Legislature(2025 - 2026)BARNES 124
02/09/2026 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB293 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 293 | TELECONFERENCED | |
| += | HB 210 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 293-GENETIC COUNS: LICENSING; ADVISORY CNCL.
3:17:28 PM
CO-CHAIR HALL announced that the only order of business would be
HOUSE BILL NO. 293, "An Act relating to the practice of genetic
counseling; relating to the licensure of genetic counselors;
establishing the Genetic Counseling Advisory Council; relating
to the duties of the State Medical Board; relating to telehealth
by licensed genetic counselors; relating to medical malpractice
liability of licensed genetic counselors; relating to immunity
from civil liability for a licensed genetic counselor providing
free health care services; and prohibiting unfair discrimination
under group health insurance against genetic counselors."
3:18:03 PM
CO-CHAIR ZACK FIELDS, as prime sponsor, presented HB 293. He
explained that the bill covers the same topic that was discussed
in a previous committee hearing: licensing for genetic
counselors. He said that the proposed legislation is simple; it
would establish licensing for genetic counselors to make a more
sustainable billing model. He noted that genetic counselors
work as part of a healthcare team and, as previous testimony had
suggested, currently only the largest healthcare employers can
hire genetic counselors due to the need to pay them with
overhead. He noted that genetic counselors can improve both the
quality and efficiency of healthcare and rapidly advancing
medical technology would continue to assist with these
practices. He said that these services should be utilized to
provide faster and more cost-effective care for Alaskans.
3:19:27 PM
EVAN ANDERSON, Staff, Representative Zack Fields, Alaska State
Legislature, on behalf of prime sponsor, Representative Fields,
offered the sectional analysis to HB 293 [included in the
committee file], which read as follows [original punctuation
provided]:
Section 1: Amends AS 08.02.110(a) to add genetic
counselors to a list of health care professions
licensed by the Department of Commerce, Community, and
Economic Development.
Section 2: Amends AS 08.08.130(j)(1) to add genetic
counselors to a list of health care providers who are
authorized to provide services via telehealth.
Section 3: Amends AS 08.08.130(j)(4) to add genetic
counselors to a list of providers authorized to
provide services via telehealth as part of a multi-
disciplinary care team.
Section 2: Amends AS 08 with a new chapter: Chapter
53: Genetic Counselors
Article 1: Licensing of Genetic Counselors
Sec. 08.53.100 requires a license to practice
genetic counseling in the state
Sec. 08.53.110 lists the qualifications for
licensure as a genetic counselor, which include the
applicant completing a certification program and
passing an examination. The bill also requires a
review of the applicant's licenses previously
held in other states, and of any disciplinary action
taken in another state. Genetic counselors who may not
meet these qualifications but who are able to verify
that they have practiced in the field for a minimum of
10 years are also able to qualify for licensure.
Sec. 08.53.120 provides for temporary licensure
for up to one year for an otherwise qualified
applicant who has not yet received their exam results.
Temporary licensees must work under the supervision of
a licensed genetic counselor or a licensed physician.
Sec. 08.53.130 provides for licensure of a
genetic counselor who is licensed in another state.
Sec. 08.53.140 allow genetic counseling interns
to practice under the direct supervision of a licensed
genetic counselor
Article 2: Regulation of Genetic Counselors
Sec. 08.53.160 permits licensed genetic
counselors to operate within their scope of practice,
and defines the scope of practice to include ordering
and interpreting genetic tests and counseling
patients.
Sec. 08.53.170 gives the Medical Board the
authority to revoke or suspend the license of a
genetic counselor or to discipline the licensee for
any fraudulent, unprofessional, unethical, or criminal
activities.
Article 3: Genetic Counseling Advisory Council
Sec. 08.53.180 establishes a genetic counseling
advisory council under the purview of the State
Medical Board. The council consists of 3-5 members,
majority of whom are licensed genetic counselors, with
at least one licensed physician.
Article 4: General Provisions
Sec. 08.53.200 affirms that the Administrative
Procedures Act (AS 44.62) applies to any action taken
by the board
Sec. 08.53.210 provides exceptions for licensure
for genetic counselors who are in the military service
or employed by another agency of the federal
government, and it requires that those providers hold
patients to the same standard of care as other
licensed providers.
