Legislature(2015 - 2016)HOUSE FINANCE 519
03/16/2016 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| HB268 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 268 | TELECONFERENCED | |
| + | SB 53 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 53
"An Act relating to advanced practice registered
nursing; relating to certified direct-entry midwifery;
and providing for an effective date."
1:35:12 PM
SENATOR CATHY GIESSEL, SPONSOR, thanked the chair for
hearing the bill. She explained that the legislation would
update the state's 34-year-old statute titles pertaining to
nurse practitioners. The existing title was "advanced nurse
practitioner (ANP)" and "nurse anesthetist (NA)" The bill
would implement the updated term of "advanced practice
registered nurse (APRN)." The bill did not change the scope
of practice performed by advanced practice registered
nurses. She referred to a chart in members' packets
illustrating title changes the bill would put in place
(copy on file). She detailed she had served on the National
Council of State Boards of Nursing in the past; during her
time on the council the title for advanced practice
registered nurses was standardized in a consensus model
document agreed to by all of the states. She elaborated
that prior to the change, each state had its own title for
advanced practice registered nurses. The top portion of the
chart showed ANP and NA, which were the old terms. Three
subspecialties fell underneath the ANP umbrella including
nurse practitioner, certified nurse-midwife (responsible
for delivering babies), and certified clinical nurse
specialist (employed in hospitals).
Senator Giessel continued to address the title chart. The
proposed statute change was represented in the lower
portion of the chart. The title would change to APRN and
four subcategories included certified nurse practitioner,
certified nurse-midwife, certified registered nurse
anesthetist, and certified clinical nurse specialist.
1:37:51 PM
Senator Giessel relayed that the bill's only function was
to transform state statutes to reflect the updated APRN
title change. Part of the reason for the change was due to
confusion within insurance companies. She detailed that
each state had been using a different title; therefore,
sometimes reimbursements were denied because insurance
companies (including Medicare and the Veterans'
Administration) did not recognize the credential of the
person who provided the service. The bill would make Alaska
in uniform conformity with other states. Currently there
were 1,000 advanced practice registered nurses in Alaska;
therefore, the change would impact a large number of
clinicians.
Co-Chair Neuman referred to Senator Giessel's testimony
there had been reimbursements based on confusion about
service providers. He asked for examples and the associated
value.
Senator Giessel explained that a primary care provider
could bill insurance for services just like a family
practice physician. She was personally an APN or NP under
the current category. She detailed if an insurance company
did not recognize what ANP stood for, it would question
what kind of reimbursement the she would be entitled to for
the care of a patient. The bill would standardize the
title.
Co-Chair Neuman asked if Alaska was behind other states in
making the changes.
Senator Giessel answered that 13 states had implemented the
change in title. Additionally, there were currently about
29 states (including Alaska) working on making the change.
Co-Chair Thompson noted Representative Gara had joined the
meeting.
1:40:05 PM
Representative Gattis asked if the label changes would
force any kind of wage change paid by hospitals. She
wondered if the bill would make a difference from the
hospitals' standpoint. Additionally, she wondered if the
change would result in different costs to patients.
Senator Giessel responded that it would make no difference
in the reimbursement or wage for any of the categories of
APNs. In terms of hospital practice, the certified nurse-
midwife and the certified registered nurse anesthetist were
the two categories that would be practicing both inside and
outside hospital facilities. The nurses had been doing so
for numerous years if they had hospital privileges. The
clinical nurse specialist practiced almost exclusively in a
hospital. She relayed the bill should not change their pay
category at all.
Representative Guttenberg wondered if additional
credentials would be necessary if a nurse practitioner's
title changed to certified nurse practitioner. Senator
Giessel answered that the requirements for certification
would remain the same. She detailed that since ANPs had
been recognized in Alaska (for 34 years), national board
certification was required to receive a license in advanced
practice. The bill would not change the requirements. The
same national certifying boards would still administer the
same examinations and certified in the same way.
Representative Guttenberg observed the title chart showed
nurse anesthetists as separate under existing law, but it
included them under APRNs in the proposed law. He wondered
about the bill's impact on nurse anesthetists and asked if
they were supportive of the legislation.
Senator Giessel explained that the reason ANPs and NAs were
separate on the upper portion of the chart was due to the
way the statutes had been originally written. The new title
would put everyone under the APRN title. All four of the
categories under APRN were part of a coalition, which
unanimously supported the legislation.
Representative Guttenberg appreciated the answer. He
commented that sometimes alliances did not always speak
out.
Co-Chair Thompson called for invited testimony.
