01/28/2016 03:00 PM House HEALTH & SOCIAL SERVICES

          HB 237-INTERSTATE MEDICAL LICENSURE COMPACT                                                                       
                                                                                                                                
4:36:23 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON brought the committee back to order.                                                                               
                                                                                                                                
CHAIR SEATON announced that the  final order of business would be                                                               
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."                                                                                                                    
                                                                                                                                
4:36:55 PM                                                                                                                    
                                                                                                                                
TANEEKA HANSEN,  Staff, Representative Paul Seaton,  Alaska State                                                               
Legislature,   reported   that   proposed  HB   237   was   model                                                               
legislation,  already entered  into by  12 states  with 11  other                                                               
states considering  it, and passage  would enter Alaska  into the                                                               
Interstate  Medical  Licensure  Compact.   She  stated  that  the                                                               
purpose of this compact was  to create another venue into medical                                                               
licensure  by  joining  other  compact   states  in  creating  an                                                               
expedited license  process for qualified  physicians, as  well as                                                               
creating an  interstate commission to administer  the compact and                                                               
maintain all the necessary information.                                                                                         
                                                                                                                                
CHAIR SEATON  asked for  an explanation to  the necessity  of the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
MS. HANSEN  shared that  the proposed  bill was  a result  of the                                                               
delays in the licensure process,  and she directed attention to a                                                               
letter  from Aaron  Kusano [Included  in members'  packets] which                                                               
listed specific  changes for  improvement to  the process.   Upon                                                               
investigation,  she  shared  that  awareness  of  the  Interstate                                                               
Medical Licensure  Compact became  an option.   She  relayed that                                                               
the basic  premise of the  compact, that physicians in  a compact                                                               
state  could  verify  eligibility  within the  state  of  primary                                                               
licensure, and  then, if eligible,  register with  the interstate                                                               
commission  and list  the other  states in  which they  requested                                                               
licensure.    These   states  would  then  be   notified  of  the                                                               
physician's eligibility, and upon  receipt of the licensing fees,                                                               
the doctor  would be licensed.   This would allow a  physician to                                                               
work  through the  compact for  verification  instead of  through                                                               
each  state   individually,  thereby  avoiding   the  duplicative                                                               
process.                                                                                                                        
                                                                                                                                
CHAIR  SEATON pointed  out the  need for  physicians, emphasizing                                                               
that these were  medical licenses, and noted that  there was also                                                               
a  nurses  licensing compact,  which  was  not included  in  this                                                               
proposed bill.                                                                                                                  
                                                                                                                                
MS. HANSEN  expressed agreement, reiterating  that a goal  was to                                                               
ensure that  the state  had enough providers  to address  all the                                                               
health  care   needs,  which   was  "a   real  concern   in  some                                                               
communities,  that  we   do  have  a  shortage   of  health  care                                                               
providers."                                                                                                                     
                                                                                                                                
4:41:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ directed  attention to  the FAQ,  page 1,                                                               
[Included  in members'  packets]  and read:   "possess  specialty                                                               
certification or be  in possession of a  time unlimited specialty                                                               
certificate."    She  asked for  clarification  about  whether  a                                                               
general practitioner would be eligible for participation.                                                                       
                                                                                                                                
MS. HANSEN acknowledged  that they would "take  feedback from the                                                               
medical board  and practitioners  as to  who would  be eligible."                                                               
She shared that her research  indicated that almost 80 percent of                                                               
physicians would currently be eligible  for the expedited license                                                               
under  the current  definitions,  and that  the other  physicians                                                               
would  still be  able to  apply  for a  license in  the State  of                                                               
Alaska.  She  declared that this did not  supersede the licensing                                                               
procedure in Alaska, it only provided another venue.                                                                            
                                                                                                                                
REPRESENTATIVE VAZQUEZ  reiterated that  this appeared  that only                                                               
doctors with  a specialty certification  would be allowed  to use                                                               
the compact mechanism.                                                                                                          
                                                                                                                                
MS. HANSEN  deferred the  question to  the medical  board, noting                                                               
that the bill defined the specialty certifications.                                                                             
                                                                                                                                
REPRESENTATIVE VAZQUEZ declared  her support for the  goal of the                                                               
proposed bill.   Noting  that it  was necessary  for 7  states to                                                               
join the  compact for it be  launched, she asked how  many states                                                               
had currently joined the compact.                                                                                               
                                                                                                                                
MS.  HANSEN replied  that there  were  already 12  states in  the                                                               
compact,  although  no  licenses  had  yet  been  awarded.    She                                                               
reported that the  interstate commission had met  on December 18,                                                               
2015,  and would  meet  again in  the near  future,  in order  to                                                               
establish the by-laws.                                                                                                          
                                                                                                                                
