Legislature(2023 - 2024)BARNES 124
05/06/2024 03:15 PM House LABOR & COMMERCE
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SB89 | |
SB115 | |
Adjourn |
* first hearing in first committee of referral
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+ | SB 182 | TELECONFERENCED | |
+ | SB 234 | TELECONFERENCED | |
+ | SB 115 | TELECONFERENCED | |
+ | TELECONFERENCED | ||
+ | HJR 27 | TELECONFERENCED | |
+= | SB 89 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE HOUSE LABOR AND COMMERCE STANDING COMMITTEE May 6, 2024 7:10 p.m. MEMBERS PRESENT Representative Jesse Sumner, Chair Representative Justin Ruffridge, Vice Chair Representative Stanley Wright Representative Mike Prax Representative Ashley Carrick Representative Dan Saddler Representative Zack Fields MEMBERS ABSENT COMMITTEE CALENDAR CS FOR SENATE BILL NO. 89(FIN) "An Act relating to tobacco, tobacco products, electronic smoking products, nicotine, and products containing nicotine; raising the minimum age to purchase, exchange, or possess tobacco, a product containing nicotine, or an electronic smoking product; relating to the tobacco use education and cessation fund; relating to the taxation of electronic smoking products and vapor products; and providing for an effective date." - MOVED HCS CSSB 89(L&C) OUT OF COMMITTEE CS FOR SENATE BILL NO. 115(HSS) AM "An Act relating to physician assistants; relating to physicians; and relating to health care insurance policies." - HEARD & HELD SENATE BILL NO. 182 "An Act extending the termination date of the Big Game Commercial Services Board; and providing for an effective date." - BILL HEARING RESCHEDULED TO 5/8/24 SENATE BILL NO. 234 "An Act relating to the Marijuana Control Board; and providing for an effective date." - BILL HEARING RESCHEDULED TO 5/8/24 HOUSE JOINT RESOLUTION NO. 27 Supporting trade policies for the United States that hold China, Russia, and other countries accountable, reward leadership in clean production standards, reward superior environmental performance, support economic development, and support the rebuilding of supply chains in the United States. - BILL HEARING RESCHEDULED TO 5/8/24 PREVIOUS COMMITTEE ACTION BILL: SB 89 SHORT TITLE: AGE FOR TOBACCO/NICOTINE/E-CIG; TAX E-CIG SPONSOR(s): SENATOR(s) STEVENS 3/1/2023 (S) READ THE FIRST TIME REFERRALS 3/1/2023 (S) L&C, FIN 3/1/2023 (S) COSPONSOR(S): GIESSEL, GRAY-JACKSON, KIEHL, TOBIN 3/24/2023 (S) LABOR & COMMERCE at 01:30 PM BELTZ 105 (TSBldg) 3/24/2023 (S) Heard & Held 3/24/2023 (S) Minutes (SL&C) 3/31/2023 (S) LABOR & COMMERCE at 01:30 PM BELTZ 105 (TSBldg) 3/31/2023 (S) Heard & Held 3/31/2023 (S) Minutes (SL&C) 4/3/2023 (S) LABOR & COMERCE at 01:30 PM BELTZ 105 (TSBldg) 4/3/2023 (S) Heard & Held 4/3/2023 (S) Minutes (SL&C) 4/21/2023 (S) LABOR & COMMERCE at 01:30 PM BELTZ 105 (TSBldg) 4/21/2023 (S) Moved CSSB 89(L&C) Out of Committee 4/21/2023 (S) Minutes (SL&C) 4/24/2023 (S) L&C RPT CS 4DP NEW TITLE 4/24/2023 (S) DP: BJORKMAN, DUNBAR, BISHOP, GRAY-JACKSON 4/24/2023 (S) FN1: ZERO(CED) 4/24/2023 (S) FN2: ZERO(ADM) 4/24/2023 (S) FN3: ZERO(ADM) 4/24/2023 (S) FN4: ZERO(DOH) 4/24/2023 (S) FN5: (REV) 4/24/2023 (S) FN6: ZERO(DPS) 4/24/2023 (S) FN7: ZERO(LAW) 5/4/2023 (S) FINANCE at 09:00 AM SENATE FINANCE 532 5/4/2023 (S) Heard & Held 5/4/2023 (S) Minutes (SFIN) 5/11/2023 (S) FINANCE at 9:00 AM SENATE FINANCE 532 5/11/2023 (S) Moved CSSB 89(FIN) Out of Committee 5/11/2023 (S) Minutes (SFIN) 5/11/2023 (S) FINANCE at 01:30 PM SENATE FINANCE 532 5/11/2023 (S) <Bill Hearing Canceled> 5/11/2023 (S) Minutes (SFIN) 5/13/2023 (S) FIN RPT CS 3DP 2NR 1AM NEW TITLE 5/13/2023 (S) DP OLSON, KIEHL, BISHOP 5/13/2023 (S) NR: STEDMAN, MERRICK 5/13/2023 (S) AM: WILSON 5/13/2023 (S) FN1: ZERO(CED) 5/13/2023 (S) FN2: ZERO(ADM) 5/13/2023 (S) FN3: ZERO(ADM) 5/13/2023 (S) FN4: ZERO(DOH) 5/13/2023 (S) FN6: ZERO(DPS) 5/13/2023 (S) FN7: ZERO(LAW) 5/13/2023 (S) FN8: (REV) 5/13/2023 (S) FN9: ZERO(AJS) 5/13/2023 (S) RULES TO CALENDAR 5/13/23 5/13/2023 (S) READ THE SECOND TIME 5/13/2023 (S) FIN CS ADOPTED UC 5/13/2023 (S) ADVANCED TO THIRD READING 5/14 CAL 5/14/2023 (S) NOT TAKEN UP 5/14 - ON 5/15 CAL 5/15/2023 (S) READ THE THIRD TIME CSSB 89(FIN) 5/15/2023 (S) RETURN TO SECOND FOR AMDS UC 5/15/2023 (S) AM NO 1 FAILED Y5 N15 5/15/2023 (S) AM NO 2 FAILED Y5 N15 5/15/2023 (S) AUTOMATICALLY IN THIRD READING 5/15/2023 (S) HELD IN THIRD READING TO 5/16/CAL 5/16/2023 (S) PASSED Y14 N6 5/16/2023 (S) EFFECTIVE DATE(S) SAME AS PASSAGE 5/16/2023 (S) TRANSMITTED TO (H) 5/16/2023 (S) VERSION CSSB 89(FIN) 1/16/2024 (H) READ THE FIRST TIME REFERRALS 1/16/2024 (H) L&C, FIN 1/31/2024 (H) LABOR & COMMERCE at 03:15 PM BARNES 