Legislature(2025 - 2026)BELTZ 105 (TSBldg)
03/14/2025 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB96 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 89 | TELECONFERENCED | |
| *+ | SB 96 | TELECONFERENCED | |
SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
1:44:44 PM
CHAIR BJORKMAN 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."
1:45:03 PM
SENATOR LOKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 89 introduced the legislation and
stated that Alaska is facing a serious shortage of physicians,
and many communities are struggling to get the care they need.
Though long-term efforts are underway to grow the states
healthcare workforce, Alaska needs solutions that help people
now. SB 89 aims to do just that by allowing physician assistants
(PAs) to provide care to the maximum scope of their training
without requiring a collaborative agreement with their
physicians. SB 89 gives experienced PAs a path to independent
licensure, similar to what nurse practitioners have had in
Alaska since the 1980s. She said her office has provided studies
showing 40 years of research from hospitals, medical clinics and
treatment programs showing PAs provide care of the highest
quality. The legislation still protects patient safety and
requires physician assistants (PAs) with fewer than 4,000 hours
of clinical experience to have a collaborating physician. Any PA
changing medical specialties would need additional training, as
determined by the state medical board. SB 89 also makes clear
that PAs are not allowed to perform surgery. PAs already
complete thousands of hours of hands-on training before entering
practice, and their education includes clinical rotations with
medical students. PAs are also required to complete 100 hours of
continuing education every two years, more than any other
provider in the state. SB 89 does not compare PAs to doctors or
suggest they do the same job. This legislation gives qualified
PAs the ability to care for Alaskans more efficiently,
especially in underserved areas. With 14 percent of supervising
doctors living out of state, many PAs are already providing care
without a supervising doctor present. SB 89 helps ensure that
PAs can keep doing their jobs, legally and effectively and that
Alaskans continue to get the healthcare they need.
1:50:24 PM
SENATOR MERRICK joined the meeting via teleconference.
1:50:34 PM
MACKENZIE POPE, Staff, Senator Loki Tobin, Alaska State
Legislature, Juneau, Alaska, 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.
1:50:51 PM
MS. POPE continued with the sectional analysis:
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).
1:52:08 PM
MS. POPE continued with the sectional analysis:
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.
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.
1:53:32 PM
MS. POPE continued with the sectional analysis:
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.
Section 20: Puts in statute the definition of
physician assistant. HEALTH & SOCIAL SERVICES
JUDICIARY TRANSPORTATION
Section 21: Amends the statute referenced to be in
line with the repealed statutes removed by previous
sections.
1:54:47 PM
MS. POPE continued with the sectional analysis:
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.
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.
1:55:24 PM
SENATOR DUNBAR referred to Section 2(a)(1) of SB 89 and
mentioned having discussions in a prior committee about whether
suturing is considered surgery. He asked if "surgery" is defined
in statute and whether physician assistants would be allowed to
remove a melanoma.
1:56:31 PM
MS. POPE answered that their office consulted with legislative
legal regarding the definition of surgery and noted that, under
Section 2(a)(1), the responsibility for defining "surgery" is
delegated to the state medical board and their medical
expertise.
1:57:11 PM
SENATOR TOBIN stated that the regulatory process allows for
public comment and input. Anyone with concerns about what should
or shouldn't fall within a PA's scope of practice may be shared
with the state medical board during the public rulemaking
process.
1:57:34 PM
SENATOR DUNBAR asked if there are physicians on the state
medical board that will be determining what is considered
surgery for this new law.
1:57:48 PM
MS. POPE answered that there are medical doctors on the medical
board.
1:57:58 PM
SENATOR TOBIN stated her belief that there are three physicians
on the medical board and a dedicated seat for 1 physician
assistant.
1:58:26 PM
CHAIR BJORKMAN announced invited testimony on SB 89.
1:58:46 PM
MARY SWAIN, Chief Executive Officer (CEO), Camai Community
Health Center, Bristol Bay, Alaska, testified by invitation on
SB 89:
[Original punctuation provided.]
I strongly support Senate Bill 89, which provides a
pathway for independent licensure for experienced
Physician Assistants (PAs) in Alaska. This legislation
is critical to addressing healthcare access barriers,
especially in rural and underserved areas like Bristol
Bay Borough, where our health center operates.
