Legislature(2019 - 2020)ADAMS ROOM 519
04/30/2019 01:30 PM House FINANCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB36 | |
| SB37 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 36 | TELECONFERENCED | |
| + | SB 37 | TELECONFERENCED | |
| += | HB 49 | TELECONFERENCED | |
| += | HB 145 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 20 | TELECONFERENCED | |
SENATE BILL NO. 36
"An Act extending the termination date of the Board of
Nursing; and providing for an effective date."
1:31:18 PM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, explained that
the sponsor could not be present, as she was attending
Floor Session. She explained that the bill extended the
Board of Nursing for six years. Otherwise, the board was
set to expire on June 30, 2019. She provided additional
details of the bill. The board was established for the
purpose of regulating the practice of nursing; and covered
advance-practice registered nurses, nurse anesthetists,
registered nurses, licensed practical nurses, and certified
nurse aides (CNA).
Ms. Conway continued that the board had almost 20,000
licensees, which she thought was near to one-third the
workload of professional licensees.
Co-Chair Wilson clarified she was addressing SB 36 rather
than SB 37.
Ms. Conway discussed education requirements for the
licensees, which spanned from high school diplomas to
doctoral degrees. The board of seven individuals served
four-year terms and were capped at two consecutive terms.
The board's mission was to actively promote and protect the
health of citizens of Alaska through safe and effective
practice of nursing as defined by law. The 2018 audit cited
four recommendations. She indicated the legislative auditor
was present to provide the audit findings. The board
received its revenue from licensing and renewal fees, and
deficits were shown on page 11 of the audit. The board was
self-sustaining and required no general funds. The audit of
the board concluded that the board continued to meet its
mission and recommended its six-year sunset.
1:34:33 PM
Co-Chair Wilson asked about page 11 of the audit. It
appeared there was a deficit for the board for the first
time. She wondered why.
Ms. Conway believed there had been a large influx of
licensees. There would be a fee analysis in May. She
thought the division director could provide more detail.
Representative Josephson had been told the board did not
have an executive administrator at present. He wondered if
the position would be filled in the near future.
Ms. Conway thought the board was actively pursuing the
recruitment of the position.
1:36:37 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, responded that the
department was actively recruiting for the executive
administrator position which would close the following day.
Representative Josephson thought the board consisted almost
entirely of new members. He referenced telemedicine
regulations and asked if Ms. Chambers could explain the
turnover.
Ms. Chambers was unsure of the reason for the turnover. She
assured the committee that every effort was being made to
bring new members up to speed and avoid a gap in service.
Co-Chair Wilson directed Ms. Chambers to respond to her
query about the deficit.
Ms. Chambers informed that she had submitted an updated
fiscal report to the committee on the previous Friday,
while the audit was a year old. She detailed that as of
March 30, 2019, the board had a $1 million surplus. The
funds were adequate to maintain the licensing program
activities for a biennial licensing period. She noted that
page 11 of the audit was based on a time just before a
renewal period. She stated that it was not unusual to see a
flux of funds based on the schedule of renewals.
Co-Chair Wilson asked for the document date.
Ms. Chambers answered that the latest document that was
provided was for the end of the third quarter and showed a
$1,441,000 surplus as of March 30, 2019.
1:39:17 PM
AT EASE
1:40:06 PM
RECONVENVED
KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF
LEGISLATIVE AUDIT, reported that the audit concluded that
the board was serving the public interest. The audit also
concluded that the board was not serving the public's
interest by not establishing telehealth regulations; by not
adequately monitoring CNA training programs; and by not
notifying the appropriate entities when a licensee's
prescriptive authority had been suspended, revoked, or
surrendered. The audit also found that there needed to be
improvements in the investigative process of the Division
of Corporations, Business and Professional Licensing. The
audit recommended extension of the board for six years.
Ms. Curtis directed attention to page 7 of the audit
report, which showed licensing activity and a 46 percent
increase in activity since the previous 2010 sunset audit.
The amount of applications reflected a growing occupation.
She noted that the schedule of expenditures was on page 11
of the audit. She made note of the $337,000 deficit as of
March 2018. She continued that the fees were adjusted.
Ms. Curtis referenced page 14 of the audit which contained
the recommendations from the Division of Legislative Audit.
She read the four recommendations:
Recommendation No. 1:
The board should adopt regulations to address the
distance delivery of nursing services through
technology.