Sec. 08.53.220 makes violations of this chapter a
class B misdemeanor.
Sec. 08.53.230 allows the State Medical Board, in
consultation with the genetic counseling advisory
council to adopt regulations to carry out licensure
and regulation of services. These regulations must
include adoption of a code of ethics. The board also
has the power to administer oaths, subpoena witnesses,
and compel the production of documents.
Sec. 08.53.300 provides definitions for "board"
and "licensed genetic counselor.
Section 5: Amends AS 08.64.101(a) giving the State
Medical Board the authority to impose disciplinary
sanctions on violations of the provisions of licensing
genetic counselors under AS 08.53.
Section 6: Amends AS 08.54.103(a) clarifying the
authority of the board to conduct investigations into
violations under AS 08.53 and to review the
qualifications for licensure or renewal in
consultation with the genetic counseling advisory
council.
Section 7: Amends AS 08.64.130(a) with a conforming
change.
Section 8: Amends AS 09.55.560(2) adding genetic
counselors to the list of healthcare providers who may
be the subject of medical malpractice liability.
Section 9: Amends AS 09.65.300(c)(1) adding genetic
counselors to the list of healthcare providers who
receive liability immunity during the provision of
health care services for free.
Section 10: Amends AS 21.36.090(d) adding genetic
counselors to the list of healthcare providers who may
not practice or permit unfair discrimination based on
the type of health insurance coverage they have.
Section 11: Amends uncodified law with a new section
allowing for transition regulations permitting
certified genetic counselors to continue practicing
until July 1, 2027.
Section 12: Amends uncodified law with a new section
allowing the State Medical Board to appoint the
initial members of the genetic counseling advisory
council.
3:24:33 PM
CO-CHAIR HALL transitioned to invited testimony on HB 293.
3:24:59 PM
The committee took an at-ease from 3:25 p.m. to 3:26 p.m.
3:26:02 PM
ANNA JOHANNSEN, Certified Genetic Counselor, Southcentral
Foundation, gave invited testimony in support of HB 293. She
said that as the newest genetic counselor in Alaska, she would
attempt to speak about the existing gaps in care and the future
of the genetics workforce in the state. She said that as Monty
Worthington had alluded to in a previous committee hearing, one
of the primary benefits to licensure is reducing potential
patient harm. She said that while in Alaska, she has seen well-
intentioned medical providers give incorrect genetic information
because genetics is complex and outside the scope of many
clinicians' primary training. She noted that one patient with a
strong paternal history of breast cancer was incorrectly told
that breast cancer risk could not be inherited from her father.
In another case, a family was told that having sons with autism
suggested that another would be affected by autism; this was not
supported by genetics. She said that these types of mistakes
can lead to either inappropriate reassurance or unnecessary
fear, which can lead to missed opportunities for appropriate
care. She said that licensure helps ensure that patients
receive guidance from professionals with verified training in
genetics.
MS. JOHANNSEN remarked that a second reason that licensure would
be important is it would increase access to genetic counseling
across Alaska. She said that the current lack of licensing
makes it difficult for clinics to bill for genetic counseling
services, which renders hiring genetic counselors challenging.
She said that when she joined Southcentral Foundation, it
increased the clinic's medical capacity and helped reduce wait
times for patients who had been waiting months or even years for
evaluation. This was only Alaska Native and American Indian
pediatric patients. She said that other children and adults not
in this group generally do not have access to services in the
state and either travel out of state, rely on telehealth
services, or receive care from providers with limited experience
in genetics.
MS. JOHANNSEN said that from a workforce perspective, licensure
is critical for recruitment and retention. She said that after
graduate school in genetic counseling, she found it difficult to
find available positions in Alaska, or clinics that were willing
to create one, and billing challenges were a part of this. She
said that it took over a year to find a position in Alaska, and
she nearly accepted an out-of-state position during the waiting
period. She said that this experience highlights that future
Alaskans would likely experience this same challenge.
