Legislature(2023 - 2024)ADAMS 519
05/03/2024 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB149 | |
| SB187 | |
| HB307 | |
| SB74 || SB75 | |
| HB232 | |
| SB104 | |
| SB118 | |
| HB122 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 187 | TELECONFERENCED | |
| += | HB 307 | TELECONFERENCED | |
| + | SB 118 | TELECONFERENCED | |
| + | HB 177 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | SB 74 | TELECONFERENCED | |
| + | SB 75 | TELECONFERENCED | |
| += | HB 232 | TELECONFERENCED | |
| + | SB 104 | TELECONFERENCED | |
| += | HB 149 | TELECONFERENCED | |
HOUSE BILL NO. 149
"An Act relating to the licensure of nursing
professionals; relating to a multistate nurse
licensure compact; and providing for an effective
date."
1:41:07 PM
Co-Chair Foster mentioned individuals available to answer
questions on the bill. He moved to invited testimony.
JARED KOSIN, PRESIDENT AND CEO, ALASKA HOSPITAL AND
HEALTHCARE ASSOCIATION, ANCHORAGE (via teleconference),
spoke in strong support of the legislation. He emphasized
that enacting license reciprocity through the multistate
nurse licensure compact would align Alaska with the rest of
the country. He regularly heard stories in Alaska about
nurses who were hired, but ultimately never returned
because they could not wait weeks or months for a license
to begin work. He had plenty of data and statistics on
nursing shortages, licensing delays, and frustration from
the military community about the absence of licensing
reciprocity.
Mr. Kosin asked the committee to consider two questions.
First, how other states and jurisdictions license nurses.
He emphasized that 41 other states used the nurse licensure
compact. Second, was Alaska's licensing process faster,
safer, and more efficient. The answer was no. He
underscored that Alaska's process was slower, it was no
safer, and it required more time and effort from state
employees. He stressed that the bill would not lead to an
exodus of nurses. He stated that the bill would in no way
infringe on Alaska's sovereignty and the Board of Nursing
would continue to have exclusive control over the standard
of practice. Additionally, the bill would in no way
undermine local nurses or wages. He relayed that Alaska
already relied on out of state nurses because schools in
Alaska graduated less than one-quarter of what was needed
to meet demand industry wide. He thanked the committee for
taking up the bill and urged its passage.
1:44:23 PM
Representative Tomaszewski shared that two of his
daughters-in-law were nurses and one worked in Alaska. He
remarked that every nurse he had spoken to was in support
of the legislation. He asked Mr. Kosin if he had heard from
any nurses who were not in favor of the licensing compact.
Mr. Kosin replied in the negative. He stated that all of
the opinion against the compact he had ever heard had been
anecdotal. He stated that the Alaska Hospital and
Healthcare Association (AHHA) was finding overwhelming
support for the bill.
Representative Ortiz observed that there was quite a bit of
interest in the legislation from out of state. He
referenced out of state testimony on the bill earlier in
the day where the caller mentioned that states with a
compact agreement in place had higher vacancy rates than
other states. He asked if Mr. Kosin disagreed and if he had
evidence to the contrary.
Mr. Kosin answered that the number of states with a compact
was 40 to 10, so there was a much larger sample size of the
states with a compact, which meant there was much bigger
chance of having higher vacancy rates. He pointed out that
no one in support of the compact had ever suggested that
somehow it would cure all of the nursing shortages in
Alaska or across the country. He explained that it was
about how fast and efficiently the state could get someone
licensed so they could begin work, especially when it was
necessary to recruit from out of state. He underscored that
approximately 1,400 registered nurses needed to be hired
per year to keep up with growth and meet demand. He noted
that in-state colleges graduated 324 nursing students per
year. He stressed that Alaska was reliant on out of state
workers to help drive down vacancy rates. He would be happy
to collect information on vacancy rates to provide the
details to the committee; however, he believed that
information missed the point of the legislation.
