02/23/2012 01:30 PM Senate LABOR & COMMERCE

                 SB 175-PRACTICE OF NATUROPATHY                                                                             
                                                                                                                                
1:34:24 PM                                                                                                                    
CHAIR EGAN announced  consideration of SB 175 and  said that some                                                               
committee  members had  questions.  [CSSB 175(L&C),  27-LS1230\B,                                                               
was before the committee.]                                                                                                      
                                                                                                                                
DON  HABEGAR, Director,  Division of  Corporations, Business  and                                                               
Professional Licensing, in the  Department of Commerce, Community                                                               
and Economic Development (DCCED), introduced himself.                                                                           
                                                                                                                                
SENATOR  PASKVAN asked  Mr. Habegar  to  review the  department's                                                               
position on the recent restrictions  put upon naturopaths that no                                                               
one  could identify  the origin  of and  explain why  nothing had                                                               
been done.                                                                                                                      
                                                                                                                                
MR. HABEGAR replied  that he had done a lot  of digging in trying                                                               
find the  mileposts on this  issue and found that  the department                                                               
has  had   a  consistent  interpretation  of   the  statutes  and                                                               
regulations  about  it:  one  was  that  naturopaths  don't  have                                                               
prescriptive authority.                                                                                                         
                                                                                                                                
He found several  complaints over the last 18  years during which                                                               
naturopaths  have  been  practicing.   The  first  was  dismissed                                                               
because of lack of evidence. The  second one brought the issue to                                                               
the  forefront  and  ended  up  with  a  consent  agreement.  The                                                               
division has maintained that  naturopaths don't have prescriptive                                                               
authority, and that was the issue  in this particular case. As it                                                               
unfolded,  pharmacies started  asking the  department about  what                                                               
prescriptive  authority means  and  said  they weren't  supplying                                                               
legend drugs to  naturopaths. That is what led  to the discussion                                                               
before them today and the question  of what the division is going                                                               
to do.                                                                                                                          
                                                                                                                                
If legislation  is not passed  to correct the situation,  he said                                                               
the  division is  in a  position to  go out  with regulations  to                                                               
clear up  what is  confusing language  to all.  Those regulations                                                               
won't  go out  until after  going through  the process.  How they                                                               
proceed past that is yet undetermined.                                                                                          
                                                                                                                                
SENATOR   PASKVAN  asked   him  to   precisely  state,   assuming                                                               
legislation didn't pass, whether  the regulations will be drafted                                                               
allowing the practice that has existed  over the last 18 years or                                                               
not.                                                                                                                            
                                                                                                                                
MR.  HABEGAR replied  that because  the division  has interpreted                                                               
statute to mean  that no prescriptive authority  has been granted                                                               
by the legislature,  regulations will be developed  to comport to                                                               
that.                                                                                                                           
                                                                                                                                
SENATOR  PASKVAN said  he understood  that anecdotal  issues have                                                               
arisen -  one a consent decree  and the other dismissed  - but it                                                               
begs the  issue that directors have  let a practice exist  for 18                                                               
years without doing anything. He was  troubled about why all of a                                                               
sudden  they decided  to do  a 180  degree turn  in terms  of its                                                               
application, whatever the interpretation is.                                                                                    
                                                                                                                                
1:40:24 PM                                                                                                                    
MR.  HABEGAR said  he recognized  that there  have been  numerous                                                               
interpretations  and that  some  pharmacists  have prescribed  in                                                               
response  to written  prescriptions,  and if  legislation is  not                                                               
passed,  they  would give  the  issue  careful consideration.  He                                                               
believes it is  important for regulations to  support statute and                                                               
not confuse licensees.                                                                                                          
                                                                                                                                
SENATOR  PASKVAN  asked if  he  is  supporting the  legislation's                                                               
passage to remove any uncertainty about interpretation.                                                                         
                                                                                                                                
MR.  HABEGAR replied  yes, but  SB  175 needs  more clarity.  For                                                               
instance, hydro-therapy means  the use of water in  all forms. Is                                                               
that the  physical state of water  that is deemed a  liquid or is                                                               
it  hydrotherapy with  all its  various  components, i.e.  saline                                                               
solution? And  clarifying this language  would help  the division                                                               
immensely.                                                                                                                      
                                                                                                                                
1:43:07 PM                                                                                                                    
CHAIR EGAN said  this is the fourth meeting on  this bill and the                                                               
department should have offered an  amendment a couple of meetings                                                               
ago  if  it had  issues.  Testimony  the committee  has  received                                                               
indicates that this legislation clarifies  what has been done for                                                               
18 years; it isn't changing anything.                                                                                           
                                                                                                                                
MR. HABEGAR  responded that he had  a fiscal note and  part of it                                                               
was  about getting  a group  of professionals  together and  help                                                               
them to hammer  out the details. The mix  of professionals wasn't                                                               
specified, but  certainly MDs should  be part of the  process and                                                               
someone from the Board of Pharmacy.                                                                                             
                                                                                                                                