124 1/31/2024 (H) <Bill Hearing Canceled> 1/31/2024 (H) Minutes (HL&C) 2/9/2024 (H) LABOR & COMMERCE at 03:15 PM BARNES 124 2/9/2024 (H) -- MEETING CANCELED -- 2/28/2024 (H) LABOR & COMMERCE at 03:15 BARNES 124 2/28/2024 (H) -- MEETING CANCELED -- 3/4/2024 (H) LABOR & COMMERCE at 03:15 PM BARNES 124 3/4/2024 (H) Heard & Held 3/4/2024 (H) Minutes (HL&C) 5/6/2024 (H) LABOR & COMMERCE at 03:15 PM BARNES 124 BILL: SB 115 SHORT TITLE: PHYSICIAN ASSISTANT SCOPE OF PRACTICE SPONSOR(s): SENATOR(s) TOBIN BY REQUEST 3/27/2023 (S) READ THE FIRST TIME - REFERRALS 3/27/2023 (S) HSS, L&C 4/11/2023 (S) COSPONSOR(S): GIESSEL 1/23/2024 (S) HEALTH & SOCIAL SERVICES at 03:30PM BUTROVICH 205 1/23/2024 (S) Heard & Held 1/23/2024 (S) Minutes (SHSS) 1/31/2024 (S) COSPONSOR(S): GRAY-JACKSON, HUGHES 2/6/2024 (S) HEALTH & SOCIAL SERVICES at 03:30PM BUTROVICH 205 2/6/2024 (S) Heard & Held 2/6/2024 (S) Minutes (SHSS) 2/15/2024 (S) HEALTH & SOCIAL SERVICES at 03:30PM BUTROVICH 205 2/15/2024 (S) Moved CSSB 115(HSS) Out of Committee 2/15/2024 (S) Minutes (SHSS) 2/19/2024 (S) HSS RPT CS 3DP 2AM SAME TITLE 2/19/2024 (S) DP: WILSON, KAUFMAN, DUNBAR 2/19/2024 (S) AM: TOBIN, GIESSEL 2/19/2024 (S) FN1: ZERO(CED) 2/19/2024 (S) COSPONSOR(S): DUNBAR 2/28/2024 (S) LABOR & COMMERCE at 01:30 PM BELTZ 105 (TSBldg) 2/28/2024 (S) Heard & Held 2/28/2024 (S) Minutes (SL&C) 4/5/2024 (S) LABOR & COMMERCE at 01:30 PM BELTZ 105 (TSBldg) 4/5/2024 (S) Moved CSSB 115(HSS) Out of Committee 4/8/2024 (S) L&C RPT CS(HSS) 2DP 1NR 1AM 4/8/2024 (S) AM: BJORKMAN 4/8/2024 (S) DP: DUNBAR, BISHOP 4/8/2024 (S) NR: MERRICK 4/8/2024 (S) FN1: ZERO(CED) 4/22/2024 (S) RULES TO CALENDAR 4/22/2024 4/22/2024 (S) READ THE SECOND TIME 4/22/2024 (S) HSS CS ADOPTED UC 4/22/2024 (S) ADVANCED TO THIRD READING 4/24 CAL 4/24/2024 (S) READ THE THIRD TIME CSSB 115(HSS) 4/24/2024 (S) RETURN TO SECOND FOR AM 1 UC 4/24/2024 (S) AM NO 1 ADOPTED Y17 N3 4/24/2024 (S) AUTOMATICALLY IN THIRD READING 4/24/2024 (S) PASSED Y19 N1 4/24/2024 (S) TRANSMITTED TO (H) 4/24/2024 (S) VERSION CSSB 115(HSS) AM 4/26/2024 (H) READ THE FIRST TIME - REFERRALS 4/26/2024 (H) HSS, L&C 5/2/2024 (H) HEALTH & SOCIAL SERVICES at 03:00 PM DAVIS 106 5/2/2024 (H) Moved CSSB 115(HSS) AM Out of Committee -- Delayed to 20 Minutes Following Session 5/3/2024 (H) HSS RPT 5NR 1AM 5/3/2024 (H) NR: RUFFRIDGE, MCCORMICK, MINA, SADDLER, PRAX 5/3/2024 (H) AM: SUMNER 5/3/2024 (H) FN1: ZERO(CED) 5/6/2024 (H) LABOR & COMMERCE at 03:15 PM BARNES 124 WITNESS REGISTER TIM LAMKIN, Staff Senator Gary Stevens Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Provided the summary of changes for proposed under Version Y, a proposed House committee substitute for CSSB 89(FIN). BEVERLY WOOLEY, representing self Big Lake, Alaska POSITION STATEMENT: Testified in support of SB 89. JESSICA IVANOFF, representing self Nome, Alaska POSITION STATEMENT: Testified in support of SB 89. DOROTHY ARMSTRONG, representing self Anchorage, Alaska POSITION STATEMENT: Testified during the hearing on SB 89. SENATOR L?KI TOBIN Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, presented CSSB 115(HSS). HAROLD JOHNSTON, MD, Chair Policy & Advocacy Committee Alaska Primary Care Association (PCA) Anchorage, Alaska POSITION STATEMENT: Gave invited testimony in support of CSSB 115(HSS). JENNIFER FAYETTE, PA Anchorage, Alaska POSITION STATEMENT: Gave invited testimony in support of CSSB 115(HSS). KRISTIN M. MITCHELL, MD, FACP, President Alaska State Medical Association Soldotna, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). ROXANNE JONES, MD, Secretary of the Board Alaska Academy of Family Physicians Anchorage, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). CANDACE HICKEL, Physician Assistant Anchorage, Alaska POSITION STATEMENT: Testified in support of CSSB 115(HSS). KARI BERNARD, Physician Assistant Anchorage, Alaska POSITION STATEMENT: Testified in support of SB 115. BETSY DOUDS-PACVAN, PA, President Alaska Academy of Physician's Assistants Anchorage, Alaska POSITION STATEMENT: Testified in support of CSSB 115(HSS). KATHERINE VAN ATTA, PA Wasilla, Alaska POSITION STATEMENT: Testified in support of CSSB 115(HSS). DANIEL REYNOLDS, DO Fairbanks, Alaska POSITION STATEMENT: Testified in support of CSSB 115(HSS). CHRISTI FROILAND, PA Anchorage, Alaska POSITION STATEMENT: Testified in support of CSSB 115(HSS). ETHAN MCWILLIAMS, CEO Wilderness Medical Staffing (No address provided) POSITION STATEMENT: Testified in support of CSSB 115(HSS). MOLLY SOUTHWORTH, MD, Internist and Endocrinologist American College of Physicians, Alaska Chapter Anchorage, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). JOHNNA KOHL, MD