1:44:31 PM
CARRIE DOYLE, ADULT HEALTH CLINICAL NURSE SPECIALIST,
ALASKA CLINICAL NURSE SPECIALISTS ASSOCIATIONS (via
teleconference), read from a prepared statement:
I am Dr. Carrie Doyle, I am an adult health clinical
nurse specialist and represent the Alaska Clinical
Nurse Specialists Association. I'm also a member of
the Alaska APRN Alliance, which is comprised of all
four advanced practice registered nurse specialties,
AANA, and the University of Anchorage Alaska, as well
as the Board of Nursing. I'd like to thank you for
allowing me to testify in support of Senate Bill 53,
which is an act related to advanced practice
registered nursing that will align Alaska statute with
the nationwide movement called the consensus model.
Currently, as a clinical nurse specialist I am called
a nurse practitioner legally, which is not the role
that I perform and can be confusing to patients. So as
noted, there are four different specialties. That
being the nurse practitioner, the clinical nurse
specialist, the nurse-midwife, and the CRNA or nurse
anesthetist. The statute will separate these
categories. As I mentioned, the consensus model is a
nationwide movement that includes all four
specialties. It was comprised or built by the National
Council of State Boards and Nursing in conjunction
with an APRN workgroup that comprised of 48 different
national nursing organizations.
The consensus model does seek uniformity in APRN
licensure, accreditation, certification, and
education. Uniformity will expedite insurance
reimbursement as noted by Senator Giessel and by
eliminating confusion about service providers, which
in turn, eliminates the confusion with our patients.
It will also allow APRNs from other states to more
easily obtain Alaska licensure. Senate Bill 53 does
not change the scope of practice for ANPs and nurse
anesthetists who will still be able to continue to
provide that same high-quality, safe, accessible care
that they have provided to Alaskans across the state
for the last 34 years. It will just have a new name:
APRN. I thank you for your time today and ask that you
support Senate Bill 53.
1:47:02 PM
LAURA SARCONE, CERTIFIED NURSE-MIDWIFE AND PAST CO-CHAIR,
ADVANCED PRACTICE REGISTERED NURSE ALLIANCE (via
teleconference), read from a prepared statement:
Good afternoon. My name is Laura Sarcone. I am a
certified nurse-midwife and I am the immediate past
co-chair of the APRN Alliance. Thank you for this
opportunity to testify in support of SB 53. The four
advanced practice nursing groups have been working on
this issue for nearly five years.
The APRN Consensus Model is a national "best practice"
act. It puts consumers, employers, APRNs, the Board of
Nursing, insurance companies, and the legislature on
the same page. It standardizes licensing,
accreditation, certification, and educational
requirements for APRNs. Thirteen states have already
fully implemented the Model. Another 29 states plus
the District of Columbia are more than fifty percent
implemented. Only 8 states are less than 50 percent
implemented and 33 states use the title "APRN."
The APRN Alliance has reviewed the fiscal note. We
understand that the $7500 cost will be recovered
through licensing fees and not general funds. We would
like to thank Senator Giessel for sponsoring this
bill, and for championing this issue on behalf of her
fellow APRNs. I urge you to vote in favor of SB 53.
Thank you.
Representative Gara asked Ms. Sarcone about why it took
five years for the various nursing groups to come together
on the issue. He wondered what the dispute had been. Ms.
Sarcone corrected that the nursing groups had been working
on the issue for nearly five years; it had not taken the
groups that time to come together. She explained it had
taken five years for the groups to work through the Board
of Nursing, getting language together, and requesting the
bill through Senator Giessel.
1:49:47 PM
GAIL BERNTH, EXECUTIVE ADMINISTRATOR, BOARD OF NURSING (via
teleconference), read from a prepared statement:
Thank you for hearing this bill and for permitting me
to address this hearing. The Board of Nursing has
requested that I voice their support of this bill to
update our regulations. This will help to bring Alaska
into compliance with the national consensus model
developed by the National Council of State Boards of
Nursing. I thank you.
1:50:19 PM
TRACEY WIESE, FAMILY and PSYCIATRIC NURSE PRACTITIONER, and
CO-CHAIR, ADVANCED PRACTICE REGISTERED NURSE ALLIANCE (via
teleconference), urged support of the bill.
Co-Chair Neuman referred to the bill's sectional analysis
(copy on file) and observed that Section 10 deleted
vocational nursing and added a paragraph requiring the
Department of Commerce, Community and Economic Development
to set fees to practice registered nursing. He asked about
the reason for the change.
Senator Giessel relayed that the bill would remove the term
"vocational" because it was no longer used; it had been
removed from most of the state's statutes by legislation
approximately five years earlier; the term that would be
deleted in the current bill had been missed when the
changes had been made in the past.
Co-Chair Neuman asked for verification it was conforming
language. Senator Giessel answered in the affirmative.
Representative Neuman remarked that Section 13 would amend
statute to add advanced practice registered nurses to the
persons authorized to supervise a practical nurse. He did
not know what the current qualifications were. He believed
the bill seemed to do more than merely change the name. He
observed the bill provided for more services or duties
nurses could do. He asked for detail on the change in
Section 13.