REPRESENTATIVE  WOOL   asked  if  this  was   also  designed  for                                                               
physicians practicing telemedicine in multiple states.                                                                          
                                                                                                                                
MS. HANSEN explained  that it would still depend  on the specific                                                               
statutes  on an  eligible physician  for telemedicine  in Alaska,                                                               
although eligibility  would also  be dependent on  being licensed                                                               
in the State of Alaska.                                                                                                         
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked  if this was a step  toward more use                                                               
of telemedicine.                                                                                                                
                                                                                                                                
CHAIR SEATON  explained this was  a step that would  permit this,                                                               
but it  would not institute  it, as a  person had to  be licensed                                                               
and pay  the licensing in  the state.   He clarified that  it was                                                               
necessary for  an expedited license  in each state, and  that the                                                               
compact did  not create a single  license for use in  all compact                                                               
states.                                                                                                                         
                                                                                                                                
4:46:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ directed  attention to  the FAQ,  page 2,                                                               
and  read:    "have  successfully completed  a  graduate  medical                                                               
education  (GME)  program."   She  said  that  she would  have  a                                                               
question  about this,  opining that  it  was a  question for  the                                                               
medical board.  She directed  attention to another requirement on                                                               
page 2, of the  FAQ, and read:  "have passed  the USMLE or COMLEX                                                               
within three  attempts."  She  acknowledged that these  were both                                                               
technical questions.                                                                                                            
                                                                                                                                
MS.  HANSEN  explained  that   the  examination  requirement  was                                                               
similar to what  was currently in the medical  statutes, and that                                                               
there was  a similarly  worded requirement  for having  passed an                                                               
approved GME  program.   She noted that  the approving  bodies in                                                               
Alaska  were  different  than  those   approving  bodies  in  the                                                               
compact, and she deferred to  the state medical board for further                                                               
discussion.  She  directed attention to the  letter dated January                                                               
13,  2015, from  the Director  of the  Division of  Corporations,                                                               
Business  and Professional  Licensing detailing  interest by  the                                                               
Department of Commerce, Community  & Economic Development but not                                                               
indicating any current reservations.                                                                                            
                                                                                                                                
4:48:17 PM                                                                                                                    
                                                                                                                                
MS.  HANSEN   referenced  the  Sectional  Analysis   of  HB  237,                                                               
[Included in  members' packets]  explaining that  Sections 1  - 6                                                               
were Alaska  specific language to include  the Interstate Medical                                                               
Licensure  Compact; whereas,  Section  7, the  main  body of  the                                                               
proposed bill, was the model  language to enter into the Compact,                                                               
and could not be substantially changed  if Alaska desired to be a                                                               
part  of  the Compact.    She  reported  that  Section 8  of  the                                                               
Sectional  Analysis  was  also Alaska  specific  language.    She                                                               
paraphrased from the Sectional Analysis of HB 237, which read:                                                                  
                                                                                                                                
     Section  1- Amends  AS 08.64.101,  duties of  the state                                                                  
     medical  board,   to  include  implementation   of  the                                                                    
     Interstate Medical Licensure Compact.                                                                                      
                                                                                                                                
     Section 2- Adds to AS  08.64.190 to require a physician                                                                  
     applying for  an expedited  license under  this compact                                                                    
     to  submit the  fingerprints and  fees necessary  for a                                                                    
     criminal background  check. Statute does  not currently                                                                    
     require  physicians  licensed  in   Alaska  to  have  a                                                                    
     background check.                                                                                                          
                                                                                                                                
     Section  3-   Requires  the  medical  board   to  waive                                                                  
     licensure requirements  if a physician is  eligible for                                                                    
     expedited  licensure   under  the   Interstate  Medical                                                                    
     Compact.                                                                                                                   
                                                                                                                                
     Section  4-  Authorizes  the  Department  of  Commerce,                                                                  
     Community,  and Economic  Development to  set fees  for                                                                    
     the issuance or renewal of expedited licenses.                                                                             
                                                                                                                                
     Section 5- Clarifies in AS  08.64.370 the exceptions to                                                                  
     licensure requirements under chapter 08.64.                                                                                
                                                                                                                                
     Section 6-  Amends the definition  of the  "practice of                                                                  
     medicine" or "practice of osteopathy"  to allow for the                                                                    
     definition  under  the   Interstate  Medical  Licensure                                                                    
     Compact.                                                                                                                   
                                                                                                                                
4:50:20 PM                                                                                                                    
                                                                                                                                
MS. HANSEN  moved on to  explain that  Section 7 of  the proposed                                                               
bill  was  the  model  legislation,  and  that  the  first  seven                                                               
sections of Section 7 dealt with  the ground rules for entry into                                                               
the Compact.  She paraphrased from Section 7, which read:                                                                       
                                                                                                                                
