Legislature(2017 - 2018)CAPITOL 106
03/29/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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 | |
| HB193 | |
| SB174 | |
| SB108 | |
| Confirmation Hearing(s) | |
| HB358 | |
| HJR32 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 174 | TELECONFERENCED | |
| += | SB 108 | TELECONFERENCED | |
| += | HB 358 | TELECONFERENCED | |
| *+ | HJR 32 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 193 | TELECONFERENCED | |
SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD
3:58:22 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 108(FIN), "An
Act relating to the State Medical Board; relating to the
licensing of physicians, osteopaths, and podiatrists; relating
to the certification of medical assistants; relating to the
practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to assault of a
medical professional; and providing for an effective date."
3:58:30 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, explained that
the proposed bill included requests by the State Medical Board
for changes to their statutes. She presented a PowerPoint
titled "SB 108, State Medical Board," and introduced slide 2,
"Purpose," which listed the two purposes of the bill: to
streamline physician licensing and to address the need for both
licensed and unlicensed office assistants.
3:59:58 PM
SENATOR GIESSEL addressed slide 3, "Streamline MD licensing,"
which was addressed by the proposed bill in Sections 1, 2, 8,
and 9 [and 10] for changes to the process for license approval.
She declared that the reason to the delay for approval was the
need for the license application to first be reviewed, and then
forwarded to the State Medical Board for evaluation during its
quarterly meeting. She explained that the proposed bill would
authorize the executive administrator to look at the license
applications, and if it was complete, and there were not any
concerns, the administrator would be authorized to approve the
license and issue temporary licenses, as well as grant
certifications. The proposed bill also spelled out prohibitions
for the board to limit the executive administrator's authority
in this realm. She added that this process had already been in
use by the Department of Commerce, Community & Economic
Development for 20 years. She declared that it was a safe,
efficient, and proven system.
4:01:49 PM
SENATOR GIESSEL moved on to slide 4, "Streamline MD licensing,"
and reported that Sections 10 and 11 of the proposed bill added
an additional second person to issue temporary licenses should
the executive administrator not be available. She declared that
that this would help streamline the license approvals between
those quarterly board meetings. She reported that there were
approximately 290 licenses in backlog, although some of these
may not be complete. She noted that only about 5 percent of the
applications were complete when submitted.
SENATOR GIESSEL directed attention to slide 5, "Unlicensed
Assistive Personnel," which was addressed in Section 3 of the
proposed bill. She reported that, in the mid-1990s, physician
offices began to hire unlicensed personnel for routine medical
duties in order to reduce overhead costs. She pointed out that,
as the state medical laws prohibited the delegation of any
medical duties to an unlicensed person, the proposed bill would
correct that gap in the laws and it would authorize delegation
of routine medical tasks, as defined by the State Medical Board,
to an unlicensed person.
4:05:15 PM
SENATOR GIESSEL addressed slide 6, "2.a. Unlicensed Personnel
Medical assistants," and noted that Sections 6, 12, and 14 added
additional clean up language, and put "routine medical duties"
under the exception to the license to practice medicine as the
law currently prohibited any of these medical activities being
delegated to unlicensed people. She reported that Section 12
added medical assistant to the practice of medicine, and Section
14 added medical assistants to the definition of medical
professional under the Title 12 Criminal Procedure.
SENATOR GIESSEL directed attention to a second category of
medical assistant created in the proposed bill to again correct
a problem identified by practicing physicians, slides 7 - 8,
"2.b. Medical assistants - license/certification." She relayed
that earlier legislation had prohibited unlicensed people from
looking into the prescription drug database, as it contained
sensitive information. She stated that this had now caused
problems in the offices of pain or cancer doctors, as these
doctors did not have staff licensed to perform this task. She
relayed that the proposed bill created an entity of medical
assistants who were certified through recognized training and
certification programs. She added that Alaska's community
colleges had training programs for certified medical assistants,
which were recognized in many other states. She explained that
Section 4 of the proposed bill defined the certifying process in
regulation by the board, slide 9, "Medical assistant with
certification Process defined." She stated that Section 5
listed specific limitations for use of the term "certified," and
that Section 13 included certification in the definition of a
license. She pointed out that these certified assistants would
be qualified to look into the prescription drug database for a
physician, as well as being assigned more complex medical duties
as determined by the medical board.
