Legislature(2021 - 2022)BUTROVICH 205

04/08/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Heard & Held
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved SB 26 Out of Committee
Moved SB 99 Out of Committee
               SB  38-NATUROPATHS: LICENSING; PRACTICE                                                                      
1:41:06 PM                                                                                                                    
VICE  CHAIR  HUGHES  reconvened the  meeting  and  announced  the                                                               
consideration  of SENATE  BILL NO.  38  "An Act  relating to  the                                                               
practice  of naturopathy;  establishing the  Naturopathy Advisory                                                               
Board;  relating to  the licensure  of  naturopaths; relating  to                                                               
disciplinary   sanctions  for   naturopaths;   relating  to   the                                                               
Department of Commerce, Community,  and Economic Development; and                                                               
providing for an effective date."                                                                                               
1:42:25 PM                                                                                                                    
SENATOR  SCOTT   KAWASAKI,  Alaska  State   Legislature,  Juneau,                                                               
Alaska,  Sponsor of  SB  38,  introduced the  bill  on behalf  of                                                               
Alaska   approximately  fifty licensed  naturopath practitioners.                                                               
He stated  naturopaths provide  valuable healthcare  services and                                                               
can  help Alaska's  primary healthcare  provider shortage.  Vague                                                               
statute on  the authority of  naturopaths caused Alaska  to adopt                                                               
among the  most restrictive naturopathic medicine  regulations in                                                               
the nation.  SB 38 seeks to  establish a clear scope  of practice                                                               
for   naturopathic  physicians   and  allow   them  to   practice                                                               
consistent  with their  education and  training. Naturopaths  are                                                               
prohibited from  performing minor routine office  procedures that                                                               
they have been trained in, such  as sutures, wart removal and IUD                                                               
placements.   Many  naturopaths   have  accredited   pharmacology                                                               
degrees   and   training   but  are   prohibited   from   writing                                                               
prescriptions and must refer patients to other providers.                                                                       
1:43:49 PM                                                                                                                    
SENATOR  KAWASASKI  stated  that overly  restrictive  regulations                                                               
cause  naturopaths to  rethink  practicing in  the  state. SB  38                                                               
would correct  this by outlining clear  statutory guidelines. The                                                               
bill  would allow  licensed naturopath  practitioners to  perform                                                               
minor  office procedures  and  prescribe  vitamins, minerals  and                                                               
other  noncontrolled substance  medications.  The  same scope  is                                                               
practiced  safely  in  other  states   and  by  other  healthcare                                                               
providers. Many Alaskans' struggle  with basic healthcare access.                                                               
Naturopathic  medicine  can  provide valuable  and  complementary                                                               
care  in the  Alaska healthcare  setting. Giving  naturopaths the                                                               
ability to practice  the scope of medicine  consistent with their                                                               
training expands the availability of primary care in Alaska.                                                                    
1:44:56 PM                                                                                                                    
JOE   HAYES,  Staff,   Senator  Scott   Kawasaki,  Alaska   State                                                               
Legislature,  Juneau,   Alaska,  presented  SB  38   reading  the                                                               
[Original punctuation provided.]                                                                                                
     SENATE BILL 38 NATUROPATHIC MEDICINE REFORM                                                                                
     WHAT IS A NATUROPATHIC DOCTOR?                                                                                             
     A primary care provider  with a four-year post graduate                                                                    
     medical  degree, who  practices evidence-based  primary                                                                    
     care,  with a  patient-centered focus  that prioritizes                                                                    
     disease  prevention over  symptom  management and  drug                                                                    
     WHAT EDUCATION DO NATUROPATHIC DOCTORS RECEIVE?                                                                            
     4-Year  Medical   School  Program  accredited   by  the                                                                    
     Council of  Naturopathic Medical  Education; including:                                                                    
     2  years  of  medical  sciences  (anatomy,  physiology,                                                                    
     microbiology, immunology, etc.)                                                                                            
     2 years of clinical sciences and treatment methods                                                                         
     4 year undergraduate  degree and additional pre-medical                                                                    
     13   year  residency  options throughout  the  country;                                                                    
     however, there  are not enough  residency opportunities                                                                    
     for every graduate                                                                                                         
           Naturopaths must pass the two-part Naturopathic                                                                      
        Physicians Licensing Examination (NPLEX) before being                                                                   
     licensed to practice                                                                                                       
1:46:30 PM                                                                                                                    
At ease                                                                                                                         
1:47:13 PM                                                                                                                    
SENATOR COSTELLO asked who prepared the slides.                                                                                 
1:47:47 PM                                                                                                                    
MR.  HAYES answered  that the  Naturopathic Association  prepared                                                               
the slides.                                                                                                                     
1:47:55 PM                                                                                                                    
SENATOR  COSTELLO asked  where  the  Naturopathic Association  is                                                               
MR.  HAYES replied  that people  online could  clarify where  the                                                               
association is located.                                                                                                         
VICE   CHAIR  HUGHES   requested   Mr.   Hayes  recommend   which                                                               
association would answer.                                                                                                       
MR. HAYES replied that Ms. Lange can address the question.                                                                      
SENATOR COSTELLO restated the question  regarding the location of                                                               
the Naturopathic Association.                                                                                                   
1:49:06 PM                                                                                                                    
ABBY  LANGE, Representative,  Alaska Association  of Naturopathic                                                               
Physicians, Anchorage,  Alaska responded that the  association is                                                               
in Anchorage, Alaska.                                                                                                           
SENATOR COSTELLO  asked if the  presentation was prepared  by the                                                               
Anchorage office or a national associate.                                                                                       
1:49:22 PM                                                                                                                    
MS. LANGE answered  that it was prepared in  conjunction with the                                                               
local office, not national.                                                                                                     
