02/15/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES

          SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE                                                                      
                                                                                                                                
4:35:48 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 115                                                                 
"An Act relating to physician assistants; relating to                                                                           
physicians; and relating to health care insurance policies."                                                                    
                                                                                                                                
SB 115  was first heard on  January 23, 2024. Invited  and public                                                               
testimony was heard. On February  6, 2024, a committee substitute                                                               
was considered  and withdrawn.  Before the  committee is  SB 115,                                                               
version B.                                                                                                                      
                                                                                                                                
4:36:12 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
4:36:18 PM                                                                                                                    
SENATOR DUNBAR moved to adopt Amendment 1, work order 33-                                                                       
LS0542\B.4, to SB 115.                                                                                                          
                                                                                                                                
                                               33-LS0542\B.4                                                                    
                                                     Gunther                                                                    
                                                     2/15/24                                                                    
                                                                                                                                
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE                    BY SENATOR DUNBAR                                                                 
         TO:  SB 115                                                                                                            
                                                                                                                                
     Page 2, line 28:                                                                                                           
          Delete "2,000"                                                                                                        
          Insert "6,000"                                                                                                        
                                                                                                                                
4:36:25 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
4:36:53 PM                                                                                                                    
CHAIR WILSON reconvened the meeting and objected for purposes of                                                                
discussion.                                                                                                                     
                                                                                                                                
4:36:56 PM                                                                                                                    
SENATOR DUNBAR  stated that  overall, he agrees  with SB  115. He                                                               
wants physician assistants (PAs)  to have independence within the                                                               
field's  scope  of  practice. However,  other  states  require  a                                                               
higher  number of  hours working  under a  physician. In  SB 115,                                                               
page 2, line 28, "2,000 hours"  would change to "6,000 hours." He                                                               
opined  that  the  change  would   provide  needed  training  for                                                               
increased safety.                                                                                                               
                                                                                                                                
4:38:10 PM                                                                                                                    
CHAIR TOBIN  responded that the committee  discussed the clinical                                                               
and  patient  training  PAs  receive before  they  can  care  for                                                               
patients.  The addition  of 2000  hours is  to untether  PAs from                                                               
physicians. PAs  are not trying  to replace physicians.  The goal                                                               
is to  provide more services  at different tiers. The  average PA                                                               
has  over  3000 hours  of  direct  patient contact  during  their                                                               
training. She  described the continuing education  and exams that                                                               
PAs  complete  to maintain  certification.  She  opined that  the                                                               
amendment is onerous  and unnecessary. However, in  the spirit of                                                               
collaboration she proposed a conceptual amendment.                                                                              
                                                                                                                                
4:41:35 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
4:41:35 PM                                                                                                                    
SENATOR TOBIN moved Conceptual Amendment 1 to Amendment 1:                                                                      
                                                                                                                              
             CONCEPTUAL AMENDMENT 1 TO AMENDMENT 1                                                                          
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE                     BY SENATOR TOBIN                                                                 
          TO:  SB 115                                                                                                           
                                                                                                                                
                                                                                                                                
     Page 1, line 3:                                                                                                            
          Delete "2,000"                                                                                                        
          Insert "4,000"                                                                                                        
                                                                                                                                
4:41:48 PM                                                                                                                    
CHAIR WILSON asked if there was objection.                                                                                      
                                                                                                                                
4:41:50 PM                                                                                                                    
SENATOR DUNBAR objected for purposes of discussion.                                                                             
                                                                                                                                
4:41:53 PM                                                                                                                    
SENATOR DUNBAR  stated his belief  that most  PAs do not  want to                                                               
practice without  a collaborative physician, especially  early in                                                               
their practice. He opined that  most PAs who would take advantage                                                               
of SB  115 already  meet the  required hours.  He stated  that he                                                               
might  put  forth a  future  amendment  regarding specificity  of                                                               
hours in another committee of referral.                                                                                         
                                                                                                                                
4:43:27 PM                                                                                                                    
SENATOR DUNBAR  removed his objection  to Conceptual  Amendment 1                                                               
to Amendment 1.                                                                                                                 
                                                                                                                                
4:43:32 PM                                                                                                                    
CHAIR WILSON found no further  objection and Conceptual Amendment                                                               
1  to Amendment  1  was  adopted. Amendment  1  [as amended]  was                                                               
before the committee. He asked if there was further discussion.                                                                 
                                                                                                                                
