Legislature(2021 - 2022)BARNES 124
02/09/2022 04:30 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB289 | |
| HB295 | |
| HB276 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 289 | TELECONFERENCED | |
| *+ | HB 295 | TELECONFERENCED | |
| + | HB 276 | TELECONFERENCED | |
| + | SJR 15 | TELECONFERENCED | |
HB 295-DENTIST SPEC. LICENSE/RADIOLOGIC EQUIP
4:58:05 PM
CO-CHAIR FIELDS announced that the second order of business
would be HOUSE BILL NO. 295, "An Act relating to the practice of
dentistry; relating to dental radiological equipment; and
providing for an effective date."
4:58:17 PM
REPRESENTATIVE DAN ORTIZ, Alaska State Legislature, as prime
sponsor of HB 295, introduced the bill. He spoke as follows:
House Bill 295 works to solve two problems facing
Alaskan dentists and helps them do their jobs safely,
efficiently, and honestly. Firstly, this bill
transfers the oversight of dental radiological
equipment from the Alaska Board of Dental Examiners to
the Department of Health and [Social] Services (DHHS).
Alaskan dentists have had great difficulty finding
private radiological inspectors for their x-ray
equipment and as DHSS already oversees medical
radiological equipment and employs inspectors, this is
a way to ensure that dental equipment is being
inspected at the right intervals by the people
qualified to do the job.
Secondly, ? this bill establishes truth in advertising
for dental specialists. Alaska currently doesn't have
a legal definition of dental specialist, which means
that a dentist can advertise as an ? endodontist
specialist without having an endodontist training. I
? certainly would want the dentist performing my root
canals to know what they're doing, and I think
everyone in this room would want that as well.
Alaskans seeking dental specialists should be
confident that their dentist has the specialized
training to give them the best care possible, and HB
295 does just that.
These concerns were brought to us by dentists who
recognized obstacles in doing the best job they can
for their patients, and these concerns are worth
considering by passing HB 295.
5:00:42 PM
ABIGAIL SWEETMAN, Staff, Representative Dan Ortiz, Alaska State
Legislature, presented the sectional analysis for HB 295 on
behalf of Representative Ortiz, prime sponsor. She paraphrased
from a written sectional analysis, which read as follows
[original punctuation provided with some formatting changes]:
Section 1: Conforming language in AS 08.01.065(c).
Section 2: Adds a new section (k) to AS 08.01.065
(Title 8. Business and Professions, Chapter 1.
Centralized Licensing, Section 065. Establishment of
fees)
Requires the Board of Dental Examiners to
establish and collect fees on behalf of the
Department of Health and Social Services for the
inspection of dental radiological equipment.
Section 3: Adds new sections to AS 08.36 (Title 8.
Business and Professions, Chapter 36. Dentistry)
AS 08.36.242. License to practice as a specialist
required.
Establishes that a dentist may not advertise
using the term "specialist," the name of a
specialty, or other phrases that suggest they are
a specialist unless they have a specialist
license as established.
AS 08.36.243. Qualification for specialist; scope
of practice.
(a)Establishes that in order to qualify for a
specialist licenses a person must
(1)Hold a dental license issued by the board
and
(2)Meet the qualifications of a specialist
as established by the board in regulation.
(b) In creating the qualifications for a
specialist license, the board shall consider the
standards of a nationally recognized certifying
entity approved by the board.
(c) Establishes that a dental specialist can only
claim to be a specialist in the specialty they
hold a license in.
Sec. 08.36.245. Suspension or revocation of
specialist license.
Establishes that a board may suspend or revoke a
specialist license as set by AS 08.36.315.
Section 4: Adds a new section (d) to AS 44.29.020
(Title 44. State Government, Chapter 29. Department of
Health and Human Services, Section 020. Duties of the
Department)
Requires DHSS to establish standards of
registration, use, record keeping, and inspection
of dental radiological equipment in compliance
with federal law.
Section 5: Conforming language in AS 44.46.029
Section 6: Conforming language in AS 46.03.022
Section 7: Repeals:
AS 08.36.075: Section of law requiring the Board
of Dental Examiners to set standards for inspection of
dental radiological equipment. Placed under DHSS by
section 4.
AS 18.05.065, AS 18.60.525(e), and AS 44.29.027:
Sections of law prohibiting DHSS from regulating
dental radiological equipment.
