Legislature(1999 - 2000)

05/03/1999 03:23 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
CSSB 88(FIN) - DIETITIANS AND NUTRITIONISTS                                                                                     
                                                                                                                                
Number 0137                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG announced the committee's first order of business                                                             
is CSSB 88(FIN), "An Act relating to licensure of dietitians and                                                                
nutritionists; and providing for an effective date."  Chairman                                                                  
Rokeberg acknowledged the bill sponsor.                                                                                         
                                                                                                                                
Number 0150                                                                                                                     
                                                                                                                                
SENATOR DAVE DONLEY, Alaska State Legislature, came forward as the                                                              
sponsor of SB 88.  Senator Donley stated that SB 88 would adopt                                                                 
title licensure in Alaska for dieticians and nutritionists.  Other                                                              
states currently have licensure for these individuals; some                                                                     
Alaskans are going to other states for licensure so they can have                                                               
legitimate use of the title.  The legislation has been requested by                                                             
these professionals who would be regulated.  As is mandatory under                                                              
Alaska's occupational licensing rules, the program would pay for                                                                
itself.  Additionally, this licensure would allow possible access                                                               
by Alaskans to federal funding at a future time.  Senator Donley                                                                
noted there is legislation pending in Congress which would allow                                                                
reimbursement for nutrition services within the Medicare program.                                                               
However, this reimbursement would only be allowed to those                                                                      
recognized by a state as nutrition professionals.  If Alaska does                                                               
not have some minimum licensure, which is what title licensure is,                                                              
Alaskans would be denied this opportunity if the federal                                                                        
legislation is passed.  Senate Bill 88 would allow people to know,                                                              
when using the services of someone professing to be a dietician or                                                              
nutritionist, that person has at least the minimum standards                                                                    
required by this legislation for licensure.                                                                                     
                                                                                                                                
Number 0282                                                                                                                     
                                                                                                                                
REPRESENTATIVE HARRIS questioned if any of Alaska's universities                                                                
offer the courses or degrees necessary to qualify for either of the                                                             
two portions.                                                                                                                   
                                                                                                                                
SENATOR DONLEY noted a couple of the witnesses present have degrees                                                             
in these areas and are indicating the answer is yes.  He commented                                                              
these witnesses might able to provide more detail in their                                                                      
testimony.                                                                                                                      
                                                                                                                                
REPRESENTATIVE HARRIS questioned if it is Senator Donley's                                                                      
knowledge through his research that this is fairly standard for                                                                 
other states.                                                                                                                   
                                                                                                                                
SENATOR DONLEY indicated there is an accepted national standard for                                                             
the dietician license which is adopted by the legislation.  The                                                                 
nutritionists' licensure is a little more complicated; there is no                                                              
one accepted national standard.  Therefore, the equivalent of a                                                                 
three-part test is being adopted.  Senator Donley referred to the                                                               
language regarding nutritionist licensure on page 2 of CSSB
88(FIN).  [This language read:                                                                                                  
                                                                                                                                
          Sec. 08.38.030.  Nutritionist licensure.  The                                                                         
     department shall issue a nutritionist license to an                                                                        
     individual who pays the required fee, applies on a form                                                                    
     provided by the department, and submits evidence                                                                           
     satisfactory to the department that the individual either                                                                  
          (1) has qualified as a diplomate of the American                                                                      
     Board of Nutrition or as a Certified Nutrition Specialist                                                                  
     with the Certification Board for Nutrition Specialists;                                                                    
     or                                                                                                                         
          (2) meets the following qualifications:                                                                               
               (A) has received a master's or doctoral degree                                                                   
          from an accredited college or university with a                                                                       
          major in human nutrition, public health nutrition,                                                                    
          clinical nutrition, nutrition education, community                                                                    
          nutrition, or food and nutrition; and                                                                                 
               (B) has completed a documented work experience                                                                   
          in human nutrition or human nutrition research of                                                                     
          at least 900 hours.]                                                                                                  
                                                                                                                                
CHAIRMAN ROKEBERG commented there are five witnesses signed up to                                                               
testify.  He invited Senator Donley to remain with the committee at                                                             
the table.                                                                                                                      
                                                                                                                                
Number 0435                                                                                                                     
                                                                                                                                
DEBRA MESTAS, registered dietician (RD), testified next via                                                                     
teleconference from Anchorage in support of the legislation.  Ms.                                                               
Mestas informed the committee she has lived in Anchorage since                                                                  
1980, has worked as the renal dietician for the Alaska Kidney                                                                   
Center for those 13 years, and also worked at the WIC [Special                                                                  
Supplemental Nutrition Program for Women, Infants, and Children]                                                                
clinic at the Anchorage health department for 12 years.  In                                                                     
addition to being a registered dietician, she is a certified                                                                    
breast-feeding consultant and is looking forward to becoming a                                                                  
certified diabetes educator.  Ms. Mestas feels that registered                                                                  
dieticians, and nutritionists with the qualifications listed on                                                                 
page 2 [of CSSB 88(FIN)], are consumer advocates.  She feels these                                                              
professionals are very serious about promoting education, usually                                                               
not charging for those services in many of their job situations.                                                                
These professionals are the prime source of information for                                                                     
patients who need specialized care.  Ms. Mestas said her patients,                                                              
in particular, have kidney failure.  She indicated many of her                                                                  
patients have diabetes which causes their renal failure, or cancer                                                              
along with their renal failure.  Ms. Mestas further indicated her                                                               
patients have many other medical problems or diseases, mentioning                                                               
high blood pressure and lupus as two examples.  She is very                                                                     
concerned that people who go out into the community for services                                                                
know what they are getting.  With this legislation, she feels these                                                             
people will be assured that the qualified dietician or nutritionist                                                             
has the schooling behind him/her and resources available from the                                                               
physicians, nurses, and other parts of the medical team.                                                                        
                                                                                                                                
Number 0551                                                                                                                     
                                                                                                                                
MS. MESTAS indicated dieticians have been part of the medical team                                                              
for years but have not been recognized as licensed professionals.                                                               
She is particularly concerned about the Alaska Native population.                                                               
Ms. Mestas indicated she is seeing a rapidly expanding number of                                                                
diabetic Native patients in line to begin dialysis.  She further                                                                
indicated that if the committee is unfamiliar with the national                                                                 
cost of dialysis, it would want to discover those costs.  Diabetes                                                              
is a very expensive disease and diabetics are now living long                                                                   
enough to lose their kidneys and require dialysis.  Alaska Natives                                                              
are very prone to diabetes.  Ms. Mestas noted there are                                                                         
approximately 1,750 diabetics currently registered at the Alaska                                                                
Native Medical Center ["Native hospital"]; this number includes                                                                 
both insulin and non-insulin dependent diabetics.  In 1989 there                                                                
were only 700 diabetics registered there.  Ms. Mestas commented                                                                 
this number is only increasing.  She is very concerned that this                                                                
population is not going to be able to receive services from                                                                     
qualified professionals.  She stated, "And we need to ensure that                                                               
that is available to the Native population and that these people                                                                
out in villages and other smaller communities are assured they're                                                               
getting the right information from the right folks at the right                                                                 
time, and I think Senate Bill 88 can ensure that."  Ms. Mestas                                                                  
indicated dieticians spend a lot of their own money to become                                                                   
qualified and licensed, and to pay dues for professional                                                                        
organizations and additional certifications, because they believe                                                               
in what they do and think education is the way to go.  She feels                                                                
this does protect the consumers and she urges the committee's                                                                   
support.                                                                                                                        
                                                                                                                                