MS. JOHANNSEN discussed the economic and systems level impact of
the bill. She said that she had previous work with the Alaska
Native Tribal Health Consortium involving Medicaid authorization
and medical travel. This experience gave her insights into how
costly and inefficient in care out-of-state referrals can be,
especially for rural patients. She remarked that licensure
along with the billing and funding considerations could support
the hiring of genetic counselors in additional communities and
lower the wait times and overall cost for service access.
MS. JOHANNSEN explained that when genetic testing is ordered
incorrectly, insurance often does not cover costs for the
correct test. This causes patients to pay out of pocket or go
without care. She said even in a cost-free setting such as
Indian Health Service (IHS) affiliated clinics, dollars are
still diverted from other areas of care. She said that genetic
counselors are specifically trained to avoid these errors, which
saves both patients and healthcare systems time and money.
MS. JOHANNSEN concluded by explaining that HB 293 would
establish clear standards, accountability, and recognition for
genetic counselors in Alaska. It would align the state with
most other states and support safer care, improved access, and a
stronger healthcare workforce in the state.
3:31:21 PM
APRIL O'CONNOR, Genetic Counselor, Providence Cancer Center,
answered questions during the hearing on HB 293. She noted that
she graduated in 2005 and has been working in multiple states
across the country and currently is affiliated with the
Providence Cancer Center. She noted that she did not wish to
give a formal testimony but was available to answer any
questions.
3:32:30 PM
REPRESENTATIVE SADDLER noted that previous discussions of
genetic counseling had highlighted a national qualification or
test for licensing. He asked Ms. Johannsen whether she could
discuss what type of licensing she currently had.
MS. JOHANNSEN responded that there is a national board that
manages national board certifications, which is a certification
that she currently holds. She said that licensure operates on a
state-to-state level, whereas board certification operates at a
federal level. She remarked that licensing was important since
there is currently nothing in place regarding repercussions to
malpractice and operating under the guise of a genetic
counselor.
REPRESENTATIVE SADDLER asked whether Ms. Johannsen knew what the
national certifying board is called.
MS. JOHANNSEN responded that the national accreditation board is
called the American Board of Medical Genetics and Genomics.
3:34:17 PM
MS. O'CONNOR, in response to a question from Representative
Coulombe regarding prenatal genetics, responded that she has
been a prenatal genetic counselor for the duration of her
career. She said that in prenatal genetic counseling, there is
a discussion of concerns regarding family history and
potentially inheritable conditions. She said that genetic
considerations are made when evaluating safe pregnancies and
delivery. She explained that pre-pregnancy genetic counseling
can also occur to assess any potential inheritable conditions.
REPRESENTATIVE COULOMBE asked whether there was any counseling
involved that could include ending a pregnancy if genetic
deformities were detected.
MS. O'CONNOR responded that her counseling did involve
discussions about ending a pregnancy if there were concerns.
She said that this is something that does not often come up in
genetic counseling. She said however, sometimes there are
questions regarding maternal health. She explained that at this
point, mothers would receive consultation with their maternal
fetal medicine specialist.
REPRESENTATIVE COULOMBE inquired whether, if there was a
prognosis that didn't implicate the health of a mother, but
deformities were detected and the parents wanted to end the
pregnancy, genetic counselors would provide consultation or
would the patient be referred to a primary care provider.
MS. O'CONNOR said that they would be referred to the maternal
fetal health specialist. She said these would be the same
people who refer patients to them for genetic consultation.
3:38:08 PM
REPRESENTATIVE D. NELSON asked Co-Chair Fields how many people
in Alaska currently have board certification for genetic
counseling.
CO-CHAIR FIELDS responded that this may be a question for
testifiers and whether they all held board certification.
3:38:35 PM
MS. JOHANNSEN responded that there are currently eight genetic
counselors working in Alaska and all are currently board
certified.
REPRESENTATIVE D. NELSON said that given that there are so few
genetic counselors in the state, perhaps it would be more
practical to designate a seat on an existing board for someone
with genetic counseling experience rather than create an
entirely new council. He said that the current board proposal
seems as if it would generate an unnecessary fiscal note.
3:39:37 PM
CO-CHAIR FIELDS said that he did not have a preference for board
structure but was more interested in getting a more sustainable
billing model.