1:49:34 PM                                                                                                                    
MR. HAYES continued reading the presentation at slide 4:                                                                        
     WHO IS NOT A NATUROPATHIC DOCTOR?                                                                                          
     Other  conventionally-trained  or  allied  health  care                                                                    
     providers   practicing   integrative,  functional,   or                                                                    
     holistic  healthcare  such  as  Medical  Doctors  (MD),                                                                    
     Doctors of  Osteopathy (DO), Chiropractors  (DC), Nurse                                                                    
     Practitioners  (NP),  Physicians  Assistants  (PA),  or                                                                    
     Massage Therapists (LMT)                                                                                                   
     Other  licensed   or  unlicensed   providers  marketing                                                                    
     themselves   as   natural  care   providers,   holistic                                                                    
     healthcare providers or healers                                                                                            
     Health food store employees                                                                                                
     Essential oil sales representatives                                                                                        
     Someone who completed an online certificate course                                                                         
     LEGISLATIVE HISTORY OF NATUROPATH STATUTES IN ALASKA                                                                       
     ESTABLISHING  STATUTES  1986:  AS  08.45  (Naturopaths)                                                                    
     LEGISLATION PASSED                                                                                                         
     2004:  SB 306  -  Established  a Naturopathic  Medicine                                                                    
     Task Force                                                                                                                 
     2005: SB 42 - Extended  Task Force one year and updated                                                                    
     2005: SB  52 - Updated  statutes to  correct "division"                                                                    
     to "department"                                                                                                            
     LEGISLATION ATTEMPTS                                                                                                       
     2007: SB 107                                                                                                               
     2008: HB 363                                                                                                               
     2010: HB 282 & SB 70                                                                                                       
     2011: HB 122                                                                                                               
     2012: HB 266 & SB 175                                                                                                      
     2013: HB 7                                                                                                                 
     2017: HB 326 & SB 120                                                                                                      
     2019: HB 91                                                                                                                
     2021: SB 38                                                                                                                
1:51:02 PM                                                                                                                    
SENATOR BEGICH asked if attempted changes to legislation from                                                                   
2007-2019 were based on the 2004 task force findings.                                                                           
MR. HAYES  replied that  Ms. Chambers has  the history  and could                                                               
address the question.                                                                                                           
1:51:57 PM                                                                                                                    
VICE CHAIR  HUGHES supposed that  attempts for  changes mentioned                                                               
in the  bill began in 2007.  This bill is the  nineth attempt for                                                               
legislative change.                                                                                                             
MR.  HAYES  explained  that  slide   6  shows  the  licensing  of                                                               
naturopathic  doctors  (NDs) across  the  United  States. NDs  in                                                               
Alaska are  licensed and have  some degree of  insurance coverage                                                               
for services.  There are eleven  states aiming to file  bills for                                                               
NDs.  Several states  are  unregulated. He  stated  that slide  7                                                               
addresses  the more  controversial topic,  which is  prescriptive                                                               
authority for  NDs. In Alaska  NDs have neither  prescriptive nor                                                               
controlled  substance  authority;  Arizona  and  California  have                                                               
MR. HAYES read slide 8:                                                                                                         
[Original punctuation provided.]                                                                                                
     Senate Bill 38                                                                                                             
     Modernizes  statutes  for  Naturopaths by  cleaning  up                                                                    
     outdated   language,  requiring   continuing  education                                                                    
     every  2 years,  and  imposing the  same public  health                                                                    
     duties on Naturopaths as other medical providers                                                                           
        Updates scope of practice for Naturopaths to include                                                                    
          limited prescriptive authority and allowing minor                                                                     
     office procedures                                                                                                          
         Removes the need for duplicative office visits and                                                                     
     improves access to care for patients in Alaska                                                                             
1:53:55 PM                                                                                                                    
SENATOR  BEGICH asked  if  a  pharmacological training  provision                                                               
would be in the bill, if prescriptive authority is allowed.                                                                     
VICE CHAIR HUGHES  noted that page two of  the presentation lists                                                               
other courses but not pharmacology.                                                                                             
SENATOR  KAWASAKI   replied  that  someone  will   speak  to  the                                                               
pharmacological training NDs receive. He  stated that the bill is                                                               
not  trying  to  expand  prescriptive  authority  to  naturopaths                                                               
beyond the four-year science-based training they receive.                                                                       
1:55:21 PM                                                                                                                    
SENATOR BEGICH  offered that page  5, lines 23  - 25 of  the bill                                                               
limits  prescriptive  authority  to   naturopaths  who  pass  the                                                               
pharmacological portion of  the Naturopathic Physicians Licensing                                                               
SENATOR COSTELLO  referenced page 6  lines 14-15. She  noted that                                                               
the  prohibition on  surgery and  using the  term physician  in a                                                               
naturopath's title  are removed  from statute,  see page  6 lines                                                               
14-15. She questioned  if it is deceptive to allow  someone to be                                                               
called a  physician and  then state they  can only  perform minor                                                               
surgery. She  asked if  there will be  public confusion,  about a                                                               
person's training, if naturopaths are called physicians.                                                                        
1:57:10 PM                                                                                                                    
SENATOR KAWASAKI replied that the  term surgery implies more than                                                               
naturopaths  are requesting.  A definition,  consistent with  the                                                               
request  should be  included in  the bill,  such as  minor office                                                               
1:57:44 PM                                                                                                                    