SENATOR DAVIS  asked if  he truly understands  what SB  175 does.                                                               
For  18   years  naturopaths  had  the   authority  to  prescribe                                                               
medicines from pharmacies and all  of a sudden something happened                                                               
to take that  authority away and the director just  told them the                                                               
division plans to  write regulations in support of  that. So this                                                               
legislation won't do anything.                                                                                                  
                                                                                                                                
MR.  HABEGAR responded  that he  thinks SB  175 takes  regulation                                                               
that was  supporting their interpretation  of statute,  which was                                                               
no prescriptive authority, and  adds that prescriptive authority.                                                               
There is  room for clarification  through the  regulatory process                                                               
and he would do that with the help of experts.                                                                                  
                                                                                                                                
1:46:13 PM                                                                                                                    
SENATOR MENARD joined the committee.                                                                                            
                                                                                                                                
SENATOR DAVIS  asked if he  had shared  his idea of  clarity with                                                               
anyone, because  they had been  working on  this bill for  a long                                                               
time;  he had  even  testified on  it. Now  today  when they  are                                                               
getting  ready   to  move  it,   he  is  saying  it   needs  more                                                               
clarification and doesn't have anything to suggest.                                                                             
                                                                                                                                
MR.  HABEGAR  apologized  for  being  remiss  in  addressing  the                                                               
committee's concerns, but it is an ongoing process.                                                                             
                                                                                                                                
1:47:28 PM                                                                                                                    
SENATOR  GIESSEL  said  her  concern   and  the  concern  of  her                                                               
colleagues is  that a professional license  with its accompanying                                                               
scope of  practice is  a property  right and  it sounds  like the                                                               
division  has plans  to arbitrarily  change it.  Even if  they do                                                               
pass this bill some tweaking will be done to it.                                                                                
                                                                                                                                
Another of her  concerns was the $127,000 fiscal  note for travel                                                               
expenses  for   two  naturopath  prescription  drug   task  force                                                               
meetings that she  didn't think would be  needed. Another concern                                                               
she had was  the task force consists of  naturopaths, the medical                                                               
board, the  pharmacy board and  the division personnel,  but this                                                               
scope of practice applies to  naturopaths only, not the other two                                                               
professions.  She was  also concerned  about  the $36,000  fiscal                                                               
note  each  month for  filling  100  Medicaid prescriptions.  She                                                               
didn't think this bill needed a fiscal note.                                                                                    
                                                                                                                                
MR.  HABEGAR  replied  that  the   fiscal  note  isn't  from  his                                                               
department;  it came  from HSS.  The $16,000  fiscal note  was in                                                               
response to the  original bill, and if it needs  to be changed as                                                               
results of changes to the bill he would withdraw it.                                                                            
                                                                                                                                
CHAIR EGAN  thanked him  and announced other  people on  line who                                                               
could also answer fiscal note questions.                                                                                        
                                                                                                                                
1:50:43 PM                                                                                                                    
DR. WARD  HURLBURT, Director  of the  Division of  Public Health,                                                               
and  Chief  Medical Officer  for  the  Department of  Health  and                                                               
Social  Services (DHSS),  Anchorage, Alaska,  said he  understood                                                               
that clarification  was needed and  the language in  this version                                                               
of SB  175 would  expand the naturopathic  scope of  practice and                                                               
the fiscal note  was based on the cost  associated with expanding                                                               
that  prescriptive practice.  For instance,  the manufacturer  of                                                               
capsicum, a tincture of cayenne  pepper that is used medicinally,                                                               
made it a  prescription item. In allopathic medicine,  if you ask                                                               
someone to take ibuprofen or  Advil, the over-the-counter form is                                                               
200 milligrams and very few  insurance policies would cover that.                                                               
Whereas a physician  could prescribe an 800  milligram tablet and                                                               
it would likely be covered.                                                                                                     
                                                                                                                                
The bill's language notes that  the prescriptive authority is for                                                               
drugs that  are derived  from natural  substances and  his recent                                                               
research  and   experience  indicated   that  25-50   percent  of                                                               
pharmaceutical agents  requiring a prescription are  derived from                                                               
natural substances.  That is the  reason for the concern  that it                                                               
would expand  the scope and  therefore expand the cost  of health                                                               
care for items that are not now covered by insurance.                                                                           
                                                                                                                                
1:53:14 PM                                                                                                                    
SENATOR GIESSEL asked what the  prescriptive cost to Medicaid has                                                               
been under existing regulations for the last 18 years.                                                                          
                                                                                                                                
DR. HURLBURT said he didn't  have that information, but would get                                                               
it.                                                                                                                             
                                                                                                                                
SENATOR GIESSEL said she was  not interested in speculating about                                                               
expansion, but  was only asking  about practices for the  past 18                                                               
years.                                                                                                                          
                                                                                                                                
