Legislature(2025 - 2026)BUTROVICH 205
02/18/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Alaska Primary Care Association (apca) | |
| SB89 | |
| SB76 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 89 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 76 | TELECONFERENCED | |
SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
4:05:55 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 89 "An Act relating to
physician assistants; relating to collaborative agreements
between physicians and physician assistants; relating to the
practice of medicine; relating to health care providers; and
relating to provisions regarding physician assistants in
contracts between certain health care providers and health care
insurers."
4:06:12 PM
SENATOR LÖKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 89 introduced herself.
4:06:20 PM
MACKENZIE POPE, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, provided the sectional analysis for
SB 89. She introduced herself.
4:06:24 PM
SENATOR TOBIN explained that the legislation was reintroduced to
address barriers to care in Alaska, particularly through a
pathway to independent licensure for physician assistants (PAs).
She shared that she is currently studying public policy and
recently researched U.S. healthcare policy, noting it has
historically been ad hoc and shaped by competing interest groups
since the 1942 Stabilization Act. She emphasized that Alaska
faces the highest healthcare costs in the nation, and while SB
89 will not fix all systemic issues, it is a necessary step
toward increasing access to care.
4:08:00 PM
SENATOR TOBIN stated that SB 89 aims to establish a pathway to
independent licensure for physician assistants. She emphasized
that Alaskans face difficulty accessing preventative care and
basic medical support for common ailments. She explained that
physician assistants play a key role in patient care by
assessing conditions and consulting their networks for complex
cases outside their scope. She underscored the importance of
recognizing and elevating the professional experience of
physician assistants.
4:08:31 PM
SENATOR TOBIN explained that many may be unaware of the rigorous
education and training required for physician assistants. She
noted that the profession began in the 1970s on battlefields,
evolving into a formal education system for PAs. She stated that
applicants to accredited physician assistant programs typically
have over 3,000 patient contact hours prior to entering a 27-
month graduate-level program, which includes 2,000 hours of
clinical rotations alongside medical students. She added that
Alaska requires continuing medical education every two years and
a comprehensive exam every ten years for physician assistants to
maintain licensure.
4:09:38 PM
SENATOR TOBIN stated that SB 89 differs from previous iterations
due to stakeholder input and reflects a compromise addressing
their concerns. She explained that SB 89 permits physician
assistants to pursue independent licensure after completing
4,000 hours under a collaborative agreement, in addition to the
initial 2,000 clinical hours. She added that if a physician
assistant changes specialties, the State Medical Board may
require up to 4,000 more contact hours, totaling up to 10,000
hours before independent licensure when there is a change in
specialty. She acknowledged that this differs from the process
for nurse practitioners but emphasized that the bill seeks to
balance professional advancement with stakeholder concerns.
4:10:47 PM
SENATOR TOBIN stated that maintaining collaborative agreements
has proven burdensome for physician assistants. She noted that
last year 12 percent of collaborating physicians lived outside
Alaska, a number that has since increased to 14.5 percent. She
emphasized that physician assistants often must pay to maintain
these agreements despite providing quality care under remote
supervision. She concluded by stating that SB 89 preserves State
Medical Board oversight, restricts independent surgery,
maintains care standards, and creates a pathway to independent
licensure to expand access to affordable, community-based
preventative care.
4:12:40 PM
SENATOR HUGHES stated she had no conflict of interest, although
her husband is a retired physician assistant who served on the
Vietnam battlefield, where the profession originated. She shared
that her husband often worked remotely in villages with minimal
contact from the collaborating physician. She said when her
husband's rural patients went to Anchorage and Fairbanks for
care, often physicians consulted with her husband because he was
familiar with the patient. She expressed support for SB 89 but
asked for clarification on the required hours, summarizing 3,000
clinical hours before program entry, 2,000 during clinical
rotations, and 4,000 under a collaborative agreement before
independent licensure. She asked whether any additional hour
requirements apply.
4:13:50 PM
SENATOR TOBIN clarified that the 3,000 clinical hours mentioned
prior to entering a physician assistant program are not a formal
requirement but reflect the average experience of individuals
pursuing a graduate-level degree in the field.
4:14:34 PM
MS. POPE provided the sectional analysis for SB 89:
[Original punctuation provided.]
Senate Bill 89: Sectional Analysis
Section 1. Removes state medical board (SMB) reference
to AS 08.64.107 Regulation of Physician Assistants
which is repealed and reenacted in a later section.
Section 2. Repeals and reenacts 08.64.107 to
restructure the physician assistant authorizing
statutes.
Subsection (a) directs the SMB to adopt regulations
related to the acts within the practice of medicine
that physician assistants (PAs) may perform, which
must allow for PA practice of acts they are
generally educated and trained to perform. This
subsection specifically prevents PAs from
performing surgery without supervision. This
subsection also directs the SMB to promulgate
regulations for PAs who switch specialty, and the
methods by which a collaborating physician will
assess a PA.
Subsection (b) establishes that a PA with less than
4,000 postgraduate clinical hours may only practice
under a collaborating agreement. These
collaborative agreements must be in writing and
describe the specialty the hours are completed
within, as well as the oversight methods.
Subsection (c) outlines that assessment for PAs
practicing in rural areas can be done
telephonically or via video.
Subsection (d) outlines the process for a PA to
notify the SMB if they begin to practice a new
specialty.
