Legislature(2013 - 2014)BARNES 124
04/02/2014 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Adjourn | |
| Start | |
| HB309 | |
| HB152 | |
| HB160 |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 309 | TELECONFERENCED | |
| += | HB 152 | TELECONFERENCED | |
| *+ | HB 160 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 160-LICENSING OF ATHLETIC TRAINERS
4:04:59 PM
CHAIR OLSON announced that the final order of business would be
HOUSE BILL NO. 160, "An Act relating to the licensing and
regulation of athletic trainers."
4:05:04 PM
REPRESENTATIVE STEVE THOMPSON, Alaska State Legislature,
speaking as sponsor, stated that HB 160 would amend current
statutes to establish licensing and regulation of athletic
trainers in Alaska. He explained that athletic trainers are
health care professionals who collaborate with physicians to
ensure the practice of sports medicine clients. He said that
this profession plays a significant role in the management,
prevention, recognition, and rehabilitation of injured athletes
under the supervision of a licensed physician. Trainers are a
vital resource in administrating injury prevention and treatment
programs as well as immediate emergency care for the support in
the athletic community. He reported that Alaska is one of two
states without licensure of athletic trainers. He related that
HB 160 will require athletic trainers to have a license to
practice in the state and will hold them accountable to the
rigorous standards of the Board of Certification, Inc. (BOC),
which is a national agency created to certify health care
professionals and assure protection of the public. As Alaskans
become increasingly active, the need for properly trained and
licensed athletic trainers becomes imperative.
4:06:40 PM
BRODIE ANDERSON, Staff, Representative Steve Thompson, Alaska
State Legislature, provided a section-by-section analysis of HB
160. He stated that Section 1 would add a new paragraph to
license athletic trainers. Section 2 would add a new chapter,
chapter 7, for athletic trainers, AS 08.07.010, outlining the
licensing requirements and exemptions.
MR. ANDERSON referred to a new section, AS 08.07.020, that
identifies the qualifications, fees, and renewal process for
athletic trainers. He said that AS 08.07.030 adds a new section
that identifies the scope of practice for athletic trainers. He
identified that AS 08.07.040 outlines the regulations for
athletic trainers that the department will need to adopt. He
stated that AS 08.07.049 provides definitions and AS 09.65.300
inserts athletic trainers to the list of health care providers.
MR. ANDERSON explained the final two sections, Sec. 4 and 5,
amends AS 47.17.290 (13) adds an athletic trainer to
"practitioner of the healing arts" and adds a new section of
uncodified law outlining the applicability of the bill.
4:08:41 PM
REPRESENTATIVE HERRON asked for the catalyst for introducing the
bill.
REPRESENTATIVE THOMPSON answered that some athletic trainers
asked him to assist them in obtaining certification and
licensure since 48 states currently offer it.
4:09:14 PM
REPRESENTATIVE HERRON asked whether any recent incidents
highlight the need for the bill due to lack of skills.
REPRESENTATIVE THOMPSON said that he is aware of some but did
not have sufficient information to discuss.
MR. ANDERSON anticipated testimony by Lynn Young, Treasurer for
the Alaska Athletic Trainers Association (AATA). He said the
Association came forward since Alaska is one of the few states
that don't regulate athletic trainers. Concerns have previously
been expressed that people might take a couple of online courses
and then hold themselves out as athletic trainers.
CHAIR OLSON answered that this concept has been a work in
progress for several years. He commended the current version as
being "the cleanest" version to date.
MR. ANDERSON explained the fiscal note dated 3/28/14. He
reported that in FY 15 $48.1, and for each consecutive year for
FY 16-20 at $5.0 thousand to establish the licensing program.
4:11:40 PM
REPRESENTATIVE CHENAULT asked whether adding athletic trainer
costs associated with injuries will be passed on to insurance
companies.
MR. ANDERSON answered that he didn't know, but he offered to
check and report back to the committee.
4:12:38 PM
LYNN YOUNG, Secretary/Treasurer, Alaska Athletic Trainers
Association (ATTA), stated that she is also the chair for the
governmental affairs committee and is a certified athletic
trainer. She explained that athletic trainers are highly
trained multi-skilled professionals who are part of the allied
health care profession. She reported that athletic trainers
work, collaborate, and work under the direction of physicians.
She stated that services provided by athletic trainers are
prevention, emergency care, clinical assessment, therapeutic
intervention, and rehabilitation of injuries and medical
conditions. Individuals who wish to become athletic trainers
must earn a degree from an accredited athletic training
curriculum, and sit for the national board of certification
exam, and upon passage can call themselves a certified athletic
trainer. Athletic trainers must adhere to 50 hours biennial
continuing education approved by the national BOC, of which 10
hours must be part of an evidenced based curriculum.
Additionally, athletic trainers must obtain a current
certification in emergency cardiac care at a minimum of a
professional rescuer level or above. She reported that Alaska
is one of two states to not yet license athletic trainers. She
indicated that the trainers are proactive in asking for this.