CHAIRMAN ROKEBERG asked Ms. Mestas if she had a college degree.                                                                 
                                                                                                                                
MS. MESTAS answered that her bachelor's of science is in dietetics                                                              
from Colorado State, Fort Collins.  She received her internship                                                                 
from Washington University's Barnes-Jewish Hospital in St. Louis,                                                               
Missouri.                                                                                                                       
                                                                                                                                
CHAIRMAN ROKEBERG questioned if she had any other nursing                                                                       
credentials or anything.                                                                                                        
                                                                                                                                
MS. MESTAS answered in the negative, but pointed out that                                                                       
dieticians are basically in school with the physicians.  Their                                                                  
education track is the medical track; they take four years of                                                                   
chemistry and are right along with the pre-med students.                                                                        
                                                                                                                                
Number 0770                                                                                                                     
                                                                                                                                
JOHN WRAY, Registered Dietician, Bartlett Regional Hospital; Alaska                                                             
Dietetic Association, came forward in Juneau to testify in support                                                              
of the legislation, representing the Alaska Dietetic Association                                                                
(AKDA).  He thanked the committee for considering the bill and                                                                  
thanked Senator Donley for his sponsorship.  Mr. Wray based his                                                                 
comments on a prepared statement and provided the following                                                                     
testimony:                                                                                                                      
                                                                                                                                
     "I represent the Alaska Dietetic Association, which is a                                                                   
     group which Debra's [Ms. Mestas] a member of.  ... This                                                                    
     group represents dietitians and nutritionists in Alaska.                                                                   
     We strongly support this piece of legislation.  Currently                                                                  
     39 states, the District of Columbia and Puerto Rico have                                                                   
     some form of licensing for dietitians and nutritionists.                                                                   
                                                                                                                                
     "In Alaska there are over 120 dieticians and                                                                               
     nutritionists working in a wide variety of settings:  in                                                                   
     hospitals, continuing care facilities, outpatient                                                                          
     clinics, school districts, the WIC Program like Debra                                                                      
     mentioned, ... the University of Alaska system, ... the                                                                    
     state Department of Education, Health and Social                                                                           
     Services, and we also have dieticians who ... are out in                                                                   
     private practice trying to make a go of it.  These                                                                         
     individuals have at least a bachelor's degree, many of                                                                     
     them have master's, some of them have Ph.D.'s.                                                                             
                                                                                                                                
     "There are 2 main reasons why we would like to have the                                                                    
     state of Alaska license dieticians and nutritionists.                                                                      
     First, as Senator Donley mentioned, there is proposed                                                                      
     legislation within Congress that would provide coverage                                                                    
     for Part B portion of Medicare, which is outpatient                                                                        
     services, which would pay for nutrition therapy services                                                                   
     being furnished by dieticians or qualified nutritional                                                                     
     professionals.  Currently, only a portion of these                                                                         
     services are covered."                                                                                                     
                                                                                                                                
Number 0872                                                                                                                     
                                                                                                                                
     "The legislation provides that the services will only be                                                                   
     reimbursed to those professionals who that state legally                                                                   
     recognizes as the expert in the specific health care                                                                       
     field, in this case nutrition therapy.                                                                                     
                                                                                                                                
     "Being able to provide covered nutrition services will be                                                                  
     a cost savings to Alaskans and to the health care                                                                          
     facilities where these people are staying.  Speaking from                                                                  
     experience and also backed by many studies, proper                                                                         
     nutrition therapy reduces the length of stay for people                                                                    
     in hospitals, ... they recover from surgery, they recover                                                                  
     from trauma quicker, and more importantly, as Debra was                                                                    
     taking about, in the area of chronic diseases like                                                                         
     diabetes, proper nutrition therapy can reduce and/or                                                                       
     prevent the complications that many of these patients                                                                      
     have - just not in diabetes, but also in heart disease,                                                                    
     strokes, and some forms of cancer.                                                                                         
                                                                                                                                
     "The second reason ... we support licensure is again                                                                       
     similar to what Senator Donley said:  professional                                                                         
     recognition.  I have a degree in dietetics from UC                                                                         
     Berkeley [University of California at Berkeley], I have                                                                    
     a master's degree, I went through a year of internship,                                                                    
     ... I passed an exam to get my RD license, very similar                                                                    
     to what an RN [registered nurse] does.  ... Deborah's                                                                      
     comment ... was also very appropriate; ... a lot of my                                                                     
     training was medically-oriented.  I teach - I teach                                                                        
     nutrition.  I teach nutrition [and] I also end up                                                                          
     teaching some disease-state education because doctors are                                                                  
     so busy that they many times don't have the time to spend                                                                  
     the time with their patients that they would like to.                                                                      
     I'm part of a health care team at the hospital.  Every                                                                     
     person in that health care team is licensed by the state                                                                   
     of Alaska except my profession.  That includes                                                                             
     pharmacists, RNs, respiratory therapists, occupational                                                                     
     therapists, physical therapists, along with the doctors,                                                                   
     obviously."                                                                                                                
                                                                                                                                
Number 0986                                                                                                                     
                                                                                                                                
     "The bill before you, as someone mentioned, is for title                                                                   
     licensure or title protection.  It simply says that the                                                                    
     person may not hold ... herself or himself out to be                                                                       
     dietician or nutritionist unless so licensed.  We wish to                                                                  
     make it clear that this title licensure does not limit                                                                     
     others from engaging in nutritional care practices as                                                                      
     long as they do not call themselves dieticians or                                                                          
     nutritionists.  There are number of other professions who                                                                  
     ... currently can provide nutrition services in the                                                                        
     course of their work within the occupational licensing in                                                                  
     Alaska.  There is no effect upon them with this                                                                            
     legislation.  It's business as usual for them.  Nor does                                                                   
     this bill affect people who work in the health food store                                                                  
     or diet centers, as long as they don't hold themselves                                                                     
     out to be dieticians or nutritionists unless they are so                                                                   
     licensed."                                                                                                                 
                                                                                                                                
MR WRAY indicated he also wished to respond to Representative                                                                   
Harris' question about the University of Alaska.  The University of                                                             
Alaska Anchorage (UAA) offers a program called "AP4."  A person can                                                             
come in through the nutrition program at UAA, overseen by Dr. Nancy                                                             
Overpeck, to attain a degree and receive his/her internship to                                                                  
qualify to take the registered dietician examination.  UAA is                                                                   
currently the only school in the state which has a degree.                                                                      
                                                                                                                                
Number 1069                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI asked Mr. Wray to explain the meaning of                                                               
"registered dietician."                                                                                                         
                                                                                                                                
MR WRAY answered there is the American Dietetic Association in                                                                  
Chicago.  If a person wants to become registered, the association                                                               
requires that person to have a degree from an accredited                                                                        
university, complete an internship, and pass the association's                                                                  
day-long examination.  The person receives the designation of                                                                   
"registered dietician."  Mr. Wray noted this is very similar to the                                                             
American Nurses Association's requirements for RNs.  Registry does                                                              
not mean that a dietician is recognized by any individual state as                                                              
a nutrition expert.                                                                                                             
                                                                                                                                