3:40:06 PM
REPRESENTATIVE CARRICK said that she had the same line of
inquiry and asked Sylvan Robb whether Alaska had any licensed
professions in the state that do not have a board that regulates
them, but the department simply issues licenses and deals with
complaints.
3:40:41 PM
SYLVAN ROBB, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community &
Economic Development, responded that there are currently 24
programs that are regulated by the division that do not have
board oversight.
REPRESENTATIVE CARRICK asked whether Ms. Robb thought that,
given its small size, the division could take on oversight of
genetic counselors.
MS. ROBB responded that this would be a decision for the
sponsor. She said that 11 of the 24 mentioned programs have
fewer than 100 license holders.
3:41:48 PM
REPRESENTATIVE SADDLER raised concerns about a board that
regulates a practice, when everybody in that practice is a
member of the board. He compared it to a "fox guarding the hen
house." He said that this creates conflict and challenges. He
asked how many genetic counselors are practicing in the country.
MS. O'CONNOR noted that nationwide, thirty-five states currently
have genetic counseling licensures, and recent data indicates
that 7,514 genetic counselors were board certified, 3,287 of
which hold licensure in one of the 35 states that have licensing
requirements. She noted that this data was from mid-2025.
MS. O'CONNOR added that Alaska has eight board certified genetic
counselors, seven who practice in the state. She clarified that
anyone providing genetic counseling in a state the requires
licensure would need licensure for that state, even if the
service was provided via telemedicine. She noted that a single
laboratory with sixty genetic counselors would need sixty
licenses for operating in the state.
MS. O'CONNOR mentioned that Idaho has few genetic counselors
operating in the state as well, and the advisory board allows
genetic counselors from outside the state to serve on the board.
She said that Alaska could take a similar approach. In response
to a follow-up question, she clarified that a genetic
counselor's licensing can be designated in multiple ways, but
the most common is licensed certified genetic counselor (LCGC).
She confirmed that everyone who practices genetic counseling
must be licensed. She talked about out-of-state advisory board
members and recapped that they would still need licensing in
that state.
3:45:23 PM
MS. O'CONNOR clarified that genetic testing laboratories
employee genetic counselors, and one example is Ambry Genetics
in California. If they wanted to provide lab work for Alaska
patients, they would need licensure to operate in Alaska. She
noted that licensing would reach further than just counselors
currently residing in Alaska. She clarified that when referring
to a board, she means a board of genetic counselors, which is
tied into board certification.
3:47:49 PM
CO-CHAIR FIELDS said that in terms of options and cost, looking
at page 9, lines 20-21 and subsection (g), the committee could
certainly remove per diem and travel expenses to reduce
expenses. He noted that his staff, Mr. Anderson, could discuss
more about the current bill proposal versus talking about other
policy options.
3:48:27 PM
MR. ANDERSON noted to the committee that Ms. O'Connor is
offering an alternative means of structuring the five-member
advisory council. He said that the inclusion of out-of-state
personnel to the board would require an amendment to the current
bill proposition. Currently, the advisory board would be open
only to residents of Alaska. In response to Representative
Saddler, he clarified that the current bill proposal would have
an advisory council structure of three genetic counsellors: one
public seat and one physician.
3:49:34 PM
REPRESENTATIVE D. NELSON asked whether the bill sponsor would be
open to having an amendment that would propose alternative
routes to the advisory council, whether this was simply online
only meetings or even adding a board member with genetic
counseling experience to the Alaska State Medical Association
(ASMA). That way an entirely new advisory board could avoid
being developed from the proposed bill.
CO-CHAIR FIELDS recommended listening to the genetic counselors
regarding the strengths and weaknesses regarding the different
ways to structure the legislation. He said that he does not
have a preference in terms of whether there would be a board or
not, or whether it would meet remotely or not. He asked the
genetic counselors to come back with strengths and weaknesses of
each model, and he was supportive of how the committee wished to
address them.
REPRESENTATIVE D. NELSON directed a question to Ms. Johannsen or
Ms. O'Connor and asked whether they think that the State Medical
Board should have a chair or member with a history of genetic
counseling or whether they thought a whole separate board should
be established.
