Legislature(2021 - 2022)BUTROVICH 205
04/15/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB38 | |
| SB67 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 38 | TELECONFERENCED | |
| += | SB 67 | TELECONFERENCED | |
| += | SB 78 | TELECONFERENCED | |
| += | SB 80 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 67-NURSING: LICENSURE; MULTISTATE COMPACT
2:07:55 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 67
"An Act relating to the licensure of nursing professionals;
relating to a multistate nurse licensure compact; and providing
for an effective date."
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Juneau, Alaska stated she has some
questions, thoughts and concerns regarding amendments to SB 67.
2:09:42 PM
SENATOR BEGICH moved Amendment 1.
AMENDMENT 1
32-GS1603\A.3
Fisher
3/19/21
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 67
Page 7, line 27, following "permit":
Insert ";
(4) multistate licensure privileges to
practice registered nursing in this state under a
multistate license issued by another state under
AS 08.69, in an amount equal to the fee imposed under
(1)(A) of this section;
(5) multistate licensure privileges to
practice practical or vocational nursing in this state
under a multistate license issued by another state
under AS 08.69, in an amount equal to the fee imposed
under (2)(A) of this section"
CHAIR WILSON objected for purposes of discussion.
2:09:50 PM
SENATOR BEGICH stated Amendment 1 [A.3] is about equity. When an
Alaskan applies for an Alaska state nursing license, they are
required to pay a licensing fee. This amendment ensures every
nurse seeking to practice in the state pays the fee. Paying the
fee would have the added effect of providing a default registry
of all nurses practicing under a multi-state license in Alaska.
He offered the following example.
An advanced registered practice nurse (ARPN) regulation,
effective since May, requires a registration fee to use the
Prescription Drug Monitoring Program (PDMP). He stated his
belief that the regulation applies to traveling and telehealth
ARPNs. An APRN, who is also required to hold a registered
nursing license, would need to register and pay the PDMP fee in
order to prescribe controlled substances and participate in the
program. If the bill passes, this regulation should not be
waived for APRNs who hold and operate under a multistate
license. All APRNs working in Alaska would be required to
register and pay the fee for the PDMP access. Without Amendment
1, some APRNs under the compact would be required to pay a fee
and others would not.
2:11:39 PM
SENATOR REINBOLD asked if Amendment 1 increases fees for nurses
already practicing in the state or if they already pay the fees
mentioned.
SENATOR BEGICH replied that Amendment 1 should not increase fees
for nurses already practicing in the state. It requires fees to
be equitable.
CHAIR WILSON asked Director Chambers to confirm Senator Begich's
answer.
2:12:27 PM
MS. CHAMBERS responded that Senator Begich was just offering an
example. Amendment 1 does not have anything to do with the PDMP
nor does the compact have anything to do with APRNs. The compact
is only for registered nurses and licensed practical nurses. It
is not applicable to APRNs and does not involve the PDMP.
SENATOR REINBOLD asked if only nurses coming from outside to
practice in Alaska must pay the fee.
MS. CHAMBERS replied that Amendment 1 would be for multistate
licensed nurses who are coming to work in Alaska and do not
claim Alaska as their home state. The amendment requires out of
state nurses to pay the equivalent of the nursing application
fee. It does not require them to pay a license fee. It only
requires them to pay the initial application fee that other
nurses pay. If Alaska is a nurse's home state, then the
multistate license is issued in Alaska, which is the same
paperwork and fee process.
SENATOR REINBOLD asked the fee amount.
2:14:29 PM
MS. CHAMBERS replied that a licensing application fee is
typically not more than two hundred dollars. She does not know
the exact fee for nurses.
CHAIR WILSON asked Ms. Chambers if she has concerns with
Amendment 1..
MS. CHAMBERS stated the department concern is that Amendment 1
will keep the state from entering the compact because it places
a noncompact requirement on compact nurses, which is not
allowed. The multistate compact license and the Alaska license
are two separate licensing schemes. An Alaska license is what
the department has now. The multistate license is a completely
different mechanism to prove that a nurse has the same
qualifications as the Alaska license, if not more. It is not an
apples-to-apples comparison. Alaska nurses who want to work out
of state on a compact license are not going to pay an additional
fee to another state system. That would be counter to the
compact. The equity is that Alaska nurses do not pay to work in
another state and other state nurses do not pay to work in
Alaska. That is an equitable system.