Anchorage, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). MEGHAN HALL, PA Anchorage, Alaska POSITION STATEMENT: Testified in support in CSSB 115(HSS). MURRAY BUTTNER, MD Anchorage, Alaska POSITION STATEMENT: Testified in support of CSSB 115(HSS). MARGARET CARLSON, MD, Family Medicine Physician Anchorage, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). CAMILLA SULAK, MD, Board Member American College of Emergency Physicians, Alaska Chapter Anchorage, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). KATHRYNE MITCHELL, representing self Anchorage, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). DANA KERR, MD Juneau, Alaska POSITION STATEMENT: Testified in opposition to CSSB 115(HSS). GLENN SAVIERS, Deputy Director Division of Corporations, Business, & Professional Licensing Department of Commerce, Community & Economic Development (DCCED) Juneau, Alaska POSITION STATEMENT: Answered questions during the hearing on CSSB 115(HSS). ACTION NARRATIVE 7:10:50 PM CHAIR JESSE SUMNER called the House Labor and Commerce Standing Committee meeting to order at 7:10 p.m. Representatives Ruffridge, Wright, Carrick, and Sumner were present at the call to order. Representatives Prax, Saddler, and Fields arrived as the meeting was in progress. SB 89-AGE FOR TOBACCO/NICOTINE/E-CIG; TAX E-CIG 7:11:30 PM CHAIR SUMNER announced that the first order of business would be CS for SENATE BILL NO. 89(FIN), "An Act relating to tobacco, tobacco products, electronic smoking products, nicotine, and products containing nicotine; raising the minimum age to purchase, exchange, or possess tobacco, a product containing nicotine, or an electronic smoking product; relating to the tobacco use education and cessation fund; relating to the taxation of electronic smoking products and vapor products; and providing for an effective date." 7:11:41 PM REPRESENTATIVE RUFFRIDGE moved to adopt the proposed House committee substitute (HCS) to CSSB 89)FIN), Version 33-LS0247\Y, Nauman, 5/6/24, as the working document. REPRESENTATIVE CARRICK objected. 7:12:19 PM TIM LAMKIN, Staff, Senator Gary Stevens, Alaska State Legislature, provided the summary of changes for Version Y, the proposed House committee substitute for CSSB 89(FIN). He reiterated that Version Y would strike from the title and the remainder of the bill any reference to the new state tax program. He noted that that was the substance of the bill and offered to elaborate at the will of the committee. In response to Representative Ruffridge, he confirmed that that was the singular most substantive change proposed under Version Y. 7:13:29 PM REPRESENTATIVE CARRICK explained her objection to Version Y was the tax provision. 7:14:26 PM The committee took a brief at-ease 7:14 p.m. 7:15:01 PM REPRESENTATIVE FIELDS said that he supported Version Y but preferred to keep the tax (indisc.). 7:15:12 PM A roll call vote was taken. Representatives Ruffridge, Saddler, Wright, Fields, Prax, and Sumner voted in favor of adopting the proposed House committee substitute for CSSB 89(FIN), Version 33-LS0247\Y, Nauman, 5/6/24, as the working document. Representative Carrick voted against it. Therefore, Version Y was before the committee by a vote of 6-1. 7:15:42 PM CHAIR SUMNER opened public testimony on SB 89. 7:16:08 PM BEVERLY WOOLEY, representing self, testified in support of SB 89. She spoke about her work in public health and asked the committee to support keeping young people healthy by increasing the age to buy tobacco products and she also supported levying larger taxes. She gave examples of how effective the anti- nicotine program at the state helped youths. She pointed out that young people are price sensitive, and she offered her belief that the bill is an important step. 7:18:44 PM JESSICA IVANOFF, representing self, testified in support of SB 89. As a mother of teenagers, she spoke to her concern of vaping and the health risks that result from the use of these types of products, and offered further examples of the steps youths will take to obtain vaping products. She urged committee members to approve SB 89. 7:20:16 PM DOROTHY ARMSTRONG, representing self, stated that she was a high school senior and related how tobacco use affects people and the physical toll it took on them. She shared how the smells of the vapes are prevalent and that she could not avoid it in or outside the classroom. She stressed that people who are 19 attempt to sell vapes to youths but only some youths refuse. She stated she felt responsible to provide information to fellow students, and she thanked the committee for their time. 7:22:25 PM CHAIR SUMNER, after ascertaining that no one else wished to testify, closed public testimony on SB 89. 