     Section 08.64.500-  Enacts and  enters Alaska  into the                                                                  
     Interstate Medical Licensure Compact  as created in the                                                                    
     following sections.                                                                                                        
                                                                                                                                
     Section  08.64.510-  States  that the  purpose  of  the                                                                  
     compact is  to provide a streamlined  licensure process                                                                    
     that enhances portability  while complementing existing                                                                    
     state license authority.  Maintains the jurisdiction of                                                                    
     individual state medical boards.                                                                                           
                                                                                                                                
     Section 08.64.520- Defines terms  to be used throughout                                                                  
     the  compact,   including  definitions   of  "expedited                                                                    
     license"   and   "physician"   for   the   purpose   of                                                                    
     qualification for an interstate expedited license.                                                                         
                                                                                                                                
     Section 08.64.530- Declares that  a physician must meet                                                                  
     the eligibility  requirements defined  in 08.64.520(11)                                                                    
     to  receive   an  expedited  license.  Allows   that  a                                                                    
     physician  that does  not meet  these requirements  may                                                                    
     obtain an  individual state license  if all  state laws                                                                    
     and requirements are met.                                                                                                  
                                                                                                                                
     Section 08.64.540-  Directs a physician to  designate a                                                                  
     compact  member   state  as  the  state   of  principal                                                                    
     licensure  to register  for  an  expedited license  and                                                                    
     defines  what   qualifies  as  a  principal   state  of                                                                    
     licensure.                                                                                                                 
                                                                                                                                
4:52:28 PM                                                                                                                    
                                                                                                                                
MS. HANSEN moved on to the next section, which outlined how to                                                                  
get an expedited license, and read:                                                                                             
                                                                                                                                
     Section  08.64.550-  Outlines  how  a  physician  shall                                                                  
     apply  for an  expedited compact  licensure through  an                                                                    
     application with  the medical board of  the physician's                                                                    
     state of  principal license.  The board  shall evaluate                                                                    
     the   physician's   eligibility  under   the   compact,                                                                    
     including  through  primary   source  verification  and                                                                    
     criminal  background  checks. If  determined  eligible,                                                                    
     the physician  shall then register with  the Interstate                                                                    
     Commission,  select states  of licensure,  and pay  any                                                                    
     necessary  fees to  each selected  member state  before                                                                    
     receiving licenses  in those  states. A  physician must                                                                    
     follow  all  applicable  laws and  regulations  of  the                                                                    
     issuing state.                                                                                                             
                                                                                                                                
REPRESENTATIVE WOOL asked whether  a physician arriving in Alaska                                                               
from  a  state not  participating  in  the Compact  could  simply                                                               
fulfill  the  Alaska  requirements,   although  this  would  take                                                               
longer.                                                                                                                         
                                                                                                                                
4:54:50 PM                                                                                                                    
                                                                                                                                
MS. HANSEN expressed her agreement.  She returned attention to                                                                  
the Sectional Analysis, which read:                                                                                             
                                                                                                                                
     Section  08.64.560-  Allows  compact member  states  to                                                                  
     impose  a fee  for expedited  licensure and  authorizes                                                                    
     the  Interstate Commission  to develop  rules regarding                                                                    
     these fees.                                                                                                                
                                                                                                                                
     Section 08.64.570- Describes  how a qualified physician                                                                  
     may seek  renewal of an  expedited license  through the                                                                    
     Interstate Commission. States  that the physician shall                                                                    
     comply  with any  continuing education  requirements of                                                                    
     any  member state  where they  seek a  renewed license,                                                                    
     and that member states  may charge renewal fees through                                                                    
     the Interstate Commission.                                                                                                 
                                                                                                                                
     Section  08.64.580-  Establishes   a  database  of  all                                                                  
     physicians licensed  through the  Interstate Commission                                                                    
     and  describes what  information compact  member states                                                                    
     must report.                                                                                                               
                                                                                                                                
     Section 08.64.590-  Outlines how compact  member boards                                                                  
     may participate in joint investigations.                                                                                   
                                                                                                                                
     Section 08.64.600- States  that any disciplinary action                                                                  
     taken by one member board  may be acted upon or imposed                                                                    
     by other  member states, that  if a license  is revoked                                                                    
     by  the state  of  principal license  all other  member                                                                    
     state licenses  are automatically revoked, and  that if                                                                    
     the  license is  revoked by  a  state that  is not  the                                                                    
     principal  state  of  license all  other  licenses  are                                                                    
     automatically suspended  for 90 days  for investigation                                                                    
     by each member board.                                                                                                      
                                                                                                                                
4:57:23 PM                                                                                                                    
                                                                                                                                
MS. HANSEN described the last sections of the model legislation,                                                                
which read:                                                                                                                     
                                                                                                                                