3:51:06 PM
MS. O'CONNOR said that given her experience working in other
states, it is customary to have an advisory board focused on
genetic counseling. A board much like the one structured in the
current bill proposition. She allowed that this is not the only
way that this could be addressed. She raised concerns that
relying on a single representative on the medical board, rather
than having an advisory committee, could be an issue,
particularly when reviewing out-of-state counseling credentials.
She said that multiple people should examine other states rules
and requirements to ensure that they match Alaska's standards
before granting a license based on those credentials. She said
that this type of evaluation should have more than one person's
judgement.
3:52:54 PM
REPRESENTATIVE COULOMBE asked the bill sponsor whether ASMA
supports the bill.
CO-CHAIR FIELDS responded that there has been no formal
statement from ASMA. However, he was certain that they were
aware of the bill proposal.
REPRESENTATIVE COULOMBE noted that there would be a doctor on
the advisory council and the medical board would also sit for
the first genetic counseling board meeting. She said the
structure seems unusual.
CO-CHAIR FIELDS responded that in terms of how genetic
counselors and doctors interact, it would be good to hear from
an additional testifier.
3:54:15 PM
MS. O'CONNOR explained that genetic counselors who work in
states like Alaska where national board certification exists,
but no licensure is in place, usually work as part of a care
team under a physician's guidance. A physician usually refers a
patient to a genetic counselor, and the counselor meets with the
patient and provides information. The genetic counselor then
sends recommendations back to the physician for follow-up care.
The physician at this point would ultimately direct care. She
remarked that genetic counselors are part of a team.
MS. O'CONNOR said that in states that have licensure in place, a
genetic counselor can manage care independently. They would not
need a physician referral, and patients can self-refer or be
referred directly. She said that because of this, genetic
counselors work with physicians everywhere, but the connection
is closer in states without licensure. She said that the ASMA
was aware of the bill and the physicians she works with at
Providence Cancer Center were aware of and supportive the bill.
REPRESENTATIVE COULOMBE noted that part of the reason she asks
is because often with ASMA there is a "turf war" on these types
of things. She said this has happened with naturopaths,
chiropractors, and pharmacists. She was trying to determine why
they seem to be supporting the proposed legislation and said she
understood that a doctor would testify later.
CO-CHAIR FIELDS said that he was happy to follow-up with ASMA to
determine to what extent it has discussed the proposed
legislation. He suspected that there has not been a "turf war"
since genetic counselors usually work as part of a multi-
disciplinary team. He opined that it is a question of ensuring
that doctors have the best information to make informed clinical
decisions.
REPRESENTATIVE COULOMBE said that it sounds a bit like a
licensure compact and asked for elaboration on licensing and who
can practice in the state.
3:56:55 PM
MR. ANDERSON said that what she is referring to is that there
are three or four ways in which someone can receive their
license. He said that licensing information can be found on
page 3, line 28 of the proposed bill, referring to AS 08.53.110,
qualifications for license. He noted that the first possibility
of licensure is to follow all the steps. This would mean they
are board certified, have taken the exam, and receive a review.
He said that this is the standard path to licensure. He noted
that the proposed bill also has two other pathways towards
licensure. The second could be found on page 5, line 19,
section 08.53.120, temporary license.
REPRESENTATIVE COULOMBE noted that she was referring to the
verbiage on the top of page 6 of the proposed bill and believed
that she understood the temporary license dynamics.
MR. ANDERSON clarified that on page 6, line 4, referring to AS
08.53.140 of the bill, there is language that states that these
individuals would follow the same licensing process, but license
applicants would need to show licensure to the state. His
understanding of the bill is that it is not a compact but
provides a couple different pathways to licensure.
3:59:04 PM
REPRESENTATIVE SADDLER said that his understanding when digging
into the bill is that the Genetic Counseling Advisory Council is
essentially a creation of the State Medical Board and would
write regulations on behalf of the genetic counsellors. He
noted the use of the words "consultation with" and "together
with" in the proposed bill language. He asked whether this was
a correct understanding of the power structure.
