Legislature(2019 - 2020)BUTROVICH 205

02/28/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES

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         SB 179-NURSING: LICENSURE; MULTISTATE COMPACT                                                                      
1:49:54 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 179,                                                                
"An  Act  relating to  the  licensure  of nursing  professionals;                                                               
relating to  a multistate nurse licensure  compact; and providing                                                               
for an effective date."                                                                                                         
He said Senate  Rules Committee introduced SB 179  at the request                                                               
of the governor.  He stated his intention to have  an overview of                                                               
the bill, take invited testimony and public testimony.                                                                          
1:50:53 PM                                                                                                                    
SARA  CHAMBERS,  Division  Director,  Division  of  Corporations,                                                               
Business  and  Professional  Licensing, Department  of  Commerce,                                                               
Community  and  Economic  Development  (DCCED),  Juneau,  Alaska,                                                               
introduced herself.                                                                                                             
1:51:27 PM                                                                                                                    
JULIE ANDERSON, Commissioner,  Department of Commerce, Community,                                                               
and Economic  Development, Anchorage, Alaska, said  SB 179 allows                                                               
Alaska  to join  the Nurse  Licensure  Compact (NLC).  This is  a                                                               
multistate  compact  that  allows   nurses  to  practice  in  all                                                               
participating  states. The  Nurse  Licensing  Compact would  help                                                               
address  the  registered nurse  shortage  across  the state  with                                                               
increased flexibility  of health care emergency  preparedness and                                                               
still allow  the state  to maintain  its autonomy.  Currently, 34                                                               
states  have   joined  the  NLC   and  11  states   have  pending                                                               
legislation to join. The NLC is  supported in Alaska. In a recent                                                               
survey of Alaska licensees, 87  percent of Alaska resident nurses                                                               
indicated  their  support for  Alaska  joining  the compact.  The                                                               
Alaska Board  of Nursing  voted to support  joining the  NLC last                                                               
1:52:44 PM                                                                                                                    
DANETTE  SCHLOEDER, Chair,  Alaska Board  of Nursing,  Anchorage,                                                               
Alaska,  began a  PowerPoint "Nurse  Licensure Compact,  SB 179."                                                               
She reviewed slide 2:                                                                                                           
      Mission: Actively promote and protect the health of                                                                       
     the citizens of Alaska through the safe and effective                                                                      
     practice of nursing as defined by law.                                                                                     
     License Numbers for FY2019                                                                                                 
     *Registered Nurses:                     14,697                                                                             
     *Licensed Practical Nurses:             805                                                                                
     Advanced Practice Registered Nurses:    1,388                                                                              
     Certified Nurse Aides:                  3,416                                                                            
     Total licensees:                        20,306                                                                             
MS. SCHLOEDER reviewed slide 3, What is Licensure?                                                                              
     Minimum qualifications to practice.                                                                                        
     Age and experience are not a factor of licensure.                                                                          
     Licensure requirements for NLC are more comprehensive                                                                      
     than Alaska.                                                                                                               
MS. SCHLOEDER  said all nurses graduate  from accredited programs                                                               
and  sit  for  the  same  licensing  examination.  Licensing  and                                                               
competency are not synonymous. The  Alaska Board of Nursing voted                                                               
to support the  compact after listening to  nurses and employers.                                                               
The  board examined  the  evidence-based  literature and  nursing                                                               
practice trends  in Alaska and  throughout the nation.  The board                                                               
also considered  the experiences  of the  other 34  state nursing                                                               
boards that have joined the  compact. The Alaska Board of Nursing                                                               
recognizes that  while the  original version of  the NLC  may not                                                               
have  been a  good  fit for  Alaska, the  enhanced  NLC with  its                                                               
rigorous  requirements for  multistate licensure  is a  good fit.                                                               
She offered the Board of Nursing's support for SB 179.                                                                          
1:56:31 PM                                                                                                                    
MARIANNE  MURRAY, D.N.P.,  Executive Administrator,  Alaska Board                                                               
of Nursing,  Anchorage, Alaska, asked  what problem the  board is                                                               
trying to fix.                                                                                                                  
DR. MURRY reviewed  slide 4, Nursing Facts in  Alaska That Impact                                                               
     •  The average time for nursing licensure.                                                                                 
     •  Nurse licensure application completion rate.                                                                            
     •  Loss of income for the nurse.                                                                                           
     •  Loss of patient contact hours.                                                                                          
     •  Amount of nursing graduates                                                                                             
She said it currently takes 12 to  16 weeks for a nurse to obtain                                                               
initial  licensure, primarily  because  the application  requires                                                               
primary  source   documents.  These  documents   include  college                                                               
transcripts  and  employment  verification.  Further,  background                                                               
checks must be  completed. Once the application  is complete, the                                                               
board's licensing  examiners can start the  approval process. She                                                               
said  that 97  percent  of applications  submitted are  initially                                                               
incomplete, so  licensing examiners  work with the  applicants to                                                               
identify  the needed  documentation. Since  source documents  are                                                               
verified or  provided by  other states or  colleges, it  can take                                                               
weeks or sometimes months to  arrive. She said staff is currently                                                               
working on applications submitted in early November 2019.                                                                       