REPRESENTATIVE MURKOWSKI questioned what the internship requires in                                                             
terms of the work experience.  She noted the language in the bill                                                               
requiring 900 hours for licensure [of nutritionists] and asked how                                                              
that equates to the internship requirements for a registered                                                                    
dietician.  [The language in CSSB 88(FIN) regarding requirements                                                                
for licensure of dieticians read:                                                                                               
                                                                                                                                
          Sec. 08.38.020.  Dietitian licensure.  The                                                                            
     department shall issue a dietitian license to an                                                                           
     individual who pays the required fee, applies on a form                                                                    
     provided by the department, and submits evidence                                                                           
     satisfactory to the department of being certified as a                                                                     
     Registered Dietician by the Commission on Dietetic                                                                         
     Registration.]                                                                                                             
                                                                                                                                
Number 1131                                                                                                                     
                                                                                                                                
MR WRAY replied they are exactly the same; it is basically slave                                                                
labor for a year for a hospital.                                                                                                
                                                                                                                                
REPRESENTATIVE MURKOWSKI noted the packet contains some federal                                                                 
guidelines, either for licensure or registration, with a                                                                        
requirement that the work experience be under the supervision of a                                                              
registered dietician or a nutrition professional.  Representative                                                               
Murkowski commented the legislation does not require this                                                                       
supervision for the work experience.  She asked if Mr. Wray feels                                                               
that is an issue, having gone through the registered dietician                                                                  
process himself.                                                                                                                
                                                                                                                                
MR WRAY answered that any internship program available for a person                                                             
to complete has to be scrutinized very greatly by the American                                                                  
Dietetic Association.  The association does not bestow its                                                                      
accreditation on just any program; it is very similar to the                                                                    
internship a nurse would do.  Therefore, their feeling is that if                                                               
it is a program which has been approved by the American Dietetic                                                                
Association, it fills the bill and all those other requirements,                                                                
such as who oversees it, the hours, and so forth, will be met.                                                                  
                                                                                                                                
REPRESENTATIVE MURKOWSKI commented she had one final question                                                                   
regarding the educational requirements for a licensed dietician.                                                                
She referred to the definitions section on page 4 of CSSB 88(FIN),                                                              
specifically subsection (3) of Sec. 08.38.100, the definition of                                                                
"dietetics or nutrition practice".  [This subsection (3) read:                                                                  
                                                                                                                                
          (3) "dietetics or nutrition practice" means the                                                                       
     integration and application of scientific principles of                                                                    
     food, nutrition, biochemistry, physiology, food                                                                            
     management, and behavioral and social sciences to achieve                                                                  
     and maintain human health through the provision of                                                                         
     nutrition care services.]                                                                                                  
                                                                                                                                
REPRESENTATIVE MURKOWSKI questioned what "behavioral and social                                                                 
sciences" have to do with the food end of things.                                                                               
                                                                                                                                
Number 1255                                                                                                                     
                                                                                                                                
MR. WRAY responded that a large part of his education efforts with                                                              
patients is changing someone's behavior.  He said, "You have, for                                                               
yourself, adapted certain nutritional habits since a very early                                                                 
age.  If you are referred to me by a physician that you have now                                                                
... liver disease or even diabetes, I'm gonna be asking you to make                                                             
changes in your behavior.  I need to have a basic understanding of                                                              
the human psyche and how to go about facilitating that change in                                                                
behavior, because that actually is the biggest problem most people                                                              
have.  ... We can give them the information.  How to put that into                                                              
action, into place, is the ongoing efforts that we have."                                                                       
                                                                                                                                
REPRESENTATIVE MURKOWSKI remarked that makes perfect sense.                                                                     
                                                                                                                                
REPRESENTATIVE HALCRO asked how this affects what could be called                                                               
retail weight centers like "Jenny Craig" or "Weight Watchers,"                                                                  
where they basically sell food products.  Representative Halcro                                                                 
questioned if the people selling those food products would have to                                                              
be registered.                                                                                                                  
                                                                                                                                
MR. WRAY indicated that if these people are holding themselves out                                                              
as nutritionists and they meet the qualifications of a                                                                          
nutritionist, under this legislation, they would have to be                                                                     
licensed.  In reality, he noted, most of the people who work for                                                                
diet centers or for health food stores don't call themselves                                                                    
nutritionists but they dispense nutrition information.  It would be                                                             
business as usual for these people.  Mr. Wray indicated the use of                                                              
the title is the issue; there is no intent to dictate to anyone                                                                 
what kind of information someone can provide.                                                                                   
                                                                                                                                
Number 1353                                                                                                                     
                                                                                                                                
REPRESENTATIVE BRICE questioned if there are a large number of                                                                  
people passing themselves off as trained dieticians or                                                                          
nutritionists.  He asked what the consequences are.                                                                             
                                                                                                                                
MR. WRAY answered he could not provide exact numbers, indicating he                                                             
has heard stories.  Currently, there is no mechanism - if someone                                                               
wants to call themselves a nutritionist and has no qualifications,                                                              
this person is free to do so.  If someone wants to call                                                                         
himself/herself a dietician, he/she can do that.  The difficult                                                                 
thing to document is that specific information supplied by an                                                                   
individual to another person was bogus and caused the other person                                                              
a specific health problem.  He commented it is impossible to prove.                                                             
Mr. Wray indicated other states with licensure don't even attempt                                                               
to show that.  He summarized that within the health care setting                                                                
the dieticians' and nutritionists' work is cost effective.  His                                                                 
boss at Bartlett Regional Hospital knows it:  Mr. Wray saves people                                                             
money by getting them out of the hospital faster.                                                                               
                                                                                                                                
Number 1452                                                                                                                     
                                                                                                                                
CINDY SALMON, registered dietician and certified personal trainer,                                                              
testified next via teleconference from Fairbanks in support of the                                                              
legislation.  Ms. Salmon based her remarks on a prepared statement                                                              
and provided the following testimony:                                                                                           
                                                                                                                                
     "Hello, members of the House Labor and Commerce                                                                            
     Committee.  My name's Cindy Salmon.  ... I am a                                                                            
     registered dietitian, a certified personal trainer, and                                                                    
     a lifelong Alaskan.  I'm in private practice here in                                                                       
     Fairbanks.  ... I am also an adjunct lecturer at the                                                                       
     University of Alaska in Fairbanks [UAF].  My bachelor of                                                                   
     science degrees include nutrition science with a                                                                           
     chemistry minor.  I obtained it at Northern Arizona                                                                        
     University in Flagstaff, Arizona because there is nowhere                                                                  
     to get a degree in nutrition in Alaska.  However, I was                                                                    
     able to be accepted to and complete the requirements of                                                                    
     the first AP4 program in Anchorage, which lasted nine                                                                      
     months.  My services are presently available at the                                                                        
     University of Alaska student rec [recreation] center,                                                                      
     Fairbanks Athletic Club, and at our outpatient facility,                                                                   
     as well as in the client's home.  Clients come, or [are]                                                                   
     referred, for medical nutrition therapy from many walks                                                                    
     of life.  There's UAF students, senior citizens, local                                                                     
     professionals, children and families, for conditions such                                                                  
     as low growth/failure to thrive, eating disorders,                                                                         
     anemia, osteoporosis, hyperlipidemia, heart disease,                                                                       
     hypertension, and of course diabetes, as well as [for]                                                                     
     sound nutritional guidance.  I am a member of their                                                                        
     health care team and I'm working with other licensed                                                                       
     practitioners, closely with physical therapists,                                                                           
     occupational therapists, speech therapists, dentists,                                                                      
     physicians, nurses, nurse practitioners, social workers                                                                    
     and physician's assistants, all in an effort to decrease                                                                   
     medical cost and increase the client's quality of life."                                                                   
                                                                                                                                
