Legislature(2001 - 2002)
02/21/2002 03:04 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 411-PHYSICIAN ASSISTANTS Number 0186 CHAIR DYSON announced that the first order of business would be HOUSE BILL NO. 411, "An Act relating to physician assistants; providing that a physician assistant is a health care provider covered by certain laws relating to medical malpractice actions; adding physician assistants to the list of providers against whom unfair discrimination relating to health care insurance is prohibited and to the list of providers who can provide proof of disablement or handicap for the purpose of motor vehicle registration or for the purpose of obtaining a special license plate or a special parking permit; and providing for an effective date." Number 0190 REPRESENTATIVE HUGH FATE, Alaska State Legislature, presented HB 411 as its sponsor. He indicated HB 411 was introduced upon request of the [Alaska Academy of Physician Assistants]. The bill provides equity to the physician assistants (PAs); he stated that when the list of medical health providers was established in statute, PAs were not listed. He attributed this omission to the small numbers of PAs in practice when this list was established; he noted the growing numbers of PAs as health providers in the state. REPRESENTATIVE FATE offered that HB 411 seeks to accomplish three things. First, it places PAs on the list of health care providers in statute. Second, it gives PAs equal footing under insurance programs for both payment and liability purposes. Third, HB 411 allows PAs to authorize license plates for disabled veterans or handicapped persons. Presently, physicians and nurses can authorize these plates, but PAs cannot, he explained. In both urban and rural Alaska, PAs fill an important role for disabled veterans and disabled persons. REPRESENTATIVE FATE noted that the [Division of Insurance, Department of Community & Economic Development] is neutral on HB 411. He offered that the Division of Insurance had made a point about which office the [insurance] payment is sent to. He indicated he'd responded to the Division of Insurance that the receipt location is determined by either the office under which the PA works or by regulation of the Division of Insurance. He also indicated Division of Insurance personnel would concur with this statement. Number 0380 CHAIR DYSON offered his understanding that PAs work under the supervision of a medical doctor (MD). REPRESENTATIVE FATE explained that this supervision by a physician need not be direct; this physician needs to be licensed in Alaska. In response to a further question from Chair Dyson, he indicated that under certain circumstances, insurance payments could go directly [to the supervising physician's office]; this is determined by the office and the insurance company, or by Division of Insurance regulations. CHAIR DYSON drew attention to a proposed amendment to HB 411 that defines "unfair discrimination" in existing law. [The amendment had been provided by Jerry Reinwand, Lobbyist for Blue Cross Blue Shield of Alaska.] The amendment read [original punctuation provided]: Page 2, Line 12, replace current language with the following: *Sec. 2. AS 21.36.090(d) is amended to read: "(d) Except to the extent necessary to comply with AS 21.42.365 and AS 21.56, a person may not practice or permit unfair discrimination against a person who provides a service covered under a group health insurance policy that extends coverage on an expense incurred basis, or under a group service or indemnity type contract issued by a nonprofit corporation, if the service is within the scope of the provider's occupational license. In this subsection, (1) "provider" means a state licensed physician, physician assistant, dentist, osteopath, optometrist, chiropractor, nurse midwife, advanced nurse practitioner, naturopath, physical therapist, psychologist, psychological associate, or licensed clinical social worker, or direct-entry midwife. (2) "unfair discrimination" does not include requirements imposed by a health insurer for purposes of utilization review, cost containment and medically recognized standards of clinically appropriate health care services." REPRESENTATIVE FATE declared that he hadn't read the amendment. He said he didn't object to cleaning up language in legislation by using a "rider" attached to HB 411. He pointed out that an opportunity for a committee substitute will exist in the House Labor and Commerce Standing Committee hearing on the bill, and he said he'd like time to review the proposed amendment. He offered that his first impression of the amendment was that he didn't anticipate objecting to it. CHAIR DYSON indicated his wish to receive input from Department of Law personnel. Number 0559 ED HALL, Physician Assistant, Alaska Academy of Physician Assistants, testified via teleconference. He stated that his goal in testifying was threefold. First, he wanted to elaborate on the academy's resolution[s], but he said Representative Fate had sufficiently spoken to the issues. Second, he wanted to respond to members' questions. And third, he offered assurance that it isn't the goal of the Alaska Academy of Physician Assistants to seek independence [from physicians]. MR. HALL noted that by definition, PAs are required to work with a collaborative physician. The State of Alaska upholds laws pertaining to this. This physician is usually responsible for billing issues when the PA and supervising MD work in the same office, he offered. If a PA establishes a clinic under the direction of a collaborating MD, however, billing becomes the responsibility of the PA. That may give the appearance that PAs are independent, Mr. Hall noted, but this is not the case. MR. HALL referred to Section 1 of the bill and said: This was brought to our attention a couple of years ago by an attorney who indicated that they had had problems in the past whenever they were involved with any litigation with a physician assistant. ... An arbitration board can appoint an expert advisory panel, ... [which] usually consists of ... the [providers] that are defined in this section. Number 0803 MR. HALL pointed out that the list of health care providers in AS 09.55.560 