Legislature(2019 - 2020)BELTZ 105 (TSBldg)
02/07/2019 01:30 PM Senate LABOR & COMMERCE
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 | |
| SB29 | |
| SB25 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 36 | TELECONFERENCED | |
| *+ | SB 29 | TELECONFERENCED | |
| *+ | SB 25 | TELECONFERENCED | |
SB 36-EXTEND BOARD OF NURSING
1:32:50 PM
CHAIR REINBOLD announced that the first order of business would
be SENATE BILL NO. 36, "An Act extending the termination date of
the Board of Nursing; and providing for an effective date."
CHAIR REINBOLD stated her intention to move SB 36 if it is the
will of the committee. She solicited a motion and Senator
Costello made a clarifying motion to bring the original version
before the committee.
SENATOR BISHOP objected for discussion purposes.
1:33:59 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, said she wanted
to declare that she does not have a conflict of interest as the
sponsor of SB 36. She explained that she has two licenses
regulated by the Board of Nursing, but she will not gain any
benefit or harm in sponsoring this bill. The board's charge is
to protect the public through safe practice of nursing, not to
protect her licenses in any way.
She related her understanding that the Legislative sunset review
audit is in members' packets. She directed attention to page 7
of the audit, related to licensing activity for the board from
FY 15-18. She said she served two terms on this board and
chaired this board for five years. The total number of licenses
at the end of January 2018 is nearly 20,000. She estimated that
when she was chair, the total number of licensees for the Board
of Nursing represented about 25 percent of the total licensees
regulated by the state and she is not certain if that percentage
has changed.
SENATOR GIESSEL pointed out that the board oversees six
categories of licenses. She listed them: Certified Nurse Aide
(CNA), Advanced Nurse Practitioner Preceptorship (ANPP),
Advanced Practice Registered Nurse (APRN), Certified Registered
Nurse Anesthetist (CRNA), Licensed Practical Nurse (LPN), and
Registered Nurse (RN).
She said the Board of Nursing regulates the most diverse
population of licensees. Each category on this list has
different education and training requirements for licensure,
ranging from high school to a doctoral degree. She said that
this is a huge task. For example, the CNA is an entry level
position and for certification, a CNA must have a high school
diploma, undergo training for several months, and pass an exam.
SENATOR GIESSEL said the audit report highlights some gaps the
board needs to address. One gap the auditor identified was the
need to better monitor the CNA programs, another gap related to
nursing services being provided via distance delivery or
telemedicine. The nursing profession also refers to telemedicine
as telehealth. During the time she chaired the Board of Nursing,
the board felt that this authority had already been given to the
Advanced Practice Registered Nurses (APRNs). In fact, APRNs have
been providing telehealth services since the late 1990s, she
said. In 1998, an APRN conducted a model or test program in
Girdwood using telemedicine. Avalanches often cause road
closures and limit travel between Anchorage and Girdwood, she
said. If a skier had an injury, using telemedicine the APRN
could transmit the skier's X-ray to an orthopedic surgeon in
Anchorage, who would suggest treatment. This same APRN also
began a clinic in Hope, a small community across Turnagain Arm
that did not have health care services. Using telemedicine, the
clinic communicated telephonically and via computer imaging to
provide medical services to Hope. Until recently, the board
thought it had the authority to authorize telemedicine services.
She suggested that members may wish to ask the board's executive
administrator how the board is progressing on telemedicine.
1:40:17 PM
SENATOR BIRCH asked for further clarification on the difference
in training and qualifications for nurses and paramedics.
SENATOR GIESSEL responded that RNs are educated to care for the
"entire" person, and either are diploma graduates with a two-
year college degree or have earned a bachelor's degree. She said
that RNs can practice in hospitals or clinics and their
practices range from orthopedic care to obstetrics. Paramedics
have extensive and intensive training, are regulated by the
State Medical Board, and have focused education on emergency
medical situations. She described the difference that paramedics
provide very urgent care and RNs provide long-term global health
care and public health nursing services.
1:41:42 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
Legislative Agencies and Offices, related the division conducted
a sunset audit on the Board of Nursing [Audit Control Number 08-
20113-18]. She explained the purpose of a sunset audit is to
determine whether a board or commission is serving the public's
interest and if its termination date should be extended. The
legislative audit determined that the Board of Nursing is
serving the public's interest by conducting meetings in
accordance with state law, by amending certain regulations to
improve the CNA and nursing occupations, and by effectively
licensing CNAs and nurses. The audit also determined that the
board failed to serve the public's interest because it failed to
establish telehealth regulations, did not adequately monitor the
CNA training program, and did not notify appropriate entities
when a licensee's prescription authority was suspended, revoked,
or surrendered. The audit determined that improvements were
needed with the Division of Corporation, Business, &
Professional Licensing's (DCBPL) investigative process. She said
the auditors recommend the legislature extend the Board of
Nursing for six years.
