist goes through
an educational program, becomes a licensed dental hygienist, and
then can practice in the community under the supervision of a
dentist. HB 111 would create an advanced practice permit that
would require 4,000 hours of clinical experience. She
introduced Ms. Virgin to provide more clarity on the matter.
3:46:15 PM
KATRINA VIRGIN, President, Alaska Dental Hygienists'
Association, said that Representative McCarty's assertion that
the requirement of 8,000 hours is incorrect; the requirement
would be 4,000 of clinical experience under the supervision of a
dentist.
3:47:09 PM
REPRESENTATIVE MCCARTY expressed understanding of the
requirement of 4,000 hours of clinical experience and five or
more years in the field, but said that he doesn't see
educational requirements in the proposed legislation. He then
said that after the previous committee meeting, he studied the
other states with an advanced practice permit equivalent, in an
effort to understand their criteria. He shared his perception
that the other states have higher criteria than Alaska would
have under the proposed legislation, and mentioned being
concerned about reciprocity. He asked Ms. Virgin to address the
concern.
MS. VIRGIN characterized the requirements under HB 111 as
"double" what the other states mandate. For example, she said,
Washington's advanced practice permit requires two years'
experience, which is approximately the same as what is proposed
under HB 111. Maine's advanced practice permit, established in
2008, requires 2,000 hours of clinical experience.
Massachusetts' permit, established in 2009, asks for 3 years'
experience. Connecticut's permit, established in 1999, requires
2 years' experience. Colorado's permit, established in 1987,
has no additional requirements after graduation.
REPRESENTATIVE MCCARTY asked whether all of the aforementioned
states require a bachelor's degree to be a dental hygienist.
MS. VIRGIN replied that they do not.
REPRESENTATIVE MCCARTY expressed understanding that some other
states require a dental hygienist to have a bachelor's degree,
take special courses, and pass an exam on law and ethics. He
said that he doesn't see such language in the proposed
legislation.
MS. VIRGIN said that she's not sure what he's referring to as
far as continuing education required by other states. She said
that Alaska requires continuing education credits in order for
dental hygienists to renew their licenses, which is every two
years.
REPRESENTATIVE MCCARTY agreed that dental hygienists have
continuing education requirements, but he said that he doesn't
know how many credits are required. He expressed understanding
that obtaining the advanced practice permit under HB 111 would
mean having the ability to practice independently and stated
that the permit would come with higher standards for the
practitioner. He expressed concern about how to ensure public
safety. He stated that other states require a certain amount of
experience and "almost double" the continuing education
requirements, and that an individual would hold a dental
hygienist license as well as an advanced license. He then
restated his perception that the standard for advanced practice
dental hygienists in Alaska would be lower than the standards in
other states, and expressed concern that such a dental hygienist
from Alaska would not be recognized in another state.
3:52:41 PM
REPRESENTATIVE SPOHNHOLZ offered to clarify that HB 111, in
creating the advanced practice permit requiring 4,000 hours of
clinical practice on top of a bachelor's degree, would be the
highest standard in the nation for this type of permit. She
pointed out that Ms. Virgin explained that other states require
between 2,000 and 3,000 hours of clinical experience, while
Alaska would require 4,000. She said that Ms. Virgin also
stated that not every state requires a bachelor's degree to
become a dental hygienist, and said that achieving a bachelor's
degree is the first step in the process, followed by 4,000 hours
of clinical experience, followed then by the application for the
advanced practice permit. She stressed that the standards under
HB 111 would be the highest in the nation, and she expressed
reluctance at the idea of "backing up" standards in Alaska in
order to establish reciprocity with other states. She
reiterated her earlier statement that this proposed legislation
is the result of a carefully crafted compromise between the
Alaska Dental Hygienists' Association and the Alaska Dental
Society.
3:54:01 PM
REPRESENTATIVE KAUFMAN asked Ms. Virgin to comment on AS
08.36.075, which establishes standards regarding dental
radiological equipment, and how it would translate to the
statutes amended by HB 111.
MS. VIRGIN directed attention to an amendment which would change
page 2, line 17, of the proposed legislation and quoted, "expose
and develop radiography, and maintain and register dental
radiological equipment as provided in AS 08.36.075." She said
that it refers to current statutes and regulations already in
effect.
3:55:40 PM
REPRESENTATIVE SPOHNHOLZ added that there is a draft amendment
addressing radiological equipment.