doesn't include PAs; therefore, they don't have the ability to serve on the advisory panel or be assessed by their peers. He referenced the second resolution, titled "Resolution to Amend AS 21.36.090(d) to Protect Physician Assistants From Unfair Discrimination." He offered that a clinic in Healy has several examples of cases for which it was not reimbursed by an insurance company. While this doesn't happen frequently, one instance of nonpayment because a PA is not a recognized provider in the state is too often, he offered. MR. HALL noted that the third resolution pertains to the [Division] of Motor Vehicles; because PAs are not specified in statute, patients have been denied temporary or permanent disability parking permits due to the signature of a PA on the application. He offered his opinion that these state laws were not created to exclude PAs; rather, the laws were written before PAs were numerous in the state. Noting that he had a copy of the aforementioned amendment, he said, "Because it's going to probably change the language in the law, ... it may very well be that this ... would not pass. And I would hate for that to hinder what seems ... to be a straightforward parity." He noted his preference for the amendment to be part of a separate bill. Number 0898 CHAIR DYSON inquired how PAs practicing in a remote location know when they are getting beyond the procedures they are authorized by law to perform. He asked, "Do you have a spelled- out protocol for what you can do and what you can't?" MR. HALL replied that PAs are trained to recognize their limitations. In the collaborative agreement between the physician and the PA, the law allows PAs to do whatever the supervising physician feels comfortable with, based on the skills the PA has developed. For example, a family-practitioner PA is not typically skilled in surgery; PAs are trained in surgical procedures, but most do not practice these skills frequently enough. Whereas minor procedures can be done in an office, general surgery cannot be performed unless the PA has been trained by a general surgeon up to a level of competence to which the PA would be authorized. This is not to say that a PA is performing surgeries in rural areas, Mr. Hall added; most PAs in rural areas are in a family-practice setting. Number 0999 CHAIR DYSON queried, if a medical emergency occurs and a PA is the only medical practitioner in town, whether a PA can give the situation his/her best effort. MR. HALL answered, "Absolutely." Physician assistants go through extensive training programs, so they are prepared to handle acute emergencies. Like physicians, PAs practice with the intent to do no harm. Number 1054 MARY MARSHBURN, Director, Division of Motor Vehicles (DMV), Department of Administration, testified via teleconference. She pointed out that Section 3 affects the division; it will allow PAs to sign the certificates of disability. She concluded that this is a good addition. Number 1080 SUSAN MASON-BOUTERSE, Executive Director, Sunshine Clinic, testified via teleconference. She explained that Sunshine Clinic is a midlevel clinic with four PAs who provide primary care. These PAs work under a collaborative agreement with a physician in Wasilla. She said: These providers are critical to the ongoing health care of residents in the community we serve, as well as to the ongoing functioning of this health center. Because our current state statutes ... do not include [physician] assistants in the listing of health care providers, we periodically have our billing for medical services denied by third-party payers .... MS. MASON-BOUTERSE stated that anytime this happens to rural clinics that are struggling to maximize revenues, it becomes a problem. She added that it also becomes a significant barrier to health care for individuals with health insurance; they have to drive somewhere else to receive health care. Small, rural health clinics need to be able to explore every potential revenue source to support clinic operations. She urged members to support HB 411. Number 1177 JESSICA STEVENS, Medical Director, Physician Assistant, Sunshine Clinic, testified via teleconference. She emphasized her support for HB 411. She pointed out that this is a huge issue for rural communities that struggle to provide comprehensive health care. Often PAs are providing this care instead of physicians; the compensation and living situations are often not conducive to physicians moving into rural Alaska. MS. STEVENS mentioned the importance of having health care in rural areas in emergencies. She offered her belief that the exclusion of PAs was not deliberate, but an oversight that does great damage to the PA-patient relationship in the community. She noted that the many disabled veterans in her area have full faith in PAs' ability to provide health care; they expect that PAs will be able to sign disabled parking permits. Sometimes these patients have to drive two hours to repeat an exam to get someone to sign the forms. She added that insurance companies have, relatively frequently, denied [payment for services provided by PAs]. She urged members to pass HB 411. Number 1297 [Chair Dyson asked Jerry Reinwand, Lobbyist for Blue Cross Blue Shield of Alaska, if he was comfortable dealing with the amendment in the House Labor and Commerce Standing Committee; he received confirmation from Mr. Reinwand that he was amenable to this proposal.] REPRESENTATIVE WILSON commented that having worked in a small, rural clinic, she has experienced the difficulties encountered in recruiting and retaining a physician. Advanced nurse practitioners and PAs worked in this clinic; without these practitioners, people would have been required to drive 250 miles to Fairbanks for health care. She emphasized the importance of [mid-level care providers] in rural areas. She added that she is a registered nurse (RN); if RNs can sign the handicapped parking permits, then surely PAs should be able to. REPRESENTATIVE WILSON moved to report HB 411 out of committee with individual recommendations and the accompanying zero fiscal note. There being no objection, HB 411 was reported out of the House Health, Education and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|