SENATOR  COSTELLO requested  the bill  clarify what  minor office                                                               
procedures are versus major surgery.                                                                                            
SENATOR KAWASAKI concurred.                                                                                                     
1:58:59 PM                                                                                                                    
VICE CHAIR HUGHES asked for sectional analysis.                                                                                 
1:59:10 PM                                                                                                                    
MR. HAYES presented the sectional analysis:                                                                                     
[Original punctuation provided.]                                                                                                
     SB 38                                                                                                                      
     Sectional Analysis                                                                                                         
     "An  Act  relating  to  the  practice  of  naturopathy;                                                                    
     establishing the  Naturopathy Advisory  Board; relating                                                                    
     to   the   licensure   of  naturopaths;   relating   to                                                                    
     disciplinary  sanctions  for naturopaths;  relating  to                                                                    
     the  Department of  Commerce,  Community, and  Economic                                                                    
     Development; and providing for an effective date."                                                                         
     Section 1  AS 08.02.010(a) Professional designation                                                                        
     requirements. (Amended)                                                                                                    
     Requires naturopathic practitioners  to use appropriate                                                                    
     letters, titles and specialist designations.                                                                               
     Section  2    AS 08.45.015  Naturopathy Advisory  Board                                                                    
     (New Section)                                                                                                              
     Establishes  a five-person  Naturopathy Advisory  Board                                                                    
     for the  purpose of making recommendations  on adoption                                                                    
     of  regulations  and  other  matters  relating  to  the                                                                    
     functions of the department under AS 08.45.                                                                                
1:59:59 PM                                                                                                                    
     Section  3     AS  05.45.020  Application  for  license                                                                    
     Requires  applicants applying  for licensure  to use  a                                                                    
     form   provided   by    the   department;   to   submit                                                                    
     fingerprints  for   purposes  of  a   criminal  history                                                                    
     background  check   for  licensure;   and  pay   a  fee                                                                    
     established by the department.                                                                                             
     Section  4      AS   08.45.030  Issuance   of  license.                                                                    
     Establishes,  to  be  issued a  license,  an  applicant                                                                    
           • have graduated with a doctoral degree from                                                                         
             an accredited naturopathic college;                                                                                
          • have passed the Naturopathic Physicians                                                                             
             Licensing Examination;                                                                                             
          • is not subject to an unresolved                                                                                     
             disciplinary action in another                                                                                     
          • complies with application requirements;                                                                             
          • have not been convicted or, or pled                                                                                 
             guilty, or no contest to a crime that                                                                              
             adversely reflects on the applicant's                                                                              
             ability to practice or jeopardizes the                                                                             
             safety of a patient                                                                                                
     Removes outdated  language requiring that to  be issued                                                                    
     a  license to  practice  naturopathy in  Alaska, if  an                                                                    
     individual graduated  before 1988, they must  also have                                                                    
     been  issued a  license  to practice  in another  state                                                                    
2:01:12 PM                                                                                                                    
     Section  5     AS 08.45.032  Documentation  of  license                                                                    
     refusals and revocations (New Section)                                                                                     
     Requires  the  department  to  provide  in  writing,  a                                                                    
     concise statement for refusal  to issue licenses or for                                                                    
     license revocation.                                                                                                        
     Section  6      AS  08.45.035(a)   Temporary  licenses.                                                                    
     Allows the  department to issue a  temporary license to                                                                    
     a naturopath if they are  signed up to take a licensing                                                                    
     exam at the  next available date after the  date of the                                                                    
     application   and  meets   all   the  other   licensing                                                                    
     requirements outlined  in AS 08.45.030(1)(A) and  (2)                                                                      
2:01:53 PM                                                                                                                    
     Section  7      AS  08.45.038  Standards   for  license                                                                    
     renewal. (New Section)                                                                                                     
     Outlines  the  requirements  for  naturopathic  license                                                                    
     Section 8   AS 08.45.045  Practice of naturopathy. (New                                                                    
     Allows naturopaths to:                                                                                                     
        • practice within the standards and scope of                                                                            
          their education and training;                                                                                         
        • prescribe natural and therapeutic                                                                                     
          substances, natural therapies, and                                                                                    
          contraceptive devices;                                                                                                
        • prescribe allowed drugs only if the                                                                                   
          naturopath has passed the Naturopathic                                                                                
          Physicians Licensing Examination                                                                                      
          pharmacology portion; and                                                                                             
        • perform minor surgeries and order diagnostic                                                                          
          procedures. Defines "naturopathic physical                                                                            
2:02:40 PM                                                                                                                    
     Section 9    AS  08.45.050 Restrictions on  practice of                                                                    
     naturopathy. (Amended)                                                                                                     
     Removes   the   prohibition  for   prescribing   drugs,                                                                    
     performing   minor  surgeries,   and  using   the  word                                                                    
      physician"  in  titles.   Prohibits  naturopaths  from                                                                    
     giving,  recommending or  prescribing cancer  drugs and                                                                    