CO-CHAIR FIELDS suggesting returning to the question of
radiological equipment after the amendments.
REPRESENTATIVE KAUFMAN said, "That specific amendment is not
present."
REPRESENTATIVE SPOHNHOLZ said that if Representative Kaufman was
not satisfied with the answer, an amendment could be offered to
reference the specific statute. She also said that dental
hygienists in the state of Alaska are already required to adhere
to AS 08.36.075, and that she's comfortable amending the
proposed legislation to be more specific, if necessary.
REPRESENTATIVE KAUFMAN said that he would like the amendment in
order to avoid confusion.
3:56:54 PM
REPRESENTATIVE SNYDER, referring to the earlier comments from
Representative McCarty regarding possible license reciprocity,
asked whether dental hygienists moving from other states would
"not necessarily be required" to have earned their license
following achievement of a bachelor's degree.
MS. VIRGIN replied, "That is correct."
3:57:39 PM
CO-CHAIR FIELDS asked Mr. Logan to confirm that the Alaska
Dental Society is comfortable with the proposed legislation. He
said that he wants to ensure expansion of services to
underserved areas without destabilizing the market for
established dentists.
3:58:18 PM
DAVID LOGAN, DDS, Executive Director, Alaska Dental Society,
stated that the Alaska Dental Society supports HB 111. He
expressed that all health care practitioners should be used at
their "best and highest levels," and the proposed legislation is
an opportunity for dental hygienists to expand their practice
opportunities while filling a need in underserved communities.
3:59:04 PM
The committee took an at-ease from 3:59 p.m. to 4:00 p.m.
4:00:46 PM
CO-CHAIR FIELDS moved to adopt Amendment 1 to HB 111, labeled
32-LS0480\A.1, Fisher, 3/30/21, which read as follows:
Page 3, line 31, through page 4, line 1:
Delete all material.
Reletter the following subsection accordingly.
4:01:03 PM
REPRESENTATIVE KAUFMAN objected for the purpose of discussion.
4:01:08 PM
CO-CHAIR FIELDS explained that he has concerns that the term
"independent contractor" could have implications regarding labor
laws. He said that he developed Amendment 1 in coordination
with Representative Spohnholz, and he asked for her confirmation
that Amendment 1 is a friendly amendment.
4:01:48 PM
REPRESENTATIVE SPOHNHOLZ agreed that Amendment 1 is a friendly
amendment.
4:02:06 PM
REPRESENTATIVE MCCARTY noted that an advanced dental hygienist
could be an employer, which means different labor laws would
apply.
CO-CHAIR FIELDS responded that the passage of House Bill 79
during the Thirtieth Alaska State Legislature codified decades
of case law in terms of the relationship between employees,
independent contractors, and employers. He said that it's best
to follow that statute for consistency.
4:03:18 PM
REPRESENTATIVE SPOHNHOLZ stated that Amendment 1 would not
prohibit an advanced practice dental hygienist from establishing
a business.
REPRESENTATIVE MCCARTY asked whether the language regarding
being an independent contractor is needed.
CO-CHAIR FIELDS said it is not needed.
REPRESENTATIVE KAUFMAN asked why the language was originally
written into the proposed legislation.
CO-CHAIR FIELDS replied it was intended to refer to a dental
hygienist practicing independently, without the direct
supervision of a dentist; however, the intention has been
adequately addressed in other sections of the bill.
REPRESENTATIVE SPOHNHOLZ said, "That is correct."
4:04:56 PM
REPRESENTATIVE KAUFMAN removed his objection to the motion to
adopt Amendment 1. There being no further objection, Amendment
1 was adopted.
4:05:03 PM
CO-CHAIR FIELDS asked if anyone else objected to Amendment 1.
There being no further objection, Amendment 1 was adopted.
4:05:09 PM
REPRESENTATIVE KAUFMAN moved to adopt Amendment 2, labeled 32-
LS0180\A.7, Fisher, 3/30/21, which read as follows:
Page 3, line 1:
Delete "receive"
Insert "access"
4:05:12 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
4:05:17 PM
REPRESENTATIVE KAUFMAN explained that Amendment 2 would change
the accuracy of the subsection.
4:05:29 PM
REPRESENTATIVE SPOHNHOLZ expressed that the word "access" is
more precise, therefore, she supports Amendment 2.