Number 1537                                                                                                                     
                                                                                                                                
     "My practice is based on sound, scientific principles and                                                                  
     focuses on matching a client's nutritional status,                                                                         
     readiness to change, with the appropriate medical                                                                          
     nutritional therapy and lifestyle intervention.  In                                                                        
     short, we teach people to separate fact from fallacy in                                                                    
     order to make informed choices about their present and                                                                     
     future health.  At present, it's pretty easy for the                                                                       
     public to take a wrong turn when seeking nutritional                                                                       
     care.  For example, if using the local phone directory,                                                                    
     there is a 50/50 chance a person looking under the                                                                         
     heading of Nutritionists would find six separate listings                                                                  
     - only three of which meet the proposed definition.  So                                                                    
     state licensure of dieticians and nutritionists would                                                                      
     guide the public and reinforce the importance of                                                                           
     utilizing providers who have met the professional                                                                          
     standard and are qualified to provide nutritional care.                                                                    
     I hope this description of my practice helps increase                                                                      
     your insight of the present environment and the need to                                                                    
     pass this bill.  If you have any questions, please feel                                                                    
     free to ask.  Thanks for your consideration."                                                                              
                                                                                                                                
REPRESENTATIVE BRICE asked Ms. Salmon what type of work she does                                                                
with social workers:  What is her interaction with them?                                                                        
                                                                                                                                
MS. SALMON replied her interaction with a social worker is a cross                                                              
reference.  Social workers often work with clients who may be                                                                   
experiencing, for example, depression or eating disorders; the                                                                  
social worker has a "handle" on what may be happening in the                                                                    
client's environment.  Ms. Salmon referred to Mr. Wray's comments,                                                              
noting that nutrition therapy is all-encompassing; it is a person's                                                             
life.  The many factors going on in a person's life have to be                                                                  
dealt with, what the person has grown up with and where the person                                                              
is going.  By working with a social worker, she can gain insight on                                                             
what is occurring in a client's life, what that client might be                                                                 
working on, and how that influences the client's food and health                                                                
choices.  Ms. Salmon indicated this back and forth interface                                                                    
results in reinforcement to the client and a consistent message.                                                                
She noted this is really important - with nutrition it is very easy                                                             
to get inconsistent messages.                                                                                                   
                                                                                                                                
Number 1660                                                                                                                     
                                                                                                                                
LINDA WILD, nutritionist, came forward to testify in Juneau in                                                                  
support of SB 88.  Ms. Wild informed the committee she is                                                                       
representing herself and is also a member of the Alaska Dietetic                                                                
Association.  She is a nutritionist, has a master's degree in                                                                   
nutrition, and is currently certified in Washington State where she                                                             
received her master's degree.  Ms. Wild noted certification is                                                                  
Washington's equivalent of licensing and she pays annual fees to                                                                
the state of Washington to maintain that certification.  She took                                                               
that step because Alaska does not license nutritionists and she                                                                 
wanted the professional recognition that licensure/certification                                                                
brings.  She indicated anyone could use that title if they wished,                                                              
there is no real meaning to it.   If there isn't licensure, there                                                               
is no way of knowing if someone has had the appropriate training in                                                             
the field.                                                                                                                      
                                                                                                                                
MS. WILD commented on all the letters someone looking in the phone                                                              
book for nutritional counseling might see after people's names.                                                                 
She thinks most people don't really know what those letters mean                                                                
but "licensed by the state of Alaska" gives someone a high degree                                                               
of comfort.   The public knows that person has met at least the                                                                 
minimum qualifications for licensure in the state; that comfort and                                                             
security is important for the public.  Ms. Wild continued that it                                                               
is important for the dietitians and nutritionists to be on the same                                                             
playing field as the other licensed health care professionals.  She                                                             
noted dieticians and nutritionists are very passionate about their                                                              
field - about the benefits of healthy eating.  To her, sound                                                                    
nutrition is really the key to the establishment and maintenance of                                                             
good health.  Additionally, to aging baby boomers like herself,                                                                 
sound nutrition is really key to the prevention of many of the                                                                  
chronic diseases which come with aging.                                                                                         
                                                                                                                                
Number 1751                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG asked what letters would follow Ms. Wild's name                                                               
as a nutritionist.                                                                                                              
                                                                                                                                
MS. WILD answered she could use "MSN" for master of science in                                                                  
nutrition and "CN," certified nutritionist, in Washington State.                                                                
                                                                                                                                
CHAIRMAN ROKEBERG asked what she would have if this legislation                                                                 
passes.                                                                                                                         
                                                                                                                                
MS. WILD answered she would be a licensed nutritionist.                                                                         
                                                                                                                                
CHAIRMAN ROKEBERG indicated the bill allows for letters or titles                                                               
that appear on all signs, stationery, et cetera.  He noted they are                                                             
almost required to have initials.                                                                                               
                                                                                                                                
MS. WILD replied she would say "LN."  She added that she is close                                                               
to becoming a registered dietician.  In response to the chairman's                                                              
comment, she noted would be able to have more initials.                                                                         
                                                                                                                                
CHAIRMAN ROKEBERG mentioned the bill requirements to become a                                                                   
licensed nutritionist.  He noted there is also a reciprocity                                                                    
provision which would apply in Ms. Wild's case because she is                                                                   
already certified ["registered"] in Washington.                                                                                 
                                                                                                                                
Number 1808                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI commented she assumes Ms. Wild had to do                                                               
an internship-type work experience under the supervision of another                                                             
licensed or certified dietician or nutritionist, within the process                                                             
of her Washington State certification.                                                                                          
                                                                                                                                
MS. WILD explained that to become certified in Washington, she is                                                               
required to have a master's degree, as opposed to a bachelor's                                                                  
degree which is the minimum to be a dietician.  Washington also                                                                 
requires completion of a special training course in HIV/AIDS [human                                                             
immunodeficiency virus/acquired immunodeficiency virus].  She is                                                                
currently undergoing an 1,020-hour internship program.                                                                          
                                                                                                                                
REPRESENTATIVE MURKOWSKI noted that was the direction she was                                                                   
going.  She mentioned the 900 hours in the legislation, questioning                                                             
whether that is reasonable, in Ms. Wild's opinion, based on her                                                                 
Washington experience.                                                                                                          
                                                                                                                                
MS. WILD replied she thinks it is.  It is equivalent to the                                                                     
registered dietician internship program.  She noted there are a                                                                 
variety of ways that experience can be obtained:  in a community                                                                
setting, possibly working for WIC, a school district, the state                                                                 
Department of Education, individual counseling, teaching classes,                                                               
et cetera.  Ms Wild indicated she has experience with her own                                                                   
business doing individual counseling.                                                                                           
                                                                                                                                
REPRESENTATIVE HALCRO questioned where some of Ms. Wild's                                                                       
individual clients came from, noting the phone book example and                                                                 
also mentioning referrals.                                                                                                      
                                                                                                                                