CHAIR WILSON  asked if there  is a  process for nurses  to obtain                                                               
temporary licensure.                                                                                                            
DR.  MURRAY   answered  yes,  but  licensees   must  complete  an                                                               
application.  With the  four-month  delay  in getting  licensure,                                                               
there  is a  loss of  income for  a nurse  coming to  Alaska. The                                                               
average wage  for Alaskan nurses  is $85,000 per year,  so nurses                                                               
could  potentially  lose  about   $20,000  while  awaiting  their                                                               
licenses. Most important is the loss of patient contact hours.                                                                  
DR. MURRAY said  Alaska has two nursing schools.  As the previous                                                               
director of  the University of  Alaska Anchorage (UAA)  School of                                                               
Nursing, she offered her view  that Alaska has great schools, but                                                               
not  enough nursing  graduates.  UAA graduates  about 250  nurses                                                               
each  year and  Charter College  graduates about  75. Ninety-five                                                               
percent  of those  graduates  have jobs  within  six months.  She                                                               
pointed  to the  chart on  the bottom  of slide  4 from  the U.S.                                                               
Health Resources and Services  Administration (HRSA) from January                                                               
2020 showing  that by  2030, the expected  need is  5,400. Alaska                                                               
ranks as number one in the nation for needing registered nurses.                                                                
2:00:11 PM                                                                                                                    
SENATOR BEGICH asked  what the unmet needs are today  in order to                                                               
compare that to the projection for 2030.                                                                                        
DR. MURRAY replied she had the HRSA information for 2030.                                                                       
SENATOR BEGICH explained  that the largest growth  area in Alaska                                                               
has been the  health care industry, which is driven  by the rapid                                                               
increase in Medicaid expansion. He  asked if the projections took                                                               
into account that the need may level off.                                                                                       
DR. MURRAY replied it might, but  the average age of nurses is 50                                                               
or  55, so  in  ten years  many nurses  will  retire. The  Alaska                                                               
population over  age 65 is anticipated  to double in the  next 20                                                               
years, so Alaska will still have a significant need.                                                                            
SENATOR BEGICH  asked how UAA's  budget cuts have  impacted nurse                                                               
recruitment  and graduation.  He  asked if  there  is a  shortage                                                               
because  people  are  not  interested   or  that  resources  have                                                               
DR.  MURRAY  responded that  one  key  issue  at UAA  was  hiring                                                               
faculty to teach  nursing. She opined that a number  of people in                                                               
Alaska want to go to nursing  school, but it makes people nervous                                                               
to  think  about  becoming  faculty   at  a  university  that  is                                                               
financially unstable.                                                                                                           
2:03:18 PM                                                                                                                    
SENATOR  GIESSEL  highlighted   that  nursing  applications  went                                                               
online in  July 2019, but  it is still taking  12 to 16  weeks to                                                               
process. She asked her to identify the issues.                                                                                  
DR. MURRAY replied the application volume  of up to 350 per month                                                               
is one  issue. There is  also a backlog because  applications are                                                               
incomplete due to a lack  of primary source documentation. Source                                                               
documents must be  submitted and verified by  the universities or                                                               
employers. Thus,  the applicants and  agency staff must  wait for                                                               
other people  to submit information.  She acknowledged  that some                                                               
of the inefficiencies are related to the process.                                                                               
SENATOR GIESSEL asked how many temporary licenses are issued.                                                                   
MS. CHAMBERS offered to follow up with the information.                                                                         
SENATOR  GIESSEL recalled  that these  figures were  in the  most                                                               
recent sunset audit.  She asked how long it takes  to process and                                                               
issue temporary licenses.                                                                                                       
DR.  MURRAY  answered  that  temporary  licenses  can  take  time                                                               
because an application  must be completed and  the applicant must                                                               
meet certain criteria for a temporary license.                                                                                  
SENATOR GIESSEL  asked why  someone would  apply for  a temporary                                                               
DR. MURRAY  cited the  example of a  recent graduate  who applied                                                               
for  a  temporary  license  while   waiting  to  take  the  NCLEX                                                               
(National Council Licensure Exam).                                                                                              
2:05:47 PM                                                                                                                    
SENATOR  GIESSEL  summarized  that  there is  an  opportunity  to                                                               
become licensed while  waiting for results and then  go through a                                                               
fuller licensing  process. She asked  if the board would  be able                                                               
to issue temporary licenses in  an emergency, such as an outbreak                                                               
of coronavirus.                                                                                                                 
MS. CHAMBERS cited the 2018  earthquake as an example. Some Lower                                                               
48 states  wanted to send  nurses to Alaska  to help and  it took                                                               
over  a week  to issue  temporary licenses  for each  of about  a                                                               
dozen nurses. The board had  to mobilize people to prioritize and                                                               
expedite  those  applications.  In an  emergency  situation  that                                                               
might require several hundred nurses  in rural areas, the process                                                               
of  obtaining  a  temporary  license   could  take  time  because                                                               
applicants  must still  make an  application and  go through  the                                                               
vetting process.                                                                                                                
MS CHAMBERS  said this bill  will help diminish or  eliminate the                                                               
impact of waiting weeks for  documents to trickle in. The compact                                                               
eliminates  that for  applicants  who want  multiple licenses  in                                                               
compact  states  because the  home  state  completes the  primary                                                               