Representative Ortiz noted that Mr. Kosin referenced the
problems with nurses getting licensed in Alaska. He
remarked that particularly during the COVID-19 pandemic
there was a period where it took way too much time for
healthcare workers in general to get licensed in Alaska. He
asked about the current status of licensing nurses in
Alaska. He wondered if there was significant improvement in
the process.
1:49:33 PM
Mr. Kosin responded that there had been improvement when
comparing the present with six months to a year ago.
However, he stated that the current status was not a good
place to be. He stated that Alaska's system was not safer,
faster, or more efficient when compared to almost all other
states. He understood the department [Department of
Commerce, Community and Economic Development] would testify
and would likely say it took anywhere from four weeks or
more to get a license. He stated it was not very fast. He
recognized that while it was better than it had been in the
past, it was still not an acceptable place to be when there
was something widely used across the country that would be
significantly faster.
Representative Hannan stated that one of the concerns she
had heard about the compact had to do with nurses who came
to work in Alaska who may be under disciplinary action or
complaint in another state. First, the compact did not
require the state to keep any kind of registration of
people working in Alaska on a nurse license compact.
Meaning a person could leave another jurisdiction and work
in Alaska while they were under investigation. She asked if
AHHA supported a registration of nurses working in Alaska
under compact licensure that would enable tracking
individuals if a disciplinary action arose.
Mr. Kosin answered affirmatively; however, AHHA did not
believe it was necessary because when a person was under
investigation within a home state it was flagged through
the investigatory process and the individual may even lose
eligibility for a multistate license. He stated that if it
was necessary to make people feel comfortable, AHHA would
absolutely support the concept. He pointed out that the
department would not be able to currently identify where
all of the licensed nurses were in Alaska. He explained
that once a person was licensed, they could go where they
wanted. He elaborated that they could practice telehealth
from out of state, work in a facility in or outside
Anchorage, or not be working at all. He emphasized that the
details were not available at present. He believed there
would be no difference under the compact; however, if a
registry would make people feel more comfortable, AHHA
would have no problem with it.
Representative Hannan explained how she had heard the
situation described as a concern. She explained that when a
person was licensed in a state, the nurse licensure fees
paid for the investigation. She furthered that a nurse in
Alaska would have to support the investigation costs of a
nurse using a multistate compact license to work in Alaska.
She elaborated that currently, if there was an
investigation of a nurse with an Alaska license, the
department was notified, and it would be reflected in the
licensure fees for the rest of the nurses. She was trying
to construct a way to keep Alaska nurses working in Alaska
from being responsible for paying for investigations of
nurses who came to work in Alaska under a multistate
licensure. She had heard the concern from nurses who pay
the licensure fees.
Mr. Kosin deferred the question to the department. The
department had thought the issue through and had figured
out how it would structure a fee schedule so that
investigations tied to a multistate license would not
impact licensing fees for Alaska nurses. He relayed that if
licensing fees increased, there were other financial ways
to cover the situation, including assessments, even on
AHHA. He stated that AHHA had zero concern about doing
something so mainstream like the compact. The agency
believed once it was in place, everyone would see there was
no downside. He noted that if problems arose, it was
something that could be addressed in the future. He assured
the committee that the department had thought about the fee
issue and could speak to it.
Co-Chair Foster asked to hear from the Department of
Commerce, Community and Economic Development (DCCED).
1:54:45 PM
GLENN SAVIERS, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESS, AND PROFESSIONAL LICENSING, DEPARTMENT OF
COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, pointed to a
fee provision in Section 2 of the bill that would separate
fees for single state licenses versus multistate licenses.
She explained that while it would be Alaska multistate
license holders paying the fees, the department would
ensure that individuals who only wanted an Alaska license
had the opportunity to only pay for Alaska licensees. As
long as a registry did not create too much work for the
hospitals and department, the department was happy to
implement one. The department did not know if or where
Alaska's nurses were currently working. She relayed that no
other states had seen an increase in investigation costs as
a result of joining the compact. She informed the committee
that DCCED did not know whether a nurse applying in Alaska
was under investigation unless it had been reported to the
national registry; if it had been reported, DCCED would see
it under the compact license in the same way it did for a
single license.