Senator Giessel explained that a practical nursing degree
was typically two years. She read from Section 13 of
existing statute: "a practical nurse shall work under the
supervision of a licensed registered nurse..." She
explained that a registered nurse was a higher level
licensure that qualified a registered nurse to supervise a
licensed practical nurse (LPN). She elaborated that an
advanced practice registered nurse was at minimum a
master's degree (most of the education was moving towards a
doctoral degree). The section added the doctorally prepared
nurse who would also supervise the LPN.
1:54:01 PM
Co-Chair Neuman referred to Sections 52 through 54. He
stated that the bill would add APRNs to the list of
practitioners who may, under statutory provisions
concerning mental health commitment, determine if a person
may be administered psychotropic medication without a
person's consent. He remarked that in other occurrences
pertaining to the medical industry, doctors were sensitive
to the ability to administer different prescription drugs
because of the amount of education they received,
particularly with the use of psychotropic drugs. He
wondered why the language was needed and believed it
advanced a nurse's authority substantially.
Senator Giessel began with Section 52. She clarified that
the underlined words in the bill draft represented areas
that would change current statute. The existing statute
read "as determined by a licensed physician or a registered
nurse..." She emphasized a registered nursing degree was
either two to four years (a bachelor's degree) and an
advanced practice registered nursing degree was a master's
or doctorate. Under existing statute an advanced practice
registered nurse could administer psychotropic medication.
The language simply clarified the statute by inserting
"advanced practice registered nurse" as well. She specified
that an advanced practice registered nurse was a higher
level registered nurse with prescriptive authority; a
registered nurse did not have prescriptive authority.
Senator Giessel moved to Section 53 related to the
definition of a mental health professional. The existing
statute applied to a registered nurse with a master's
degree in psychiatric nursing, which was the definition of
an APRN. She stated it was possible for an RN to have a
master's degree in psychiatric nursing, but not be an APRN.
She detailed it clarified that a nurse with a master's
degree or a doctorate could also be categorized as a mental
health professional. She referred to testimony by Dr.
Tracey Wiese who is a doctorally prepared mental health
professional. The definition did not extend or expand the
scope of practice.
Senator Giessel moved to Section 54 on page 25 of the
legislation. The original language had been "...reviewed by
a registered nurse licensed under..." The section pertained
to reviewing a residence assisted living plan. She
explained that an APRN was also an RN (the individuals held
two licenses and paid twice to the State of Alaska). The
language had been updated to clarify the inclusion of
APRNs.
1:57:34 PM
Co-Chair Neuman assumed that specific training would be
required for an APRN to administer psychotropic medication.
Senator Giessel answered that a nurse practitioner held
either a master's or doctoral degree and were currently
statutorily authorized to prescribe. She furthered that
with drug enforcement authority, nurse practitioners also
prescribed controlled substances should they decide to
apply for the authorization. She explained that nurse
practitioners had full prescriptive authority just like a
family practice or other physician.
Co-Chair Neuman remarked that nurses performed some of the
clinical work in villages and some health centers without
doctors. He believed the bill would provide increased
opportunities within the state. He asked if it was part of
the reason for the legislation. He spoke to the need to
continue to reduce the budget, while ensuring medical
services were available throughout the state.
Senator Giessel answered that he was speaking to her heart.
She clarified that the bill did not change anything that
did not currently exist. She elaborated that many APRNs
practice in rural areas where no other healthcare was
available (including an Indian Health Service clinic). She
detailed that one of the provisions in another bill that
would come before the committee related to Medicaid would
allow nurse practitioners (particularly practitioners in
mental and behavioral health) to expand their ability to
practice. She thanked him for the question. She reiterated
SB 53 did not expand work performed by APRNs in rural
Alaska or in any other venue.
2:00:03 PM
Vice-Chair Saddler asked if the bill changed the membership
of the Board of Nursing such that it would impact the
professional licensing fee.
Senator Giessel replied in the negative. She explained
there was currently a seat on the Board of Nursing for an
APRN and the bill would make no changes to the area.
Vice-Chair Saddler asked which professional board would
regulate APRNs. He wondered if it would change the
"universe of license fee payers" and the required rate.
Senator Giessel responded that the bill would make no
changes to the area. She explained that currently APRNs
fell under the Board of Nursing; the board regulated about
12,000 licensees from certified nurse aides up to a
doctorally prepared APRN.
Senator Giessel thanked the committee for its time.
SB 53 was HEARD and HELD in committee for further
consideration.
2:01:54 PM
AT EASE
2:02:51 PM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB268 Sectional Analysis.pdf |
HFIN 3/16/2016 1:30:00 PM |
HB 268 |
| HB268 Transmittal Letter.pdf |
HFIN 3/16/2016 1:30:00 PM |
HB 268 |
| HB268 031616 HFIN Presentation.pdf |
HFIN 3/16/2016 1:30:00 PM |
HB 268 |
| SB 53 NEW FN DCCED-CBPL 3-11-16.pdf |
HFIN 3/16/2016 1:30:00 PM |
SB 53 |