4:05:39 PM
CO-CHAIR FIELDS removed his objection. There being no further
objection, Amendment 2 was adopted.
4:06:02 PM
The committee took a brief at-ease.
4:06:52 PM
REPRESENTATIVE KAUFMAN moved to adopt Amendment 3, labeled 32-
LS0480\A.8, Fisher, 3/30/21, which read as follows:
Page 2, lines 5 - 29:
Delete all material and insert:
"Sec. 08.32.125. Advanced practice permits. (a)
The board may issue an advanced practice permit to a
licensed dental hygienist with a minimum of 4,000
documented hours of clinical experience. A licensed
dental hygienist holding an advanced practice permit
may
(1) promote oral health and provide disease
prevention education and oral systemic health
education;
(2) remove calcareous deposits, accretions,
and stains from the exposed surfaces of the teeth
beginning at the epithelial attachment by scaling and
polishing techniques;
(3) apply topical preventive or
prophylactic agents, including silver diamine
fluoride, fluoride varnishes, and pit and fissure
sealants;
(4) remove marginal overhangs;
(5) perform preliminary charting and triage
to formulate a dental hygiene assessment and dental
hygiene treatment plan;
(6) expose and develop radiographs;
(7) use local periodontal therapeutic
agents;
(8) perform nonsurgical periodontal
therapy;
(9) screen for oral cancer;
(10) if certified by the board, administer
local anesthetic agents;
(11) prescribe
(A) fluoride that is applied or provided to
a patient; and
(B) chlorhexidine or a similar
antibacterial rinse; and
(12) delegate dental operations and
services to a dental assistant as provided in
AS 08.36.346."
4:06:55 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
4:06:56 PM
REPRESENTATIVE KAUFMAN said that the language of Amendment 3 is
intended to "bring forth the full scope" of practices allowed by
a dental hygienist with an advanced practice permit under HB
111.
4:07:18 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 1 to Amendment
3, labeled 32-LS0480\A.11, Fisher, 3/31/21, which read as
follows:
Page 1, line 10 of the amendment:
Delete "exposed"
4:07:21 PM
CO-CHAIR FIELDS objected for purposes of discussion.
4:07:23 PM
REPRESENTATIVE SPOHNHOLZ said that, while the overall intent of
Amendment 3 is acceptable, she had a concern about the use of
"exposed" when it comes to teeth. She said that there are some
elements of dental hygiene which require going below the surface
of the epithelial attachment, which would not be possible with
the adoption of Amendment 3 as written.
4:08:06 PM
CO-CHAIR FIELDS removed his objection. There being no further
objection, Amendment 1 to Amendment 3 was adopted.
4:08:16 PM
CO-CHAIR FIELDS removed his objection to Amendment 3, as
amended. There being no further objection, Amendment 3, as
amended, was adopted.
4:08:26 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 4, labeled 32-
LS0480\A.3, Fisher, 3/30/21, which read as follows:
Page 2, line 7, following "experience":
Insert "in addition to attained dental hygienist
hours"
Page 4, line 31, through page 5, line 2:
Delete all material and insert:
"(10) permitted a dental assistant employed
by or working under the supervision of a dental
hygienist who holds an advanced practice permit issued
by the board under AS 08.32.125 to perform a dental
procedure in violation of AS 08.32.110 or
AS 08.36.346;"
Page 6, line 10:
Delete "hygiene"
Insert "hygienist"
4:08:30 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
4:08:35 PM
REPRESENTATIVE MCCARTY said that Amendment 4 addresses his
confusion regarding the number of hours of clinical experience
required to attain the advanced practice permit.
4:09:15 PM
REPRESENTATIVE SPOHNHOLZ stated that what she believes
Representative McCarty's desired outcome is would not be
achieved by Amendment 4. She said that, with respect to page 4,
line 31, through page 5, line 2, Amendment 4 would limit censure
to an advanced practice permit dental hygienist, rather than all
hygienists. The underlying language of HB 111, she said, allows
censure for inappropriate behavior for all dental hygienists,
rather than only those holding an advanced practice permit.
4:10:11 PM
REPRESENTATIVE MCCARTY requested an at-ease.
4:10:15 PM
The committee took an at-ease from 4:10 p.m. to 4:12 p.m.