     controlled substances.                                                                                                     
     Section 10    AS  08.45.053 Public health  duties. (New                                                                    
     AS  08.45.055  Duty  of  naturopaths  to  report.  (New                                                                    
     AS  08.45.058 Naturopaths  to report  certain injuries.                                                                    
     (New  Section) Imposes  same  public  health duties  on                                                                    
     naturopaths as other physicians.                                                                                           
     Section  11     AS 08.45.060  Grounds  for  suspension,                                                                    
     revocation, or refusal to issue a license. (Amended)                                                                       
     Amends  and   applies  the  same   suspension,  license                                                                    
     revocation, or  refusal to issue  a license  grounds on                                                                    
     naturopaths as other physicians.                                                                                           
2:03:33 PM                                                                                                                    
     Section  12     AS 08.45.060  Grounds  for  suspension,                                                                    
     revocation,  or  refusal  to   issue  a  license.  (New                                                                    
     Adds a new  subsection to clarify the  authority of the                                                                    
     entity  taking disciplinary  action  against a  license                                                                    
     under AS 08.45.060(a)(14)                                                                                                  
     Section  13    AS 08.45.070(a)  Disciplinary sanctions.                                                                    
     Amends  to clarify  that  disciplinary sanctions  apply                                                                    
     for all of AS 08.45 and  imposes a limit of $25,000 for                                                                    
     civil penalties.                                                                                                           
     Section 14   AS  08.45.070 Disciplinary sanctions. (New                                                                    
     Establishes  and  outlines   when  the  department  may                                                                    
     reinstate  or  suspend  a   license  and  requires  the                                                                    
     department  to  report  actions  on  licensees  to  the                                                                    
     National Practitioner Data Bank.                                                                                           
     Section  15    AS  08.45.105  Automatic suspension  for                                                                    
     mental incompetency. (New Section)                                                                                         
     AS 08.45.110 Voluntary surrender. (New Section)                                                                            
     AS  08.45.115  Medical   and  psychiatric  exams.  (New                                                                    
     AS  08.45.120 Reports  relating to  malpractice actions                                                                    
     and claims. (New Section)                                                                                                  
     AS 08.45.125 Penalty for  practicing without a license.                                                                    
     (New Section                                                                                                               
     AS  08.45.130 Prohibited  use of  title. (New  Section)                                                                    
     Establishes new  sections and applies the  same grounds                                                                    
     for naturopaths as physicians for licensing:                                                                               
        • Automatic suspension of a license for mental                                                                          
        • Voluntary surrender of a license;                                                                                     
        • Requiring medical and psychiatric exams;                                                                              
        • Requires reporting for malpractice actions                                                                            
          and claims;                                                                                                           
        • Applies penalties for practicing naturopathy                                                                          
          without a license; and                                                                                                
        • Prohibits using the title "naturopath"                                                                                
          without a license.                                                                                                    
     Section  16    AS  08.45.200(3) Definitions.  (Repealed                                                                    
     and Reenacted)                                                                                                             
     Repeals and replaces definition for "naturopathy"                                                                          
     Section 17    AS  08.45.200(4) & (5)  Definitions. (New                                                                    
     Defines  "approved  naturopathic  medical  school"  and                                                                    
     Section 18   AS  12.62.400(a) National criminal history                                                                    
     record  checks  for  employment, licensing,  and  other                                                                    
     noncriminal justice purposes. (New Paragraph)                                                                              
     Amends 12.62.400 to include  and require naturopaths to                                                                    
     submit fingerprints  to complete the  national criminal                                                                    
     history record check.                                                                                                      
     Section 19  Transitional Language (Uncodified law)                                                                         
     Transitional   language  allowing   currently  licensed                                                                    
     naturopaths to practice under the new law.                                                                                 
2:06:20 PM                                                                                                                    
     Section 20   Transitional Regulations (Uncodified law)                                                                     
     Allows   the    Department   to    adopt   transitional                                                                    
     regulations immediately following  passage and prior to                                                                    
     the bill's effective date.                                                                                                 
     Section 21  Effective date. (Uncodified law)                                                                               
     Establishes immediate effective date for section 20                                                                        
     Section 22  Effective date. (Uncodified law)                                                                               
     Establishes  effective  date for  sections  1    19  as                                                                    
     January 1, 2022                                                                                                            
2:06:48 PM                                                                                                                    
SENATOR  COSTELLO  expressed  concern,  about  the  provision  in                                                               
Section 10 requiring  naturopaths to report gun  wounds and other                                                               
potential life-threatening  injuries to the Department  of Public                                                               
Safety.  She   asked  if  it   misleads  the  public   to  assume                                                               
naturopaths  treat  such  injuries.  She noted  that  on  page  5                                                               
Section 8 pharmacology,  as an elective portion  of the licensing                                                               
exam, creates a variance in  licensure. This could make the scope                                                               
of a  naturopath's practice confusing  to the public.  The public                                                               
should  be  aware  that prescriptive  authority  is  an  elective                                                               
credential for naturopaths.                                                                                                     
2:09:31 PM                                                                                                                    
SENATOR  KAWASAKI  answered  that   he  believes  Section  10  is                                                               
conforming  language  that has  naturopaths  adhere  to the  same                                                               
reporting requirements as medical doctors.                                                                                      
VICE CHAIR HUGHES commented that  Ms. Chambers nodded her head in                                                               
SENATOR COSTELLO  added to her  previous comment  on prescriptive                                                               
authority. She  stated that  a portion of  an exam  that provides                                                               