4:43:54 PM                                                                                                                    
SENATOR GIESSEL objected  to Amendment 1 [as  amended] and stated                                                               
that  the  discussion  is  arbitrary.  PAs  are  highly  educated                                                               
healthcare professionals.  She opined  that it is  a bureaucratic                                                               
assertion   to  arbitrarily   choose   a   number  to   establish                                                               
competency. She stated  that the national exam  is difficult, and                                                               
PAs must pass it every 10  years. The letters of concern that the                                                               
committee  received were  not constituents  injured by  PAs. They                                                               
were from a special interest  group. She challenged the committee                                                               
of non-health care  professionals to explain how  the extra hours                                                               
were determined.                                                                                                                
                                                                                                                                
4:46:34 PM                                                                                                                    
SENATOR DUNBAR  rhetorically replied that the  committee does not                                                               
drill for oil  and gas but sets oil and  gas policy. Other states                                                               
have set hours of up to  10,000 to ensure the public's safety. He                                                               
opined that 4,000 seemed like a reasonable compromise.                                                                          
                                                                                                                                
4:47:48 PM                                                                                                                    
SENATOR GIESSEL  stated that continuing education  is required of                                                               
PAs every two  years. PAs primarily work in  family practice. She                                                               
wondered if  hours would need  to be obtained working  in varying                                                               
clinical settings. She noted that  physicians are remunerated for                                                               
the  clinical care  that PAs  provide, and  PAs must  also pay  a                                                               
supervising  physician fee.  She  suggested SB  115 should  place                                                               
limits on the fees physicians can charge PAs.                                                                                   
                                                                                                                                
4:49:38 PM                                                                                                                    
CHAIR TOBIN thanked  Senator Giessel for her expertise  on PAs in                                                               
Alaska. She said she agrees  that the conversation denigrates the                                                               
education and  experience of PAs.  Rural areas in Alaska  rely on                                                               
PAs  for healthcare.  PAs  in  Alaska agreed  to  the 2000  hours                                                               
because  they understand  there  is opposition  from doctors  who                                                               
hold the  power position.  She wondered  whether doctors  want to                                                               
continue  agreements  with  PAs for  financial  and  professional                                                               
reasons. She acquiesced  to the increase in hours  because she is                                                               
committed to moving SB 115.                                                                                                     
                                                                                                                                
4:51:59 PM                                                                                                                    
CHAIR WILSON  asked for further  discussion and if  objection was                                                               
maintained.                                                                                                                     
                                                                                                                                
4:52:01 PM                                                                                                                    
SENATOR GIESSEL maintained her objection.                                                                                       
                                                                                                                                
4:52:03 PM                                                                                                                    
CHAIR  WILSON asked  for  a roll  call vote  on  Amendment 1,  as                                                               
amended.                                                                                                                        
                                                                                                                                
A roll call vote was  taken. Senators Kaufman, Dunbar, and Wilson                                                               
voted in favor  of Amendment 1, as amended,  and Senators Giessel                                                               
and Tobin voted against it. The vote was 3:2.                                                                                   
                                                                                                                                
4:52:50 PM                                                                                                                    
CHAIR WILSON announced that Amendment  1, as amended, was adopted                                                               
on a vote of 3:2.                                                                                                               
                                                                                                                                
4:53:01 PM                                                                                                                    
CHAIR WILSON  asked if  the committee  or sponsor  of SB  115 had                                                               
additional comments.                                                                                                            
                                                                                                                                
4:53:09 PM                                                                                                                    
CHAIR TOBIN thanked  the committee for hearing  SB 115. Physician                                                               
Assistants  (PAs) have  worked diligently  to find  common ground                                                               
with the  entity that oversees  their ability to provide  a much-                                                               
needed service to the State. SB  115 ensures PAs are afforded the                                                               
ability to work to the scope of their training.                                                                                 
                                                                                                                                
4:53:43 PM                                                                                                                    
CHAIR WILSON solicited the will of the committee.                                                                               
                                                                                                                                
4:53:46 PM                                                                                                                    
SENATOR KAUFMAN  moved to report  SB 115,  workorder 33-LS0542/B,                                                               
as amended,  from committee  with individual  recommendations and                                                               
attached fiscal notes.                                                                                                          
                                                                                                                                
4:53:57 PM                                                                                                                    
CHAIR WILSON  found no further  objection and CSSB 115  (HSS) was                                                               
reported  from the  Senate Health  and  Social Services  Standing                                                               
Committee.