7:22:30 PM The committee took an at-ease from 7:22 p.m. to 7:23 p.m. 7:23:56 PM REPRESENTATIVE WRIGHT moved to report HCS CSSB 89, Version 33- LS0247\Y, Nauman, 5/6/24, out of committee with individual recommendations and the accompanying fiscal notes. 7:24:15 PM REPRESENTATIVE RUFFRIDGE objected. He said he is in support of the bill but in looking at language in Version Y around shipping. He offered a suggestion to hear from the U.S. Postal Service (USPS). CHAIR SUMNER listed other options in buying and receiving tobacco. REPRESENTATIVE RUFFRIDGE restated that his concern was the language surrounding the delivery of products and he pointed out that the deliverer would have to verify the person's age. He reiterated his uncertainty of how this would work. 7:27:25 PM MR. LAMKIN stated that the amendments [within Version Y] are conforming in nature and he related an example regarding buying an age-restricted product such as alcohol and there being a requirement to check the identification (ID) of the person receiving the product. It is common carrier language, he said. 7:28:24 PM REPRESENTATIVE PRAX commented that he knew nothing about how the products get shipped and said he would not expect that they are shipped through Lynden, but maybe FedEx or USPS. MR. LAMKIN reiterated that there is an allowance for "this type of thing" at USPS and it is common practice. When one is at the post office counter with an agent and the package has a label requiring age verification, the person picking up the package must be asked for proof of age. 7:29:26 PM REPRESENTATIVE FIELDS noted that the processes are already in place for alcohol so it should not be a big deal. 7:29:35 PM REPRESENTATIVE WRIGHT inquired whether someone who ordered tobacco online and were not home for the delivery would be required to go to the post office and show identification. MR. LAMKIN said he was not certain whether tobacco products are delivered through USPS, but if it were UPS or FedEx, the agent would have to check the recipient's ID upon delivering the product. REPRESENTATIVE WRIGHT offered his belief that it could cause a problem with people receiving their goods in a timely manner. MR. LAMKIN responded that there are a lot of components to the bill and indicated that continuing to ask more hypothetical questions would result in "losing sight of the ball." He suggested that committee members not lose track of the point of the bill. 7:31:23 PM CHAIR SUMNER pointed out that some packages need signatures whether they contain age restricted products or not. He gave personal examples of having to pick up packages at the post office after receiving a notice. REPRESENTATIVE WRIGHT reiterated his concern about those who cannot get to the post office after hours resulting in delays for people getting their goods. 7:32:38 PM REPRESENTATIVE RUFFRIDGE questioned what the process would look like, and whether or not it would cause some other step to be taken by those who have already had their identification checked. He said he would feel more at-ease about the shipping language in the proposed legislation if there were an understanding of the affidavit from the shipper. MR. LAMKIN replied that he did not know how to further articulate. If ID checks were eliminated, then youths would have easier access, he proffered. REPRESENTATIVE RUFFRIDGE stressed that the committee's intention was not to make tobacco easier to obtain. 7:36:05 PM REPRESENTATIVE CARRICK shared her confusion in reference to deliveries and what is in statute regarding [ID] verification. She further inquired about the conforming changes in the proposed legislation. MR. LAMKIN clarified that it was intended to target online sales and to put a stopgap on these products getting into the hands of youth. REPRESENTATIVE CARRICK asked whether the conforming language is new language being put in place. MR. LAMKIN confirmed that it is new language for electronic smoking products. 7:38:25 PM REPRESENTATIVE FIELDS referred to Title 11 and that there are prohibitions on selling to those underage. He shared anecdotes about receiving mail and signing for it. He noted special software that vendors can use for age verification online. 7:40:01 PM REPRESENTATIVE RUFFRIDGE shared his concerns about the transition happening with alcohol products, and he sought further discussion on the shipping language and what it looks like "in real life." He removed his objection. 7:41:36 PM CHAIR SUMNER announced there being no further objection, HCS CSSB 89(L&C) was reported out of House Labor and Commerce Standing Committee. 