MS. WILD responded that a lot come from word-of-mouth referrals, or                                                             
referrals from other health care professionals in the community.                                                                
She noted a lot of people do say, because she always asks how they                                                              
heard of her, that they found her name in the phone book.                                                                       
                                                                                                                                
Number 1908                                                                                                                     
                                                                                                                                
CATHERINE REARDON, Director, Division of Occupational Licensing,                                                                
Department of Commerce and Economic Development (DCED), came                                                                    
forward.  If this legislation passes into law, the division will be                                                             
administering the program directly; there will not be a licensing                                                               
board.  Ms. Reardon said she does not have a lot to add and is                                                                  
available for questions regarding the fiscal note or any other                                                                  
aspect.  Because the division will be administering the program,                                                                
she has no concerns about the legislation's wording.                                                                            
                                                                                                                                
REPRESENTATIVE MURKOWSKI referred to the grounds for suspension,                                                                
revocation, or refusal to issue a license [Sec. 08.38.040].  She                                                                
noted one of the items is basically a determination that someone                                                                
has become unfit due to either professional incompetency, alcohol                                                               
or drug addiction, or physical or mental disability.                                                                            
Representative Murkowski questioned how the division, without a                                                                 
board, would make a determination that someone has an alcohol                                                                   
dependency, for example, which renders them unfit.  [Sec. 08.38.040                                                             
of CSSB 88(FIN) read:                                                                                                           
                                                                                                                                
          Sec. 08.38.040.  Grounds for suspension, revocation,                                                                  
     or refusal to issue a license.  The department may refuse                                                                  
     to issue a license or impose a disciplinary sanction                                                                       
     authorized under AS 08.01.075 on an individual licensed                                                                    
     under this chapter when the department finds that the                                                                      
     license applicant or licensee, as applicable,                                                                              
          (1) secured or attempted to secure a license through                                                                  
     deceit, fraud, or intentional misrepresentation;                                                                           
          (2) engaged in deceit, fraud, or intentional                                                                          
     misrepresentation in the course of providing professional                                                                  
     services or engaging in professional activities;                                                                           
          (3) advertised professional services in a false or                                                                    
     misleading manner;                                                                                                         
          (4) has been convicted of a felony or of another                                                                      
     crime that affects the licensee's ability to continue to                                                                   
     practice competently and safely;                                                                                           
          (5) failed to comply with this chapter, with a                                                                        
     regulation adopted under this chapter, or with an order                                                                    
     of the department;                                                                                                         
          (6) continued dietetics or nutrition practice after                                                                   
     becoming unfit due to                                                                                                      
               (A) professional incompetence;                                                                                   
               (B) addiction or severe dependency on alcohol                                                                    
          or a drug that impairs the licensee's ability to                                                                      
          practice safely;                                                                                                      
               (C) physical or mental disability; or                                                                            
          (7) engaged in lewd or immoral conduct in connection                                                                  
     with the delivery of professional service to patients.                                                                     
                                                                                                                                
MS. REARDON answered that the process is very similar to when there                                                             
is a board.  However, the commissioner of the department serves in                                                              
the capacity of the board.  Even when there are boards, it is                                                                   
division staff who investigate complaints.  Ms. Reardon noted                                                                   
generally it is going to be citizen complaint driven, unless the                                                                
division somehow learns on its own of something troubling.                                                                      
Therefore, a citizen complaint is received, the division                                                                        
investigates it and sees if it has sufficient evidence to prove the                                                             
grounds for the complaint in a hearing process.  The division works                                                             
with the Department of Law to determine whether it has sufficient                                                               
evidence.  The Department of Law reviews the division's formal                                                                  
accusation documents before the documents are issued under the                                                                  
division's name.  Often the division has to hire expert witnesses                                                               
because division staff asserting someone treated a client                                                                       
improperly would not be that convincing in a hearing.                                                                           
                                                                                                                                
Number 2001                                                                                                                     
                                                                                                                                
MS. REARDON continued that the division does a formal charging                                                                  
document, and almost always the person decides to defend                                                                        
himself/herself.  There is a hearing before the department hearing                                                              
officer under the Administrative Procedure Act [AS 44.62]; the                                                                  
division is represented by the Department of Law, the accused                                                                   
either represents himself/herself or has an attorney.  The hearing                                                              
officer makes a proposed decision.  When there is a board, the                                                                  
decision proposed by the hearing officer goes to the board for                                                                  
adoption or rejection.  When there is no board, the hearing                                                                     
officer's proposed decision goes the department's commissioner for                                                              
adoption or rejection.  Ms. Reardon noted there are 15 or 16                                                                    
programs without boards, two examples are acupuncturists and                                                                    
naturopaths.  She commented the other place the department serves                                                               
in the board's capacity is in the adoption of regulations.  This                                                                
means participation from the professionals and the public will be                                                               
particularly important when the department public notices proposed                                                              
regulations, since there won't be a board to provide that necessary                                                             
input.                                                                                                                          
                                                                                                                                
REPRESENTATIVE MURKOWSKI noted the penalty provision provided on                                                                
page 1 of CSSB 88(FIN) imposed on those who use the title of                                                                    
nutritionist or licensed dietitian without actually being licensed.                                                             
She asked, then, if it would be the department that would impose a                                                              
fine based on a consumer complaint.  [This language regarding the                                                               
penalties in CSSB 88(FIN) read:                                                                                                 
                                                                                                                                
          Sec. 08.38.010.  License required. (a) An individual                                                                  
     may not, unless licensed as a dietician or nutritionist                                                                    
     by the department, use the title of "dietician,"                                                                           
     "licensed dietician," "nutritionist," "licensed                                                                            
     nutritionist," or an occupational title using the word                                                                     
     "dietician" or "nutritionist."                                                                                             
          (b) The only penalty that may be imposed on an                                                                        
     individual who engages in conduct that violates (a) of                                                                     
     this section is a fine of not more than $1,000 under a                                                                     
     citation issued under AS 08.01.102 - 08.01.104.                                                                            
          (c) An individual who obtains or attempts to obtain                                                                   
     a dietician or nutritionist license by dishonest or                                                                        
     fraudulent means or who forges, counterfeits, or                                                                           
     fraudulently alters a dietitian or nutritionist license,                                                                   
     is punishable by a fine or not more than $1,000 under a                                                                    
     citation issued by the department.  For a citation under                                                                   
     this subsection , the department shall use the citation                                                                    
     procedures applicable to citations for unlicensed                                                                          
     practice under AS 08.01.102 - 08.01.104, and an                                                                            
     individual who receives a citation under this subsection                                                                   
     is subject to the same requirements as an individual who                                                                   
     receives a citation under AS 08.01.102 - 08.01.104.]                                                                       
                                                                                                                                
MS. REARDON answered in the affirmative, although to enforce the                                                                
fine the department would probably need to go to the court system.                                                              
Ms. Reardon explained that this in lieu of the misdemeanor language                                                             
often seen in the department's statutes for unlicensed activity.                                                                
Any action would almost always be in response to citizen                                                                        
complaints; the department does not initiate a lot of enforcement                                                               
actions on its own without a complaint.                                                                                         
                                                                                                                                
Number 2106                                                                                                                     
                                                                                                                                
REPRESENTATIVE HALCRO referred to language in the fiscal note:                                                                  
"The division of occupational licensing anticipates existing staff                                                              
will perform the licensing and investigative functions; however,                                                                
like all licensing programs, time spent on this program will be                                                                 
based on positive timekeeping."  He questioned what "positive                                                                   
timekeeping" is.                                                                                                                
                                                                                                                                