She was not aware of any improper behavior; however, they do not
want to wait [until an issue occurs] and be reactive. In 2011,
athletic trainers also testified on HB 15, which relates to
concussions, and athletic trainers are one of the health care
providers who can assist with the prevention, recognition, and
proper care of concussions. Due to the severity and risk of
concussions, athletic trainers do not want anyone holding
themselves out to be an athletic trainer and putting school age
children at risk. She urged members to regulate athletic
trainers to ensure at a minimum that people calling themselves
athletic trainers have the basic education and qualifications.
4:16:06 PM
REPRESENTATIVE MILLETT asked which sports have the highest
incidence of concussions.
MS. YOUNG answered that football has the highest incidence, and
she added girls' soccer, boys' soccer, girls' basketball, and
boys' basketball; however, not enough data exists for ice hockey
since not every state has ice hockey programs. She surmised
that ice hockey probably would rank as high as football.
4:16:44 PM
REPRESENTATIVE MILLETT asked whether helmet design has improved,
if they are helpful, or if it is just the nature of sports.
MS. YOUNG answered that helmets are "marketed," as concussion-
proof; however, the anatomy of the brain is such that it sits in
fluid and nothing can prevent concussions. She noted that skull
fractures or structural problems can be minimized, but the brain
will slosh against the skull, which can cause concussions when
injured. She offered her belief that "concussion proof" helmets
help prevent skull fractures help but they will not eliminate
the risk of concussions.
4:17:36 PM
REPRESENTATIVE JOSEPHSON asked for examples of what an athletic
trainer does.
MS. YOUNG explained that the traditional setting for athletic
trainers is on the sidelines of sporting events. Some military
and other employers hire athletic trainers to minimize injuries.
She stated that athletic trainers provide education and provide
emergency health care and assess whether the treatment falls
within their scope of practice. Athletic trainers can provide
post-surgery therapeutic exercises and provide rehabilitation to
safely return them to their sports activities.
4:19:20 PM
REPRESENTATIVE JOSEPHSON asked why California does not currently
have regulation for licensed athletic trainers.
MS. YOUNG answered that California is a big state with
significant licensure of professions so the state is trying to
figure out the athletic trainer's role. She said that she has
held discussions with California's governmental affair's agency,
and their director indicated that it is in part due to the size
of the state, but also due to the politics involved.
4:20:02 PM
REPRESENTATIVE SADDLER asked her to discuss the national BOC and
the relationship to athletic trainers and if the BOC certifies
other professions.
MS. YOUNG answered that the BOC is the board for the national
Athletic Trainers' Association. It regulates and certifies
athletic trainers and ensures that competencies are met. The
BOC establishes the basic educational and clinical components
necessary to show competency in order for applicants to sit for
the exam. The BOC outlines the practice standards, code of
professional responsibility, ethics, and establishes continuing
education. Athletic trainers must maintain 50 hours of
continuing education biennially and the DOC assesses, documents,
and certifies the athletic trainers have met continuing
education.
4:21:26 PM
REPRESENTATIVE SADDLER asked how this bill will affect athletic
trainer's income or reimbursement rate.
MS. YOUNG answered it probably will not have much impact in
terms of insurance and fees, but HB 160 will improve youth
safety. She related that currently athletic trainers are
looking nationally at reimbursement, but she thought that will
take years to implement. Currently, athletic trainers are
employed by schools, orthopedic groups, or hospitals to help
ensure safety of their clients. She said some athletic trainers
work in the capacity of physician extenders so the athletic
trainer services would be billed similar to a medical assistant,
under the license of a physician.
4:22:40 PM
REPRESENTATIVE REINBOLD related her own experience when her son
played football. She said she bought an expensive concussion-
proof helmet, but her son suffered a concussion anyway. She
asked if there was a website parents can go to for information.
MS. YOUNG answered that some sites, such as the centers for
disease control and the national athletic trainers' websites
acknowledged that good helmets decrease the risk of skull
fractures, but they do not endorse statements that helmets will
prevent concussions. She acknowledged that unfortunately
marketing will make claims; however, she said it is likely that
she decreased a worst-case scenario, in which her son may have
avoided a skull fracture.
4:24:56 PM
SARA CHAMBERS, Director, Professional Licensing, Division of
Corporations, Business, and Professional Licensing, Department
of Commerce, Community, & Economic Development (DCCED), asked to
discuss the fiscal note and the basic process of licensing fees.
She said that the fiscal note estimates $180 for the first year,
followed by $100-$150 per year for an biennial license fee.
4:27:02 PM
REPRESENTATIVE SADDLER asked whether any economy of scale exists
to set up two boards at the same time.
MS. CHAMBERS answered that she would need to ponder it; however,
AS 08.01.065 dictates how the division sets licensing fees. She
explained that this statute requires each cost must be borne by
the licensees. She described it as a fairly rigorous process to
identify costs that directly support individual programs. She
suggested it is unlikely there would be substantial savings to
do so.
4:28:16 PM
REPRESENTATIVE SADDLER remarked that several new licensing
programs are likely headed her way.
MS. CHAMBERS answered that it is possible potential savings
could occur if multiple licensing programs share work. She
offered to check into it for the committee.
