Legislature(2015 - 2016)HOUSE FINANCE 519
04/07/2016 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB237 | |
| HB230 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 247 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | HB 230 | TELECONFERENCED | |
| + | HB 237 | TELECONFERENCED | |
HOUSE BILL NO. 237
"An Act relating to an interstate compact on medical
licensure; amending the duties of the State Medical
Board; and relating to the Department of Public
Safety's authority to conduct national criminal
history record checks of physicians."
1:53:31 PM
REPRESENTATIVE PAUL SEATON, SPONSOR, appreciated the
opportunity to present the bill. He relayed that the bill
would make Alaska a party to the Interstate Medical
Licensure Compact, which would expedite licensing to bring
qualified physicians to Alaska. He shared that it was
currently a 14 to 18-week licensure process. He had heard
from new doctors who were from Alaska and licensed in other
states who wanted to return to practice in Alaska. The
individuals had been waiting over six months and still had
not received their Alaskan license and were considering
jobs outside of Alaska due to the delay. He noted that the
department [Department of Commerce, Community and Economic
Development (DCCED)] was attempting to speed up some of the
processes. He spoke to the importance of getting doctors
into Alaska on a quicker basis due to the state's need for
physicians. He cited turnover as an issue. He explained
that licensure under the compact had a higher criteria and
required fingerprinting, background checks, and other. A
state seeking to be a member of the compact had to agree to
the qualifications; the state could have additional
qualifications and under the compact a physician would
receive a provisional license until they fulfilled the
state's additional requirements. When a person received a
license under the compact they would then have the ability
to apply for work in any other states within the compact.
Individuals had to pay the full fees to the state and would
receive a license to practice very quickly in any of the
states under the compact.
1:57:00 PM
Representative Kawasaki could see the need and benefits for
the state. He asked for verification that becoming one of
the 13 states with the licensure compact should make it
easier for Alaska state examiners to qualify a person
registered in another state.
Representative Seaton replied in the affirmative. He
detailed that a person who had satisfied the compact
criteria for licensure could get a license to practice in
any of the other compact states. He furthered that Alaska's
physicians who met the criteria could also obtain licenses
more quickly in other states as well.
Representative Kawasaki pointed to the fiscal note that
appeared to be "hefty." He observed that the fund source
was receipt supported services. He believed that once the
compact was in place it would actually cost less for the
agency to administer.
Representative Seaton deferred the question to his staff.
TANEEKA HANSEN, STAFF, REPRESENTATIVE PAUL SEATON, replied
that the largest portion of the fiscal note was due to the
background checks, which were a requirement of the compact.
She relayed that currently background checks and
fingerprinting were not required for Alaskan physicians.
The bill had a specific authorization for physicians
applying for an expedited license through the compact to
undergo the background checks; the bulk of the fiscal note
included the fingerprinting fee. Additional funds in the
note were related to travel and designating a person to be
in communication with the commission. She explained that
under the compact, two commissioners would come from Alaska
to participate on the Interstate Commission; they would be
current members or staff of the medical board. She added
that there would be additional travel and needs to
coordinate with the commission.
Representative Kawasaki asked if the State of Alaska would
be made aware if a physician in the compact had been
sanctioned in another state. He wondered how it would
impact licensure.
Ms. Hansen replied that there were compact provisions
listed in the bill that outlined disciplinary actions. She
detailed that if there was a disciplinary sanction taken
against any expedited license in another state, the other
states were automatically notified by the state's medical
board and the individual's state license would be suspended
until a review was conducted. Alaska's current statutes
included a provision for suspending a license upon
notification or proof of another state action upon the
license until a hearing could be held.
2:01:09 PM
Representative Guttenberg shared a story about a dentist
from New Zealand who could not obtain a license in Alaska.
He thought it appeared that an individual had to live in
another state or have a percentage of their practice in
another state before they could transfer the license. He
furthered that the individual could not have merely
obtained a license in California and transferred the
license to Alaska; the requirements for residency were
still in place. He asked how the bill related to
international compacts. He wondered if the residency issue
still played a role.
Ms. Hansen answered that there was a section that addressed
the definition of the designation of a state of principal
licensure, which was a baseline requirement for compact
eligibility. She detailed that an individual was required
to designate a compact state as their state of principal
licensure. Requirements included that the state be the
individual's primary residency, a minimum of 25 percent of
the practice of medicine occurred, and the location of the
individual's employer. She elaborated that if no state
qualified under the requirements, the state had to be
designated as a state of residence for the purpose of
federal income tax. Individuals would have to meet the
qualifications in one of the 12 compact states (13 states
if Alaska joined the compact).