7:41:46 PM The committee took an at-ease from 7:41 p.m. to 7:44 p.m. SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE 7:44:48 PM CHAIR SUMNER announced that the final order of business would be CS FOR SENATE BILL NO. 115(HSS), "An Act relating to physician assistants; relating to physicians; and relating to health care insurance policies." 7:44:57 PM SENATOR L?KI TOBIN, Alaska State Legislature, as prime sponsor, presented CSSB 115(HSS) and paraphrased the sponsor statement [included in the committee packet], which read as follows [original punctuation provided]: We have all heard about long wait times and difficulty accessing care across Alaska which frustrates patients and creates impediments to quick diagnosis and treatment. Senate Bill 115 would allow experienced physician assistants to practice medical care independently to the fullest extent of their licensing, thus increasing the capacity of our medical system and reducing unnecessarily strict regulations on physician assistants. Senate Bill 115 grants experienced physician assistants the flexibility to increase their ability to see and treat patients, which will benefit the capacity of Alaska's medical system. This also maintains the collaborative agreement structure currently in place for less experienced physician assistants. Alaska has a demonstrated need for increasing accessible medical care, reducing high medical costs, and decreasing barriers to experienced medical practitioners across Alaska. Over 90% of the physician assistants in Alaska practice in rural areas. Increasing the medical care available locally in rural Alaska produces better outcomes and less expensive care. This also allows patients to stay in their home communities, thereby reducing strain on hub communities. Additionally, Alaskans will be able to receive care in their place of home, maintaining their support networks and reducing the need for costly inpatient services. Senate Bill 115 does not sacrifice medical rigor or oversight, but simply allows experienced and licensed physician assistants to continue to offer high quality medical care within their scope of practice. Thank you for considering this prudent legislation. 7:52:24 PM CHAIR SUMNER noted that there would not be a reading of the sectional analysis for CSSB 115(HSS) and the committee would hear invited testimony. 7:52:37 PM HAROLD JOHNSTON, MD, Chair, Policy & Advocacy Committee, Alaska Primary Care Association (PCA), gave invited testimony in support of CSSB 115(HSS). He provided a background and related the number of physician assistants (PAs) there are in the state. He stressed strong support for CSSB 115(HSS) on behalf of himself and PCA. He said the system is outdated and created an unnecessary expense for community health centers thereby becoming a barrier to recruitment. He opined that the bill would not decrease the quality of care and collaborative agreements would continue. He said it was time to recognize the value that physician assistants provide and their unique role in Alaska's health care system. 7:56:06 PM REPRESENTATIVE FIELDS asked whether PCA collaborated remotely or only at specific clinic sites. DR. JOHNSTON responded that it depended on the number of staff available. REPRESENTATIVE FIELDS asked whether the medical doctors (MDs) the PAs are collaborating with are not part of the federally qualified health center (FQHC). DR. JOHNSTON answered that if FQHC does not have any physicians on staff then [the MDs] are not part of the FQHC. REPRESENTATIVE FIELDS questioned whether there was anything that prohibited PCA from collaborating with multiple rural sites that may not have MDs on site at the time. DR. JOHNSTON replied that PCA does not do direct patient care, and for them to have a physician employed by PCA would be a very challenging situation. REPRESENTATIVE FIELDS noted that some HQFCs are part of tribal health systems. He asked who the collaborative MDs were working for. DR. JOHNSTON replied that he had not worked for the health tribal systems but offered his understanding that the tribal partners collaborate with MDs employed by the tribal health system. 7:59:38 PM REPRESENTATIVE FIELDS asked whether it was PCA's goal to have PAs run the clinics. DR. JOHNSTON answered that it varies and further noted that PCA does not run anything itself. 