different licensure should be its own test and license.                                                                         
2:10:50 PM                                                                                                                    
VICE   CHAIR   HUGHES   asked  if   the   bill   requires   extra                                                               
certifications  to be  listed on  the  license. She  is aware  of                                                               
other  practitioners  who  take  exams in  order  to  have  added                                                               
2:11:11 PM                                                                                                                    
SENATOR BEGICH  suggested that naturopaths  could be  required to                                                               
publicly post their qualifications on a placard.                                                                                
2:11:47 PM                                                                                                                    
MR. HAYES  replied that Senator  Kawasaki's office is  willing to                                                               
work with the committee on changes.                                                                                             
2:12:08 PM                                                                                                                    
SENATOR COSTELLO  commented that  AS 08.45.050 prohibits  the use                                                               
of the word physician in a  naturopath's title. She asked if this                                                               
legislation reverses the restriction.                                                                                           
MR. HAYES replied that clear definitions need to be determined.                                                                 
2:13:06 PM                                                                                                                    
SENATOR COSTELLO  commented that  the presentation used  the term                                                               
doctor of naturopathy. She found  use of the term confusing since                                                               
there is no statutory right to do so.                                                                                           
VICE CHAIR HUGHES commented that  the word doctor applies to many                                                               
professions, whereas  Americans associate  the word  physician to                                                               
mean medical doctors  (MDs) and doctors of  osteopathy (DOs). She                                                               
questioned  the  necessity  of  changing  the  statute  to  allow                                                               
naturopathic doctors to be referred  to as physicians, since they                                                               
are called NDs. Referring to  the presentation, she asked whether                                                               
some vitamins and minerals are prescribed.                                                                                      
SENATOR  KAWASAKI replied  that  someone online  will talk  about                                                               
prescriptive authority.                                                                                                         
2:15:06 PM                                                                                                                    
VICE CHAIR HUGHES  recalled from the presentation  that there was                                                               
a  lack of  residency locations  for naturopathic  graduates. She                                                               
asked if some NDs do not complete a residency.                                                                                  
MR. HAYES replied yes.                                                                                                          
2:15:29 PM                                                                                                                    
VICE CHAIR HUGHES opined that  NDs not completing residencies and                                                               
being elevated to  the level of physician is a  problem. MDs, DOs                                                               
and  even behavioral  health doctors,  complete residencies.  She                                                               
asked how  limited ND residency opportunities  are. She suggested                                                               
that the legislature consider making residency a requirement.                                                                   
2:16:01 PM                                                                                                                    
SENATOR  KAWASAKI   responded  that   there  are   other  medical                                                               
professions  governed  by  the   state  medical  board,  such  as                                                               
physician  assistants  and  nurse  practitioners,  which  do  not                                                               
require  residency  but  have  advanced  levels  of  prescriptive                                                               
2:16:18 PM                                                                                                                    
VICE CHAIR  HUGHES countered that physician  assistants and nurse                                                               
practitioners are not  called doctors. She asked  for the student                                                               
to residency ratio.  She asked how many students  do not complete                                                               
a residency.                                                                                                                    
SENATOR  KAWASAKI  replied   that  practicing  naturopaths  could                                                               
answer the question.                                                                                                            
2:16:52 PM                                                                                                                    
VICE  CHAIR HUGHES  mentioned that  the bill  allows a  person to                                                               
obtain a temporary  license if all course work,  except the exam,                                                               
has  been completed.  She  asked if  a  temporary license  limits                                                               
authority to function and practice as a ND.                                                                                     
SENATOR  KAWASAKI  replied  that  Ms. Chambers  will  answer  the                                                               
2:17:22 PM                                                                                                                    
VICE CHAIR  HUGHES expressed concern  that a person, who  has not                                                               
passed an  exam, might possess  full authority  to act as  an ND.                                                               
She noted that the bill  refers to the National Practitioner Data                                                               
Bank. She wondered if  the data bank is specific to  NDs or if it                                                               
is used for all licensed healthcare providers.                                                                                  
SENATOR   KAWASAKI  stated   that   the  National   Practitioners                                                               
Databank, maintained by  the US Department of  Human Services, is                                                               
a   large   bank   containing  all   associated   licensing   and                                                               
accreditation information of an individual.                                                                                     
2:19:12 PM                                                                                                                    
VICE  CHAIR HUGHES  asked  if NDs  want  licensure for  insurance                                                               
billing purposes.                                                                                                               
MR. HAYES  stated that  insurance billing  will be  discussed. He                                                               
explained that  the 1986 statutes  are outdated,  and enforcement                                                               
of  2021 regulations  is difficult.  Updating  the statues  would                                                               
make   issues,  such   as   continuing   education,  easier   for                                                               
naturopaths. The  primary point  of updating  the statutes  is to                                                               
make  them  reflective of  what  is  happening  in the  field  of                                                               
naturopathy today.                                                                                                              
2:20:16 PM                                                                                                                    
SENATOR  KAWASAKI  shared an  example  of  the need  for  statute                                                               
updates.  He stated  that several  years ago  by happenstance,  a                                                               
naturopath  found  out that  a  mineral  procedure, he  had  been                                                               
permitted  to  do and  was  still  doing,  had been  affected  by                                                               
medical board  regulation changes.  As a  result of  the changes,                                                               
only  MDs and  ODs  could  do the  procedure.  He concluded  that                                                               
updating  the  statues  is essential  to  understanding  how  the                                                               
practice of naturopathy has changed over the years.                                                                             