The board has permitted the distance delivery of
nursing services via technology (telehealth) without
formal statutory or regulatory guidance. In FY 15, a
licensee approached the board and asked for guidance
on providing telehealth services which prompted the
board to issue an advisory opinion. The board's
advisory opinion defined telehealth and provided
limited guidance on the scope of practice. The
guidance was inadequate to promote, preserve, and
protect the public's health, safety, and welfare.
Although the board discussed the need for regulations
to guide the distance delivery of nursing services,
the board could not agree on regulatory language.
Per AS 08.68.100(a)(1), the board shall adopt
regulations pertaining to the scope of practice of
nursing in Alaska. Providing insufficient guidance to
licensees increases the risk that nurses may not
maintain acceptable standards of practice or may not
adequately protect patients' confidentiality.
We recommend the board adopt regulations to address
the distance delivery of nursing services through
technology. Additionally, the board should ensure
statutes appropriately allow for the establishment of
telehealth regulations.
Recommendation No. 2:
The board should take steps to ensure the appropriate
entities are notified when a licensee's prescriptive
authority is suspended, revoked, or surrendered.
The audit identified eight APRNs that had their
prescriptive authority suspended, revoked, or
surrendered between July 1, 2014, and January 31,
2018. In all cases, the board did not notify the Board
of Pharmacy or the Drug Enforcement Administration
(DEA) about the licensing action. The entities were
not notified because there were no statutes or
regulations in place that require notification.
The board is established under AS 08.68 for the
purpose of controlling and regulating the practice of
nursing, including:
APRNs, nurse anesthetists, registered nurses, LPNs,
and CNAs. The board's mission statement is: "to
actively promote and protect the health of the
citizens of Alaska through the safe and effective
practice of nursing as defined by law." Per AS
17.30.200, the Board of Pharmacy is responsible for
administering the controlled substance prescription
database. The database is reviewed by pharmacists
prior to dispensing controlled substances, with
certain exceptions. Failure to notify the Board of
Pharmacy when prescriptive authority has been revoked,
suspended, or surrendered increases the risk that
controlled substances may be abused or diverted.
Per federal law, the DEA may rescind or revoke the
federal authority to prescribe controlled substances
if an existing DEA registrant loses his or her state
privileges. Failure to notify the DEA that an APRN's
prescriptive authority has been suspended, revoked, or
surrendered may result in improper or unauthorized
prescriptions.
We recommend the board take steps to ensure the
appropriate entities are notified when a licensee's
prescriptive authority is suspended, revoked, or
surrendered.
1:43:29 PM
Ms. Curtis continued discussing the audit:
Recommendation No. 3:
The DCBPL chief investigator should ensure nurse
investigations are adequately documented and performed
timely.
The audit identified 13 investigations with periods of
unjustified inactivity and two investigations which
were inadequately documented. Specifically:
Thirteen cases in a random sample of 2810 had periods
of unjustified inactivity ranging from 61 days to 3.6
years. Furthermore, 10 of the 13 cases had multiple
periods of inactivity. The periods of unjustified
inactivity were mainly due to changes in investigative
staff assigned to the case and competing priorities.
The long-term care ombudsman identified two licensees
for investigation that were potentially practicing
outside a LPN's scope of practice. Auditors could not
evaluate the investigations due to a lack of
documentation in the DCBPL case fi les. One of the
licensees continued to practice during the four years
that the investigation was open, potentially posing a
risk to public safety. The DCBPL investigator fi les
note that the two cases were put in storage from
October 2012 until April 2014 due to an office remodel
and did not progress during that time.
Per AS 08.01.050(a)(19), DCBPL is responsible for
investigating and monitoring occupational licensing
activity. Investigations and complaints that sit idle
for extended periods may pose a risk to public safety.
We recommend the DCBPL chief investigator ensure nurse
investigations are adequately documented and performed
timely.
Recommendation No. 4:
The board chair should take steps to ensure the
required CNA on-site training program reviews and
self-evaluations are conducted prior to reapproving
the programs.
The audit found the required self-evaluations were not
received and on.notdefsite reviews were not conducted prior
to board re.notdefapproval of CNA training programs. During
the audit, the process to approve five of 22 CNA
training programs was reviewed. Auditors found on site
reviews were not conducted for four of the five
programs as required prior to re-approval.