8:01:24 PM JENNIFER FAYETTE, PA, gave invited testimony in support of CSSB 115(HSS). She said that in current times, PAs are involved in almost every specialty and, in addition, their scope of practice includes examining, diagnosing and treating their own patients. She said CSSB 115(HSS) does not increase the scope of practice but puts responsibility on it. She stressed that PAs help Alaska as well as other states navigate provider shortages. She opined that current statute is not supportive to the profession and must be modernized. Passage of CSSB 115(HSS) is about recognizing PAs full authority to fill the gaps in healthcare. 8:04:07 PM REPRESENTATIVE FIELDS asked whether there are smaller community clinics that are not served by a tribal health provider. MS. FAYETTE offered her belief that there was another testifier who could best speak to the question. REPRESENTATIVE FIELDS asked whether the goal of the legislation was for PAs to provide primary care. MS. FAYETTE answered that the bill is about access to care and stressed that people are waiting for care, especially in rural communities. REPRESENTATIVE FIELDS indicated that he struggled with the idea of doctors who have received training versus a PA with much less training. MS. FAYETTE said it became harder to find collaborators in Anchorage. [The committee heard public testimony beginning here:} 8:08:41 PM KRISTIN M. MITCHELL, MD, FACP, President, Alaska State Medical Association, said she was opposed to CSSB 115(HSS), as written. She listed medical entities that agree that medical teams should be led by physicians, as they are uniquely qualified and have extensive training. She noted prior testimony surrounding PAs and close collaboration, and she stated that even PAs with many years of clinical experience do not have the same training and are not interchangeable with physicians. She clarified that the Alaska State Medical Board is distinct from the State Medical Board, which has undergone leadership changes recently. She gave examples of other states' procedures regarding PAs. She mentioned nationwide experiments in primary care utilizing PAs to ease the burden of access, and the results lead to higher costs for patients and health systems. She said wait lists for specialists can grow from weeks to months. She stressed that the current systems needed improvement and that the Alaska State Medical Association would like to streamline licensing and administration to focus on providing the best possible patient care. Eliminating collaborative agreements could lead to unintended consequences, she said, and without a physician to give ultimate responsibility for a patient's care, she foresaw a rise in malpractice insurance. She said CSSB 115(HSS) would redefine the term "attending physician," which she opined was a mistake. She reiterated that the Alaska State Medical Association was in opposition to the bill as written but would be willing to work with PA colleagues to craft better regulations and submit improved legislation to the committee. 8:16:34 PM REPRESENTATIVE FIELDS referenced Title 8 and the scope of practice for MDs in statute versus regulation. DR. MITCHELL replied that she was not an expert on the scope of practice for MDs and would defer the inquiry to someone who had access to statute. REPRESENTATIVE FIELDS asked whether there was anything in the legislation that would list PAs performing anything different from MDs. DR. MITCHELL questioned the language, "provide consultation upon request", noting that typically it is a request by someone with a higher level of specialty training. She speculated on further verbiage that she found might be problematic. REPRESENTATIVE FIELDS noted his discomfort in supporting the bill in reference to whether what MDs do should be differentiated. He sought guidance on how the scope of practice for PAs could be narrowed to provide primary care, as he was not persuaded of that yet. DR. MITCHELL responded that she had asked for numbers about how the PA workforce is distributed in Alaska but could not speak knowledgably since she had not seen the numbers yet. She spoke to other health systems being led by higher-level trained physicians. 8:23:20 PM The committee took an at-ease from 8:23 p.m. to 8:26 p.m. 8:26:06 PM ROXANNE JONES, MD, Secretary of the Board, Alaska Academy of Family Physicians, testified in opposition to CSSB 115(HSS). She provided her professional background, including her experience serving as a collaborating physician to PAs in many states, and shared her first-hand experience around PAs. She urged members to take more time on the bill and opined that PA collaborative agreements need to be fixed, as it should be used as a tool for PA practices. She added that the curricula in the PA programs do not prepare PAs to practice without a supervisor or collaborator. She noted that liability speaks loudly. She urged the committee to not pass CSSB 115(HSS). 