source  verification. Her  staff  can usually  issue a  completed                                                               
application within 10 days.                                                                                                     
SENATOR   GIESSEL  expressed   concern  that   the  process   has                                                               
deteriorated.  In  the past,  Alaska  has  had outbreaks  of  RSV                                                               
(respiratory  syncytial virus)  affecting newborns,  primarily in                                                               
rural  Alaska.  Thus,  Alaska  has had  a  need  for  specialized                                                               
neonatal   nurses.  The   board   expeditiously  executed   those                                                               
temporary licenses and worked hard  to put that process in place.                                                               
She recalled  that the  board had a  very efficient  process. She                                                               
noted that the board has gone to online applications.                                                                           
MS.  CHAMBERS  replied  that  the  division  has  worked  on  the                                                               
inefficiencies  it can  control. However,  it cannot  control the                                                               
time  it  takes for  documentation  to  arrive. During  the  2018                                                               
earthquake, the  board waited for  the health care manger  at the                                                               
facility to  gather the  documentation for  its nurses.  Once the                                                               
board  receives  the  documentation, temporary  licenses  can  be                                                               
processed  quickly. She  acknowledged  that processing  temporary                                                               
licenses for  a dozen nurses  took up to  a week. In  a situation                                                               
where  more  nurses  were  needed, it  would  have  taken  longer                                                               
because the board must follow current laws.                                                                                     
2:11:14 PM                                                                                                                    
SENATOR  VON  IMHOF  related her  understanding  that  nurses  go                                                               
through  the rigorous  process  of qualifying  for  a license  in                                                               
their home  state. If Alaska is  part of the compact  or modified                                                               
compact,  nurses  would have  60  days  to provide  documentation                                                               
during  the  licensure  process.   She  understood  Ms.  Chambers                                                               
identified  bottlenecks  out  of   the  division's  control.  She                                                               
related her  understanding that the bill  suspends an application                                                               
after  60  days if  the  documentation  is  not received  and  it                                                               
remains suspended until it is completed.                                                                                        
MS.  CHAMBERS  said the  compact  is  a uniform  agreement  among                                                               
participating  states  that  agree  to   all  of  the  terms  and                                                               
requirements.  This  particular  compact cannot  be  modified  or                                                               
altered. She  pointed out that  SB 157, a  professional licensing                                                               
reform  bill, would  give the  division and  boards the  tools to                                                               
offer modified  or increased temporary licensure  similar to what                                                               
Senator von  Imhof described. SB  157 would provide  the solution                                                               
since it would apply to all professions, including nurses.                                                                      
SENATOR VON  IMHOF asked whether  it makes sense to  pull nursing                                                               
out of the reform  bill or think about how to  enhance SB 179 due                                                               
to  the   nursing  shortage,  the   aging  population,   and  the                                                               
geographic location of  Alaska. She said any  number of illnesses                                                               
or pandemics could come to the state at any given time.                                                                         
SENATOR GIESSEL asked for the duration of a temporary license.                                                                  
DR. MURRAY answered six months.                                                                                                 
SENATOR GIESSEL  noted that temporary licenses  are covered under                                                               
AS 08.68.210. She asked Dr.  Murray to describe what licensure by                                                               
endorsement means.                                                                                                              
DR.  MURRAY  responded  that licensure  by  endorsement  involves                                                               
licensing an applicant  in Alaska who holds a  license in another                                                               
2:15:30 PM                                                                                                                    
SENATOR GIESSEL  said licensure by  endorsement is  covered under                                                               
AS  08.68.200,  which  seems  like  an  expeditious  process  for                                                               
someone who is licensed in another state.                                                                                       
DR.  MURRAY   replied  that   applicants  seeking   licensure  by                                                               
endorsement still must  apply for licensure and  be vetted, which                                                               
takes time.                                                                                                                     
2:16:21 PM                                                                                                                    
DR.  MURRAY  reviewed  slide  6,  What  is  the  Nurse  Licensure                                                               
     It is  an agreement among  states to offer  an optional                                                                    
     multistate license  to nurses who have  met eleven high                                                                    
     standards of  education, training,  and discipline-free                                                                    
     AS  28.37.010.  Compact  Enacted.  The  Driver  License                                                                    
     Compact is enacted  into law and entered  into with all                                                                    
     other jurisdictions  legally joining in it  in the form                                                                    
     substantially contained in AS 28.37.110 - 28.37.190.                                                                       
     Alaska joined the Driver License Compact in 1986.                                                                          
She reported that Alaska participates in over 25 different                                                                      
DR. MURRAY reviewed slide 7, What is the Nurse License Compact?                                                                 
     The Alaska Board of Nursing retains full authority to:                                                                     
     •  Ensure all nurses practicing  in Alaska follow its                                                                      
     standards, laws, and rules                                                                                                 
     •  Offer   multistate  licensure   or  single   state                                                                      
     licensure as an option                                                                                                     
     •  Remove the  ability of a  nurse with  a multistate                                                                      
     license to practice in our state.                                                                                          
     The  Interstate  Compact  Commission  agreement  is  in                                                                    
     statute and can only  be changed when all participating                                                                    
     states agree to new laws.                                                                                                  
DR. MURRAY reviewed slide 8, Benefits to Alaska:                                                                                