MR. ANDERSON responded that this is a correct understanding and
the question about the number of meeting dates came up earlier,
but he thought there was a requirement for an annual meeting,
with the ability to schedule more frequent meetings if needed.
4:00:01 PM
REPRESENTATIVE SADDLER said that looking at the proposed bill,
page 10, line 25, subsection (b), the language states that the
board would have subpoena power. He asked whether the medical
board had this power and asked why it would be necessary to
restate it in this part of the bill.
MR. ANDERSON said that he would assume that they may have this
power, but this language gives that authority specifically to
the advisory council.
REPRESENTATIVE SADDLER said that the language he reads gives the
authority to the board, not the advisory council. He said that
it is important to have a representative from the medical board
and medical association to get their perspective.
4:01:09 PM
CO-CHAIR FIELDS noted that this is a great idea and he was happy
to follow up.
4:01:22 PM
REPRESENTATIVE COULOMBE said that she was reviewing the national
code of ethics and the last code in section IV gave her pause.
It read that genetic counselors must "adhere to applicable laws
and regulations." However, when such laws are in conflict with
the principles of the profession, genetic counselors work toward
change that will benefit the public interest. She asked whether
one of the testifiers could describe the intent of this
language.
4:02:21 PM
MS. O'CONNOR responded that the field of genetic counseling has
traditionally been centered in large institutions contained in
major cities, largely because many communities cannot afford to
include genetic counselors as part of their care teams. As a
result, the population receiving services have tended to come
from specific demographic groups which has left many across the
country underserved. She explained that this has created gaps
in genetic data. She noted that people of European decent have
well documented genetic variance and disease patterns, whereas
many other populations including Alaska Natives remain
underrepresented in genetic data and access to counseling
services. She said that this impacts the accuracy and
applicability of commonly used genetic tests. Therefore,
genetic counselors must adjust their testing choices and
methodologies when working with populations for whom standard
tests are not reliable and recognizing when typical panels are
insufficient. This means modifying their practice to meet the
specific needs of the patient, rather than relying on standard
approaches.
REPRESENTATIVE COULOMBE expressed concern with the section
regarding "laws in conflict with the principles of the
profession" and asked for further elaboration.
MS. O'CONNOR clarified that the reference to "law" is not about
an actual statute but more similar in spirit to the Hippocratic
Oath, which requires clinicians to do no harm and act in the
best interests of their patients. She said that in practice,
this means that if there is a barrier to providing appropriate
care, clinicians are expected to navigate around that barrier
when necessary to ensure the patient receives correct care. She
offered her understanding that there is no specific federal or
state law that mandates this. She noted that after living in 10
states and practicing genetic counseling across the country, one
has not been encountered. She concluded by noting that the
intent of this language was about ethical obligation to do what
is best for a patient.
4:05:40 PM
MS. JOHANNSEN added that the language was not implying to break
any laws but addresses when a patient's care goes against
arbitrary laws that a state may have. She said at this point,
there is a duty to advocate for legal changes in the best
interest of patients.
REPRESENTATIVE COULOMBE said that she was pointing out that the
code of ethics does not just refer to "law" but also says that
genetic counselors are required to work toward change that
benefits public interest. She said that the wording seems very
specific and it could overlap with abortion-related
controversies.
CO-CHAIR FIELDS said that he would like to follow-up with
Legislative Legal Services and ask about the bill language.
REPRESENTATIVE COULOMBE noted that Legislative Legal Services
did not write this language, but it was part of a national code
of ethics that pertains to genetic counselors.
4:07:42 PM
REPRESENTATIVE SADDLER mentioned page 6, line 26, subsection (g)
of the proposed legislation, regarding genetic counseling
interns. He said that he has heard from testimony that genetic
counseling is a complicated practice. It needs to be practiced
by licensed and certified counselors. He said that the bill
would allow interns to work as genetic counselor interns with
supervision. He asked who would hire an intern to provide
genetic counseling services and where such a person would fit in
the chain of medical practice.
MS. O'CONNOR responded that at Providence Alaska Medical Center
and Providence Cancer Center, there are genetic counseling
students who make rotations during the spring, fall, or winter
semesters. She noted that often they work with certified
genetic counselors and see patients to better help foster their
education and prepare them for graduation and transition into a
career as a genetic counselor.