2:16:26 PM
SENATOR HUGHES asked if the application fee could be paid by the
employer to help cover the costs of supervision by the board.
2:17:01 PM
MS. CHAMBERS responded that it is an innovative question that
relates to the registry amendment. It would not be an imposition
on the nurse but would create another level of bureaucracy for
employers. It would not keep the state out of the compact.
SENATOR HUGHES asked Senator Begich if he would be open to the
idea of the employer paying the application fee.
SENATOR BEGICH commented that the idea may fall under the next
amendment. He stated it is a good idea, but he does not want to
hold the bill up unnecessarily. He is open to exploring it.
SENATOR REINBOLD noted the amendment does not say who pays the
fee and questioned why the idea could not be part of the
amendment.
MS. CHAMBERS responded that the amendment is in context of the
fees set for nurses to pay.
SENATOR REINBOLD stated support for in Alaska jobs first. She
said she sees a tremendous amount of opposition to the bill, and
she is going to support the amendment.
2:18:52 PM
SENATOR BEGICH clarified that having an employer pay the
application fee should apply to all nurses. Employers of all
nurses would pay the application fee so that equity is retained.
He stated he will continue to support his amendment, but Senator
Hughes has proposed an idea that should be looked at as the bill
moves forward.
SENATOR HUGHES asked if this amendment kills the bill.
MS. CHAMBERS replied that is correct.
SENATOR BEGICH asked if her answer is absolute and if she has a
note from the compact.
2:20:08 PM
MS. CHAMBERS responded yes. She stated that she has been in
communication with Ms. Fotsch from the National State Council of
Boards of Nursing about the amendments. There is more than one
amendment that would end the bill. Amendment 1 would keep Alaska
out of the compact because it imposes noncompact restrictions on
compact nurses.
SENATOR BEGICH interjected unless, the compact adopted the
restriction.
MS. CHAMBERS agreed that if all thirty-five states adopted the
amendment in their state legislature, then the amendment could
become part of the compact. Alaska would not be able to join the
compact until the amendment was ratified.
SENATOR COSTELLO related her concern that multistate licensure
takes away the autonomy of Alaskans to manage nurses by having
to obtain approval from a national organization to make
statutory changes.
2:21:27 PM
CHAIR WILSON asked for a roll call vote on Amendment 1 [A.3].
2:21:30 PM
A roll call vote was taken. Senators Begich and Reinbold voted
in favor of Amendment 1 and Senators Hughes, Costello, and
Wilson voted against it. Therefore, Amendment 1 failed by a 2:3
vote.
2:22:27 PM
CHAIR WILSON moved Amendment 2 [A.5].
AMENDMENT 2
32-GS1603\A.5
Fisher
4/12/21
OFFERED IN THE SENATE BY SENATOR WILSON
TO: SB 67
Page 1, line 1, following "professionals;":
Insert "relating to employment of nurses holding
multistate licenses;"
Page 10, following line 26:
Insert a new bill section to read
"* Sec. 20. AS 08.68 is amended by adding a new
section to article 6 to read:
Sec. 08.68.710. Registry of nurses practicing
under a multistate license. (a) A person who employs a
nurse practicing in this state under a multistate
license issued under AS 08.69 shall, before the nurse
practices in the state, submit to the board the name
and date of hire of the nurse and notify the board
when the nurse's employment terminates.
(b) A nurse who holds a multistate license
issued under AS 08.69 may submit the nurse's address
and other workforce-related data to the board.
(c) The board shall develop a reporting system
to collect information submitted under this section
and shall maintain a registry of the information,
including the number of nurses practicing in the state
under a license issued under AS 08.69 and the state in
which each nurse is a resident.
(d) The failure of a nurse or a person who
employs a nurse to provide information under this
section may not be the basis for disciplinary action
against the nurse or the nurse's license and does not
prohibit the nurse from practicing in the state."