     Reduces cost/burden on nurses.                                                                                             
     Reduces cost/burden on employers.                                                                                          
     Expedites disaster relief.                                                                                                 
     Adds options to keep Alaska-trained nurses in state.                                                                       
She said the board held townhall stakeholder meetings in Juneau,                                                                
Anchorage, and Fairbanks. The board met many nurses who hold                                                                    
licenses in many other states.                                                                                                  
DR. MURRAY reviewed slide 9, Benefits to Alaska:                                                                                
     Increases access to care.                                                                                                  
     Increases telehealth solutions for Alaskans.                                                                               
     Eases burden on military families.                                                                                         
     Expands employment opportunities for Alaska nurses:                                                                        
        • Facilities online education.                                                                                          
        • Telehealth work.                                                                                                      
        • Seasonal employment flexibility.                                                                                      
2:19:05 PM                                                                                                                    
DR.  MURRAY  reviewed  slide  10,   NLC  Requirements  vs  Alaska                                                               
Requirements. She said that Alaska  licensees do not have to pass                                                               
an English  language proficiency  exam. Alaska licensees  are not                                                               
required  to  be free  of  a  felony or  misdemeanor  convictions                                                               
related to  the practice of  nursing nor do applicants  in Alaska                                                               
need to have a social security number.                                                                                          
DR.  MURRAY reviewed  slide  11, Nurse  Licensure  Compact in  34                                                               
states. The  slide depicted a  map of the  34 states in  the NLC.                                                               
She noted that Indiana and New  Jersey were joining and 10 states                                                               
have pending legislation.                                                                                                       
DR.  MURRAY reviewed  slide 12,  Nurse Licensure  Survey Results.                                                               
She noted  that when she  joined the  board in September,  it had                                                               
just voted to move forward  with the compact. The board conducted                                                               
a survey about  the Nurse Licensure Compact in  December 2019 and                                                               
over 3,527 licensees  responded, the majority of  which reside in                                                               
CHAIR  WILSON asked  what type  of nurses  were included  in that                                                               
DR. MURRAY said  the survey was sent  to anyone who had  an RN or                                                               
LPN   [licensed  practice   nurse]  license.   Advanced  Practice                                                               
Registered Nurses hold an APRN and  an RN license, so APRNs would                                                               
have received the survey.                                                                                                       
SENATOR VON IMHOF asked if traveling  nurses are paid the same as                                                               
Alaska nurses  and if  using traveling  nurses is  less expensive                                                               
for hospitals.                                                                                                                  
MS. CHAMBERS replied those are  questions to ask employers; nurse                                                               
salaries  are not  regulated  by licensure.  She  noted that  the                                                               
Alaska  State  Hospital  and  Nursing  Home  Association  (ASHNA)                                                               
supports the bill.                                                                                                              
2:22:44 PM                                                                                                                    
DR. MURRAY reviewed slide 13, Survey Results, which read:                                                                       
     3,573 nurse completed the 2019 Alaska Compact Survey!                                                                      
        92 [percent] of all respondents are in favor of                                                                         
     joining the Nurse Licensure Compact                                                                                        
      89 [percent] of Alaskan resident nurses are in favor                                                                      
     of joining the compact                                                                                                     
      87 [percent] of the nurses would apply for a compact                                                                      
     nurse license if available.                                                                                                
DR. MURRAY  reviewed slide  14, Nurse  Licensure Compact  SB 179.                                                               
The table in this slide  shows overwhelming support by residents,                                                               
union and  nonunion members, and  respondents who hold  a license                                                               
solely in Alaska as well as other jurisdictions.                                                                                
SENATOR GIESSEL  related her understanding that  about 40 percent                                                               
of nurses  with an  Alaska license  have their  primary residence                                                               
outside  of the  state, so  nurses  living in  Oregon were  asked                                                               
whether Alaska should be a compact state.                                                                                       
DR. MURRAY  confirmed that  the board polled  all of  the Alaskan                                                               
nurse licensees.                                                                                                                
SENATOR  GIESSEL pointed  out  that an  estimated  40 percent  of                                                               
those are out-of-state residents.                                                                                               
SENATOR VON  IMHOF asked  how much the  licensing fee  for nurses                                                               
DR. MURRAY replied a new application costs $375.                                                                                
SENATOR VON IMHOF asked if fees will change with the compact.                                                                   
DR. MURRAY  said the  board believes  fees for  compact licensure                                                               
would probably  be more since the  nurse will not pay  extra fees                                                               
in other states.                                                                                                                
SENATOR VON IMHOF asked if nurses  coming to Alaska will pay $375                                                               
to get an Alaskan endorsement, if Alaska is in the compact.                                                                     
2:26:17 PM                                                                                                                    
MS. CHAMBERS  said that  under the  compact, nurses  could select                                                               
either  a single  state license  or a  multistate license,  which                                                               
would allow them  to work in any of the  other 34 compact states.                                                               
Nurses with a  multistate license would not have to  apply for or                                                               
pay  for  licensure  because they  already  have  the  multistate                                                               
privilege. The multistate  compact is tied to the  home state, so                                                               
anytime a  nurse moves  from Alaska to  another compact  state or                                                               
from  a compact  state to  Alaska,  they would  need to  transfer                                                               