MS. REARDON indicated this is somewhat licensing jargon.  The                                                                   
division employees' record on their biweekly time sheets which                                                                  
professions they spent time on and how much time per day per                                                                    
profession.  This is how the division figures out how much to bill                                                              
each profession during the year for the division's efforts.                                                                     
                                                                                                                                
REPRESENTATIVE HALCRO mentioned the licensing fees, noting it is                                                                
being assumed that 100 people will apply for these licenses.                                                                    
Representative Halcro mentioned other boards and commissions,                                                                   
especially with biennial licensing where there is a peak [in                                                                    
funding].  He questioned if any money left over in a licensing                                                                  
program remains credited to that program.                                                                                       
                                                                                                                                
MS. REARDON answered in the affirmative, noting this would be                                                                   
dependent on the front section of the state budget language                                                                     
continuing as it has since fiscal year (FY) 1995.  Unexpended                                                                   
occupational licensing fee revenue rolls forward to the next year.                                                              
Program deficits also roll forward.  If the division spends more                                                                
for a program than was brought in for it, the program has to pay                                                                
that back so that the other professions can be reimbursed.                                                                      
                                                                                                                                
Number 2189                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI referred to Section 4 of CSSB 88(FIN)                                                                  
which allows individuals until June 30, 2001, to come into                                                                      
compliance with this Act.  She commented this would give a person                                                               
about a year once the legislation became law, although the                                                                      
sectional analysis notes the legislation would give a person                                                                    
approximately 1-1/2 years to get everything in order.                                                                           
Representative Murkowski noted, however, the sectional analysis was                                                             
probably drafted at the same the legislation was introduced.  She                                                               
asked Ms. Reardon if this time frame is reasonable, given                                                                       
discussions they have had on similar issues this session.                                                                       
                                                                                                                                
MS. REARDON commented she thinks they would be able to get moving                                                               
somewhat more quickly because there is no board and corresponding                                                               
appointments.  She could conceive that some regulations might need                                                              
to be written regarding the 900 hours of work experience for                                                                    
nutritionists ["(B) has completed a documented work experience in                                                               
human nutrition or human nutrition research of at least 900                                                                     
hours."].  These regulations might entail defining what the work                                                                
experience is that would count for an internship or something                                                                   
similar; this would cause a small amount of delay.  However, Ms.                                                                
Reardon said she would hope the division would have the application                                                             
forms and regulations by this January [2000].  This scenario is                                                                 
more likely than 1-1/2 years.  She said it is unlikely the division                                                             
would begin processing licenses on July 1, 1999.  Ms. Reardon noted                                                             
she would also defer somewhat to the bill sponsor.                                                                              
                                                                                                                                
Number 2282                                                                                                                     
                                                                                                                                
SENATOR DONLEY responded a normal workday for 6 months would be                                                                 
approximately 900 hours.  A person would not have to get this work                                                              
experience until July 1, 2001.  Therefore, people would have all of                                                             
the year 2000 and until July 1, 2001, so it is still quite a ways                                                               
away.                                                                                                                           
                                                                                                                                
MS. REARDON commented she had not done her math correctly.                                                                      
                                                                                                                                
CHAIRMAN ROKEBERG invited Ms. Wild to join the committee at the                                                                 
table and asked her to explain the 900-hour requirement.  He                                                                    
mentioned there were two different directions to go for                                                                         
nutritionists.                                                                                                                  
                                                                                                                                
MS. WILD informed the committee that there are possibly two                                                                     
nutritionists in the state of Alaska currently, herself and maybe                                                               
one other person.  She noted the vast majority of the people are                                                                
already dieticians.  Both the people they know of have already                                                                  
completed that [work] experience.  She thinks a grandfather clause                                                              
was included in case there is someone else unknown out there.  Ms.                                                              
Wild indicated the grandfather clause gives a person time, if                                                                   
he/she has the degree, to complete the work experience requirement,                                                             
and it seems sufficient to them.  She commented they think                                                                      
possessing the master's degree is very important.                                                                               
                                                                                                                                
Number 2341                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG asked for confirmation that bachelor's degrees in                                                             
the field of nutrition are given.                                                                                               
                                                                                                                                
MS. WILD agreed, noting this bachelor of science degree in                                                                      
nutrition is the minimum requirement for a dietician.  A dietician                                                              
must have a bachelor's or above, a nutritionist must have a                                                                     
master's or above.  She commented the master's degree takes two to                                                              
three years to obtain.  In addition, in her case at least, there is                                                             
on-the-job training, practicums in different areas, counseling                                                                  
experience, several quarters in clinic working one-on-one with                                                                  
patients in the hospital or clinical setting.  She said, therefore,                                                             
it is very similar.                                                                                                             
                                                                                                                                
CHAIRMAN ROKEBERG confirmed the dietician is not required to have                                                               
a master's degree.  However, he indicated it is somewhat ironic                                                                 
that dietician is the highest designation in the profession.                                                                    
                                                                                                                                
MS. WILD explained that the dietician has the bachelor's degree,                                                                
the 900-hour internship program, and has passed the examination                                                                 
from the American Dietetic Association.  The nutritionist has a                                                                 
master's degree, which takes two or three years to obtain, and the                                                              
900-hour work experience.  Those are equivalent work experiences.                                                               
She commented it is a different group; for one reason or another                                                                
there are people called nutritionists who have not gone through the                                                             
internship program and the registration through the American                                                                    
Dietetic Association.  This legislation recognizes that there are                                                               
other professionals in the nutrition field who have not chosen, for                                                             
one reason or another, to become registered dieticians.  Ms. Wild                                                               
added that they feel this is quite appropriate.                                                                                 
                                                                                                                                
Number 2421                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG confirmed, then, it is a difference in                                                                        
nomenclature rather than a significant difference in terms of                                                                   
academic backgrounds and requirements.                                                                                          
                                                                                                                                
MS. WILD confirmed the educational experiences would be relatively                                                              
parallel.  The dietician would tend to have his/her experience in                                                               
a hospital setting.  The nutritionist would tend to be more likely                                                              
to have his/her experience in a community or educational sort of                                                                
setting, rather than a hospital setting per se.                                                                                 
                                                                                                                                
CHAIRMAN ROKEBERG confirmed, then, the recommendation that someone                                                              
shouldn't go to a dietician but instead to a nutritionist because                                                               
of a difference in knowledge wouldn't necessarily be correct.  The                                                              
chairman continued, "It depends on their own personal knowledge and                                                             
background and specialties."                                                                                                    
                                                                                                                                
MS. WILD said, "The - the..." [TESTIMONY INTERRUPTED BY AUTOMATIC                                                               
TAPE CHANGE]                                                                                                                    
                                                                                                                                
[From tape log notes: 'different initials']                                                                                     
                                                                                                                                
TAPE 51, SIDE B                                                                                                                 
Number 0001                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG requested Ms. Reardon rejoin the committee.                                                                   
                                                                                                                                