Subsection (e) requires a copy of the collaborative
agreement be provided to the SMB. At such a time as
the PA reaches the required postgraduate hours,
they shall notify the SMB and complete an
attestation provided by the SMB.
Subsection (f) directs the SMB to assess whether
that specialty will require additional requirements
or hours. For specialty change, or in other
regulation change, the requirements are not to
exceed the clinical hours required in subsection
(b).
4:16:23 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 3. Amends 08.64 to add a new section laying
out the qualifications for physician assistant
qualifications for licensure.
Section 4. Amends 08.64.230 to add an additional
section directing the SMB or it's executive secretary
to grant a license to qualified applicants.
Section 5. Amends the existing statute to include
physician assistants in the list of medical
practitioners whose licensure we recognize from other
states and provinces of Canada.
Section 6. This amends 08.64.250 to include PAs in the
existing temporary licensure process and reference the
new applicable section 08.64.206.
4:16:48 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 7. This section amends the existing statute to
include physician assistants alongside the other
medical practitioners in the list of temporary
licensure and substitute roles in different medical
facilities.
Section 8: Adds a subsection to include PAs in the fee
requirement when applying for a license.
Section 9: Amends the section to include PAs in the
existing statute regarding the SMBs parameters for
evaluating any extenuating circumstances to waive
certain requirements for meeting licensure
qualifications.
Section 10. This section amends AS 08.64.326
subsection (a) to include PAs in the existing statutes
regarding the process for being sanctioned for crime,
misrepresentation, and failure to pay fees, to name a
few of the examples given in the statute.
Section 11. This amends the existing statute to
include PAs in the existing voluntary surrender
provisions in AS 08.64.334.
Section 12. This amends the existing statute to
include PAs in the process for medical practitioners
who treat fellow licensed medical practitioners for
alcoholism, drug addiction, and mental/emotional
disorders who might constitute a danger to their
patients or themselves, to report to the SMB.
4:17:56 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 13. Grants immunity in civil liability for PAs
who submit a report in good faith to the SMB relating
to addictive substances abuse.
Section 14. Amends statute so that PAs cannot refuse
to submit a report to the SMB or withhold evidence on
the grounds that it is under doctor-patient
confidentiality.
Section 15. Updates the statute covering all state
licensees under this chapter, including PAs, to
specify that if they practice without a valid license,
they are guilty of a class A misdemeanor.
Section 16. Amends the statute to include PAs in the
list of medical providers who can support a licensed
physician in another state, in the support of the
regular medical service of the United States Public
Health Service, or volunteering services to the armed
services of the US among other unique medical support
situations.
Section 17. Amends the statute to allow physicians
assistants to show their PA credentials to communicate
their qualifications.
Section 18. Amends 08.64.380 to include PAs as
providers who can accept concurrent referrals for
systemic disease treatment.
Section 19: Amends the definition of practitioner to
include physician assistant in the statute.
4:19:10 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 20: Puts in statute the definition of
physician assistant. Section 21: Amends the statute
referenced to be in line with the repealed statutes
removed by previous sections. Section 22: Adds a
section under AS 21.07.010 to prevent any requirements
within a health care insurance policy from being more
restrictive than or inconsistent with the practice,
education, or collaboration provisions outlined in AS
08.64.
4:19:32 PM
MS. POPE continued the sectional analysis for SB 89:
[Original punctuation provided.]
Section 23: Updates the definition of licensed
physician assistants to remove the supervision
requirement allowing for PAs who have completed their
postgraduate clinical requirements and are no longer
subject to a collaborating physician agreement to
continue their practice. Section 24: Amends the
statute to include physician assistant in the
definition of health care provider in statute.
4:19:52 PM
CHAIR DUNBAR stated that he initially believed the 4,000 hours
mentioned in SB 89, Section 2(f), were required for a new
specialty. He sought clarification, asking whether the State
Medical Board has discretion to set additional hours up to
4,000. He asked if the Board could reduce the hours depending on
the specialty.
4:20:40 PM
MS. POPE replied that an initial 4,000 hours are required. She
explained that if a physician assistant chooses to switch to a
different specialty, the State Medical Board may require
additional hours, not to exceed 4,000.
4:21:07 PM
SENATOR HUGHES noted that definitions for surgery vary widely.
She observed that some definitions include minor procedures like
stitching a wound, which physician assistants commonly perform
without direct supervision. She contrasted this with major
procedures such as heart surgery. She asked if "surgery" is
defined elsewhere in statute or if clarification is needed.
4:21:42 PM
SENATOR TOBIN responded that her office would follow up on the
definition of "surgery." She stated that the current language
was recommended by Legislative Legal Services, based on her
intent to align physician assistants' scope of practice with
standards accepted across all 50 states.
4:22:07 PM
CHAIR DUNBAR stated that [surgery] was a point of contention
last year with some groups interested in the bill and emphasized
that it is an issue that needs to be clearly defined.
4:22:21 PM
SENATOR TOBIN thanked the committee for hearing SB 89 and
reiterated the goal of addressing concerns from stakeholders,
associations, and groups. She emphasized the importance of
creating a pathway to independent licensure, noting that an
unfair system arbitrarily limits the ability of qualified
individuals to provide quality care. She stated that
reintroducing the bill reflects a policy decision she believes
is the right course of action.
4:22:57 PM
CHAIR DUNBAR held SB 89 in committee.