their  home  state status  within  the  compact. Everyone  renews                                                               
their license in their home state,  which is the way licenses are                                                               
currently renewed.  She said the division  anticipates being able                                                               
to charge  more for  the multistate licenses  and the  board will                                                               
continue to  adjust fees annually.  The board has  committed that                                                               
the  multistate  license  will not  cost  single-state  licensees                                                               
additional  fees.  The board  wants  to  make sure  that  Alaskan                                                               
nurses who  do not  want to  enter the compact  will not  pay for                                                               
compact activities.                                                                                                             
SENATOR VON IMHOF said $375 is  not a large fee but multiplied by                                                               
500 people it is substantial. She  asked what out of state nurses                                                               
are paid and said she wants to  make sure that this bill will not                                                               
displace Alaskan nurses.                                                                                                        
CHAIR WILSON  added that licensure  fees go to  investigations of                                                               
bad  actors  and complaints.  He  does  not  want to  short  fund                                                               
investigative  services  that  provide safety  of  residents.  He                                                               
asked  if there  would be  a  way to  add an  additional fee,  if                                                               
necessary, for nurses who come to Alaska under the compact.                                                                     
MS.  CHAMBERS replied  the division  is  considering setting  the                                                               
multistate compact fee higher. The  compact does not allow states                                                               
to assess  an additional  fee for visiting  nurses since  it will                                                               
circumvent the purpose  of the compact. However,  every state has                                                               
its own fee-setting  process. She pointed out  that Alaska nurses                                                               
currently absorb  the investigative costs. The  division wants to                                                               
make sure  that when investigating  multistate nurses,  the costs                                                               
are allocated  to those  nurses who  are in  the compact.  The 34                                                               
states in the  compact have not seen an  overwhelming increase in                                                               
investigative   activity.  Currently,   650   nursing  jobs   are                                                               
available in the  state. There is quite a  difference between the                                                               
available nurses and the available jobs.                                                                                        
SENATOR BEGICH said residents want  jobs in Alaska, but the state                                                               
cannot provide the  training and recruit for  faculty. He related                                                               
his  understanding that  Alaskan  residents would  pay more,  but                                                               
out-of-state residents would not pay any fees to work in Alaska.                                                                
MS.  CHAMBERS confirmed  that  is  how the  compact  works. If  a                                                               
flight  nurse works  in  the  Lower 48,  the  nurse  must have  a                                                               
license to  care for  that patient once  the flight  lands. There                                                               
are  plenty of  opportunities  for Alaskan  residents to  benefit                                                               
from  not having  to pay  when  these residents  want to  utilize                                                               
additional economic opportunities, for example, in telehealth.                                                                  
SENATOR BEGICH  said that  sounds almost  like a  disincentive to                                                               
keep people in the state. The  state does not want to trap people                                                               
in Alaska,  but if  the state  has a shortage  of 670  nurses and                                                               
adds an additional incentive to leave  the state, this could be a                                                               
potential  disincentive   to  fill   the  nursing  gap,   not  an                                                               
incentive. Twenty-one percent of the  workforce today are not in-                                                               
state  residents.  These  non-residents   get  services  and  pay                                                               
nothing  for them.  This seems  to  be an  example of  increasing                                                               
that. He asked for some reassurance.                                                                                            
CHAIR WILSON suggested that some employers could speak to that.                                                                 
2:35:31 PM                                                                                                                    
MS. SCHLOEDER said she has  always had a primary Alaskan license.                                                               
Three years  ago she answered the  call to help train  new nurses                                                               
through online education. She has  to have licenses in Washington                                                               
and Montana in order to teach  online. She is lucky that she only                                                               
needs three  licenses. She met a  nurse educator who has  37. She                                                               
has to  have a license  for every state  where she has  a student                                                               
because teaching nursing is practicing  nursing. There are highly                                                               
trained  nurses in  Alaska who  would like  to teach  online, and                                                               
online  education  is  very  popular  in  advanced  practice,  in                                                               
doctorate programs, and  others, but these nurses do  not want to                                                               
get a license in every state where they have students.                                                                          
CHAIR WILSON noted  the interest in the bill  and reminded people                                                               
that they could send written testimony to shss@akleg.gov.                                                                       
SENATOR  BEGICH  said  Ms.  Schloeder  indicated  that  it  is  a                                                               
disadvantage to  APRNs, but  according to  slide 2,  these nurses                                                               
are not eligible to enter the compact.                                                                                          
MS. SCHLOEDER said an online  instructor who is teaching Advanced                                                               
Practice Registered Nurses  would still need to  hold licenses in                                                               
those states.                                                                                                                   
SENATOR  BEGICH   asked  what  government  regulates   the  nurse                                                               
licensure compact.                                                                                                              
MS. CHAMBERS  said the Alaska  Board of Nursing has  full control                                                               
and sovereignty over nursing practice in Alaska.                                                                                
2:38:32 PM                                                                                                                    
SENATOR BEGICH said he was  asking a slightly different question.                                                               
The NLC has structures and processes  that can be changed and the                                                               
state would be under those processes  if it signs the compact. He                                                               
asked which government is in charge of that.                                                                                    
MS. CHAMBERS said that like  the other 27 compacts, including the                                                               