She remarked Senator Giessel already reviewed the licensing
statistics. She directed attention to page 11 of the sunset
audit to the schedule of revenues and expenditures. This board
had a deficit of $337,000 at the end of March 2018, she said.
According to DCBPL's management, a fee analysis was planned for
May 2018. She directed attention to the board's license fees on
page 12 for more detail.
MS. CURTIS said page 14 of the audit included four
recommendations for improvements. Audit Recommendation No. 1
recommended that the board adopt regulations to address the
distance delivery of nursing services through technology, also
referred to as telehealth. In FY 15, a licensee approached the
board requesting guidance to provide telehealth services. This
prompted the board to issue an advisory opinion, which defined
telehealth and provided limited guidance on the scope of
practice. However, this guidance was insufficient to promote,
preserve or protect the public health, safety, and welfare, she
said. Although the board discussed the need for telehealth
regulations, it could not agree on the specific regulatory
language. Providing insufficient guidance to licensees increases
the risk that nurses may not maintain acceptable standards of
practice and may not adequately protect patient confidentiality.
She said Recommendation No. 2 asked the board to take steps to
ensure that the appropriate entities are notified when a
licensee's prescription authority is suspended, revoked or
surrendered. The audit identified eight APRNs who had their
prescription authority revoked or surrendered between the dates
of July 2014 through January 2018. In all cases, the board did
not notify the Board of Pharmacy or the federal DEA [Drug
Enforcement Agency] about the licensing action. These entities
were not notified because the statutes or regulations were not
in place to require the notification. Failure to notify the DEA
or the Board of Pharmacy increases the risk that controlled
substances are abused or diverted, she said.
1:44:54 PM
MS. CURTIS referred to page 15 to Recommendation No. 3. The
audit recommended that the DCBPL's chief investigator ensure
nurse investigations are adequately documented and performed
timely. The audit identified 273 cases that were open for a
period of more than 180 days. The auditors found that 13 of the
28 cases it reviewed had unjustified periods of inactivity that
ranged from 61 days to 3.6 years. The delays were mainly caused
by investigative staff turnover and competing priorities. The
auditors also found two licensees who had been recommended for
investigation by the Long-term Care Ombudsman as potentially
practicing outside their scope of practice. Auditors could not
evaluate these cases due to a lack of documentation in the
files. However, auditors did note that these cases had been
placed in storage for 1.5 years due to an office remodel and did
not progress during that time. One of the two licensees
continued to practice during the 4 years that the cases were
outstanding, potentially posing a risk to public safety.
1:46:08 PM
MS. CURTIS referred to page 16 to Recommendation No. 4, which
recommends the board chair take steps to ensure that the
required Certified Nurse Aide (CNA) onsite training program
reviews and self-evaluations are conducted prior to re-approving
the programs. The regulations require the CNA training programs
be "board approved" every two years with an onsite review. Self-
evaluations are required in the year that the onsite review is
not conducted. The audit found the onsite reviews and the self-
evaluation forms were not being conducted during the audit
period. According to board staff, the onsite reviews were
performed by a contractor who was terminated in FY 14 due to a
conflict of interest. The procurement process to hire a new
contractor was not successful. Eventually the division was able
to re-designate a PCN [Position Control Number] as a nurse
consultant position, hired and trained a person, and the reviews
resumed in the spring of 2016. The board continued to approve
these training programs due to the need for the programs to
continue to be available to train CNAs.
She said that responses to this audit begin on page 27. The
department stated that procedures had been implemented to notify
the Board of Pharmacy and the federal DEA when the prescription
authority has been revoked or surrendered. Additionally, the
department stated it has instituted procedures to help improve
the timeliness of investigations.
MS. CURTIS said the board's response to the audit begins on page
29. The board agreed with all four recommendations and stated it
will take corrective actions. The board also stated it will work
on the telehealth regulations at its November 2018 meeting.
1:48:00 PM
CHAIR REINBOLD asked for further clarification on the $337,000
deficit for license fees.
MS. CURTIS said the audit does not have any recommendation on
fees. She noted that the board has operated in a surplus except
for this year. The way the statute reads, the board must set
license fees to cover its operating costs. This results in
alternating years of deficit with increased fees, followed by a
surplus with decreased fees. Unless auditors see a pattern arise
in which the board fails to increase fees when the board
routinely has deficits, the auditors will not write a
recommendation and will allow the process to carry out.
CHAIR REINBOLD asked for the next audit date to follow up on the
audit recommendations.
MS. CURTIS answered that it depends on how long the legislature
extends the termination date. If SB 36 were to pass in its
current form, it would extend the board for six years, and the
legislative auditors will conduct another sunset audit in six
years.
1:49:22 PM
SENATOR COSTELLO asked if the division takes into consideration
the board's response to the audit when the agency makes a
recommendation for the length of time to extend the board. She
said six years seemed like a long time, but it seemed that the
Division of Legislative Audit received information that the
board agrees with the audit recommendations and is willing to
address the concerns.