8:31:45 PM MS. FAYETTE spoke to medicine definitions in statute. She noted the importance of putting the PA profession in statute, as it is currently only in regulation. Additionally, she said she has been engaging in this process for PAs, and that she had given multiple presentations to the State Medical Board on the topic. 8:34:36 PM CHAIR SUMNER opened public testimony on SB 115. 8:35:21 PM CANDACE HICKEL, Physician Assistant, shared her extensive background in the PA profession and opined that PA regulation laws are antiquated, and she provided a brief history. She highlighted the importance of PAs in Alaska and related the training requirements for PAs. She said that she continued close collaboration with surgeons by the design of a PA's practice and policies already in place at the hospital. She said people are asking for quality care and opined that PAs are the solution. She urged support for CSSB 115(HSS) from the legislature. 8:39:03 PM The committee took a brief at-ease at 8:39 p.m. 8:39:19 PM KARI BERNARD, Physician Assistant, testified in support of SB 115 and provided a research report and summary to the committee [included in the committee packet]. She related that she had been a PA for 20 years and provided a brief educational background. She listed studies regarding PA provided care, which included costs. She said studies do not support that PAs are driving up the cost of care. She further summarized studies of PAs following the same guidelines as physicians. She offered to be available to answer more specific questions. 8:42:42 PM BETSY DOUDS-PACVAN, PA, President, Alaska Academy of Physician's Assistants, as a PA, provided her background working in outpatient addiction treatment and behavioral health. She noted that Alaska is experiencing a shortage of healthcare providers and CSSB 115(HSS) would allow PAs the ability to practice to the full extent of their rigorous training and education. She opined that CSSB 115(HSS) is a tool that would allow PAs to join the workforce more easily while continuing to be regulated. 8:45:53 PM KATHERINE VAN ATTA, PA, testified in support of CSSB 115(HSS) and shared her educational and professional background. She noted that collaborative plans are not required to perform effective consulting. She said CSSB 115(HSS) would support giving healthcare providers to the rural and underserved areas of the state that really need PAs. She touched on proposed regulations and offered her belief that a different approach is needed and that SB 115 could alleviate many issues. 8:48:38 PM DANIEL REYNOLDS, DO, shared his work and military experiences and noted the extensive time he spent working with PAs. He opined that CSSB 115(HSS) supported the change that is needed because of the training and skill level PAs currently get. He said if there was a problem with care that is delivered, PAs would not be practicing. He stressed that the care PAs deliver is excellent and at a high level and he reiterated his support for the proposed legislation. 8:51:24 PM CHRISTI FROILAND, PA, provided her background in dermatology and highlighted that she is a specialist to whom other offices refer. She spoke to collaboration and that it is "built into the DNA" of a PA. She further noted her teaching experiences. She opined that CSSB 115(HSS) is not about independent practice; it is about giving a PA the ability to practice to the full extent of their training and to not be tied to one physician. 8:53:48 PM ETHAN MCWILLIAMS, CEO, Wilderness Medical Staffing, testified in support of CSSB 115(HSS). He provided his professional and personal background. He said it is hard to find collaborating physicians with the time needed for paperwork. He touched on liability and insurance, and noted other states in which he had worked. He added that his broker or carrier had never expressed any concern about the insurability of PAs in those states; therefore, he did not understand why Alaska would be different. 8:56:57 PM MOLLY SOUTHWORTH, MD, Internist and Endocrinologist, American College of Physicians, Alaska Chapter, testified in opposition to CSSB 115(HSS) because of patient safety concerns and the need to build stronger teams. She stressed that PAs are a vital part of the system but are not trained with independent practice in mind. She opined that the bill is a threat to Alaskans. She suggested that CSSB 115(HSS) not be passed in its current form and that a stronger bill be crafted that focused on improving team collaboration. 