VICE  CHAIR HUGHES  asked if  naturopaths  could bill  insurance,                                                               
Medicaid and Medicare.                                                                                                          
MR.  HAYES  replied  that  question can  be  answered  by  online                                                               
2:21:29 PM                                                                                                                    
SENATOR BEGICH responded that naturopaths  can bill insurance. He                                                               
stated he  was married to  someone who  went to a  naturopath and                                                               
used  his insurance.  He  asked  if the  terms  ND  or Doctor  of                                                               
Naturopathy are currently in use and  if the use is allowed under                                                               
current regulation.                                                                                                             
2:22:14 PM                                                                                                                    
VICE  CHAIR  HUGHES  speculated that  insurance  may  only  cover                                                               
certain  procedures, which  may be  a reason  updates to  current                                                               
statutes are being sought.                                                                                                      
2:22:30 PM                                                                                                                    
SENATOR KAWASAKI stated that a lot  of answers will be given from                                                               
people online and  Ms. Chambers. The bill was  brought forward to                                                               
allow  naturopathic healthcare  providers to  practice consistent                                                               
with their education and scope of practice.                                                                                     
2:22:54 PM                                                                                                                    
VICE CHAIR HUGHES stated that  access and affordability is better                                                               
when trained providers can work  to their full scope of practice.                                                               
She  stated that  naturopaths  are a  valuable  part of  Alaska's                                                               
medical professions.                                                                                                            
2:23:31 PM                                                                                                                    
SENATOR  REINBOLD  stated  that  she has  visited  a  naturopath,                                                               
values their expertise  and is thankful for  the alternative care                                                               
they provide.                                                                                                                   
2:24:15 PM                                                                                                                    
SENATOR  COSTELLO  expressed  that  her  concern  with  the  bill                                                               
resides in the  authority naturopaths will be  given to prescribe                                                               
drugs. Although  the bill states categories  of drugs naturopaths                                                               
will not be allowed to prescribe,  she would like a list of drugs                                                               
that  will be  allowed. The  bill is  presumed to  update statute                                                               
based  on  naturopathic training.  She  would  like to  know  how                                                               
naturopath and medical doctor  trainings compare, before allowing                                                               
the  terms doctor  and physician  to be  used by  naturopaths. As                                                               
proposed statutes are opposite of  current statutes, she believes                                                               
there is more to the bill than updating statute.                                                                                
2:25:57 PM                                                                                                                    
SENATOR BEGICH stated  he would like a list  of drugs naturopaths                                                               
could  prescribe.  He  reminded the  committee  that  prescribing                                                               
power  is limited  to naturopaths  who  pass the  pharmacological                                                               
portion  of  the licensing  test.  He  suggested  a copy  of  the                                                               
pharmacological portion of  the test be obtained  and its content                                                               
viewed.  He suggested  members look  through the  pharmacological                                                               
portion of the test to gain understanding of its content.                                                                       
2:26:34 PM                                                                                                                    
VICE  CHAIR  HUGHES  asked  the sponsor  to  provide  a  thorough                                                               
overview  of  AP,  MD and  ND  pharmacological  requirements  and                                                               
whether they are comparable.                                                                                                    
2:27:02 PM                                                                                                                    
SENATOR COSTELLO  reminded the committee that  MDs complete years                                                               
of  residency  training.  She  stated that  in  terms  of  public                                                               
protection and  the transparency of  what a person is  allowed to                                                               
do, legislators need to be careful.                                                                                             
2:27:42 PM                                                                                                                    
VICE CHAIR HUGHES called Sara Chambers to the table.                                                                            
2:27:54 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development (DCCED),  Juneau, Alaska,  stated that  the                                                               
administration  has not  taken a  position  on the  bill. She  is                                                               
present  as  a technical  resource.  She  provided the  following                                                               
answers and comments to members' questions:                                                                                     
   • The term naturopathic doctor is allowed by current law.                                                                    
   • The language that requires naturopaths to report certain                                                                   
     injuries to public  safety was taken from  the Medical Board                                                               
     statutes  and  regulations.  She  noted  that  like  Senator                                                               
     Johnston's  bill  last  session,  an  objective  of  Senator                                                               
     Kawasaki's  bill is  to provide  greater responsibility  and                                                               
     accountability to naturopaths. Current  statute has a gap in                                                               
     patient protections.  This bill contains  accountability not                                                               
     found in legislation                                                                                                       
   • She addressed the trend of updating statues and keeping                                                                    
     laws relevant  as licensing  and investigation  concerns are                                                               
     identified.  For  this  legislation that  means  allowing  a                                                               
     person to perform to the  full extent of their education and                                                               
     providing   public  protections.   In   recent  years,   the                                                               
     legislature  has   seen  scope   of  practice   updates  for                                                               
     optometrists,  advanced   practice  registered   nurses  and                                                               
     chiropractors. These  updates were in recognition  of modern                                                               
     advancements in education  and training. Current legislation                                                               
     recognizes the  need for  modernization and  flexibility for                                                               
     paramedic  and physical  therapists. She  is aware  of other                                                               
     boards working to identify and update statutes.                                                                            
   • Naturopaths can bill insurance. Names of insurance experts                                                                 
     working  for  the  state can  be  provided.  She  understood                                                               
     insurance was not the onus for the legislation.                                                                            
   • The National Practitioner Data Bank (NPDB) is monitored by                                                                 
     the   federal  government.   Before   a   State  of   Alaska                                                               