REPRESENTATIVE MURKOWSKI noted she thinks this is a question for                                                                
everyone - for the sponsor, Ms. Wild and possibly anyone else who                                                               
wishes to join in.  Representative Murkowski commented she had                                                                  
raised the point earlier about the 900-hour work experience being                                                               
under the supervision of a registered dietitian or nutrition                                                                    
professional, at least for the federal requirements.  She                                                                       
questioned if they needed to indicate on page 2, line 23 ["22"]                                                                 
where this work experience is coming from or that it should be                                                                  
under the supervision of a registered dietitian or nutrition                                                                    
professional; or if, in their experience, that is just how it                                                                   
happens [CSSB 88(FIN), page 2, lines 23 and 24,"(B) has completed                                                               
a documented work experience in human nutrition or human nutrition                                                              
research of at least 900 hours."].                                                                                              
                                                                                                                                
MS. WILD responded she thinks that when the department adopts                                                                   
regulations, the regulations would define what the parameters of                                                                
that work experience are in the areas of nutrition.  She noted it                                                               
may or may not be under the supervision of a registered dietician,                                                              
or it may be a combination of things.                                                                                           
                                                                                                                                
MS. REARDON added it seems like there is a concern that if the                                                                  
department did not adopt regulations requiring that type of                                                                     
supervision, that possibly the licenses would not achieve the goal                                                              
in terms of Medicare reimbursement.  Therefore, Ms. Reardon                                                                     
indicated it would be pretty essential the department adopt                                                                     
regulations which require that type of supervision, if this is the                                                              
intention.                                                                                                                      
                                                                                                                                
Number 0075                                                                                                                     
                                                                                                                                
SENATOR DONLEY indicated, however, the federal law has not passed                                                               
so it somewhat depends on the final version of that legislation.                                                                
                                                                                                                                
CHAIRMAN ROKEBERG confirmed this relates to Medicare.                                                                           
                                                                                                                                
SENATOR DONLEY indicated, then, the current language in subsection                                                              
(B) on page 2 of CSSB 88(FIN) provides the department with some                                                                 
flexibility to address the work experience, depending on what the                                                               
federal law would consider title licensure.                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI noted, then, it would be the sponsor's                                                                 
preference to leave it as is and address it within the regulations                                                              
when the regulations come up.                                                                                                   
                                                                                                                                
SENATOR DONLEY answered in the affirmative.                                                                                     
                                                                                                                                
MS. WILD added that the proposed [federal] legislation for Medicare                                                             
reimbursement says "licensed nutritional professionals in their                                                                 
state".  She said the legislation proposed in Alaska is quite                                                                   
similar to the legislation that has gone through the other states.                                                              
                                                                                                                                
REPRESENTATIVE MURKOWSKI said that satisfies her.                                                                               
                                                                                                                                
Number 0115                                                                                                                     
                                                                                                                                
REPRESENTATIVE HALCRO mentioned fly-by-night operations and misuse                                                              
of the titles.  He asked Senator Donley where the enforcement is.                                                               
                                                                                                                                
SENATOR DONLEY answered that there is a provision that the person                                                               
can be cited for up to $1,000 by the department.  He noted this                                                                 
citation could occur if there was a consumer complaint or if the                                                                
department did its own investigation.  Senator Donley said it would                                                             
not be a crime, it would simply be a citation.                                                                                  
                                                                                                                                
REPRESENTATIVE HALCRO asked who would issue the citation.                                                                       
                                                                                                                                
MS. REARDON answered the Department of Commerce and Economic                                                                    
Development, under AS 08.01.  She  noted the department has an                                                                  
entire section of law that speaks about citations.                                                                              
                                                                                                                                
SENATOR DONLEY commented he thinks citations are a good way to go                                                               
in a regulatory system because the behavior is not being                                                                        
criminalized; it is a much simpler procedural system to go through.                                                             
                                                                                                                                
Number 0166                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG referred to the $31,000 fiscal note, mentioning                                                               
it looked a bit high.  He asked if the licensing examiner would be                                                              
drafting the regulations or what.                                                                                               
                                                                                                                                
MS. REARDON responded the $31,000 is for two years, pointing out                                                                
that the chairman is looking at the "revenue" line.  The division                                                               
is planning on spending $15,500 a year, but was showing it would                                                                
probably receive most of the money in one year because of the                                                                   
biennial renewal cycle.  The spending breakdown is on the second                                                                
page of the fiscal note.  Ms. Reardon informed the chairman she has                                                             
asked for a quarter-time range 12 licensing examiner for $8,500;                                                                
the remaining $7,000 is in contractual services and supplies.                                                                   
These costs would include AG [attorney general] time and phone,                                                                 
postage, printing and advertising costs for regulations and things                                                              
like that.  Ms. Reardon expressed that it is difficult to predict                                                               
in advance how much time something will take.  However, she                                                                     
anticipates that at least for the first two years, a quarter of                                                                 
range 12 is not unreasonable.  She indicated there will be others                                                               
working on this program but extra funds were not requested for                                                                  
their services.  There is a range 16 regulation specialist who                                                                  
helps with the writing of regulations, some supervisors will assist                                                             
the range 12, but this will just be part of everyone's daily job.                                                               
Therefore, she is estimating about one day a week of a licensing                                                                
examiner would be appropriate for the first year or two.  Ms.                                                                   
Reardon indicated the examiner would be handling the telephone                                                                  
calls, information requests, et cetera, from all of the 100 or so                                                               
potential licensees.                                                                                                            
                                                                                                                                
Number 0246                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG questioned the fiscal note language, "Provides                                                                
2.5 months of an Occupational Licensing Examiner I position, Range                                                              
12, $8.5 [$8,500]."  He noted the 2.5 months and the quarter time,                                                              
asking if most state employees only worked 10 months a year.                                                                    
                                                                                                                                
MS. REARDON commented she had overestimated - they are asking for                                                               
a bit less than quarter time.  She noted it's not really possible                                                               
to hire a quarter-time person; she has a half-time employee whose                                                               
time she would intend to increase by an hour or two per day.                                                                    
                                                                                                                                
CHAIRMAN ROKEBERG commented this is not the House Finance Standing                                                              
Committee either, but he is concerned by her 50-50 overhead to                                                                  
services.  [From the 3/26/99 fiscal note:  "REVENUE & FUND SOURCE:                                                              
Revenue will be generated by the licensing fees sufficient to cover                                                             
program costs.  Approximately 100 licensees are expected to seek                                                                
licensure and renew licenses biennially.  Licensing fees must cover                                                             
direct costs plus approximately $100 per licensee for                                                                           
division/department overhead for the two-year period.  Based on 100                                                             
licensees, licensing fees are estimated to be $410.00 for the first                                                             
biennium , and adjusted to actual costs based on positive                                                                       
timekeeping for the first renewal."]                                                                                            
                                                                                                                                
MS. REARDON responded she was probably waving a "red flag" by                                                                   
typing that, but indicated it is included in the interests of                                                                   
honesty.  She added "overhead" might not be the most delicate way                                                               
of putting it.  However, it is costing the department about that                                                                
amount for every licensee.  This would be all costs the department                                                              
does not attribute down to the profession level; for example:  her                                                              
time at this hearing, the receptionists' answering the telephone.                                                               
Ms. Reardon noted there are a variety of employees who would be                                                                 
providing real services but whose services cannot be tracked                                                                    
efficiently at the profession level.  She noted there are real                                                                  
things like receptionists, people who open the mail, photocopier                                                                
costs, that are billed out as overhead.                                                                                         
                                                                                                                                
Number 0322                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI referred to the exemptions, questioning                                                                
why federal government employees and those in the armed services                                                                
would be exempted.  Additionally, she asked if there are really                                                                 
animal nutritionists, and if so, she needs the name of one.                                                                     
                                                                                                                                