At Cama'i Community Health Center, we regularly face
significant provider shortages, notably during the
busy summer months when our community population
dramatically increases due to the influx from the
world's largest wild sockeye salmon run. Our Physician
Assistants play a crucial role in delivering
continuous, high-quality healthcare amidst these
seasonal fluctuations. Physician openings in rural
Alaska often remain vacant for extended periods,
frequently averaging 12 months or longer, as noted by
the Alaska Primary Care Association. Even when we
actively seek to recruit physicians, the reality is
that physicians rarely apply for these remote
positions. When they do, the compensation required to
attract and retain them often far exceeds the
financial capabilities of rural clinics, leaving
critical roles unfilled. Independent practice for
experienced Physician Assistants will help mitigate
these gaps by leveraging existing, highly trained
healthcare professionals already embedded within our
communities.
2:00:13 PM
MS. SWAIN continued her testimony of SB 89:
The American Academy of Physician Assistants (AAPA)
notes that states such as Arizona, North Dakota, and
Wyoming, which have implemented similar measures
allowing PAs independent practice, have observed
enhanced healthcare outcomes and increased patient
satisfaction. Importantly, these states did not see
physicians replaced; rather, PAs complemented the
existing physician workforce, allowing teams to
operate more efficiently, patient outcomes and
expanding overall access to medical care. Evidence
consistently indicates no decline in physician
employment or replacement of physicians following PA
independence; instead, it enhances the healthcare
team's capacity to serve patients more effectively.
PAs undergo rigorous training comparable to medical
school, completing approximately 27 months of
intensive education that includes 580 hours of
clinical medicine coursework and at least 2,000 hours
of supervised clinical rotations across various
medical disciplines. The accreditation and continuous
professional development required of PAs ensure that
they remain highly competent and prepared to deliver
independent care.
By passing SB 89, Alaska would join other forward-
looking states in improving healthcare accessibility,
particularly in rural communities, without
compromising medical standards or physician oversight.
The bill aligns with proven outcomes, enhances
healthcare delivery, and supports community-based care
providers like Cama'i Community Health Center.
2:02:21 PM
MEGHAN HALL, President, Alaska Academy of Physician Assistants,
Anchorage, Alaska, testified by invitation on SB 89:
[Original punctuation provided.]
Over 50 years ago, the PA profession was born out of
the need for a new type of healthcare provider to ease
the burden on overworked physicians. Back then, the
American Medical Association helped create the PA
profession and actively lobbied for increased funding
for PA programs.
2:02:53 PM
MS. HALL continued with her testimony of SB 89:
In order to rapidly deploy this novel provider type a
new credentialing structure was needed. Enter the
collaborative plan, supervising physician, or practice
agreement. These are all forms of the same idea.
In lieu of independent licensing a PA would work under
the medical license of the physician they had followed
through their clinical year. It was not uncommon in
the beginning for a PA student to spend an entire year
with one physician learning that practice. Then after
graduation the PAs worked under the supervising
physician's license, ensuring collaboration and
liability coverage.
This arrangement made it possible for PAs to provide
care to workers in camps along the pipeline as it was
being built in the 1970s.
Since then, the PA profession has evolved
significantly. We now graduate with Master's degrees,
hold national certifications, complete 50 hours of CME
annually, and are individually state licensed and DEA
registered. We are governed by the medical board and
held to the same statutes as all licensees of the
board.
The need for formal collaborative agreements between
one or more physicians and one PA has diminished as
PAs, even in remote areas, can access several
physicians or other providers for consultations
anytime. Collaboration is integral to the practice of
medicine, not just a formality on paper and will
continue even without written plans.
These collaborative agreements that once allowed a new
profession to flourish have now become barriers to
hiring PAs and are increasingly viewed as outdated and
unnecessary. They increase the cost of hiring a PA and
in some cases completely prevent smaller clinics from
being able to hire us at all.
2:04:39 PM
MS. HALL continued with her testimony of SB 89:
In Alaska, we face the worst healthcare shortage in
the nation, and many PAs are considering leaving to
practice in states with updated statutes. Many of the
states with modernized PA practice laws are in the
west with large rural areas, not unlike Alaska. This
outmigration of healthcare providers is the last thing
we need right now.
The heart of the PA profession has always been
increasing access to care through collaboration,
nothing in this bill will change that.
With your support of SB89, PAs can continue to grow
and meet the evolving needs of Alaskans with safe and
effective care, while ensuring a more robust
healthcare workforce
2:05:24 PM
SENATOR DUNBAR stated that he heard a few critiques of SB 89
from physicians claiming there are no guardrails for
independently practicing PAs; this will lessen the quality of
patient care and endanger patients. The hours of training needed
is also a concern. He asked why PAs should be allowed to
practice their specialties independently when PAs have way fewer
hours of training than a doctor.