Representative Hannan referenced Mr. Kosin's mentioning of
license delays for military spouses. She believed he had
been one of the advocates for changing the law in 2020 or
2021. She was concerned or alarmed to hear that the law had
been changed to "scoop in" and create a carve out for
military spouses, but that it had not impacted the number
of spouses working as nurses in Alaska while they were in
the state for a short time. She asked if she had understood
Mr. Kosin's statements correctly.
Mr. Kosin answered that she understood him correctly. He
relayed that all of his points thus far had come directly
from groups that were affected. He stated that the
Department of Defense could easily come on record to
support the statements. He explained that the catchment
area of the compact was so large (41 states and
jurisdictions) that if a military spouse with a compact
license came to Alaska, they were still put into an Alaska
license situation. The state was not allowing individuals
to freely use their compact license. He shared that AHHA
was hearing from military spouses that they had a compact
license and the mobility to begin work immediately, but it
was still not allowed despite Alaska changing its law a
couple of years back. He relayed that the bill was about
adopting what was used everywhere else. He believed the law
passed a few years ago helped, but it did not solve the
issue.
1:58:26 PM
Representative Josephson referenced Mr. Kosin's testimony
that he had not heard from any nurses who oppose the
compact. He asked if Mr. Kosin had met with the Alaska
Nurses Association.
Mr. Kosin answered that AHHA worked directly with the
Alaska Nurses Association for almost two years to try to
find ways to improve the licensing system in a way that
would be faster and more efficient to see if there was a
solution to the problem outside the compact. Despite
working together for close to a year they could never see
eye to eye on the issue. He knew that the Alaska Nurses
Association opposed the compact. He relayed that AHHA was a
trade association representing all of its members, whereas
the nurses association was a union. The AHHA talked to
Alaska Nurses Association members and nurses on a day to
day basis and he had not heard what was reflected from
their leadership down below. He confirmed that he had met
and knew nurses who opposed the compact, but on a day to
day basis the nurses he worked with and met in hospital
hallways did not oppose the compact. He stated it was
substantiated by all of the surveys that had been
conducted.
Representative Josephson understood that there were many
important issues to nurses, but he surmised the one at hand
had to be at the top of the list. He observed that they had
elected leaders who opposed the compact. He asked for
verification that someone was electing them.
Mr. Kosin deferred to the nurses association on how its
members were elected. He noted that the legislature was
hearing a lot of different information from different
perspectives. He emphasized that from the beginning, AHHA
had relied on facts and all of the information he had
provided was statistically backed up through some source.
He considered how people were elected and how people were
making decisions he believed there had been a lot of
misinformation and stated that misinformation could
compel people to act in different ways. He agreed that
people were elected, and he did not know whether the
compact was a platform for election. He emphasized that the
facts and information showed it was what the rest of the
country did, the vast number of nurses supported it, and
there was no reason not to join the compact.
Representative Josephson countered that the committee had
heard a number of reasons [to not join the compact]. He
thought it sounded like people were perhaps merely talking
past one another.
2:01:58 PM
JULIE SANDE, COMMISSIONER, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT (via teleconference),
shared that the department had heard overwhelming support
for the bill. She noted that DCCED had requested that
supporters primarily provide written comments out of
respect for the committee's time. She appreciated the
opportunity to call in and speak in favor of the
legislation. She shared that she held a master's degree in
health administration and served over 20 years at the
Ketchikan Pioneer Home and had retired as the director. She
detailed that the pioneer home employed nurses and
certified nurse aides to provide care to residents around
the clock. She had also served on the Ketchikan general
hospital medical center for over 12 years on the governing
board. She relayed that when DCCED was posed with
questions, it considered how it could protect Alaska
consumers and how to promote a strong community and
economy. She did not believe it was possible to have strong
and healthy communities without quality healthcare. She
strongly supported the bill for those reasons.