MR. WRAY answered that there is an individual who teaches animal                                                                
nutrition at the University of Alaska Fairbanks and is a Ph.D.  Mr.                                                             
Wray explained all the other 39 states with licensure/certification                                                             
have the same exemption.                                                                                                        
                                                                                                                                
REPRESENTATIVE MURKOWSKI asked about the exemptions for the                                                                     
military and the federal government.                                                                                            
                                                                                                                                
SENATOR DONLEY responded they just felt it was appropriate for                                                                  
someone who is working for the armed forces or the federal                                                                      
government.  The government will be controlling that person; it is                                                              
not as if the person is out in the open marketplace offering                                                                    
his/her services.                                                                                                               
                                                                                                                                
REPRESENTATIVE BRICE noted it is a practice commonly used as well                                                               
with the other professions.  The state does exempt federal                                                                      
employees and military employees from licensure.                                                                                
                                                                                                                                
REPRESENTATIVE HALCRO indicated he had posed this question earlier                                                              
that day to Ms. Wild.  If someone is in the military and is using                                                               
the title dietician or nutritionist, the legislation clearly states                                                             
the person needs to be licensed if he/she is using the title                                                                    
outside the scope of the person's military service.  Representative                                                             
Halcro noted, however, it does not dictate that for a federal                                                                   
government employee and he asked if there is a reason for that,                                                                 
mentioning the possibility of someone moonlighting.                                                                             
                                                                                                                                
Number 0407                                                                                                                     
                                                                                                                                
SENATOR DONLEY answered there was no particular reason other than                                                               
that a specific circumstance was being addressed in subsection (3)                                                              
[of the exemptions].  He noted it could be made to apply to both                                                                
and they have language available if that is the committee's will.                                                               
[The exemptions section of CSSB 88(FIN) read:                                                                                   
                                                                                                                                
          Sec. 08.38.080.  Exemption.  The requirements of                                                                      
     this chapter do not apply to                                                                                               
          (1) an animal nutritionist whose activities are                                                                       
     limited to the nutritional care of animals; animal                                                                         
     nutritionists may use the title "nutritionist" as long as                                                                  
     they provide nutrition services only to animals;                                                                           
          (2) a person who is serving as an employee of the                                                                     
     federal government whose job title includes the term                                                                       
     "dietician" or "nutritionist"; or                                                                                          
          (3) a person who is serving as a dietician or                                                                         
     nutritionist in the armed forces of the United States,                                                                     
     but the exemption provided under this paragraph does not                                                                   
     authorize the person to use the title "dietician,"                                                                         
     "licensed dietician," "nutritionist," "licensed                                                                            
     nutritionist," or an occupational title using the word                                                                     
     "dietician" or "nutritionist" outside the scope of the                                                                     
     person's military service.]                                                                                                
                                                                                                                                
REPRESENTATIVE HALCRO indicated he had simply been curious.                                                                     
                                                                                                                                
MR. WRAY commented, regarding the military exemptions, that                                                                     
Elmendorf Airforce Base hospital has a dietician and there are                                                                  
number of dietitians in active military reserve.  These dieticians                                                              
have all told him the direction received from their superiors, at                                                               
their commanders' discretion - and he noted this applies to all                                                                 
health professions - is that person should obtain licensure in the                                                              
state he/she is assigned to if licensure exists for his/her                                                                     
specific health care field.  Mr. Wray indicated it had not been the                                                             
intention to dictate this with the legislation's language, adding,                                                              
"If it's their call, they make that call themselves ...."                                                                       
                                                                                                                                
CHAIRMAN ROKEBERG asked Mr. Wray if medical schools are now                                                                     
including an integrated degree of nutritional training.  He noted                                                               
they had never done anything in the past.                                                                                       
                                                                                                                                
MR. WRAY replied his understanding is that it varies greatly.                                                                   
There is some emphasis, but on the other hand, medical school is                                                                
"no walk in the park."  He noted there is not a lot of free time                                                                
and trying to throw in electives is probably very difficult for any                                                             
sort of regular medical school program.  His understanding is that                                                              
most medical school curriculums do offer a basic nutritional                                                                    
program.  Mr. Wray referred to Representative Halcro's question                                                                 
about where Ms. Wild receives her patients; Mr. Wray receives all                                                               
of his from physician referrals.  Physicians basically count on him                                                             
to teach nutrition to the patients, knowing that dieticians have a                                                              
level of knowledge the physicians didn't have a chance to get in                                                                
medical school.                                                                                                                 
                                                                                                                                
Number 0505                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG questioned the sponsor if there is anything in                                                                
the legislation that would require a payment to a dietician or a                                                                
nutritionist under an insurance contract that would not otherwise                                                               
be made without the bill.  The chairman asked if there is anything                                                              
in this legislation which require an insurance company to make                                                                  
payments they would not have to make otherwise.                                                                                 
                                                                                                                                
SENATOR DONLEY replied he guesses it would depend on the insurance                                                              
contract.  In response to the chairman's comment, the senator                                                                   
answered that if a company wrote a contract which said the company                                                              
would pay a person's costs for a licensed dietician, then the                                                                   
company would be obligated to do that if the state licenses                                                                     
dieticians.                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG noted he thinks the answer is correct but doesn't                                                             
believe it is typically a covered area.  The chairman asked for Mr.                                                             
Wray's assistance.                                                                                                              
                                                                                                                                
Number 0553                                                                                                                     
                                                                                                                                
MR. WRAY responded his understanding, from the other 39 states with                                                             
licensure/certification, is that there has been no additional cost                                                              
to any insurance companies involved.  He said he would echo Senator                                                             
Donley's comment, stating, "What you find ... in the health care                                                                
reimbursement is the big player who's dictating the field is HCFA                                                               
[Health Care Financing Administration, United States Department of                                                              
Health and Human Services], the people who administer Medicare."                                                                
He commented HCFA decides the service is going to be covered.  Many                                                             
times years later, the insurance companies may decide to cover                                                                  
those services, but may not.  Currently some of his services are                                                                
covered by insurance companies and some are not; it is the                                                                      
insurance company's prerogative.                                                                                                
                                                                                                                                
CHAIRMAN ROKEBERG commented that Alaska has an unusual insurance                                                                
statute - it has a special section or list.  The chairman indicated                                                             
he did not see "dietician" or "nutritionist" appearing on that list                                                             
and simply wanted to put it on the record.                                                                                      
                                                                                                                                
SENATOR DONLEY said perhaps another way to answer the chairman's                                                                
question is that nothing in this bill mandates that this is covered                                                             
by insurance.                                                                                                                   
                                                                                                                                
CHAIRMAN ROKEBERG asked the pleasure of the committee.                                                                          
                                                                                                                                
Number 0605                                                                                                                     
                                                                                                                                
REPRESENTATIVE HALCRO made a motion to move CSSB 88(FIN) out of                                                                 
committee with individual recommendations and the attached fiscal                                                               
note.  There being no objection, CSSB 88(FIN) moved out of the                                                                  
House Labor and Commerce Standing Committee.                                                                                    
                                                                                                                                
Number 0619                                                                                                                     
                                                                                                                                
CHAIRMAN ROKEBERG called an at-ease at 4:26 p.m.  The committee                                                                 
came back to order at 4:47 p.m.                                                                                                 
                                                                                                                                

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