03/14/2002 01:35 PM Senate L&C

         SB 265-PHYSICIAN ASSISTANTS/NURSE PRACTITIONERS                                                                    
                                                                                                                                
CHAIRMAN STEVENS announced SB 265 to be up for consideration.                                                                   
                                                                                                                                
SENATOR  DONALD   OLSON,  sponsor  of   SB  265,  said   it  names                                                              
physicians'  assistants  as  bonafide health  care  providers.  He                                                              
said:                                                                                                                           
                                                                                                                                
     As a  physician, I have  used physician assistants  many                                                                   
     times, especially those that  are experienced - are very                                                                   
     good  resources to  be depending  on  especially out  in                                                                   
     rural Alaska  where many of them are by  themselves. The                                                                   
     reason I presented  this is because I feel  in order for                                                                   
     them to be recognized by the  health insurance industry,                                                                   
     the health  maintenance organizations  and other  health                                                                   
     care delivery entities out there  - that they need to be                                                                   
     equivalent to other providers  there so they can be paid                                                                   
     and  continue on unencumbered  by other  aspects of  the                                                                   
     health  care  delivery  system.   That  is  why  I  have                                                                   
     submitted this bill.                                                                                                       
                                                                                                                                
     Section  1  amends  AS 09.55.560(1)  to  add  "physician                                                                   
     assistant"  to  the  definitional   clause  for  medical                                                                   
     liability  statutes.  Section   2  similarly  amends  AS                                                                   
     21.36.090(d)  to  include  "physician  assistant"  as  a                                                                   
     provider that may not be unfairly  discriminated against                                                                   
     by  a  health  insurance  company,   health  maintenance                                                                   
     organization  or  other  health  delivery  organization.                                                                   
     Section 3  responds to a  third request of  the academy.                                                                   
     It is to allow physician assistants  to provide proof of                                                                   
     eligibility  for a  special,  disabled veterans  license                                                                   
     plate  and  for  issuance  of a  parking  permit  for  a                                                                   
     handicapped   or   disabled   person.   Eligibility   is                                                                   
     currently  provided  by  only  physicians  and  advanced                                                                   
     nurse practitioners.                                                                                                       
                                                                                                                                
MR. ED HALL,  Physician Assistant representing the  Alaska Academy                                                              
of Physician  Assistants,  supported Senator  Olson's comments  on                                                              
the resolution. He  said the question was raised  whether this was                                                              
an  attempt by  physician assistants  to  become independent  from                                                              
physicians and said:                                                                                                            
                                                                                                                                
     I wanted to assure the committee  that that's absolutely                                                                   
     and in  no way accurate.  All this  is is a request  for                                                                   
     recognition as  a licensed provider  in the state  to be                                                                   
     included  in the  statute…. We  don't feel  as if  we've                                                                   
     been excluded  for anything vindictive or  anything, but                                                                   
     I think these  statutes were actually written  years ago                                                                   
     before   physician   assistants  were   a   recognizable                                                                   
     treating provider  within the state. So I  think this is                                                                   
     more of a  housecleaning type of thing and  bringing the                                                                   
     current statutes up to date…                                                                                               
                                                                                                                                
MS. SUSAN  MASON-BONTUSE, Executive  Director, Sunshine  Community                                                              
Health Center, supported SB 265.  They are a mid-level clinic with                                                              
four  physician  assistants  providing  primary care  in  a  rural                                                              
setting. They are  working under a collaborative  agreement with a                                                              
doctor in Wasilla.                                                                                                              
                                                                                                                                
     These  providers  are critical  to the  on-going  health                                                                   
     care of  residents in the  communities that we  serve as                                                                   
     well  as  to  the on-going  functioning  of  our  health                                                                   
     center.  Because  our current  statutes  do not  include                                                                   
     physician  assistants  in  the listing  of  health  care                                                                   
     providers, we periodically have  our billing for medical                                                                   
     services  by these  medical  providers  denied by  third                                                                   
     party  payers…This can represent  a significant  barrier                                                                   
     to  health  care.  This  can  represent  a  barrier  for                                                                   
     individuals with health insurance  as well as to clinics                                                                   
     in  terms  of  being  able  to  maximize  our  potential                                                                   
     remedies - particularly for  small rural health clinics…                                                                   
                                                                                                                                
MR.  JOHN  RILEY,  Chairman,  Alaska   Primary  Care  Association,                                                              
supported SB 265. They exist to provide  support to clinicians who                                                              
serve patients regardless of their ability to pay.                                                                              
                                                                                                                                
     P.A.s  provide  a  significant   share  of  health  care                                                                   
     services in small communities  in rural Alaska and there                                                                   
     are several  rural clinics that are staffed  exclusively                                                                   
     by  P.A.s.   There  are   many  examples  of   insurance                                                                   
     companies  who   are  refusing  to  reimburse   services                                                                   
     provided  by the  P.A.s  because of  not  being on  this                                                                   
     list.  This  may  require  insured  patients  to  travel                                                                   
     outside their communities to  obtain needed health care.                                                                   
     So  ironically  this creates  a  barrier to  access  for                                                                   
     insured patients. We urge the  committee to approve this                                                                   
     legislation and remedy this oversight…                                                                                     
                                                                                                                                
MS. ELIZABETH RIPLEY, Director, Community  Health Planning, Valley                                                              
Hospital, fully  supported SB 265  and explained that  P.A.s staff                                                              
local physician  offices in  Wasilla and  Palmer. They  also staff                                                              
rural  clinics such  as Sunshine  Community Health  Center in  the                                                              
Upper Susitna Valley.                                                                                                           
                                                                                                                                
     Especially in  our rural areas, these P.A.s  work out of                                                                   
     sense of  mission and they  provide services  where most                                                                   
     doctors  would not choose  to set up  a practice  due to                                                                   
     [indisc] and  volume of patients. So, the  mid-levels in                                                                   
     terms  of the P.A.s  are a  critical piece  of our  mid-                                                                   
     level providers.  This is especially important  in light                                                                   
     of the health care workforce shortage.                                                                                     
                                                                                                                                
SENATOR  LEMAN moved  to pass  CSSB 265(TRA)  from committee  with                                                              
individual recommendations.  There were  no objections and  it was                                                              
so ordered.