4:10:04 PM
SENATOR GIESSEL emphasized that the proposed bill would provide
a more efficient, expeditious, and effective licensing of
physicians, it would provide legal clarity for the delegation of
routine medical duties to unlicensed personnel, and create more
stringent licensing for a person certified or licensed by the
board, slides 10 - 11, "Urgent need for SB 108." She declared
that the state medical board "really needs this" and that there
had not been any opposition to the proposed bill.
4:11:09 PM
REPRESENTATIVE SULLIVAN-LEONARD acknowledged that other medical
professionals had indicated the time element to manage all the
tasks. She relayed that certified medical assistants (CMA) were
very beneficial and asked if the CMAs could apply a prescription
or write a prescription.
SENATOR GIESSEL offered her belief that the board intended that
CMAs not be allowed to do any prescribing or management of
opioids other than accessing the data base. She cautioned that
the term CMA was a registered trademark by one of the certifying
bodies, and that neither the term or the words were used in the
proposed bill.
4:13:00 PM
REPRESENTATIVE KITO mused that the proposed bill was providing
for licensing, registration, or certification of a medical
assistant, as well as allowing medical professionals to
designate routine tasks to unlicensed medical assistants. He
asked if this created two classes of medical assistants,
licensed and unlicensed.
SENATOR GIESSEL acknowledged that there were two categories of
medical assistants. One was a regular medical assistant whereas
the other had sought on-going education, had taken the national
certifying examination, and was qualified to pursue licensing by
the State Medical Board.
REPRESENTATIVE KITO expressed concern for the ability to oversee
a doctor's office which could have both categories of medical
assistant.
SENATOR GIESSEL stated that the medical board would define the
limitations on both entities, and that it would be up to the
facility to monitor that the clinicians were practicing within
the scope of their license. She said that these were all
logistics that the medical profession would work out.
4:15:22 PM
REPRESENTATIVE KITO asked about the applicability of the medical
board asking to authorize a new category of medical professional
when they were not in support of a similar request by the
naturopath board. He expressed concern for leaving this
entirely to the medical board while not knowing the
requirements.
SENATOR GIESSEL acknowledged that he had identified a turf
situation which occurred in medicine. She shared an anecdote
for the nursing profession putting in statute and regulation the
authority to delegate to unlicensed assistive personnel. She
said that it was "pretty routine" to trust professional boards
with this.
REPRESENTATIVE KITO said that, although he appreciated areas of
turf, it was necessary to carefully understand what was being
added. He expressed his concern for the new certification of
medical assistants without fully understanding their task. He
asked for a commitment from the medical profession that this
would result in decreases in cost, as there would be a
delegation of tasks from a licensed professional to unlicensed
individuals. He expressed concern that the public would not be
receiving the benefit.
SENATOR GIESSEL said that these cost reductions should have been
seen in the mid-1990s when medical assistants began to replace
licensed professional in physician offices.
REPRESENTATIVE KITO pointed out that medical costs had continued
to increase since then.
CHAIR SPOHNHOLZ noted that the requirement that health care
providers use the prescription drug database had been added in
the last few years at a time when they had not been able to bill
for that.
4:19:25 PM
REPRESENTATIVE TARR asked whether the role of untrained students
working in medical offices was now becoming professionalized.
SENATOR GIESSEL explained that the "regular" medical assistant,
usually high school graduates, had been trained on the job. She
reported that, as the education became more formalized over
time, the State of Alaska now needed to recognize this training.
REPRESENTATIVE TARR opined that, as people would be better
prepared to provide information, there would be a positive
benefit. She suggested that many of these had been
administrative, rather than health care positions.
SENATOR GIESSEL expressed her agreement and suggested that the
certified medical assistant would now perform more invasive
medical procedures, such as immunizations. She listed some of
the safeguards as a result of medical training.
REPRESENTATIVE TARR questioned whether there would be a public
comment period after the State Medical Board prepared
regulations.
SENATOR GIESSEL expressed her agreement, noting that the
regulatory process took about one year to complete, which
included a period for public comment.