Additionally, self-evaluations were not obtained and
reviewed. The board's failure to adequately monitor
programs may lead to undetected deficiencies, which
could result in inadequately trained CNAs.
According to board staff, on-site reviews and
monitoring of self-evaluation forms were not completed
timely because the contractor hired to complete the
reviews was terminated in FY 14, and procurement to
hire another contractor was not successful. DCBPL
received approval for a nurse consultant position,
which was filled in October 2015; however, the nurse
consultant did not begin performing reviews until
spring 2016. Programs were approved by the board
without on-site visits or self-evaluations due to a
lack of resources to complete the reviews and a need
for the programs to continue to be available to train
CNAs.
Regulation 12 AAC 44.857(a) and (c) requires CNA
training programs be board-approved every two years
with an on-site review. Self-evaluations are to be
completed during a year in which an on-site review is
not scheduled.
We recommend the board chair take steps to ensure the
required CNA training program on-site reviews and
self-evaluations are conducted prior to reapproving
the programs.
1:46:22 PM
Ms. Curtis pointed out that the department response was
found on page 27 of the audit. The department did not
comment on recommendations 1 and 4, which were directed to
the board. The department agreed with recommendations 2 and
3. Administrative procedures had been implemented to notify
the Board of Pharmacy and the Drug Enforcement Agency when
licensing action was taken. Additionally, procedures had
been improved to help improve the timeliness of the
investigative process. She added that the board's response
was found of page 29 of the audit. The board did agree with
all four recommendations and planned to take corrective
action.
Representative Josephson asked about the telemedicine
recommendation. He was told that the board had submitted a
regulation packet the previous fall and wondered if the
auditor had seen it.
Ms. Curtis informed that the audit was dated April 2018.
The board's response to the audit indicated that it planned
to take corrective action in November 2018.
Ms. Chambers reviewed the fiscal note from the Department
of Commerce, Community and Economic Development (DCCED)
that reflected the cost of extending the board. The bill
did not change the licensing program. If the bill was
unsuccessful and the board sunset, there would be no
change. If there was an extension of the board; DCCED had
proposed $28,400 to cover travel for the board to meet as
required, to advertise public meetings, and for various
training and conference fees.
Co-Chair Wilson highlighted that page 3 showed the board
costs and licensing fees.
Representative Knopp asked Ms. Chambers about
recommendation 4 regarding CNAs. He referred to a previous
conversation.
Ms. Chambers reported that the board had addressed all four
of the audit recommendations and regulations were moving
forward. The CNA program was moving forward with
evaluations as prescribed by law. She discussed the
importance of licensing in a timely manner. She reported
that the division was fully staffed. The department was
always looking to do more streamlining of processes,
particularly with regard to military spouses and healthcare
facilities that needed to get people on staff quickly.
1:50:23 PM
Representative Knopp referred to the military spouse issue.
He asked how long it took for CNA licensees to receive a
license once they have applied.
Ms. Chambers stated that once a licensee submitted the
legally required elements, the department usually processed
the application in two weeks.
1:51:15 PM
Co-Chair Wilson OPENED Public Testimony.
CHRIS LOGAN, ALASKA ADVANCE PRACTICE REGISTERED NURSE
ASSOCIATION ALLIANCE, ANCHORAGE (via teleconference), spoke
in support of SB 36. She relayed that the alliance
supported the bill. She discussed the importance of the
Board of Nursing. She urged the committee to pass the bill.
1:52:28 PM
LYNN HARTZ, SELF, ANCHORAGE (via teleconference), spoke in
favor of advancing SB 36. She thanked the committee. She
thought the Board of Nursing was an essential government
tool in promoting the health and welfare of the Alaska
public. She expressed that through licensure, oversight of
education and discipline, the board and its staff exert
vital and unique functions on the states behalf and should
be allowed to continue their important work.
1:53:20 PM
KAREN MORTON, ALASKA NURSES ASSOCIATION, SOLDOTNA (via
teleconference), strongly supported SB 36. She read from a
prepared statement. She discussed the work of the Alaska
Nurses Association. She thought the board worked in a
transparent fashion and ensured that regulations utilizes
best practices.
1:54:50 PM
Co-Chair Wilson CLOSED Public Testimony.
Co-Chair Wilson indicated amendments were due on Wednesday,
May 1, 2019 by 5:00 P.M.
SB 36 was HEARD and HELD in committee for further
consideration.