Renumber the following bill sections accordingly.
Page 38, line 22:
Delete "Section 37"
Insert "Section 38"
Page 38, line 23:
Delete "sec. 38"
Insert "sec. 39"
SENATOR HUGHES objected for purposes of discussion.
2:22:39 PM
CHAIR WILSON stated Amendment 2 concerns a multistate license
registry. The amendment would require employers to register
multistate licensed nurses with the board of nursing to maintain
a record of nurses practicing in the state. This ensures the
state maintains some control over the practice of nursing. The
amendment requires employers to notify the board when multistate
nurses are hired and terminated. This will ensure the registry
is updated in a timely manner.
SENATOR HUGHES stated she likes the amendment. She asked to hear
from Ms. Chambers on the impact this amendment would have on the
bill and what the boards oversight of multistate nurses would
be.
MS. CHAMBERS stated Amendment 2 would not kill the bill because
it does not place the onus on the nurse. It adds additional
requirements on the employer. The department's unbiased concern
rests in the enforceability of the registry. Implementation of
the registry could be employers entering information into a
database. The department would spend no time or resources on the
database because it does not regulate employers. Conversely, if
the expectation is that the department have a system to check,
follow-up and reconcile failures to report, that is a different
type of registry. She stated the department is interested in
hearing more about the expectations of the registry. As written
in the amendment, the registry would be a website where
employers, on their honor, enter information and if they did not
there would be no recourse.
MS. CHAMBERS noted that the department does not know who is
practicing in Alaska now. Holding an Alaska license does not
mean a nurse practices in state. There is no requirement for
employers to inform the department which nurses they employ from
the department's list of licensed nurses. The department would
know if a nurse were multistate licensed through the compact's
database, just as it knows a nurse is licensed in Alaska though
the department's database. Neither the Alaska nor multistate
database tells the department who is employed. Amendment 2's
registry creates a higher threshold. The department does not
know if a nurse is employed; it is the employer's responsibility
to check that an employee has the appropriate license and
credentials for a job.
2:27:04 PM
MS. CHAMBERS stated that the board will continue to govern the
practice of Alaska over multistate license nurses. Multistate
licenses nurses who behave inappropriately in Alaska will be
disciplined by the Alaska Board of Nursing. This may affect
their ability to work in other states. It is a bigger punishment
than if the nurse were just licensed and punished in Alaska.
The Alaska Board of Nursing would continue to govern the
practice of nursing. Multistate licensed nurses would perform
only the duties that Alaska licensed nurses perform. Regulations
on nursing are managed and monitored by the Alaska Board of
Nursing through the legislature's authority. This is not changed
by being part of the compact. Joining the compact enters Alaska
into an agreement with a group of states, like the driver's
license, EMS and fingerprinting compacts that the state has
entered. The states agree what will be allowed. If a state wants
something different to happen, all states must agree. A state
can remove itself from the compact.
The driver's license compact allows people to drive in other
states without being licensed in other states. It is the same
thing except it is the practice of nursing with higher standards
and expectations than Alaska's current standards.
2:29:09 PM
SENATOR REINBOLD stated she is not a fan of government
databases. She asked why the bill is coming before the
legislature at this time, what its purpose is and if Ms.
Chambers thinks it is necessary.
MS. CHAMBERS stated that the administration proposed the bill
last year and this year because it is bogged down in the
bureaucracy of getting nurses licensed in Alaska. The state has
healthcare needs that are not being met due to delays and
requirements caused by Alaska statutes and regulations. The
compact is a model that has been adopted by more than half of
the states. It provides efficiency with adequate oversight and
retains state control. It is important because qualified nurses
must currently go through a system of proving the same
information multiple times.
SB 67 is a military family bill. It is the number one priority
of the Department of Defense. The gold standard of licensure is
to set high standards and have states rigorously agree to them.
This allows people to seamlessly transition from one
jurisdiction to another while maintaining a clean record. The
Department of Military and Veterans Affairs, Department of
Defense and various military constituencies in the state are
strongly in favor of the nurse licensure compact for that
reason.