     professional  healthcare license  is issued,  the Department                                                               
     of Commerce, Community and  Economic Development (DCCED) has                                                               
     a responsibility  to check the  NPDB for  violations against                                                               
     the   individual.   By   state   law   DCCED   ensures   all                                                               
     jurisdictions share  data about  licensee violations.  It is                                                               
     used for NDs and other healthcare professions.                                                                             
2:33:08 PM                                                                                                                    
VICE  CHAIR HUGHES  asked  if  the databank  is  checked for  all                                                               
healthcare professions, including NDs.                                                                                          
MS. CHAMBERS replied yes.                                                                                                       
2:33:22 PM                                                                                                                    
SENATOR BEGICH asked if naturopaths  are currently allowed to use                                                               
the term Doctor  of Naturopathy and the abbreviation  ND in their                                                               
MS.  CHAMBERS replied  that naturopaths  are allowed  to use  the                                                               
term naturopathic doctor and ND. They  are not allowed to use the                                                               
term physician.                                                                                                                 
2:33:41 PM                                                                                                                    
She stated that  temporary licensure before passing an  exam is a                                                               
convention among healthcare professions  because some exams occur                                                               
only  twice a  year. In  conjunction with  a temporary  license a                                                               
board may  require oversight  from a  sponsor. A  licensing board                                                               
may  require  sponsor  oversight  as  a  condition  of  temporary                                                               
2:34:40 PM                                                                                                                    
VICE CHAIR  HUGHES stated that a  supervisory statute requirement                                                               
for a temporary  license is not in  the bill. She asked  if it is                                                               
in statute for other professions.                                                                                               
2:34:56 PM                                                                                                                    
MS.  CHAMBERS replied  that supervision  while under  a temporary                                                               
license  is either  in statute  or regulation,  depending on  the                                                               
profession. She offered to provide template language.                                                                           
2:35:13 PM                                                                                                                    
VICE  CHAIR HUGHES  said she  would  be more  comfortable with  a                                                               
supervisory provision if the sponsor agrees.                                                                                    
2:35:21 PM                                                                                                                    
MS.  CHAMBERS  noted  that prescriptive  endorsement  is  another                                                               
convention  that  exists   in  healthcare  professions.  Advanced                                                               
practice registered nurses (APRN) can  opt to have a prescriptive                                                               
endorsement.  Dentists  and  optometrists are  other  professions                                                               
that offer  specialized endorsements beyond a  basic license. She                                                               
stated that models exist for how  to clearly state and display an                                                               
ND's prescriptive authority.                                                                                                    
2:36:19 PM                                                                                                                    
VICE CHAIR  HUGHES asked if  prescriptive endorsement  would need                                                               
to be in statute.                                                                                                               
MS. CHAMBERS replied  that it is akin to a  license, therefore it                                                               
needs to be in statute.                                                                                                         
2:36:38 PM                                                                                                                    
SENATOR COSTELLO  asked if  naturopaths have a  voice or  seat on                                                               
any boards.                                                                                                                     
MS. CHAMBERS answered that naturopaths  have no official voice in                                                               
licensure.  Naturopaths are  fully regulated  by the  Division of                                                               
Corporations,  Business   and  Professional  Licensing.   When  a                                                               
regulatory  matter  arises, it  is  handled  informally with  the                                                               
director.  If a  regulations package  is moved  forward, it  goes                                                               
through the public process.                                                                                                     
2:37:35 PM                                                                                                                    
SENATOR   COSTELLO  noted   a  section   in  the   bill  mentions                                                               
naturopaths would  provide recommendations for policy.  She asked                                                               
if that language is found in all licensure board statues.                                                                       
2:37:55 PM                                                                                                                    
MS.  CHAMBERS responded  that there  are  twenty-one boards.  All                                                               
boards are  authorized, by the legislature,  to adopt regulations                                                               
and  create  policy,  within statutory  restrictions,  for  their                                                               
profession. The  director, through the  commissioner, establishes                                                               
regulations and  policy for non-boarded professions.  There is no                                                               
middle  ground.  For   example,  construction  contractors,  like                                                               
naturopaths, do not have an official voice on a board. She.                                                                     
offered her  belief that the  bill proposes an advisory  board be                                                               
created.  It is  not a  full board.  It would  not have  the full                                                               
ability to adopt its own  regulations through the public process.                                                               
Naturopaths would  have an official  seat at the table  to advise                                                               
the  division on  policy changes  and help  accomplish them  more                                                               
efficiently and effectively.                                                                                                    
2:39:11 PM                                                                                                                    
SENATOR  COSTELLO  asked  what  other  professions  do  not  have                                                               
MS. CHAMBERS  recalled that construction  contractors, mechanical                                                               
administrators,  electrical  administrators  and others  in  that                                                               
family  of  professions  do  not have  a  board.  Recently  DCCED                                                               
proposed regulations  on behalf  these professionals, as  they do                                                               
not have a voice except  through the public process. She recalled                                                               
healthcare  professions without  boards are  behavioral analysts,                                                               
athletic  trainers,  speech language  pathologists,  audiologists                                                               
and hearing aid dealers.                                                                                                        
2:40:21 PM                                                                                                                    
SENATOR  COSTELLO commented  that advisory  boards are  sometimes                                                               
created  temporarily   to  offer  recommendations.   A  permanent                                                               
advisory board    purpose would be to  make recommendations about                                                               
statutes. She  opined that  naturopath's administering  their own                                                               