driving,  mining, and  children  placement compacts,  there is  a                                                               
body made  up of member  states who facilitate  the conversation.                                                               
That is  the Interstate Commission.  If Alaska joins,  there will                                                               
be 35  board chairs who represent  each state. Each state  has an                                                               
equal voice. The  terms of what the commission can  and cannot do                                                               
is in  the bill. All  legislatures adopting the compact  say that                                                               
state  boards  retain  sovereignty  over  practice  and  set  the                                                               
priorities for licensure.  The commission has nothing  to do with                                                               
the  day-to-day  evaluation  of  nurses.   It  is  about  how  to                                                               
facilitate the  conversation about  how the  compact is  going to                                                               
CHAIR  WILSON  asked  if  the Department  of  Law  reviewed  this                                                               
MS.  CHAMBERS  replied   it  is  the  governor's   bill,  so  the                                                               
Department  of  Law  wrote  it.  The  division  worked  with  the                                                               
Department of Law many months in drafting the bill.                                                                             
SENATOR GIESSEL  recapped that nurses  with a  multistate license                                                               
who come  to Alaska will  not be charged anything.  She expressed                                                               
concern  about the  potential loss  of revenue  for the  Board of                                                               
Nursing under the compact.                                                                                                      
MS.  CHAMBERS  responded that  not  all  those licensees  are  in                                                               
compact states.  There is  a percentage  of licensees  outside of                                                               
Alaska who would  still be required to obtain  an Alaskan license                                                               
because  these licensees  are not  part of  a compact.  The board                                                               
anticipates that  there may be  a loss  of revenue for  the board                                                               
from up  to 4,000 nurses.  Conversely, the workload on  the board                                                               
will  decrease  because  it  will not  be  processing  all  those                                                               
licenses.  The division  held conversations  internally and  with                                                               
the staff to  answer questions about whether the  expenses of the                                                               
board will decrease. If the board  does not need as much staff to                                                               
process  applications, it  will lose  staff through  attrition or                                                               
the division  will assign  staff members  to other  programs. The                                                               
division  is not  only keen  on tracking  those expenses  to have                                                               
transparent  conversations with  the board  and stakeholders  but                                                               
also  so that  the board  and licensees  know that  the costs  of                                                               
multistate licenses might go up.                                                                                                
SENATOR  GIESSEL questioned  whether that  makes sense.  She said                                                               
there are currently  6,000 licensed nurses and it  takes about 10                                                               
minutes to  renew a license, so  there should not be  staff costs                                                               
to process.  She acknowledged that  renewal fees allow  the board                                                               
to stay solvent.                                                                                                                
DR. MURRAY  said the  board loses  3,000 licensees  each biennial                                                               
renewal. The  board has  a steady rate  of nurse  licensees along                                                               
with considerable fluctuation in the number of other licensees.                                                                 
CHAIR  WILSON  invited  Ms. Chambers  to  present  the  sectional                                                               
analysis for the bill.                                                                                                          
2:44:45 PM                                                                                                                    
MS. CHAMBERS  noted that much of  the bill is adding  the compact                                                               
license where nursing licenses already  exists. She presented the                                                               
following sectional analysis for SB 179:                                                                                        
     Section   1:   Amends    AS   08.02.010   (Professional                                                                    
     Designation   Requirements)  to   add  AS   08.69  (the                                                                    
     Multistate Nurse Licensure  Compact chapter, created by                                                                    
     Section 23 of this  Act) as a qualification designation                                                                    
     requirement for registered nurses.                                                                                         
     Section  2: Adds  AS 08.69  (created by  Section 23  of                                                                    
     this Act)  to AS  08.11.120 (Audiology  Exemptions), to                                                                    
     allow  a  nurse  that  holds a  multistate  license  to                                                                    
     perform hearing sensitivity evaluations.                                                                                   
     Section  3: Extends  the  Board  of Nursing's  existing                                                                    
     authority to govern AS 08.69  (created by Section 23 of                                                                    
     this  Act), and  identifies the  executive director  of                                                                    
     the  board  as   the  interstate  commission  licensure                                                                    
     compact administrator                                                                                                      
     Section 4: Exempts  AS 08.69 (created by  Section 23 of                                                                    
     this Act)  from the  Administrative Procedures  Act, as                                                                    
     nurses licensed  under this chapter are  subject to the                                                                    
     due process provided in the Nurse Licensure Compact.                                                                       
     Section  5:  Requires  the  Registered  Nurse  (RN)  or                                                                    
     Licensed Practical Nurse (LPN)  offering to practice in                                                                    
     this  state  to  submit evidence  of  qualification  to                                                                    
     practice  and to  be licensed  under  this chapter  (AS                                                                    
     08.68)  or AS  08.69  (created by  Section  23 of  this                                                                    
2:47:04 PM                                                                                                                    
     Section    6:    Extends    the    existing    required                                                                    
     qualifications  in  AS   08.68.170  (Qualifications  of                                                                    
     Registered  or  Practical  Nurse Applicants)  to  nurse                                                                    
     applicants  under AS  08.69 (created  by Section  23 of                                                                    
     this Act).                                                                                                                 
     Section  7:  Clarifies   that  AS  08.68.190(b)  (under                                                                    
     License by  Examination) pertains only to  Alaska state                                                                    
     nursing licensure.                                                                                                         