     Section  08.64.610-  Creates   the  Interstate  Medical                                                                  
     Licensure   Compact   Commission  to   administer   the                                                                    
     Interstate Medical Licensure  Compact and describes the                                                                    
     voting   members   and   meeting  procedures   of   the                                                                    
     commission.  Each member  state shall  have two  voting                                                                    
     representatives.                                                                                                           
                                                                                                                                
     Section 08.64.620-  Describes the powers and  duties of                                                                  
     the Interstate Commission.                                                                                                 
                                                                                                                                
     Section    08.64.630-    Authorizes   the    Interstate                                                                  
     Commission to levy an  assessment against member states                                                                    
     to  cover  its  costs and  requires  certain  financial                                                                    
     restrictions of the commission.                                                                                            
                                                                                                                                
     Section  08.64.640-  Sets   out  the  organization  and                                                                  
     operation  of the  Interstate Commission  including the                                                                    
     adoption of  bylaws, the election of  officers, and the                                                                    
     immunity  and  liability  of commission  directors  and                                                                    
     employees.                                                                                                                 
                                                                                                                                
     Section   08.64.650-   States   that   the   Interstate                                                                  
     Commission  shall promulgate  reasonable rules  for the                                                                    
     administration of the compact  and describes a petition                                                                    
     against a commission rule.                                                                                                 
                                                                                                                                
     Section  08.64.660- Declares  that  all  branches of  a                                                                  
     state   government  shall   enforce  the   Compact  and                                                                    
     maintains that the Compact  shall not override existing                                                                    
     state authority to regulate medicine.                                                                                      
                                                                                                                                
     Section  08.64.670-  Provides  guidelines for  how  the                                                                  
     Interstate Commission may take  legal action to enforce                                                                    
     the provisions and the rules of the Compact.                                                                               
                                                                                                                                
     Section   08.64.670-   Outlines   procedures   of   the                                                                  
     Interstate Commission should a  member state default in                                                                    
     its obligations under the Compact.                                                                                         
                                                                                                                                
     Section 08.64.690- Allows  the Interstate Commission to                                                                  
     promulgate rules  for dispute mediation  and resolution                                                                    
     at  the  request  of  a member  state  or  states.  The                                                                    
     following  sections  relate   to  the  effective  date,                                                                    
     withdrawal   proceedings,    and   other   construction                                                                    
     questions relating to the Compact.                                                                                         
                                                                                                                                
4:59:35 PM                                                                                                                    
                                                                                                                                
MS. HANSEN paraphrased from the Compact, that for any change to                                                                 
the Compact, the member states would have to give unanimous                                                                     
consent, which read:                                                                                                            
                                                                                                                                
     Section 08.64.700-  Declares that the Compact  shall be                                                                  
     effective and binding on member  states once enacted by                                                                    
     no less than seven  states, that nonmember states shall                                                                    
     be invited  to participate as a  non-voting member, and                                                                    
     that  a proposed  amendment to  the  Compact shall  not                                                                    
     become binding  unless enacted by unanimous  consent of                                                                    
     the members states.                                                                                                        
                                                                                                                                
     Section  08.64.710- Provides  that a  member state  may                                                                  
     withdraw from the Compact one  year after the effective                                                                    
     date of a statute repealing the Compact in that state.                                                                     
                                                                                                                                
     Section  08.64.720- States  that  the  Compact and  the                                                                  
     Interstate  Commission shall  dissolve  if the  Compact                                                                    
     membership is reduced to one member state.                                                                                 
                                                                                                                                
     Section 08.64.730-  Allows that  the provisions  of the                                                                  
     Compact  are severable,  should  any  one provision  be                                                                    
     deemed unenforceable.                                                                                                      
                                                                                                                                
     Section 08.64.740- Details  the interaction between the                                                                  
     Compact  and other  laws  of  member states,  including                                                                    
     that laws  in conflict  with the Compact  are supersede                                                                    
     to  the  extent  of  the   conflict  and  that  Compact                                                                    
     provisions   that  are   in  conflict   with  a   state                                                                    
     constitution shall be ineffective  to the extent of the                                                                    
     conflict.                                                                                                                  
                                                                                                                                
     Section 08.64.750-  Allows the  state medical  board to                                                                  
     designate  a  compact  administer  to  facilitate  that                                                                    
     administration of the  Compact across state departments                                                                    
     and agencies.                                                                                                              
                                                                                                                                
5:00:35 PM                                                                                                                    
                                                                                                                                
MS. HANSEN reviewed the final section, Section 8, which read:                                                                   
                                                                                                                                
     Section 8- Amends existing  Alaska statute AS 12.62.400                                                                  
     to  allow the  Department  of Public  Safety to  submit                                                                    
     fingerprints to the Federal  Bureau of Investigation to                                                                    
     obtain  a   national  criminal  background   check  for                                                                    
     physicians applying for expedited licensure.                                                                               
                                                                                                                                
[HB 237 was held over]