MS. O'CONNOR noted that at Providence Alaska Medical Center they
are referred to as interns and are individuals enrolled in a
master's level program. She said that they have not passed to
boards and hold certification and are classified as interns.
4:09:32 PM
MS. JOHANNSEN added that intern was not necessarily an
internship but a clinical rotation for graduate level students
preparing for a career in genetic counseling. This way students
can enter the career field without only "textbook knowledge."
4:09:51 PM
REPRESENTATIVE SADDLER noted that the proposed bill states that
a person may perform genetic counseling services using the title
of genetic counseling intern. He said that it is still not
quite clear what services would be provided. He said that it
appears to be a thorough bill and he suspects that those
advocating for genetic counseling helped draft it. He
reiterated that he did not know what services interns would
provide. He asked whether this meant that interns could bill
services or were simply operating as auxiliaries to other
genetic counselors.
MS. O'CONNOR responded that this could be one of two things.
For one, she said that they can see patients but always with a
board-certified genetic counselor. The counselor would be
observing and working with the intern. She said that second,
board certified genetic counselors do the full counseling and
the interns watch them. She said that this often depends on
whether the intern is a first- or second-year student in a
genetic counseling program. She said that if they are a second-
year student and near graduation, they are required to have a
certain number of cases of counseling experience while under
direct supervision. She noted that the clinical experience
determines eligibility to take the board. She said that they
cannot bill for the services of any genetic counselor that is
not board certified.
REPRESENTATIVE SADDLER, regarding billing, asked if there was a
place in the proposed bill that would allow genetic counselors
to bill Medicaid for services.
CO-CHAIR FIELDS responded that this may be a question for the
testifiers as to why licensure enables billing.
4:12:41 PM
MS. O'CONNOR explained that licensure enables billing for a
licensed healthcare provider. She said billing codes would
operate similarly to the way that many other clinicians bill
insurance. She noted that if someone is not licensed, they are
seen as "incident to" billing, where they are "incident to" the
physician's time. She said that many times there are higher
costs than what can be recouped.
MS. O'CONNOR said that genetic counselors could not bill
Medicare, as it does not recognize genetic counselors as
professionals who should be reimbursed. She said that a recent
bill in the U.S. House and Senate was drafted to address this,
but it did not pass. She noted that it is currently being
reintroduced by the National Society of Genetic Counselors to
get genetic counselors accredited with Centers for Medicare &
Medicaid Services (CMS) and allow Medicare billing. She noted
that even genetic counselors in states with licensure in place
could not bill Medicare. In response to a request from
Representative Saddler for clarification, she confirmed that
licensure would allow Medicaid billing, but the state would have
to modify its CMS plan to do so.
4:15:23 PM
REPRESENTATIVE COULOMBE drew attention to page 9, line 22,
regarding general provisions, which include a list of exceptions
to the application. She said that some of these exemptions
include the military, the federal government, and Indian Health
Services. She asked for clarification regarding the exemptions.
MR. ANDERSON clarified that if the proposed legislation passed,
these exemptions would be in place.
4:16:13 PM
REPRESENTATIVE SADDLER drew attention to page 13, line 25 of the
proposed legislation regarding the transition for current
genetic counselors. He asked for clarification as to how
current genetic counselors would be impacted while the licensing
would be established.
CO-CHAIR FIELDS responded that the effective date was July 1,
2027, and the bill section of reference was to enable current
genetic counselors to continue practice while licensure goes
into place.
REPRESENTATIVE SADDLER asked whether there was a database of
genetic information that exists and whether cheek swabbing was a
method to collect genetic information. Furthermore, whether a
family member would have to give permission to allow their
genetic material to be sampled and stored in a database. He
asked for clarification of the process.
4:17:52 PM
MS. O'CONNOR responded that genetic information is typically
provided from a testing laboratory. She noted that these labs
typically have information on various genetic variants that
impact disease function. She noted that these laboratories all
have their own variant classification teams that include Medical
Doctors (MDs), People holding a Doctor of Philosophy (PhDs), and
genetic counselors. She said that genetic counselors and
laboratories both have access to certain national databases.