4:12:36 PM
REPRESENTATIVE MCCARTY asked Ms. Virgin whether page 4, line 31,
of HB 111, refers to a dental hygienist employing a dental
assistant. He then asked whether there are dental hygienists
who employ dental assistants.
MS. VIRGIN responded that in Alaska it is not currently the
case; however, in other states, dental hygienists often employ
assistants.
4:14:11 PM
REPRESENTATIVE SPOHNHOLZ directed attention to Section 3 of HB
111, beginning on page 4, line 5, noting that it would amend AS
08.32.160, [regarding grounds for discipline, suspension, or ,
which read:
The board may revoke or suspend the license of a
dental hygienist, or may reprimand, censure, or
discipline a licensee, if, after a hearing, the board
finds that the licensee
REPRESENTATIVE SPOHNHOLZ then directed attention to proposed
paragraph (10), on page 4, line 31 through page 5, line 2, which
read as follows:
(10) permitted a dental
assistant employed by a dental hygienist or working
under the supervision of a dental hygienist to perform
a dental procedure in violation of AS 08.32.110 or AS
08.36.346;
REPRESENTATIVE SPOHNHOLZ said that the way Amendment 4 is
drafted would prohibit the Board of Dental Examiners from
holding accountable dental hygienists who supervise dental
assistants and allow them to do work beyond their training.
REPRESENTATIVE MCCARTY stated his understanding that the state
of Alaska currently doesn't allow dental hygienists to have
employees.
REPRESENTATIVE SPOHNHOLZ pointed out the language "or working
under the supervision of a dental hygienist", and said that it
is common practice for a dental hygienist to supervise a dental
assistant, as the assistant has less education and legal
authority to perform certain procedures. She said that
Amendment 4 would limit censure to only advanced practice dental
hygienists, rather than allowing all dental hygienists to be
censured. In response to Representative McCarty's follow-up
question, Representative Spohnholz explained, "Because all
advanced practice dental hygienists will also be dental
hygienists, I think the language is broad enough to ensure that
an advanced practice dental hygienist who employs a dental
assistant, and also a dental hygienist who is not an advanced
practice dental hygienist, but who supervises a dental
assistant, in both cases they would be able to be censured for
inappropriate delegation of responsibilities."
REPRESENTATIVE MCCARTY asked, "If we do not put in the term
defining it 'advanced,' does that not open up this ... a dental
hygienist could now start employing when it hasn't existed
before?"
4:17:55 PM
SANDON FISHER, Attorney, Legislative Legal Services, Legislative
Affairs Agency, explained that under HB 111, a dental hygienist
with an advanced practice permit could hire a dental assistant,
as evidenced by the language of Section 4, subsection (c).
REPRESENTATIVE MCCARTY expressed his belief that the language of
Section 4, subsection (c), needs to be reworked.
4:19:52 PM
CO-CHAIR FIELDS told Representative McCarty to either withdraw
Amendment 4 and rework it, or the committee can vote on it.
4:20:10 PM
REPRESENTATIVE KAUFMAN expressed being confused by Amendment 4.
4:20:44 PM
REPRESENTATIVE SPOHNHOLZ expressed that the wording of Amendment
4 is unclear and could complicate the proposed legislation
moving forward. She suggested withdrawing Amendment 4 and
adding a conceptual amendment on page 4, line 31, so that the
paragraph would read:
(10) permitted a dental assistant employed by an
advanced practice permit dental hygienist or working
under the supervision of a dental hygienist to perform
a dental procedure in violation of AS 08.32.110 or AS
08.36.346;
REPRESENTATIVE SPOHNHOLZ said that this would clarify that an
advanced practice permit holder would be able to employ dental
assistants, and that a dental hygienist in a regular dental
practice could supervise dental assistants.
4:21:52 PM
CO-CHAIR FIELDS asked Representative McCarty if he is amenable
to that suggestion.
REPRESENTATIVE MCCARTY expressed his agreement.
CO-CHAIR FIELDS asked Representative Spohnholz to move her
suggestion as a conceptual amendment to Amendment 4.
REPRESENTATIVE SPOHNHOLZ said that she would prefer Amendment 4
be withdrawn.
4:22:10 PM
REPRESENTATIVE MCCARTY withdrew Amendment 4 and said, "I believe
we did not talk about page 6, line 10."
CO-CHAIR FIELDS suggested addressing it later.