1:54:10 PM                                                                                                                    
SENATOR PASKVAN asked  if he ever protested  what the naturopaths                                                               
were doing in the last 18  years - even one time, because someone                                                               
is protesting now, and he was wondering what it was about.                                                                      
                                                                                                                                
DR. HURLBURT  said he had  been in  his current position  for 2.5                                                               
years and during that time  he hadn't protested what naturopathic                                                               
doctors had been doing.                                                                                                         
                                                                                                                                
1:55:08 PM                                                                                                                    
CHAIR  EGAN  asked  Dr.  Hurlburt  if  any  other  chief  medical                                                               
officers  had protested  naturopathic  practices in  the last  18                                                               
years.                                                                                                                          
                                                                                                                                
DR. HURLBURT replied that he didn't know but would find out.                                                                    
                                                                                                                                
1:55:46 PM                                                                                                                    
JON  SHERWOOD, Medicaid  Special  Projects,  Medicaid and  Health                                                               
Care  Policy, Department  of Health  and Social  Services (DHSS),                                                               
said  Medicaid has  two  fiscal  notes and  that  this issue  has                                                               
stayed  beneath their  radar. He  understood that  naturopaths do                                                               
not have prescriptive authority and  they are not included in the                                                               
Medicaid program,  and since he  doesn't pay them, they  have not                                                               
had to enroll in the  Medicaid program. Changes to Medicaid under                                                               
the  Affordable  Care  Act  require   that  any  prescriber  that                                                               
Medicaid  is paying  for a  prescription needs  to enroll  in the                                                               
program so  that their  provider number can  be captured.  A one-                                                               
time cost  for creating a way  for them to enroll  in the program                                                               
and  $36,000  a   year  for  100  prescriptions   per  month  was                                                               
estimated. But he  emphasized that was only an  estimate and that                                                               
a wide variety of medicines are  prescribed, and it would help to                                                               
have a  clearer understanding  of what  substances they  would be                                                               
talking about.                                                                                                                  
                                                                                                                                
SENATOR DAVIS asked him to explain the two fiscal notes.                                                                        
                                                                                                                                
MR.   SHERWOOD    explained   that   the    Medicaid   Assistance                                                               
Administration has a  one-time cost of $75,000,  $18,800 of which                                                               
would come from general funds; the  other one is $36,000 per year                                                               
for  health  care  Medicaid  services  and  that  is  50  percent                                                               
federal, 50 percent state general  funds. The $16,000 fiscal note                                                               
is  from  the  Department  of Commerce,  Community  and  Economic                                                               
Development (DCCED).                                                                                                            
                                                                                                                                
2:00:02 PM                                                                                                                    
SENATOR  GIESSEL asked  Dr. Jasper  if naturopaths  have national                                                               
provider identifier (NPI) numbers.                                                                                              
                                                                                                                                
DR. JASPER answered yes.                                                                                                        
                                                                                                                                
SENATOR  GIESSEL  asked  if  they  are  reimbursed  by  insurance                                                               
companies.                                                                                                                      
                                                                                                                                
DR.  JASPER  answered  yes;  Alaska  statute  provides  for  that                                                               
coverage in its group health policies.                                                                                          
                                                                                                                                
SENATOR GIESSEL asked if any  Alaska naturopaths have enrolled in                                                               
Medicaid or are Medicare providers.                                                                                             
                                                                                                                                
DR. JASPER replied  that naturopaths are not  eligible to enroll.                                                               
Eligibility for Medicare  is determined by federal  laws, and the                                                               
eligibility for Medicaid is determined  by state law; neither has                                                               
authorized  naturopathic doctors  to participate  in Medicare  or                                                               
Medicaid.                                                                                                                       
                                                                                                                                
2:01:29 PM                                                                                                                    
DR. JASPER  also added  that hydrotherapy  is the  application of                                                               
hot and cold water packs to  the body and shouldn't result in any                                                               
prescription expenses;  it's not  IV water or  saline injections.                                                               
Maybe it would help Mr. Habegar to have that clarified.                                                                         
                                                                                                                                
2:02:32 PM                                                                                                                    
SENATOR PASKVAN  moved to report  CSSB 175(L&C), version  B, from                                                               
committee  with individual  recommendations  and attached  fiscal                                                               
note(s)  although he  hoped  the fiscal  note  would be  removed.                                                               
There were no objections, and it was so ordered.                                                                                
                 SB 175-PRACTICE OF NATUROPATHY                                                                             
                                                                                                                                
2:30:35 PM                                                                                                                    
CHAIR EGAN  reconvened the meeting  and returned attention  to SB
.                                                                                                                            
                                                                                                                                
SENATOR PASKVAN moved to rescind  the committee's previous action                                                               
to report  SB 175  out of  committee and  restated the  motion as                                                               
follows: to report CSSB 175(L&C),  version \B from committee with                                                               
a  restated  Labor   and  Commerce  fiscal  note   of  zero  with                                                               
individual recommendations.  There were no objections  and it was                                                               
so ordered.