She noted that ClinVar was one such database and it is managed
by the National Institute of Health (NIH). She said that using
ClinVar, one can input a genetic variant and see what current
research is available. She noted that most pathogenic variants
that would be disease causing are known today from years of
genetic testing. She said that occasionally they come across
things that they were not certain of that require additional
work and research.
MS. O'CONNOR noted that in terms of patients giving permission,
most labs in the U.S. release de-identified data to the central
national databases. It is only information about the variant
and disease state, and nothing is traceable to a patient through
this kind of data. She said that patients that sign consent
forms and undergo testing, consent to being tested at a
laboratory that shares genetic information nationally to further
genetic testing and genetic practice. In response to
Representative Saddler, she explained DNA sequence.
REPRESENTATIVE SADDLER said that Ms. O'Connor had mentioned that
genetic information was shared with laboratories and asked
whether they simply processed data and gave it back or provide a
diagnosis and recommendations as well. He asked whether the
labs were neutral and reflected the facts or came with
suggestions.
MS. O'CONNOR responded that they are effectively neutral in the
sense that the report back just says where the variant is, what
gene it is in, and then, based on published research, what
studies and clinical case reports were available. She said that
PubMed is a repository in the United States with affiliation
with the National Institute of Health that allows for access to
information on what genes cause issues, such as sickle cell
anemia. She said that the laboratories team, after a variant is
identified, will look up what genetic conditions are associated
with the gene.
4:23:44 PM
REPRESENTATIVE COULOMBE asked whether insurance companies were
able to see genetic testing results and whether they were
connected to the testing process.
MS. O'CONNOR responded that this has been an ever-changing
landscape, but essentially the law that protects against medical
health insurance discrimination was the Genetic Information
Nondiscrimination Act (GINA). She said this is a federal law
that was passed in 2000 and states have adopted their own
versions following its passing.
MS. O'CONNOR noted that prior to the passage of GINA, many
people chose to do genetic counseling as self-pay and kept the
results out of the medical record because insurance companies
were asking about the results and labeled people as having a
pre-existing condition. She said that insurance companies were
not dropping coverage but charging higher rates depending on
test results. She said that this is unfair because most
variants do not guarantee that someone will develop a condition
but simply have an increased risk. This was why the federal
government and states stepped in.
MS. O'CONNOR said that there are protections with GINA, but they
are not universal. She noted that full-time, active-duty
military personnel covered under TRICARE were not covered under
GINA. She said that individuals who work for businesses that
employ 15 or fewer employees, were not covered by GINA. She
explained that during her career as a genetic counselor, she has
not seen any concerns outside of active-duty military settings.
MS. O'CONNOR explained that there are no laws on the book that
protect patients from genetic discrimination related to long-
term disability or life insurance. She said that this has not
had the same level of concern as health insurance and may be a
reason that the federal and state governments have not acted on
this.
MS. O'CONNOR said that when counseling patients, they are told
these things prior to genetic testing. If they are worried
about potential discrimination, they may want to ensure that
policies are in place prior to testing. This would ensure that
rates cannot be retroactively amended if the patient tests
positive. She concluded by noting that reviewing risks,
benefits, and limitations is always part of the pre-test genetic
counselling session.
4:27:38 PM
CO-CHAIR HALL announced that HB 293 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB0293A.pdf |
HL&C 2/9/2026 3:15:00 PM |
HB 293 |
| HB 293 - Sectional Analysis.pdf |
HL&C 2/9/2026 3:15:00 PM |
HB 293 |
| GC Licensure Alaska White Paper.pdf |
HL&C 2/9/2026 3:15:00 PM |
HB 293 |
| HB293-DCCED-CBPL-02-06-26.pdf |
HL&C 2/9/2026 3:15:00 PM |
HB 293 |
| HB 293 - Sponsor Statement.pdf |
HL&C 2/9/2026 3:15:00 PM |
HB 293 |
| AK HB293_ GC Licensure_LOS.pdf |
HL&C 2/9/2026 3:15:00 PM |
HB 293 |