4:22:39 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 5, labeled 32-
LS0480\A.9, Fisher, 3/30/21, which read as follows:
Page 2, line 3, following "AS 08.36.346":
Insert "or that a licensed dental hygienist who holds
an advanced practice permit issued by the board under
AS 08.32.125 may delegate to a dental assistant under
AS 08.36.346(c)"
REPRESENTATIVE SPOHNHOLZ said that Amendment 5 was recommended
by the Alaska Dental Society to add clarity about the ability of
dental hygienists to assign tasks to a dental assistant.
4:22:54 PM
CO-CHAIR FIELDS objected then withdrew his objection. There
being no further objection, Amendment 5 was adopted.
4:23:07 PM
REPRESENTATIVE KAUFMAN moved to adopt Amendment 6, labeled 32-
LS0480\A.10, Fisher, 3/31/21, which read as follows:
Page 2, line 19, following "radiographs":
Insert "and maintain and register dental
radiological equipment under AS 08.36.075"
4:23:16 PM
CO-CHAIR FIELDS objected for the purpose of discussion
4:23:20 PM
REPRESENTATIVE KAUFMAN said that the purpose of Amendment 6 is
to link the standards of radiological safety and equipment
required of dentists to holders of an advanced practice permit.
4:23:48 PM
REPRESENTATIVE SPOHNHOLZ stated that she has no objection.
4:23:59 PM
CO-CHAIR FELDS withdrew his objection. There being no further
objection, Amendment 6 was adopted.
4:24:05 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Conceptual Amendment 7,
which would insert "advanced practice permit dental hygienist"
after "permitted a dental assistant employed by a" on page 4,
line 31, of HB 111.
4:24:16 PM
CO-CHAIR FIELDS objected for the purpose of discussion.
4:24:37 PM
REPRESENTATIVE MCCARTY stated his agreement and asked that the
text read "an" instead of "a".
4:24:43 PM
CO-CHAIR FIELDS asked whether there was any objection to
Conceptual Amendment 7. [The objection by Co-Chair Fields was
treated as removed.] There being none, Conceptual Amendment 7
was adopted.
4:25:01 PM
The committee took a brief at-ease.
4:25:21 PM
REPRESENTATIVE MCCARTY moved to adopt Conceptual Amendment 8,
which would change the language of page 6, line 10, to read
"dental hygienist" instead of "dental hygiene".
4:25:32 PM
CO-CHAIR FIELDS objected for the purpose of discussion and noted
that committee members can see the language on Amendment 4,
which was withdrawn.
4:25:43 PM
REPRESENTATIVE SPOHNHOLZ objected because the wording would be
grammatically incorrect. She said that page 6, line 10, reads
"adult dental and dental hygiene services"; therefore, saying
"dental hygienist services" would be grammatically incorrect and
not what the proposed legislation is trying to achieve.
4:26:05 PM
REPRESENTATIVE MCCARTY asked whether there needs to be special
recognition in the proposed legislation for insurance purposes.
4:26:36 PM
REPRESENTATIVE SPOHNHOLZ explained that Section 6, subsection
(b), provides the services which can be billed for, not the
providers.
CO-CHAIR FIELDS stated that he is comfortable with the existing
semantics in subsection (b).
4:27:12 PM
REPRESENTATIVE MCCARTY withdrew Conceptual Amendment 8.
4:27:17 PM
CO-CHAIR FIELDS stated the intention to move HB 111, as amended,
at the end of the meeting.
4:27:34 PM
CO-CHAIR FIELDS opened public testimony on HB 111, as amended.
After verifying that no one wished to testify, he closed public
testimony.
[HB 111, as amended, was held and revisited later in the
meeting.]
HB 111-DENTAL HYGIENIST ADVANCED PRAC PERMIT
5:11:55 PM
CO-CHAIR FIELDS announced that the final order of business would
be a return to HOUSE BILL NO. 111, "An Act relating to the
practice of dental hygiene; relating to advanced practice
permits for dental hygienists; relating to dental assistants;
prohibiting unfair discrimination under group health insurance
against a dental hygienist who holds an advanced practice
permit; relating to medical assistance for dental hygiene
services; and providing for an effective date."
5:12:02 PM
REPRESENTATIVE SCHRAGE moved to report HB 111, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 111(L&C) was
reported out of the House Labor and Commerce Standing Committee.