Section 8: Allows the Board of Dental Examiners, the
Department of Commerce, Community, and Economic
Development, and the Department of Health and Social
Services to adopt regulations in line with this act.
Section 9: Allows the departments and board to
immediately begin setting regulations.
Section 10: Set a delayed effective date for the rest
of the act to July 1, 2023.
5:03:01 PM
CO-CHAIR FIELDS opened invited testimony on HB 295.
5:03:11 PM
DAVID LOGAN, DDS, Executive Director, Alaska Dental Society,
provided invited testimony in support of HB 295. He explained
that currently there isn't an avenue for dentists to get the
necessary inspections of their x-ray equipment. Dentists must
use state certified inspectors, but for several years there have
been no certified inspectors that dentists can use.
DR. LOGAN said there have been a couple false starts at
legislation, but this year is coming to a deadline as dentists
are going to start falling out of compliance at year's end.
Without action of some sort, dentists will be in the situation
at year's end of their x-ray machines becoming out of compliance
with the necessary inspections. Consequently, dentists will
have to use machines that are no longer compliant or not be able
to use their machines at all neither of which is a great
option. These machines need to be inspected periodically, not
doing so doesn't help things from a public health standpoint.
Dentists would like to get those machines inspected.
5:05:03 PM
DAVID NIELSON, DDS, Chair, Board of Dental Examiners, Division
of Corporations, Business, and Professional Licensing,
Department of Commerce, Community, and Economic Development
(DCCED), provided invited testimony in support of HB 295. He
said he agrees with Dr. Logan's testimony. Regarding Section 3
of the bill, he explained that the Dental Practice Act repealed
specialty license categories in 2012 for reasons he is not aware
of because he was not on the Board of Dental Examiners at that
time. Since then, the board has shied away from investigating
false and misleading advertising complaints that tend to crop
up. For the board to address this, specialty license categories
are needed that can hold up under legal scrutiny. The board
needs the ability to reduce public confusion over deceptive or
false advertising brought by dentists using the term specialist
for specializing in an area of dentistry that is professionally
recognized to require significantly more training than they have
received. Typically, an accredited post-graduate specialty
program demands two years minimum of training beyond dental
school.
DR. NIELSON related that the board has had to deny a few license
applications to specialists trying to come work in Alaska
because the board didn't have a way to approve their
applications. That is because, without having a license type
that's limited to the specialty area of dentistry that they've
been practicing in for years or that they have a specific
training in, the board had to deny licenses to dentists who have
graduated from an accredited specialty program. If [the board]
can limit the scope of practice of the specific branch of
dentistry covered by the specialty license, it will open the
doors a little wider to more qualified specialists to come to
Alaska.
5:08:07 PM
REPRESENTATIVE MCCARTY offered his understanding that currently
there is not someone to inspect the machines used in dentistry.
He asked whether there are dentists under investigation because
they cannot comply with this. He further asked whether this
means every dentist is going to have to shut down if this is not
implemented fast enough.
5:09:02 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community, and
Economic Development (DCCED), replied that the division is not
currently investigating these potentially out of compliance
dentists because there is no program with which to comply. The
division does not want to put them in a "catch 22." If this
bill passes, the plan would be to assist the Department of
Health and Social Services (DHSS) in getting this up and running
quickly and then move toward compliance rather than an
enforcement right out of the gate. The division would want to
make sure dentists were aware of how to comply and that there
was a program that allowed compliance.
DR. NIELSON agreed with Ms. Chambers. He pointed out that
realistically there isn't a process in place for one dental
examiner to figure out which of the approximately 2,400 devices
being used are out of compliance. Dentists have had nobody
qualified to do their inspections for years. Everyone wants to
get caught up and get this program going again and DHSS has the
people to do it.
REPRESENTATIVE MCCARTY asked how viable it is that DHSS will be
able to find people to do the inspections given dentistry hasn't
been able to find inspectors.
MS. CHAMBERS responded that it would be a different model. The
board, she explained, has typically utilized a private sector
model that would rely on a supply of people who are performing
this type of service for other healthcare devices, but the board
hasn't been able to identify anyone in the last several years
who is qualified or willing to do that. The DHSS model, which
is reflected in the fiscal notes of both departments, would be
to employ someone who would be able to do this. A fee would be
collected by DCCED from the dentist to pay for this service,
which would then be sent over to DHSS through a reimbursable
service agreement (RSA) to pay for the person on staff, thereby
ensuring that someone is available to perform these inspections.
