Legislature(2021 - 2022)DAVIS 106
04/13/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB168 | |
| HB103 | |
| SB21 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 168 | TELECONFERENCED | |
| + | HB 103 | TELECONFERENCED | |
| + | SB 21 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 21-LICENSE MOBILE INTENSIVE CARE PARAMEDICS
4:12:37 PM
CO-CHAIR SNYDER announced that the final order of business would
be SENATE BILL NO. 21, "An Act relating to mobile intensive care
paramedics; relating to duties of the State Medical Board and
the Department of Health and Social Services; and providing for
an effective date."
4:13:17 PM
SENATOR JOSH REVAK, Alaska State Legislature, as the prime
sponsor, presented SB 21. He reported that licensure oversight
of Alaska's approximately 600 licensed paramedics is currently
split between two separate agencies - the State Medical Board
under the Department of Commerce, Community, and Economic
Development (DCCED), and the Emergency Medical Services Office
under the Department of Health and Social Services (DHSS). He
stated that the purpose of SB 21 is to help Alaska's paramedics
by consolidating the emergency medical service system under a
single agency, DHSS, to improve peer and professional oversight.
Unanimously supported by the State Medical Board, it also has
broad support from first responders and paramedics around the
state.
SENATOR REVAK explained that SB 21 would transfer all paramedic
licensure to the Emergency Medical Services Office. He noted
that, currently, paramedics are the only one of their kind under
DCCED, all other emergency medical services are already under
DHSS, which is responsible for certifying all emergency medical
technicians (EMTs) and intensive care paramedics. The bill
would not change the scope of practice, the licensure
requirements, or the fee structure. The medical direction would
be provided by the existing DHSS Chief Medical Officer and the
EMS Medical Directors Committee. He further noted that the bill
would have zero fiscal impact and that DHSS's existing data
systems are already able to incorporate paramedic licensure,
making the move a seamless transition. Aligning all EMS
services under a single agency would promote public health and
safety, he continued, while also providing efficiencies through
peer and professional oversight. The bill has bipartisan
support and passed unanimously on the Senate floor.
4:15:25 PM
SETH DUGGAN, Staff, Representative Josh Revak, Alaska State
Legislature, provided the sectional analysis for SB 21 on behalf
of Senator Revak, prime sponsor. He paraphrased from the
written document titled, "SECTIONAL ANALYSIS, Senate Bill 21,"
which read [original punctuation provided except for some minor
formatting changes]:
Sec. 1 amends 08.64.107, State Medical Board/
Regulation of physician assistants and intensive care
paramedics, to remove regulation of paramedic
licensure from the Medical Board. (See also Sec. 8.)
Sec. 2 amends 08.64.170(a), License to practice
medicine, podiatry, or osteopathy, allowing paramedics
to practice medicine to render emergency lifesaving
service under "another law" instead of under the
Medical Board's authority. (See also Sec. 6)
Sec. 3 amends 08.64.360, Penalty for practicing
without a license or in violation of chapter, to
remove paramedics. (See also Sec. 10)
Sec. 4 amends 08.64.369(d), Health care professionals
to report certain injuries, to change paramedics
licensed under the Medical Board to those licensed
under DHSS, for health care providers who must report
certain injuries to the Department of Public Safety.
Sec. 5 amends 12.55.185(11), Sentencing and Probation,
to change paramedics licensed under the Medical Board
to those licensed under DHSS.
Sec. 6 amends 18.08.075, Authority of emergency
medical technician, to allow paramedics to provide
emergency medical care. (See also Sec. 2.)
Sec. 7 amends 18.08.080, Emergency Medical Services/
Regulation, to require DHSS to adopt regulations
establishing standards for paramedic licenses.
Sec. 8 adds a new paragraph 18.08.082(a)(5), Issuance
of certificates; designations, to add regulation of
paramedic licensure to DHSS. (See also Sec. 1.)
Sec. 9 amends 18.08.082(b), Issuance of certificates;
designations, to clarify that DHSS is the central
certifying and licensing agency for emergency medical
services.
Sec. 10 amends 18.08.084(a), Certificate required, to
prohibit a person from practicing as a paramedic
without a license. (See also Sec. 3.)
Sec. 11 amends 18.08.086(a), Immunity from liability,
Adding the term license. Provides civil immunity to
licensed or certified emergency medical providers who
are providing emergency medical service. They are not
liable for civil damages unless [it's] gross
negligence.
Sec. 12 18.08.089(a) is amended to clarify a paramedic
is allowed to pronounce someone dead in certain
circumstances.
Sec. 13 adds a new paragraph (14) to 18.08.200,
Emergency Medical Services/Definitions, to add the
definition of "mobile intensive care paramedic". (See
also Sec. 14.)
Sec. 14 Amends 29.45.050(r) to include mobile
intensive care paramedics in a municipal property tax
exemption.
Sec. 15 amends 37.05.146(c)(77)(F), Definition of
program receipts and non-general fund program
receipts, to add fees for licensure of paramedics to
the list of fees collected by DHSS.