MS. CURTIS answered that the division relies on the legislative
oversight process and the committee process in terms of the
legislature holding the board and the division accountable for
implementing any recommendations and determining the status. She
said that a lag time of eight to ten months typically happens
between the audit and the legislative review. During that time,
the board has an opportunity to take corrective action. She said
the Division of Legislative Audit does not have a standard, but
its auditors review prior recommendations during the next sunset
audit to determine how well the board has implemented them. She
said the 2010 sunset audit had four recommendations, three of
which are still outstanding.
CHAIR REINBOLD said she read the board's letter that the board
agreed with all four recommendations and indicated it will take
corrective action. She said she was very impressed with the
board's response.
1:50:56 PM
SENATOR GIESSEL referred to the budget report on page 14 dated
March 2018. In November 2018 most license renewals are due and
"a glut" of revenue will be collected.
1:51:52 PM
CHAIR REINBOLD opened public testimony on SB 36 and after first
determining no one wished to testify, closed public testimony on
SB 36.
1:54:03 PM
SENATOR GIESSEL said she urged the board to act on two items,
including monitoring the CNA program. The federal government
supplies $100,000 per year to fund a position to examine the
program. She acknowledged it does involve travel throughout the
state. She emphasized that the board needs to fill the position.
She will hold the board's "feet to the fire" on telehealth and
the auditor mentioned the division will also monitor it.
1:54:43 PM
SENATOR BISHOP removed his objection.
1:54:54 PM
SENATOR BISHOP reviewed the fiscal note from the Department of
Commerce, Community and Economic Development (DCCED). The
appropriation is to the Division of Corporations, Business, and
Professional Licensing, the allocation is to the Division of
Corporations, Business, and Professional Licensing, and the OMB
component number is 2360. The bill would extend the Board of
Nursing until June 30, 2025. The source of the total operating
costs of $28,400 are designated general fund (DGF) dollars. He
reviewed the breakdown of expenditures: $26,000 is for seven
board members and one examiner to travel to board meetings, $400
is for advertising, $1,000 is for training and conference fees,
and $100 is for stipends.
1:56:31 PM
SENATOR COSTELLO moved to report SB 36, Version 31-LS0314\A,
from committee with individual recommendations and attached
fiscal note. There being no objection, SB 36 was reported from
the Senate Labor and Commerce Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB36 Ver. A.PDF |
HL&C 4/24/2019 3:15:00 PM SL&C 2/7/2019 1:30:00 PM |
SB 36 |
| SB36 Sponsor Statement 1-28-19.pdf |
HL&C 4/24/2019 3:15:00 PM SFIN 3/1/2019 9:00:00 AM SL&C 2/7/2019 1:30:00 PM |
SB 36 |
| SB36 Fiscal Note - SB036-DCCED-CBPL-02-01-19.pdf |
HL&C 4/24/2019 3:15:00 PM SL&C 2/7/2019 1:30:00 PM |
SB 36 |
| SB36 Supporting Document Division of Legislative Audit Sunset Review April 2017.pdf |
HL&C 4/24/2019 3:15:00 PM SFIN 3/1/2019 9:00:00 AM SL&C 2/7/2019 1:30:00 PM |
SB 36 |
| SB36 Supporting Document Division of Legislative Audit Sunset Review Summary 08-20113-18.pdf |
SFIN 3/1/2019 9:00:00 AM SL&C 2/7/2019 1:30:00 PM |
SB 36 |
| SB29 Version A.PDF |
SL&C 2/7/2019 1:30:00 PM |
SB 29 |
| SB29 Sponsor Statement Version A.pdf |
SFIN 3/1/2019 9:00:00 AM SL&C 2/7/2019 1:30:00 PM |
SB 29 |
| SB29 Supporting Document Division of Legislative Audit Board of Marine Pilots Sunset Review.pdf |
SFIN 3/1/2019 9:00:00 AM SL&C 2/7/2019 1:30:00 PM |
SB 29 |
| SB 29 - Letter of Support SEAPA.pdf |
HL&C 4/24/2019 3:15:00 PM SL&C 2/7/2019 1:30:00 PM |
SB 29 |
| SB29 Fiscal Note - SB029-DCCED-CBPL-02-01-19.pdf |
SL&C 2/7/2019 1:30:00 PM |
SB 29 |
| SB25 Version A.PDF |
SL&C 2/7/2019 1:30:00 PM |
SB 25 |
| SB25 Sponsor Statement.pdf |
SFIN 3/1/2019 9:00:00 AM SL&C 2/7/2019 1:30:00 PM |
SB 25 |
| SB25 Letter of Support ADS.pdf |
SL&C 2/7/2019 1:30:00 PM |
SB 25 |
| SB25 Board of Dental Examiners Division of Legislative Audit Sunset Review.pdf |
SL&C 2/7/2019 1:30:00 PM |
SB 25 |
| SB25 Fiscal Note - SB025-DCCED-CBPL-02-01-19.pdf |
SL&C 2/7/2019 1:30:00 PM |
SB 25 |