     Section  8:  Creates  a new  subsection  (c)  under  AS                                                                    
     08.68.190   (under  License   by  Examination),   which                                                                    
     explains that  if the qualifications  are met  for both                                                                    
     AS 08.69  (created by  Section 23 of  this Act)  and AS                                                                    
     08.68.170,  the   Board  of   Nursing  shall   issue  a                                                                    
     multistate license.                                                                                                        
     Section   9:   Amends   AS  08.68.200   (Licensure   by                                                                    
     Endorsement) to pertain only  to single state licensure                                                                    
     in Alaska.                                                                                                                 
     Section  10: Amends  AS 08.68.220  (Fees) to  authorize                                                                    
     the  Department  of  Commerce  Community  and  Economic                                                                    
     Development to set fees  for multistate licenses issued                                                                    
     by the board.                                                                                                              
     Section 11: Amends AS 08.68.230(a)  (under Use of Title                                                                    
     and  Abbreviation) to  authorize  a multistate  license                                                                    
     holder under  AS 08.69 (created  by Section 23  of this                                                                    
     Act)  to  use  the   title  Registered  Nurse  and  the                                                                    
     abbreviation R.N.                                                                                                          
     Section 12: Amends AS 08.68.230(b)  (under Use of Title                                                                    
     and  Abbreviation) to  authorize  a multistate  license                                                                    
     holder under  AS 08.69 (created  by Section 23  of this                                                                    
     Act) to use the title  Licensed Practical Nurse and the                                                                    
     abbreviation L.P.N.                                                                                                        
     Section 13: Amends AS 08.68.230(d)  (under Use of Title                                                                    
     and  Abbreviation)  to  add single  state  language  to                                                                    
     temporary permits and to note  that an LPN that holds a                                                                    
     temporary  permit  in  the  state  can  use  the  title                                                                    
     Temporary    Licensed   Practical    Nurse   and    the                                                                    
     abbreviation TLPN.                                                                                                         
     Section   14:  Clarifies   in   AS  08.68.251   (Lapsed                                                                    
     Licenses)  that  single  state  or  multistate  nursing                                                                    
     licenses  may be  reinstated if  lapsed for  fewer than                                                                    
     five years.                                                                                                                
     Sections  15-19:   Amend  AS  08.68.270   (Grounds  for                                                                    
     Denial,  Suspension,   or  Revocation)   and  08.68.275                                                                    
     (Disciplinary Sanctions) to  add the multistate license                                                                    
     to  the   existing  types  of  licenses   that  may  be                                                                    
     disciplined by the board.                                                                                                  
2:49:59 PM                                                                                                                    
SENATOR BEGICH  asked, if  the board  invalidates someone  with a                                                               
multistate license, is that person affected in every state.                                                                     
MS.  CHAMBERS answered  yes.  If  someone is  in  violation of  a                                                               
statute  or  regulation in  a  state  where these  licensees  are                                                               
authorized to practice, that Board  of Nursing can determine that                                                               
someone is guilty under the  state's administrative procedure and                                                               
not  welcome  to  practice  in  the state  any  longer.  That  is                                                               
reported through the nursing database,  which the state currently                                                               
uses. The other  states are notified and can take  action on that                                                               
license. No  nurse with active  discipline can hold  a multistate                                                               
license. A  state would have to  convert the license to  a single                                                               
state license for the nurse to practice.                                                                                        
     Section  20:  Maintains   exemptions  in  AS  08.68.800                                                                    
     (Exceptions to  Application of Chapter) for  nurses who                                                                    
     are working  in limited  circumstances under  a license                                                                    
     issued in another state.                                                                                                   
     Section 21: Amends AS  08.68.805 (Delegation of Nursing                                                                    
     Functions)  to include  nurses  who  hold a  multistate                                                                    
     license  under 08.69  (created by  Section  23 of  this                                                                    
     Section  22:  Amends  AS  08.68.850(1)  (Definition  of                                                                    
     "advanced   practice  registered   nurse)  to   include                                                                    
     registered nurses  licensed under AS 08.69  (created by                                                                    
     Section 23 of this Act).                                                                                                   
     Section   23:  Creates   AS  08.69,   Multistate  Nurse                                                                    
     Licensure   Compact.    It   includes    the   purpose,                                                                    
     definitions,   provisions,    jurisdiction,   licensing                                                                    
     provisions,  authority  of state  boards,  information-                                                                    
     sharing,  governance  and   rulemaking  authority,  due                                                                    
     process,  enforcement, dispute  resolution, withdrawal,                                                                    
     severability,   and  amendment.   These  articles   are                                                                    
     uniform to all  34 other states within  the compact and                                                                    
     are mandatory for participation.                                                                                           
     Sections  24-36:   Amend  statutes  to  add   AS  08.69                                                                    
     (created by Section 23 of  this Act) to the definitions                                                                    
     of nursing as found throughout state law:                                                                                  
     Section 37: Allows the  department to adopt regulations                                                                    
     necessary to  implement the changes  made by  this Act,                                                                    
     to take effect under AS  44.62 on the effective date as                                                                    
     noted in Section 38.                                                                                                       
     Section 38:  Makes Section 37  (Transition Regulations)                                                                    
     effective immediately once the bill is signed.                                                                             