Representative Guttenberg asked for verification that
international doctors could not come in and receive a
license. He surmised that the individuals would be required
to have residency in another state. He asked about the time
requirement.
Ms. Hansen answered that the compact did not outline a
requirement for the length of residency. She noted that the
information may be outlined in the commission bylaws. She
did not know the current standards for an individual Alaska
license for an international physician coming into the
state. She explained that currently physicians not living
in Alaska could apply for a license in Alaska; they had to
apply for a license in each state they wanted to practice.
Representative Seaton noted that the primary reason for the
bill was to save individuals who wanted to practice in
multiple states from applying for a license separately in
each of the locations. He furthered that expedited licenses
were electronically issued. He explained that currently
getting a license in Alaska was only done on paper - it was
not as efficient as it could be. He added that the
department was trying to expedite things by the end of the
year - some renewals were done electronically. The state
was behind the curve on electronic verification and
submission of background information.
2:05:09 PM
Vice-Chair Saddler asked about the current process a
physician licensed in another state undertook to get a
license in Alaska. He asked how long the process took.
Representative Seaton replied that the current licensing
process for first-time licenses in Alaska was done on paper
and required all of the background information. The normal
timeframe was 14 to 16 weeks; however, with staff cuts the
length of time had been somewhat extended in recent years.
Vice-Chair Saddler asked how much it cost to apply for and
receive a state license.
Representative Seaton answered that the charge for a state
license through the compact was whatever the state charged.
He explained that an individual did not receive a price
break by applying electronically for the expedited license.
The process provided an expedited way to obtain a license
and saved applicants from going through paperwork for each
state they wanted to practice in.
Vice-Chair Saddler asked if it was common for physicians to
want to be licensed in multiple states.
Representative Seaton did not have numerical data on hand;
however, he provided an example of eye surgeons traveling
from the Pacific Northwest to do surgeries once a week in
Anchorage.
Ms. Hansen elaborated that the licensure compact had been
adopted by many rural states where physicians traveled
between small communities or those taking advantage of
telemedicine, which required the physician to be licensed
in the state they were practicing.
Representative Wilson thanked the sponsor for the bill. She
relayed that she had helped three or four physicians in the
past year with the process that had taken three or four
months. She added that a physician could have been
practicing for 30 years and they were still required to
have their original transcripts and residency - some of the
items did not exist any longer because a person had been
practicing for so long. She discussed that the Fairbanks
hospital cancer center only had one specialist in several
different areas, which meant if someone went on vacation
the hospital had to bring a physician up to fill in for
that two-week period. She believed the bill would make the
process go much quicker for individuals in states
participating in the compact.
Ms. Hansen replied that theoretically the answer was yes.
She detailed that the bylaws were currently being written
by the Interstate Commission. How long it would take for
states to be notified had not yet been seen in practice.
She furthered that if a physician had an expedited license
in one state all they needed to do was notify the
commission that they would like to be licensed in another
state. A state was directed to issue a license as soon as
it received the fees and notification. She concluded that
the process should be much faster.
Representative Wilson did not believe there would be
thousands more doctors applying for a license because it
was easier. She remarked that the fiscal note specified the
need for an additional employee [within DCCED]. She
believed that in reality after the bill was implemented the
process would be much easier. She reasoned that there would
be less paperwork.
Representative Seaton deferred the question to DCCED.
Representative Wilson wondered if the bill would require
all physicians in Alaska - Alaskan residents included - to
adhere to the fingerprinting requirement.
Representative Seaton answered in the negative. Individuals
would not be subject to the fingerprinting requirement
unless they wanted to obtain an expedited license for
another state. The bill did not change Alaska requirements
for its licenses. He furthered that if a physician in
Alaska wanted to obtain an expedited license for another
state they would have to satisfy the background check and
fingerprint requirements for the compact.
Representative Wilson shared that a doctor had participated
in the Iditarod, but had almost been unable to participate
because it took so long to get his replacement physicians
licensed. She believed the bill would make more doctors
want to come to Alaska.
2:11:32 PM
Representative Munoz believed the bill went hand-in-hand
with the Medicaid reform bill currently before the
legislature - especially as it related to telemedicine. She
thanked the sponsor for bringing the bill forward.