REPRESENTATIVE MCCARTY asked whether this is kicking the can
from one department to another - previously dentists were paying
for the inspections until they couldn't find any inspectors in
the state. He further asked whether a grace period for dentists
is planned since it will take a while into the future to find an
inspector given the current labor shortage.
MS. CHAMBERS answered that everyone is in support of moving this
program. Radiological physicists are required to perform these
inspections, but since DCCED doesn't specialize in that, it is
looking to its partner sister agency for an assist to do
something that is currently under dental board statute. To not
reinvent the wheel, DCCED often works that way with other
departments for efficiency measures as well as expertise. The
grace period would extend to a length of time that it would take
for this program to be up and running, DCCED is not in the
business of enforcing impossible-to-comply-with laws. So, DCCED
would be working closely with DHSS to make sure that the program
is functional, fully staffed, and available, and to clearly
communicate a rollout of that inspection series to the dentists
involved so, compliance rather than enforcement.
5:13:50 PM
JAYME PARKER, MD, Chief, Alaska State Public Health Laboratory
Fairbanks, Division of Public Health, Department of Health and
Social Services (DHSS), responded to Representative McCarty's
questions. She explained that her laboratory houses the
radiological health program, which currently has a single
radiological health physicist who inspects and registers over
1,000 non-dental devices every year. For this to be successful
[the laboratory] would need to hire another radiological health
care physicist to take on this additional capacity. While this
isn't easy to come by, it isn't impossible.
REPRESENTATIVE MCCARTY asked whether the effective date of
7/1/23 is a doable timeframe.
MS. CHAMBERS replied that [DCCED] has been in communication with
DHSS and this effective date seems to work best for most people
and is a realistic start date. The original start date was
3/1/23 and July is a more reasonable date.
DR. PARKER added that [DHSS] would not investigate if the
program was not able to be complied with. Investigations would
not be initiated for people who could not comply with a program
that was not fully up and running.
5:15:52 PM
REPRESENTATIVE NELSON recalled Ms. Chambers' statement that
impossible laws would not be enforced. He asked what the future
looks like if this doesn't get through in time.
MS. CHAMBERS responded that DCCED will have to work closely with
the industry to determine. The first step would be for dentists
to not utilize equipment that wasn't properly inspected or where
they were not complying with the laws that are attainable. This
means that if a dentist has a piece of radiological equipment
that hasn't been inspected within that six years the dentist
would need to make a professional call as to whether he or she
wants to run the risk of damage happening to staff or patients.
[The departments] aren't going to seek investigations because
dentists didn't comply with a date that is on the books. That
is different than professionals making a call as to whether they
feel comfortable using equipment that is out of compliance but
that they believe is safe. The departments will link arms and
plow forward if the bill passes and gives DHSS the tools to do
that, along with communicating with dentists because neither one
is an outcome that anybody wants.
REPRESENTATIVE NELSON asked if the fees would be enough to cover
the bill's attached fiscal notes [totaling about $500,000].
MS. CHAMBERS answered that this would be completely receipt
supported, as indicated in the fiscal notes. One way to look at
it is that this program is currently theoretically on the books
and [DCCED] should have been collecting these fees or dentists
should have been paying a private contractor these fees these
last several years. Dentists are aware of going to a model of a
state employee at DHSS because this has been discussed with the
board on the record, and that the fees for all licensing
programs and each sector's group payment will be set through an
annual fee analysis. If the final model is [an inspection]
every sixth year, then that amount would be paid every six
years, so it would not be an annual amount to every dentist.
[The departments] will have to work through the cost, which was
previously paid through the private sector and now will be paid
through the public sector.
REPRESENTATIVE NELSON said he has heard about struggles with
recruiting people for public jobs compared to private jobs that
pay much better. He asked what the relationship would be of
having this on the books, but no one could be hired before the
deadline for this position had passed.
MS. CHAMBERS deferred to the writer of the DHSS fiscal note to
answer the question.
5:20:17 PM
IRENE CASARES, Radiological Health Physicist, Alaska State
Public Health Laboratory Fairbanks, Division of Public Health,
Department of Health and Social Services (DHSS), responded that
the situation of the inspections would be once the program is
attainable and a person is hired. She related that people
currently in Alaska have asked her about the salary and duties
of this position, and said they are willing to take this
position of getting the program in alignment, inspecting the
equipment, and getting the dentists in compliance. It is just a
fact of who, when, where, and how does this get started.