2:31:50 PM
SENATOR REINBOLD opined that Ms. Chambers contradicted herself
regarding local control. She offered her belief that local
control is being given up, which is apparent from previous
amendments. She does not agree that the bill is needed for
military transition purposes. There are many military license
preferences. Military personnel get preference in Alaska if they
turn in their residency. She supports Amendment 2.
SENATOR HUGHES withdrew her objection to Amendment 2.
CHAIR WILSON asked if there was further objection; finding no
further objection, Amendment 2 passed.
2:32:42 PM
SENATOR BEGICH moved Amendment 3 [A.6].
AMENDMENT 3
32-GS1603\A.6
Fisher
4/12/21
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 67
Page 1, line 1, following "professionals;":
Insert "relating to the powers and duties of the
Board of Nursing;"
Page 8, line 19, following "AS 08.69":
Insert "or the privilege to practice in the state
under a multistate license issued by another state
under AS 08.69"
Page 9, lines 16 - 17:
Delete "granted by the board under this chapter
or"
Insert "issued by the board under this chapter or
AS 08.69 or against the privilege to practice in the
state under a multistate license issued by another
state under"
Page 9, line 18:
Delete "or permit to practice"
Insert ", [OR] permit to practice, or privilege
to practice in the state, as applicable"
Page 9, line 19, following "license":
Insert "or privilege to practice in the state, as
applicable,"
Page 9, line 30, following "license":
Insert "or privilege to practice in the state, as
applicable"
Page 10, line 1, following "issued":
Insert "or privilege to practice in the state
under a multistate license issued by another state
under AS 08.69"
Page 10, line 9:
Delete "that the board issued,"
Insert "issued by the board"
Page 10, line 10, following "revoked":
Insert ", or privilege to practice in the state
under a multistate license issued by another state
under AS 08.69 that has been suspended,"
Page 10, lines 12 - 26:
Delete all material and insert:
"* Sec. 19. AS 08.68.275(e) is amended to read:
(e) The board may return a license that has been
voluntarily surrendered or reinstate the privilege to
practice under a multistate license issued by another
state under AS 08.69, as applicable, if the board
determines that the licensee is competent to resume
practice and that the applicable renewal fees are
paid."
CHAIR WILSON objected for purposes of discussion.
2:32:53 PM
SENATOR BEGICH stated this amendment addresses the issue of gold
standards and local standards. It is about ensuring every nurse
practicing in the state is required to meet the same
expectations.
He said the Alaska Board of Nursing outlined in regulation a
comprehensive list of barrier crimes that prohibit a nurse from
practicing in Alaska; not every state has the same expectations.
Any person practicing nursing in Alaska should be required to
meet the states barrier crimes threshold. If Alaska joins the
compact, it would be unable to add new barrier crimes to the
list, unless every state in the compact agreed. Alaska regulates
the practice of nursing for the sole purpose of protecting the
public from people who prey on the vulnerable. Nursing services
are provided in a variety of settings such as private houses and
one on one settings. Amendment 3 provides assurances for the
public that Alaska nurses have been vetted.
CHAIR WILSON stated he does not want to put anyone who cannot
meet the barrier crime threshold into vulnerable populations. He
asked Ms. Chambers to comment.
2:34:16 PM
MS. CHAMBERS stated she has had less than a day to review the
amendments, but she did not see anything in Amendment 3 that
would kill the bill.
SENATOR HUGHES opined that healthcare facilities that are likely
to employ multistate licensed nurses also bill Medicaid, which
has a high standard for barrier crimes. She offered her belief
that the facilities would only hire employees that met the
Medicaid barrier crimes threshold.
CHAIR WILSON stated that background checks are necessary for
facilities to bill Medicaid. He was unsure if the state adopted
a federal barrier crime list or if it created its own. He asked
Mr. Armstrong to comment on the question.
SEAN ARMSTRONG, Deputy Chief of Nursing, Public Health Nursing,
Department of Health and Social Services (DHSS), Anchorage,
Alaska, stated he cannot respond.
CHAIR WILSON called on the Alaska Board of Nursing Chair Janette
Schlaeder.