4:28:52 PM
CARY KELLER, Orthopedic Surgeon, stated that he has offices in
Fairbanks and Sitka. He said that he probably has more
experience than anyone in Alaska in terms of athletic trainers.
He related that he has cared for collegiate and high school
athletes and has worked closely with athletic trainers. He
currently is the chair of Alaska State Activities Association
Sports Medicine advisory committee and he has served nationally
on the National Federation of High Schools' sports medicine
advisory committee. He explained that the national federation
is the National Collegiate Athletic Association (NCAA) of high
school sports. He indicated that he is a former trustee and
fellow of the American College of Sports Medicine. He has also
served as the team physician for the University of Alaska
Fairbanks and for the schools in the Fairbanks North Star
Borough School District for 30 years. He offered his belief
that athletic trainers are incredibly important in the school
setting and also a tremendous help to persons outside the school
setting. It has become increasingly clear that the public
schools and university have responsibility to student athletes
to help prevent injuries, evaluate injuries when they occur, and
to care for those injuries - both the acute care and the
rehabilitation as Ms. Young described. He offered his belief
that it has been clear since the months following the state's
passage of concussion legislation that schools are poorly
prepared to take on the responsibility in the absence of
athletic trainers in the schools. Therefore, the AATA and the
schools have worked together to establish protocols for taking
care of and protecting concussed athletes.
4:31:53 PM
DR. KELLER offered his belief that the schools that do the best
job with concussions are ones with athletic trainers and other
schools have difficulty finding substitutes. He suggested the
best substitute is the school nurse. Concussions are just one
example since athletes obtain all kinds of injuries, and the
schools are poorly prepared to take care of all of the injuries.
He recalled that in the 1980s he performed a study in Alaska of
all injuries in two seasons in the FNSBSD. Once athletic
trainers were added another study was conducted over two years.
He concluded that with the presence of athletic trainers, a 70
percent reduction of injuries happened and the associated
medical costs decreased by 50 percent. He said the statistics
emphasize the value of the athletic trainers. He has worked
closely with ASAA, and its board passed a motion recommending
all schools have athletic trainers and they further recommended
that the University of Alaska develop a curriculum to train
athletic trainers to meet the needs of the state. He
complimented the sponsor and encouraged passage of HB 160.
4:34:33 PM
CHRISTOPHER DEAN, Certified Athletic Trainer; President, Alaska
Athletic Trainers Association (AATA), thanked members for the
opportunity to address the committee. He explained that
athletic trainers are allied health care professionals who serve
communities at many levels, including youth competitive teams
through high school, collegiate, and professional athletic
teams. He reiterated that Alaska and California are the only
states that do not license athletic trainers. He asked the 49th
state to be the 49th state to pass licensure. He acknowledged
that some confusion exists between personal trainer and athletic
trainers. He said Ms. Young has highlighted the role,
qualifications, and duties of athletic trainers. He emphasized
that athletic trainers are not personal trainers.
MR. DEAN offered his belief that the greatest consideration for
licensure is public safety. He recalled that House Bill 15 was
enacted in 2011 and specifically named athletic trainers as a
qualified health care provider who can evaluate, manage and
treat concussions; however, currently in Alaska, anyone could
call his/herself an athletic trainer. The Alaska State
Activities Association (ASAA), the Anchorage School District,
and the FNSB School District have worked hard to promote
concussion education and awareness and identify athletic
trainers as a qualified health care provider to treat concussed
student athletes. Further, a parent, student, and coach should
be assured that the athletic trainer is a certified trainer and
has the necessary education and competency to provide quality
health care. Earlier, a question was asked about any negative
events in Alaska regarding athletic trainers. He related a
scenario in which a 14-year-old student who suffered a
concussion that took 3.5 weeks to heal. The student completed
the return-to-play protocol as defined by ASAA, which is
standard in the medical community and returned to full
participation on a Wednesday. He played again and suffered
another concussion, was helped off the field by the coaches, and
sat on the sideline in pain for 30 minutes. At the end of the
game the mother was informed that her son was simply scared, but
the coach insisted her son did not have a concussion. Although
she asked whether the coach was an athletic trainer and
qualified to make the determination and he said he was, he was
not. The scenario highlights an instance in which someone
represented himself incorrectly and placed a student athlete at
risk, he said.
4:39:06 PM
MR. DEAN, in response to an earlier question, related that
insurance billing is an area he would like to pursue.
Currently, athletic trainers cannot bill because they are not
licensed providers. He said his number one priority after
obtaining licensure will be to ask insurers to recognize them,
as other states have, to identify them as health care providers.
In further response to a question on employment opportunities,
he indicated one physical therapist's office has the
authorization to hire five athletic trainers once this bill is
passed. He emphasized that this bill will help, and he thanked
members for the opportunity to testify.
4:40:24 PM
REPRESENTATIVE REINBOLD surmised that injuries likely happen
more often since coaches need players to win and may not "have
the will" to identify the injury. She suggested that it is
better to have a more objective person make these decisions.
She thanked him for his testimony.
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on HB 160.
4:41:17 PM
REPRESENTATIVE REINBOLD moved to report HB 160 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 160 was reported from the
House Labor & Commerce Standing Committee.