Sec. 16 repeals 08.64.366, Liability for services
rendered by a mobile intensive care paramedic (See
Sec. 11, 18.08.086, Immunity from liability, under
DHSS). Repeals 08.64.380, Medicine/Definitions to
remove (3) "emergency lifesaving service" and (4)
"mobile intensive care paramedic" (See also Sec. 13).
Sec. 17 amends the uncodified law to provide
transitional authorities:
(a) A current paramedic license issued before
January 1, 2022 remains valid until it expires
under the Medical Board, is suspended or revoked,
or is converted to a license under DHSS.
(b) The Department of Commerce, Community and
Economic Development and the Medical Board will
transfer to DHSS on January 1, 2022, files of all
pending paramedic-related records and
proceedings, applications, and disciplinary
actions.
(c) Authority for DHSS to adopt regulations which
shall include the conversion of unexpired
paramedic licenses issued under the Medical
Board.
Sec. 18 provides an immediate effective date for DHSS
to adopt regulations.
Sec. 19 provides an effective date of January 1, 2022.
4:18:45 PM
REPRESENTATIVE SPOHNHOLZ noted that most of the licensing for
health care professionals is done in DCCED. She remarked that
there seems to be an exception here, wherein SB 21 is seeking to
consolidate licensure for EMTs and paramedics into one spot.
She asked why [the sponsor] chose to go with DHSS rather than,
for example, staying with DCCED and creating a new board.
SENATOR REVAK answered that all the EMS services are already
housed under one roof within DHSS. The split between the two
occurred at the time when intensive care mobile paramedics were
created, and [this split] has caused some significant challenges
to licensure. So, [consolidating EMTs and paramedics] is a
cleanup measure.
REPRESENTATIVE SPOHNHOLZ said she understands the rationale for
moving paramedics from under the Medical Board. It used to be
that everything was under the Medical Board, she continued, but
now it has been realized that health care providers who have
different expertise can regulate and manage their own licensure,
and paramedics should be allowed to do that. However, she
pointed out, most licensure in the state of Alaska is done in
DCCED and the choice is being made here to move paramedics under
DHSS as opposed to moving EMTs under DCCED. She inquired about
the rationale for doing that.
SENATOR REVAK deferred to the agency to answer the question.
4:21:58 PM
BRIAN WEBB, Emergency Medical Services Officer, Division of
Public Health, Department of Health and Social Services (DHSS),
noted he is one of a remaining few who were on the ground at the
time this whole thing was started. He stated that there are no
emergency medicine or paramedical subject matter experts in
DCCED, plus emergency medicine and paramedical professionals do
not have much input into changing regulations for their craft.
So, paramedics always seem to be left behind. However, the
Emergency Medical Services Office, with all its in-house
paramedics, would have the ability to develop and change
regulations and keep up to date with new procedures in the
craft. Changes to education requirements, standards, and
procedures are easily done within the Emergency Medical Services
Office, yet it is exceedingly hard to do for the Medical Board.
[Paramedics] have tried for years to have a seat on the Medical
Board because there are over 655 paramedics in Alaska. However,
[paramedics] have been repeatedly told they will not have a seat
on the Medical Board because that would mean somebody else would
have to give up a seat. One reason why [paramedics] have
requested this, Mr. Webb continued, is to have some control over
their craft and their future. Another impetus comes from the
2014 National Highway Transportation Safety Administration's
(NHTSA's) reassessment of emergency medical services in Alaska,
which recommended that the Alaska State Legislature transfer the
licensing of paramedics from the State Medical Board to DHSS. A
footnote to this recommendation, he added, is that only four
states have a similar regulatory split; most states have their
personnel under their semblance of an Emergency Medical Services
Office.
REPRESENTATIVE SPOHNHOLZ said she understands the issue of
wanting to move out from underneath the State Medical Board it
doesn't make any sense that paramedics be licensed and decisions
about licensing for paramedics be done by the State Medical
Board, particularly if there isn't space for paramedics to sit
on that board. But, she continued, most of the other health
care practitioners have their own boards that are made up of
peers of their own choosing and they make the regulations and
licensing standards, and they sit under DCCED's Division of
Corporation, Business, and Professional Licensing. All other
health care items, health care licensing and facility licensing,
sit at DHSS, but the practitioners themselves are governed,
licensed, and managed under DCCED. She asked whether
consideration was given to creating a board of paramedics that
was made up of paramedics and which would be responsible for
managing licensure under the DCCED.
4:26:07 PM
SARA CHAMBERS, Director, Division of Corporation, Business, and
Professional Licensing, Department of Commerce, Community, and
Economic Development (DCCED), replied that the bill was
originally, and continues to be, presented not as a "let's solve
a problem with a variety of options;" rather, this is the
proposal. She stated that the division did not explore deeply
the idea of creating a new board, or proposing that the
legislature create a new board, because DHSS is already so well
resourced and already has all the staff and the programming set
up for emergency services that it didn't make sense from an
efficiency standard to try to recreate that or something similar
on DCCED's side. She said DCCED's model of governance through a
board is very different than the EMS management model with
paramedics already on staff who are working to govern those
regulations through the public process. Of these two processes,
DHSS is far better resourced than DCCED to provide the value to
paramedics and consistency with the [Emergency Medical Services
Office].