2:36:28 PM
JANETTE SCHLAEDER, Chair, Alaska Board of Nursing, Anchorage,
Alaska, stated that from her experience working at a large
facility, employees were fingerprinted and a background check
for barrier crimes was done.
She pointed out that under the Nurse Licensure Compact (NLC)
requirements a person cannot qualify for a multistate license if
they have been convicted or found guilty or have entered into an
agreement disposition of a felony offense under applicable state
or federal criminal law. A person also cannot have any
misdemeanor convictions related to the practice of nursing. A
person who committed these offenses would not qualify for a
multistate license and would have to seek a single state
license.
2:37:47 PM
SENATOR BEGICH stated that misdemeanors and crimes vary from
state to state. Each state adopts its own criminal code. Ms.
Schlaeder's answer does not address Alaska's unique criminal
behavior and statutes; Amendment 3 does. He concluded it does
not appear to affect the compact and hopes there is no
resistance to it.
2:38:22 PM
CHAIR WILSON stated he does not see the amendment as a deal
breaker. If it is found to cause a problem, there are two other
committees of referral to address it.
CHAIR WILSON withdrew his objection to Amendment 3; finding no
further objection, Amendment 3 passed.
2:39:00 PM
SENATOR BEGICH moved Amendment 4 [A.7].
AMENDMENT 4
32-GS1603\A.7
Fisher
4/12/21
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 67
Page 5, line 21, following "completed":
Insert "two hours of training in Alaska Native
culture in a program approved by the board under
AS 08.68.330 and has successfully completed"
Page 7, following line 3:
Insert a new bill section to read:
"* Sec. 10. AS 08.68 is amended by adding a new
section to read:
Sec. 08.68.205. Educational requirements for
licensees practicing under a multistate license issued
by another state. Before practicing nursing in the
state, a licensee who holds a multistate license
issued by another state under AS 08.69 shall complete
two hours of training in Alaska Native culture in a
program approved by the board under AS 08.68.330."
Renumber the following bill sections accordingly.
Page 38, line 22:
Delete "Section 37"
Insert "Section 38"
Page 38, line 23:
Delete "sec. 38"
Insert "sec. 39"
CHAIR WILSON objected for purposes of discussion.
2:39:09 PM
SENATOR BEGICH stated Amendment 4 addresses the unique nature of
nursing in Alaska and the fact that twenty percent of Alaska's
population is Alaska Native. The amendment would require nurses
practicing in Alaska to successfully complete a two-hour
training in Alaska Native cultures. Native communities are where
many nurse practitioners practice, where service is provided
remotely, and often where nurses are the lead medical provider.
Multiple sources of educational training materials exist. The
practice of healing and health counseling requires respect for
the culture of those being served and an understanding of their
cultural practices. Amendment 4 would increase the effectiveness
of Alaska nurse licensees in serving the public. He asked if the
compact considers the amendment an overreach.
MS. CHAMBERS replied yes; Amendment 4 requires additional
requirements before practicing in the state. It has not been a
requirement in Alaska, and it has not been a problem. Most of
the nurses in Alaska come from out of state. If members feel the
training is important for nurses to have, there are other ways
to accomplish it, such as employee training. Amendment 4 will
keep Alaska out of the compact.
SENATOR BEGICH asked if it would violate the agreement if the
requirement were adopted after the state joined.
MS. CHAMBERS deferred the question to Ms. Fotsch.
2:42:13 PM
REBECCA FOTSCH, Director of State Advocacy and Legislative
Affairs, National Council of State Boards of Nursing, Chicago,
Illinois, stated she does not have a definitive answer but can
get one from the NLC attorney. She offered her belief that it
would not because it would not be an impediment to beginning
practice.
SENATOR BEGICH expressed concern that the compact will take away
state autonomy. Alaska's Native populations and geographic
challenges make it unique. He questioned at what point Alaska
sacrifices its uniqueness for a broader template, which may not
reflect the needs of Alaskans.
2:44:32 PM
At ease
CHAIR WILSON reconvened the meeting and held SB 67 in committee
with Amendment 4 [A.7] pending.