8:59:25 PM JOHNNA KOHL, MD, testified against CSSB 115(HSS) in its current form and explained that two years of clinical practice does not constitute an experienced assistant. She gave examples of real- life situations in family medicine that, for example, there is a difference in training between a PA and nurse practitioner. She urged members to continue to work on the bill and not pass CSSB 115(HSS), as written. 9:01:53 PM MEGHAN HALL, PA, testified in support in CSSB 115(HSS) in its current form because the amendments have been made and many of the concerns have been voiced. She offered her belief that the bill would keep PAs relevant, recognize them as full members of the health care team, and protect patient safety. 9:03:15 PM MURRAY BUTTNER, MD, testified in support of CSSB 115(HSS). He spoke to his work and board experience, as well as working with PAs. He added that he had been a collaborating physician for 10 to 15 PAs in his 27 years in the profession. He went over the outdated regulatory framework for PAs but not for other areas such as for nurse practitioners. He offered his belief that the bill currently written seemed reasonable and he hoped the committee would see a way to move it. 9:06:20 PM MARGARET CARLSON, MD, Family Medicine Physician, testified in opposition to CSSB 115(HSS) and gave her professional background. She said that she has been a collaborative physician for PAs her whole career and respects them; however, there is a difference in training that comes down to experience and leadership. She related examples of patients not being satisfied with their care and the wait times. She asked whether access to care is more important than the quality of care. She encouraged the committee to reconsider the bill. 9:09:27 PM CAMILLA SULAK, MD, Board Member, American College of Emergency Physicians, Alaska Chapter, testified in opposition to CSSB 115(HSS). She said a concern is safety and opined that PAs are more likely to over-prescribe opiates. She related that health care costs are already high and must not be increased; neither should the wait times for care. Access to care is an issue as well, she said, and many other states have voted against this type of legislation. 9:12:30 PM KATHRYNE MITCHELL, representing self, testified against CSSB 115(HSS) and opposed the 4,000-hour requirement. She highlighted the differences in the education of a PA and a medical doctor. She asked why Alaskans would want to go to medical school when they can go practice with fewer hours. 9:15:17 PM DANA KERR, MD, testified against CSSB 115(HSS) and the 4,000- hour requirement. She opined that there needed to be minimum testing. She stressed that she valued PAs both professionally and personally. She relayed a personal anecdote regarding PAs' knowledge, and the lack thereof. She said there needed to be better standards. REPRESENTATIVE FIELDS asked whether, if the state were to create standards and diversity of training, there be a model to look to for PAs. MS. KERR replied that she was not aware of current tests as PA training has not been for independent practice. She agreed that it should be explored. 9:19:00 PM CHAIR SUMNER, after ascertaining no one else wished to testify, closed public testimony. 9:19:12 PM REPRESENTATIVE FIELDS asked about standards of apprenticeship testing. MS. HICKEL replied that there are post-graduate fellowship trainings. She highlighted that the purpose of the bill was to improve access to quality care in Alaska. 9:20:49 PM REPRESENTATIVE RUFFRIDGE inquired about current PA licensing and collaboration. He said he heard that there are 1,000 licensed PAs in the state and asked whether there was a record of the collaborative physicians that reside in the state. 9:21:47 PM GLENN SAVIERS, Deputy Director, Division of Corporations, Business, & Professional Licensing, Department of Commerce, Community & Economic Development (DCCED), addressed Representative Ruffridge and said it would not be an easily pulled record; it would take some time. REPRESENTATIVE RUFFRIDGE asked whether an MD outside the state could sign a collaborative agreement. MS. SAVIERS offered to follow up regarding out of state collaborating physicians. 9:24:06 PM REPRESENTATIVE FIELDS asked whether there was a way to regulate collaborative fees or whether there were options other than collaborative fees. MS. HICKEL answered that that had been considered the past several years but culminated in the bill in its present form, which she supported. 9:25:30 PM CHAIR SUMNER announced that CSSB 115(HSS) was held over. 9:25:39 PM ADJOURNMENT There being no further business before the committee, the House Labor & Commerce Standing Committee meeting was adjourned at 9:26.