Commissioner Sande addressed license processing times and
improvements. She discussed that when she had been
considered for her current role, legislators were unified
in the need to improve licensing times for Alaskans. Her
commitment to the legislature at the time was that she
needed time to meet with the DCCED team to determine where
the largest challenges were and where the bottlenecks were
located. She noted that many legislators had communicated
their commitment to provide support wherever possible.
She was very proud of the DCCED team and of all the
improvements the department had put into place. She
reported that the licensing process had gone from 14 weeks
to 4 weeks. She noted that 4 weeks was not ideal, but it
was a tremendous improvement. She highlighted that the
department was receiving a couple hundred fewer nurse
license applications each month, which was extremely
concerning. The department was very concerned it would
continue to see a downward trend in the nurse license
applications as Alaska became less appealing for nurses who
could work in 41 other jurisdictions without applying for
and renewing an additional license.
Commissioner Sande highlighted nurse vacancies and stated
it was necessary to make it easier for nurses to come check
out Alaska and realize it was where they wanted to be,
while ensuring Alaskans had access to needed care. She
viewed it as a quality healthcare issue as opposed to a
licensing issue. She referenced public testimony heard by
the committee earlier in the day. She cited testimony that
if the state joined the compact it would lose the ability
to discipline nurses working in Alaska on a multistate
license. She underscored it was incorrect and clarified
that the Board of Nursing and DCCED would not support the
legislation if it were the case. She relayed that the Board
of Nursing would retain full jurisdictional authority over
every nurse treating patients in Alaska regardless of what
state issued their license. The state could investigate any
nurse practicing in Alaska and take action against their
privilege to practice in Alaska, including prohibiting them
from working in the state if the violation was severe.
Commissioner Sande referenced public testimony statements
about state sovereignty. She relayed that the Alaska
Legislature and the Board of Nursing would retain full
authority over the nurse practices laws in Alaska. The
compact and its commission had no authority over state
practice laws. She referred to earlier statements that
nurse license fees would increase under the compact. The
department expected the opposite would be true. She
elaborated that joining the compact would result in fewer
applications, which meant part of the DCCED team currently
working on nurse licensing could help other programs
including medical licensing. She explained that fees were
set based on regulatory costs of running the program;
therefore, if less staff was needed to process the
applications, fees would likely decrease. Currently, the
nurse licensing team was more than double the size of any
other licensing team within the division. She explained
that if the team had fewer nurse licenses to process, it
would mean more staff available to process other licenses
(e.g., contractor licenses) in a timelier manner.
Commissioner Sande addressed testimony that compact states
had higher nurse vacancy rates compared to non-compact
states. The department had been unable to locate data
mentioned by the testifier. She noted the only data DCCED
had found on healthdata.gov was specific to California. The
department would be interested to see the data if it was
sent to the committee. The department found other data from
the U.S. Chamber of Commerce showing otherwise. She relayed
that on January 29, 2024, the U.S. Chamber of Commerce
published a data deep dive on the national nursing crisis.
[Note: due to poor teleconferencing connection some of
Commissioner Sande's testimony is inaudible].
Co-Chair Foster noted that Commissioner Sande's phone
connection was breaking up.
2:08:59 PM
Commissioner Sande concluded her remarks by providing her
support for the bill.
Co-Chair Foster noted others available.
2:09:47 PM
Representative Josephson referenced an appeal to licensed
nurses that went out four days earlier. He remarked it had
been an administration practice in the past to use its
email databases to rally people to a cause. He asked if
there was an administration policy or if it was typical
protocol.