REPRESENTATIVE NELSON asked whether Ms. Casares is confident
that within a few months of passing HB 295, someone could be
hired and already out inspecting equipment.
MS. CASARES replied yes.
5:21:51 PM
REPRESENTATIVE KAUFMAN inquired about how the risk is managed to
prevent specialists from being locked out of what they are
qualified to do because of categorization. He further asked
whether the state has good definitions with enough latitude for
specializing along with doing general dentistry.
DR. NIELSON answered that certain specialties have more cross
training in general dentistry procedures than others, and each
specialty must be looked at individually to see what they
routinely do. It's a bit of a gray area, he said, but he
wouldn't suspect it would be a problem if an endodontist put in
a small filling. It would be on a case-by-case basis, so he
can't give the scope of practice for each specialty down to the
letter. It's just more appropriate, he advised, to allow a
specialist to work in their specialty area and keep it at that.
DR. LOGAN pointed out that, in general, most specialists are not
interested in performing general dentistry. Some specialists,
like a root canal specialist (endodontist), may routinely throw
in a filling. A periodontist (gum specialist) would have no
interest in putting in a filling because that is not what they
deal with, it is a completely different piece of the anatomy.
Therefore, this would not take away something.
MS. CHAMBERS added that these will be some of the things that
the board will need to work through in regulation. It would
typically fall to the education and training that the person is
presenting, so [DCCED] would not intentionally prevent someone
from practicing something they were qualified to do and want to
do. If they wished to pursue both pathways there is a method in
the law to do that, and the board will just need to narrow that
down through the regulatory process.
DR. NIELSON agreed with Ms. Chambers. He explained that the
intent of this is really the other way around which is to
allow someone who has had training in a specialty area to come
to Alaska even though they haven't done "general dentistry" for
a long time. The intent is to open this up for specialists who
are highly trained in their area, [the board] is not going to
focus a lot of time on not allowing a specialist to put in a
little filling once in a while if they feel qualified to do it.
REPRESENTATIVE KAUFMAN cautioned against creating a catch-22
situation where there is a little piece of work, and someone is
afraid to do it even though they are competent to do so but it
isn't per the regulations. In general, he continued, he is
seeing that everything is going in a good direction.
5:27:19 PM
REPRESENTATIVE MCCARTY concurred with Representative Kaufman
about micro-managing, but said he isn't hearing that from the
invited testimony. He stated he is confused about where the
problem is in recognizing specialists trying to get into the
state given specialists are already in Alaska.
DR. LOGAN confirmed there are about 150 specialists in Alaska.
He explained that by not having a specialty license they cannot
differentiate themselves from somebody else as a specialist; or
they can but the reverse is also unfortunately true in that a
general dentist can list himself or herself as a specialist even
without the requisite training, and the board is powerless to
prevent them from doing that because the board doesn't have the
statutory authority with the specialty license.
[HB 295 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 295 ver. A 2.9.22.PDF |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Sponsor Statement 2.9.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Sectional Analysis 2.9.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Letter of Support - DEN 2.1.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Letter of Support - ADS 2.9.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Fiscal Note DCCED-CBPL 2.4.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Fiscal Note DOH-LABS 2.4.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 295 Fiscal Note DOH-MAA 2.4.22.pdf |
HHSS 3/31/2022 3:00:00 PM HL&C 2/9/2022 4:30:00 PM |
HB 295 |
| HB 289 ver. B 2.9.22.PDF |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Sectional Analysis 1.31.2022.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Sponsor Statement 1.31.2022.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Letter of Support - AMIA 1.31.2022.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Letter of Support - AMIA 1.31.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Research - ADN Article on Alaska Marijuana Industry 11.07.2021.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Research - ADN Article on Alaska Marijuana Industry 11.30.2021.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 289 Fiscal Note DCCED-AMCO 2.4.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |
| HB 276 ver. A 2.7.22.PDF |
HL&C 2/9/2022 4:30:00 PM |
HB 276 |
| HB 276 Sponsor Statement 2.7.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 276 |
| HB 276 Sectional Analysis 2.7.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 276 |
| HB 276 Fiscal Note DCCED-CBPL 2.4.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 276 |
| HB 276 MLA Overview Presentation 2.7.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 276 |
| HB 289 Letter of Support - AMIA 1.31.22.pdf |
HL&C 2/9/2022 4:30:00 PM |
HB 289 |