REPRESENTATIVE EASTMAN directed attention to Section 4 of the
proposed bill and asked for the reasons that immunity was
offered.
4:24:20 PM
SENATOR GIESSEL stated that this was standard language in health
care statutes for providing immunity to people making reports of
incidences.
REPRESENTATIVE EASTMAN, referencing AS 08.64.111, asked whether
use of the abbreviation C.M.A. was intended and whether it would
run "afoul of the trademark issue" mentioned previously.
SENATOR GIESSEL replied that this decision to choose the
certifying body for the trademark C.M.A. was up to the State
Medical Board, pointing out that these initials were not
specified in the proposed bill.
REPRESENTATIVE EASTMAN directed attention to Section 12 of the
proposed bill and asked whether the certified medical assistants
were practicing medicine.
SENATOR GIESSEL explained that Section 12 indicated that a
medical assistant licensed under a separate chapter of the
proposed bill was exempt from practicing without a medical
license.
REPRESENTATIVE EASTMAN asked if the other chapter provided a
comparable penalty.
SENATOR GIESSEL acknowledged that there were penalties for
practicing medicine without a license. She shared the State
Medical Board list of other licenses and certificates.
4:27:51 PM
REPRESENTATIVE KITO expressed concern regarding the definition
of medical professional in Section 14.
SENATOR GIESSEL directed attention to similar positions on the
medical board list and acknowledged that it was a rather broad
definition.
REPRESENTATIVE KITO compared this to dental assistants who could
be delegated tasks and asked about the consideration of someone
as a medical professional "who has zero training."
SENATOR GIESSEL explained that the purpose for the definition of
medical professional was to authorize for the routine medical
tasks, which included the medical assistant with certification.
She suggested that the dental assistant should be added.
4:31:03 PM
CHAIR SPOHNHOLZ opened invited testimony on SB 108.
4:31:15 PM
FRED PARADY, Deputy Commissioner, Office of the Commissioner,
Department of Commerce, Community & Economic Development, stated
his support of the proposed bill. He stated that, in FY17, the
Department of Commerce, Community & Economic Development had
processed 22 percent more medical licenses and 31 percent more
nursing licenses, reflecting the increased demand for health
care professionals in Alaska. He reported that the department
had initiated a strategic planning process which identified
streamlining the application process for health care professions
as its highest priority. This initiative included a
comprehensive examination of the processes, which identified
every step of the process to search for roadblocks and
bottlenecks. He noted that 27 of these roadblocks were
identified and evaluated for the cause in order to determine if
this was a public safety need, whether the process was obsolete,
and whether the roadblock could be simplified. He explained
that there was a three-pronged approach to implementing the
solutions to these roadblocks: some were in board regulation,
some were improvements to the IT process, and some were changes
to statute.
4:34:50 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if the processing for the
positions in the proposed bill would be paid by the State
Medical Board.
MR. PARADY said that they would.
4:35:20 PM
CHAIR SPOHNHOLZ opened public testimony on SB 108.
4:35:43 PM
DANNY ROBINETTE, MD, Chief Medical Officer, Foundation Health
Partners, stated that his organization was in support of the
proposed bill to expedite the process. He reported on the
struggle to bring physicians to Alaska. He lauded the
safeguards in the proposed bill to ensure clean applications.
4:37:35 PM
CHAIR SPOHNHOLZ closed public testimony on SB 108.
4:37:54 PM
The committee took a brief at-ease.
4:38:22 PM
REPRESENTATIVE TARR said that the proposed bill was an important
step forward to hopefully result in more access to care and to
lower costs. She stated that it would be imperative for the
legislature to maintain a vigilance for the regulations upon
release to the public.
CHAIR SPOHNHOLZ said that she had heard concerns from physicians
about the prescription drug database requirement, and that this
new category would allow health care practitioners more office
efficiency. She stated that the temporary licensing was an
important aspect and that there were appropriate fail safes.
4:40:03 PM
REPRESENTATIVE ZULKOSKY moved to report CSSSSB 108 (FIN),
Version 30-LS0740\I, from committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSSSSB 108 (FIN) was reported from the House
Health and Social Services Standing Committee.