REPRESENTATIVE SPOHNHOLZ asked whether paramedics are governed,
regulated, and licensed this same way in other states or whether
paramedics tend to sit in the same department as nurses,
physician assistants, doctors, and other health care providers.
MR. WEBB responded that four states have this same split and are
currently trying to solve that as well. Therefore, the majority
are through their semblance of a state EMS office. In further
response, he agreed to provide written details.
4:29:27 PM
CO-CHAIR SNYDER opened public testimony on SB 21.
4:29:48 PM
WILMA VINTON, testified in support of SB 21. She related that
she is the assistant chief of EMS for the state's volunteer fire
department, which is responsible for ensuring that folks are
certified, and she is also an instructor for the State of Alaska
and teaches many EMTs throughout the Interior. She said she
assists EMTs and Mobile Intensive Care Paramedics (MICPs) with
acquiring and maintaining their certifications and licensure.
She stated she has personally gone through both processes, first
becoming certified as an EMT in Alaska from Montana in 1979 and
then becoming an MICP in 2007, and it is her opinion that moving
from the State Medical Board to the Emergency Medical Services
Office in DHSS is an excellent way to streamline the licensing
and certification process.
MS. VINTON pointed out that EMTs and MICPs work side by side,
yet certification and recertification requires working with two
different agencies and two different processes. She said the
Emergency Medical Services Office currently certifies EMTs
within 7-20 days of testing, and she doesn't see a problem with
MICPs being licensed in the same timeline. Currently, the MICP
licensing process under the State Medical Board can take several
months because the board only meets quarterly to approve
licenses, causing a backup in receiving certifications and
licenses. The Emergency Medical Services Office, however, has
staff whose daily job is to provide licensing and certification.
They have honed the process and will be as thorough as the State
Medical Board's process, albeit in a shorter amount of time.
This shortened timeframe is important to someone who is trying
to get a paramedic job in Alaska. Ms. Vinton offered her strong
belief that it would be a seamless move and would align the
MICPs with EMS like in many other states. She concluded by
urging the committee to support SB 21.
4:33:01 PM
CO-CHAIR ZULKOSKY offered her understanding that SB 21 would
create an intensive care paramedic in addition to an EMT.
SENATOR REVAK replied that it doesn't create a new one, it moves
the paramedics from DCCED over to DHSS with the rest of EMS.
SENATOR REVAK returned to an earlier question by Representative
Spohnholz and explained that when initially looking at this
problem this seemed to be the easiest path that made the most
sense since EMS is already running seamlessly under DHSS.
4:34:15 PM
CO-CHAIR SNYDER closed public testimony on SB 21.
CO-CHAIR ZULKOSKY asked whether adopting this legislation would
have any downstream impacts for people who are currently
paramedics in Alaska.
SENATOR REVAK responded that SB 21 should not affect the scope
of service in any way.
MS. CHAMBERS responded that DCCED has pledged to DHSS that it
would be a seamless transition and there are no proposed or
anticipated changes other than to potentially receive augmented
services through the new department. She said DCCED is working
behind the scenes to make this as coordinated as possible.
REPRESENTATIVE MCCARTY expressed his support for SB 21.
[SB 21 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 103 Transmittal Letter 2.17.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Sectional Analysis Version GH 1675 A.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Version 32-GH1675 A.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB0103 Fiscal Note 1-2-021821-DHS-N.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - Final Rule 42 CFR 441.301c.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - HCBS Transition Plan (DHSS).pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Hearing Request.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - All Ways Caring.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| 09 HB 103 Letter of Support - LTCO 3.16.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 One Page Summary (003).pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 103 |
| HB 103 Final Rule 42 CFR 441.301c.pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 103 |
| HB 103 FAQ on Final Rule prepared by Coalition for Community Choice.pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - Final Rule 42 CFR 441.301c.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - One Page Summary by SDS.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - ACoA 3.8.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/25/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - Colony Assisted Living Home 3.24.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/25/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - MSHF 3.26.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 4/1/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - AK Regional Hospital 3.26.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 4/1/2021 3:00:00 PM |
HB 103 |
| SB 89 AARP Support HB103 and SB89.pdf |
HHSS 4/13/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM |
HB 103 SB 89 |
| SB 21 version B.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sponsor Statement.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DHSS.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DCCED.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sectional Analysis.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Point Paper.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Updated Sectional Analysis 3.1.21.pdf |
HHSS 4/13/2021 3:00:00 PM |
SB 21 |
| SB 21 v. B Sectional Analysis.pdf |
HHSS 4/13/2021 3:00:00 PM SL&C 3/15/2021 1:30:00 PM |
SB 21 |
| SB 21 v. B.pdf |
HHSS 4/13/2021 3:00:00 PM SL&C 3/15/2021 1:30:00 PM |
SB 21 |
| HB 168 Sectional Analysis, Ver W..pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 168 |
| HB 168, Ver W..PDF |
HHSS 4/13/2021 3:00:00 PM |
HB 168 |
| HB 168 Sponsor Statemen.pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 168 |