2:06:31 PM
MS. HALL answered that SB 89 clarifies that all medical statutes
that apply to doctors and podiatrists also apply to physician
assistants. The guardrails remain in place regardless of whether
there is a collaborative plan. She said PAs cannot perform
procedures they aren't trained or competent to do, including
independent surgery. Institutions can still set stricter
internal standards, like chart reviews or additional oversight.
A collaborative plan is just one layer of safety and is a low-
level guardrail. She said regarding specialty care; PAs are not
and will not become physicians or specialists. In specialty
clinics, PAs typically handle follow-up visits or routine care
under the direction of a specialist. This helps clinics serve
more patients without lowering the quality of care and improves
access to services.
2:09:10 PM
CHAIR BJORKMAN asked when going to the "doctor" what different
experience would a common person receive when they see a PA who
does family practice, instead of a physician.
2:09:47 PM
MS. HALL answered that in family practice, the care provided by
PAs can often look very similar to that of physicians. Many
patients report that PAs spend more time with them during visits
possibly because PAs are typically not paid based on
productivity, so they aren't under the same time pressures as
physicians. As a result, appointments with PAs are often longer.
She said there isn't much difference in the content of the visit
like reviewing vaccinations and recommending screenings. She
said overall family practice is an area where the care delivered
by PAs and physicians is quite comparable.
2:11:14 PM
CHAIR BJORKMAN asked if there is not a recognizable difference
of experience between a family practice doctor and a PA how
would this legislation assist PAs in providing primary care to
patients.
2:11:40 PM
MS. HALL responded that SB 89 would allow PAs with the 4,000
hours of practice to work where there are not two physicians on
staff to sign collaborative plans. If further benefits smaller
clinics by reducing paperwork and costs.
2:12:25 PM
MS. SWAIN answered that the law already requires providers to
introduce themselves and state their credentials, and the
providers must wear identification; this will continue under SB
89. She stated that currently, she has two physicians who sign
collaborative agreements, neither lives in the community, and
one lives out of state. The main collaborator consults by phone
or Zoom and visits the clinic quarterly. This setup costs a
small clinic of 12 employees over $55,000 annually. She said the
state takes up to three months to approve the collaborative
plan. SB 89 would let the clinic bring in a PA quickly without
waiting months for approval. She said PAs would still need to be
privileged, with clear documentation outlining what procedures
they're allowed to perform, like sutures or x-rays. That scope
is already regulated by the state medical board, and SB 89
doesn't change that.
2:15:21 PM
CHAIR BJORKMAN asked what guardrails will define the PA's scope
of practice and outline the difference between a PA and a
physician once the PA's collaborative agreement ends.
2:16:10 PM
MS. SWAIN answered that currently collaborative plans are in
place, but moving forward, clinics may choose whether to
maintain the plans. She said Federally Qualified Health Center
(FQHC), like many rural clinics in Alaska, must follow specific
rules tied to the clinic's funding. One requirement is ongoing
collaboration for all providers, regardless of their role or
level. The clinic must have a medical director who sets the
scope of practice for all staff, including PAs, NPs, and medical
assistants. So even without a mandated collaborative plan,
strong guardrails remain through clinic policy and oversight.
2:17:31 PM
SENATOR BJORKMAN asked since the Camai Community Health center
and other rural clinics are operating as a FQHC, do the
collaborative agreements that PAs currently have for those
clinics fulfill the state law's mandate for collaborative
practice agreements.
2:17:56 PM
MS. SWAIN answered that the PAs at FQHCs aren't required to have
a collaborative plan, but PAs are required to have peer reviews.
A peer review is when another provider reviews the PA's work.
She said the peer reviews and privileging documents required by
the state medical board are the bigger guardrails that wont be
lost in this legislation.
2:19:01 PM
SENATOR TOBIN stated that the main issue for physician
assistants is the unnecessary administrative burden of
collaborative agreements. Six other rural states have already
removed this step. These agreements don't ensure better care;
true oversight comes from the state medical board, continuing
education, and practicing within a defined scope. SB 89 removes
that outdated paperwork, which often lacks enforcement. She said
in some cases, out-of-state doctors are paid just to be listed
on these plans, turning the agreements into a costly barrier for
PAs to do their jobs in Alaska.
2:20:53 PM
SENATOR DUNBAR stated that Ms. Pope confirmed there are five
physicians on the medical board and one physician assistant.
2:21:12 PM
CHAIR BJORKMAN held 89 in committee.