Commissioner Sande replied it was not an administration
call. She believed Representative Josephson was referring
to an email from Patty Wolfe, the executive administrator
for the Board of Nursing, representing the board and
administration, both of which fully supported and saw a
strong need for the compact. She relayed that the email was
sent at the direction of the board and division management.
She relayed that the communication on April 30, was only
sent to individuals who opted to receive communication from
the Board of Nursing.
Representative Ortiz remarked that he and Commissioner
Sande were from the same community, and he was very
familiar with the good work she had done prior to beginning
as the commissioner. He had heard of the Ketchikan city
council's support for the nursing compact. He was aware
that there was support in the community for joining the
compact. He was also aware that there was opposition from
nurses to joining the compact. He noted that Mr. Kosin had
testified there was no downside to joining the compact. He
asked if the commissioner saw any downsides to joining the
compact.
Commissioner Sande responded that she did not anticipate
the compact would be a silver bullet and she did not think
there was just one fix for the nursing shortage; however,
she viewed the compact as a necessary tool. She thought a
downside would be choosing not to take action and not
moving forward with the compact that so many other states
had chosen to join. She believed adopting the nurse
licensure compact was the responsible choice based on the
current nurse shortage and fear that it would only worsen.
She thought the state was at risk and by not joining the
compact, it limited Alaska's ability to access nurses that
other states had access to. She stated that hindsight was
20/20 and the state may look back four years from now and
see that there were unintended consequences. She stated
there was always an opportunity to revise something if that
occurred and the department was open to it. She believed
based on the information, the state should participate in
the compact and she was fully in support.
2:14:28 PM
Representative Ortiz asked about the compact and its
potential for undermining wages and benefits for local
nurses. He asked if Commissioner Sande saw it as a threat.
Commissioner Sande understood that some of the opposition
to the bill had come from the union out of wanting to
protect the wages of its membership. However, when she had
spoken to nurses in various communities, the nurses were
not expressing concern about their wages, but they were
expressing concern about mandatory overtime. She stated
there was a far greater concern about the quality of
outcomes when nurses were tired. Additionally, there were
nurses seeking other professions because they did not want
to miss birthdays, Christmases, and time with their
families due to a lack of relief. She had a conversation
with a hospital administrator and nurse the previous week
who was fully in support of the bill.
Co-Chair Foster asked the sponsor for any concluding
remarks.
REPRESENTATIVE MIKE PRAX, SPONSOR, thanked the committee
for hearing the bill. He highlighted that the number of
nurse license applications had declined significantly since
the end of the COVID-19 pandemic, when one would expect the
opposite to be true. There did not seem to be a good reason
for the decline in number of licenses except that it was
easier to go to work somewhere else. He noted it was not
constrained by wages or anything else. He stated it was a
fairly urgent problem and time to see some relaxation in
bureaucracy to see if it would help address the issue and
stem the recruitment problems occurring in the state.
Co-Chair Foster thanked the testifiers. He noted the bill
would be heard on the following Monday.
HB 149 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster handed Co-Chair Edgmon the gavel.
2:18:08 PM
AT EASE
2:29:37 PM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 307 Amendments 1 - 8 050324 (2).pdf |
HFIN 5/3/2024 1:30:00 PM |
HB 307 |
| SB 118 Sponsor Statement.pdf |
HFIN 5/3/2024 1:30:00 PM |
SB 118 |
| SB 118 cs Summary of Changes.pdf |
HFIN 5/3/2024 1:30:00 PM |
SB 118 |
| SB118 Sectional.pdf |
HFIN 5/3/2024 1:30:00 PM |
SB 118 |
| SB 187 HCS FIN Amendment Pkt 1-14 050324.pdf |
HFIN 5/3/2024 1:30:00 PM |
SB 187 |
| HB307 Amendment 3 Backup 050324.pdf |
HFIN 5/3/2024 1:30:00 PM |
HB 307 |
| HB 232 Public Testimony Rec'd by 050324.pdf |
HFIN 5/3/2024 1:30:00 PM |
HB 232 |