Vice-Chair Saddler asked if the primary purpose of the
compact was to expedite licenses and increase the ease of
cross-state licensure.
Ms. Hansen answered that it was primary purpose, but it
also allowed states in the compact to maintain a database.
She detailed that the exchange of information about
disciplinary actions would be up to date and easily
accessed by all states. The Federation of State Medical
Boards kept track of licenses for participating states;
therefore, Alaska was able to obtain some of the primary
documents through the coordinated database. The compact
database provided additional detail with all licensure
information, which would enable easier confirmations.
Vice-Chair Saddler remarked that there was a federalized
system and each state had the power to set its standards
for any profession. He believed the bill presumed that any
state's medical license was as appropriately set as any
other. He surmised that any physician licensed in any one
of the states should be quickly able to practice in any
other state within the compact. He asked if there were any
states that had extraordinarily high standards for extended
residencies, education, or training.
Representative Seaton responded that the assumption was not
that every state had the criteria, just like Alaska did not
require a fingerprint or background check. The compact
allowed the doctors within Alaska to also qualify for the
compact if they applied and provided the additional
required criteria; at that point they could easily obtain
licenses in other states. People understood that the
compact had a uniform group of criteria, which were higher
than required in a number of states, and that anyone
satisfying the universally high criteria would be able to
get a license and practice medicine in Alaska with an
expedited license.
Vice-Chair Saddler asked for verification that the bill
only applied to medical physicians and not nurses,
optometrists, ophthalmologists, or other.
Representative Seaton replied in the affirmative.
Representative Gara relayed that he had not heard about any
opposition or controversy related to the bill. He noted
that the state medical board and Alaska State Hospital and
Nursing Home Association (ASHNHA) had supported the bill.
He was happy to move the bill forward.
Representative Wilson asked why the bill would require
another staff because she believed it would make things
much easier.
2:15:46 PM
Representative Seaton deferred the question to the
department.
JANEY HOVENDEN, DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF
COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, replied that
the bill represented an additional pathway to licensure.
She continued that the bill only applied to individuals who
met the higher criteria [required by the compact]. The old
pathway would still have to remain in place because not all
physicians would qualify for the higher criteria (e.g. a
person could have no disciplinary records). The new system
would be housed with the executive administrator who would
track the licenses and handle the fingerprinting cards that
the other pathway did not have. The position [listed in the
fiscal note] was an Office Assistant I (range 10) that
would assist the executive administrator with the
specialized program. The position would handle
communication with the commission, travel arrangements, and
other.
Representative Gara believed the costs would be funded with
a fee charged to doctors for use of the service. Ms.
Hovenden answered in the affirmative. The fee would be
charged to physicians who selected to use the specific
pathway to licensure.
Representative Guttenberg noted that he had often heard
that due to the competitive nature of the field in Alaska,
other doctors were keeping doctors out. He asked how the
bill would deal with that process. He provided an example
of a highly skilled and qualified doctor in another state.
He wondered if the medical board had an approval or denial
basis. Alternatively, he wondered if the person would
receive a license because they qualified through the
compact.
Ms. Hovenden answered that if a person qualified through
the compact and had no discipline on their record there
were no additional requirements.
Vice-Chair Saddler asked for verification that the bill
enacted the entirety of the charter for the compact
(beginning in Section 6 of the legislation).
Representative Seaton replied that it was his
understanding. He noted that the bylaws were currently
being worked out by the commission and would not be enacted
by the bill.
Vice-Chair Saddler understood that the fees for the license
application and fingerprinting would be borne by the
applicants. He remarked that any interstate compact
required some staff support. He asked if the fiscal note
reflected any portion of the compact's shared maintenance
and management costs.
Ms. Hansen replied that the issue would be decided more
clearly in the bylaws. The compact did authorize an
assessment on the member states; however, in conversation
with current commissioners in the compact, the indication
was that they planned to raise the needed revenue through a
licensure fee. She detailed that it would essentially be a
registration fee for doctors using the compact system. She
added that until the bylaws were written it was possible
that the cost would be an assessment on member states. She
relayed that the commission was comprised of two members
from each medical board.
2:20:52 PM
Vice-Chair Saddler asked if the department had detail on
how many physicians licensed in Alaska also had medical
licenses in other states. Ms. Hovenden replied that the
department did not track that information.
HB 237 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 237 Dr. Hornberger letter.pdf |
HFIN 4/7/2016 1:30:00 PM |
HB 237 |