     Section 39:  Makes Sections 1-36 of  this Act effective                                                                    
     as of July 1, 2021.                                                                                                        
2:52:48 PM                                                                                                                    
SENATOR VON IMHOF  offered her belief that each  state has unique                                                               
statutes. She  asked if a  nurse comes to  Alaska as part  of the                                                               
compact and violates a unique  statute that is different from the                                                               
other states, would they lose  the privilege to practice in other                                                               
states for violating one unique thing in Alaska.                                                                                
DR. MURRAY replied the board  would investigate and if necessary,                                                               
would  work  with  the  licensee's home  state  to  have  his/her                                                               
license  revoked  so that  nurse  would  not  be eligible  for  a                                                               
multistate license.                                                                                                             
SENATOR VON  IMHOF noted  that Dr. Murray  spoke about  11 things                                                               
that were  similar or  standard between Alaska  and the  NLC. She                                                               
asked if each traveling nurse  who works in Alaska is responsible                                                               
for identifying the unique laws in Alaska.                                                                                      
2:54:30 PM                                                                                                                    
MS. SCHLOEDER  answered that nurses  are responsible  for knowing                                                               
the  Nurse Practice  Act in  their home  state. Nurses  holding a                                                               
multistate license must  be familiar with the  Nurse Practice Act                                                               
in each state in which the nurses practices.                                                                                    
MS. CHAMBERS  said employers have  a fiduciary  responsibility to                                                               
make sure  visiting nurses are  knowledgeable to limit  their own                                                               
liability, but the state does  work with traveling nurses to make                                                               
sure they  are familiar  with Alaska's laws.  This bill  will not                                                               
change the state's current practice.                                                                                            
SENATOR  GIESSEL asked  how the  board will  know if  nurses from                                                               
other states are in Alaska.                                                                                                     
MS. CHAMBERS said Alaska currently  licenses nurses who reside in                                                               
other states,  but the board  does not know when  these licensees                                                               
are  practicing in  Alaska. The  board  also does  not know  when                                                               
nurses  are practicing  at military  bases or  for Alaska  Native                                                               
organizations since  these organizations  are exempt  from Alaska                                                               
licensure.  The  Board  of  Nursing   and  the  division  do  not                                                               
currently keep tabs on those nurses.                                                                                            
SENATOR GIESSEL pointed out one  difference. If a person violates                                                               
the  Nurse Practices  Act,  the division  will  have collected  a                                                               
licensing  fee to  help offset  the cost  of adjudication  of the                                                               
violation. Under this  compact, the division would  not have that                                                               
same financial availability.                                                                                                    
2:57:10 PM                                                                                                                    
SENATOR  BEGICH said  the  board  knows that  a  total of  20,306                                                               
licenses were issued  to nurses in various  categories. Under the                                                               
compact, the  state would no  longer know the number  of licensed                                                               
nurses in Alaska. He said he didn't know if that was an issue.                                                                  
MS.  CHAMBERS  said  the  division  has  access  to  the  nursing                                                               
database  so  it  would  have  information  if  someone  filed  a                                                               
complaint  against  a nurse.  The  division  would use  the  same                                                               
disciplinary  process it  currently  uses. She  said knowing  how                                                               
many licensed  nurses are  practicing in  the state  is important                                                               
for  certain  data  collection   points  and  to  estimate  fees.                                                               
Employers  are responsible  for  day-to-day  management of  their                                                               
nurses, whether it is in a private  clinic under a doctor or in a                                                               
large facility under a chief nursing officer.                                                                                   
3:00:08 PM                                                                                                                    
CHAIR  WILSON  asked the  division  to  provide more  information                                                               
about the fees,  noting that he does not want  to shortchange the                                                               
investigative practice of the board.                                                                                            
CHAIR WILSON held SB 179 in committee.                                                                                          

Document Name Date/Time Subjects
SB 120 version A 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 120 Sponsor Statement 1.30.2020.pdf HFIN 3/19/2020 9:00:00 AM
SHSS 2/28/2020 1:30:00 PM
SB 120
SB 120 Fiscal Note DHSS Health Care Svcs 2.20.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 179 Fiscal Note DHSS Medicaid Svcs 2.20.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 120 Comparison Flowchart 2-26-2020.pdf HFIN 3/19/2020 9:00:00 AM
SHSS 2/28/2020 1:30:00 PM
SB 120
SB 120 Providence Testimony Support 2-24-2020.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 120 Support Testimony Montgomery 2-18-2020.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 120 Testimony - Support Dr. Alexander received by 2-18-2020.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 120 Testimony Support Heatwole 2-28-2020.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 179 version A 2.5.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Nurse Licensure Compact Transmittal Letter to President Giessel 02.04.2020.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB179 Section Analysis for (S)HSS.PDF SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Fiscal Note DCCED CPBL 2.5.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Fiscal Note DHSS Public Health 2.5.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Fiscal Note DPS Statewide Support 2.5.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 NLC as a Top-Priority Indicator of Public Health Readiness 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 USAF Support of Military Families 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 NurseSB 179 Licensure Compact Presentation for Senate Health and Social Services (2.28.2020) 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 NLC Fast Facts 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Facts about the NLC 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 NLC Map of Participating States 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Survey of Alaska Nurses' View on the NLC (Dec 2019) 2.21.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Alaska Nurse Licensure Compact 2.27.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 120 Testimony Support APRN Alliance 2-25-2020.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 179 AaNA Letter of Opposition 2.28.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 US Renal Care LOS 2.28.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 120 Letters of Support 2.28.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 120
SB 179 Public Input 2.28.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179
SB 179 Letter of Support AARP 2.19.20.pdf SHSS 2/28/2020 1:30:00 PM
SB 179