licensing would  be better  than trying  to make  changes through                                                               
regulations  forwarded  to the  state.  An  advisory board  is  a                                                               
departure from  established procedure. She questioned  whether an                                                               
advisory  board is  being created  because  past efforts  haven't                                                               
worked.  She stated  it is  important to  figure out  and satisfy                                                               
actual  need.   She  speculated   that  the  limited   number  of                                                               
naturopaths  in Alaska  and the  bureaucracy that  establishing a                                                               
board  would necessitate  are reasons  why naturopaths  would not                                                               
want a full board.                                                                                                              
2:41:51 PM                                                                                                                    
MS. CHAMBERS  confirmed that  the concept  for an  advisory board                                                               
initially was to  limit bureaucracy. She opined that  if the bill                                                               
passes, naturopaths will have  more authority and accountability;                                                               
the  division will  have  more to  oversee  and investigate.  She                                                               
stated that  as a director  having a naturopathic  board, whether                                                               
appointed,  full or  advisory, would  be a  support. In  the past                                                               
five  years   there  were  six  investigations.   The  number  of                                                               
investigations is expected to go with increased authority.                                                                      
2:43:48 PM                                                                                                                    
SENATOR BEGICH stated that he no longer has a question.                                                                         
2:44:12 PM                                                                                                                    
VICE CHAIR HUGHES questioned whether  staffing a full board would                                                               
result in  higher licensing fees.  She presumed that  having only                                                               
fifty naturopaths  in Alaska  could be why  an advisory  board is                                                               
MS. CHAMBERS agreed.                                                                                                            
2:44:41 PM                                                                                                                    
VICE CHAIR HUGHES called on Abby Lange.                                                                                         
2:44:46 PM                                                                                                                    
ABBY  LANGE stated  that the  Alaska Association  of Naturopathic                                                               
Doctors  is passionate  about providing  Alaskans  with the  best                                                               
care possible. In answer to legislator's questions, she stated:                                                                 
   • Some vitamins and minerals do require a prescription.                                                                      
     Vitamin B12  does not absorb  well orally; many  people take                                                               
     it by prescribed injection.                                                                                                
   • Page 5 line 26 specifies which surgeries naturopaths are                                                                   
     excluded  from   performing.  Providing  a  list   of  drugs                                                               
     naturopaths can  prescribe would  be problematic.  New drugs                                                               
     become  available   frequently.  Updating  the   list  would                                                               
     require use  of the  public process and  delay usage  of new                                                               
     drugs and vaccines.                                                                                                        
   • Naturopaths do not have a problem billing insurance.                                                                       
     Insurance does reimburse naturopathic doctors in Alaska.                                                                   
   • Naturopathic residency is optional. Nationwide there are                                                                   
     more  graduates than  available  residencies.  In this  bill                                                               
     naturopaths  are seeking  a scope  of practice  equal to  or                                                               
     less than  a nurse  practitioners  or  physician   assistant                                                               
     scope of practice, neither require a residency.                                                                            
2:48:19 PM                                                                                                                    
Ms. Lange asserted that Alaska  law does not allow naturopaths to                                                               
provide  the full  scope of  care they  trained for.  Current law                                                               
creates unnecessary inefficiencies in  the health care system and                                                               
Alaska's healthcare consumers incur  the negative consequences SB
38 creates  a statutory  framework allowing  naturopathic doctors                                                               
to  provide  a  scope  of   care  consistent  with  training  and                                                               
education. It  would improve healthcare  access, remove  the need                                                               
for Alaskans  to seek costly  duplicative services,  aid Alaska's                                                               
primary care provider shortage and  allow Alaskans greater choice                                                               
in   healthcare.  Two   main  provisions   of   the  bill   allow                                                               
naturopathic   doctors   to   issue  non   controlled   substance                                                               
medications and  perform minor surgeries,  such as  wart removal,                                                               
stitches  and  skin  biopsies.  The  bill  specifically  excludes                                                               
controlled   substances  and   any  surgeries   that  go   beyond                                                               
superficial  tissues.  She  asserted that  the  central  question                                                               
before the committee is whether  a naturopathic doctor   training                                                               
meets the  scope of practice  outlined in the bill.  She informed                                                               
legislators that bill packet  documents manifest that naturopaths                                                               
are qualified  for the scope  of practice contained in  the bill.                                                               
NDs follow  a standard  premed undergraduate  track and  attend a                                                               
four-year  doctoral   program,  which   includes  140   hours  of                                                               
pharmaceutical  training. Naturopathic  doctors  in other  states                                                               
prescribe  medications  and   controlled  substances.  They  also                                                               
safely perform minor surgeries.                                                                                                 
2:50:55 PM                                                                                                                    
In  Alaska, healthcare  providers,  with  less pharmacology  training,                                                          
prescribe  a broader  range of  pharmaceuticals  than naturopaths  are                                                          
allowed  to prescribe  under this  bill. Although  naturopaths promote                                                          
diet and  lifestyle modification, there are  circumstances when having                                                          
prescriptive  authority  benefits  patients.  For  example:  during  a                                                          
routine visit  a patient  could receive  a vaccination;  an antibiotic                                                          
prescription could  be written in  case a condition worsened,  such as                                                          
an earache;  a medication  dosage could  be adjusted  following weight                                                          
loss. Not  providing these services  during a visit means  the patient                                                          
must set up an appointment  with a different healthcare provider, miss                                                          
additional time off work and  pay another doctor fee. Consequently, it                                                          
is not uncommon  for a person to forego vaccination  due to additional                                                          
costs or end up at the ER seeking antibiotics.                                                                                  
2:54:45 PM                                                                                                                    
VICE CHAIR  HUGHES noted  that under  Alaska law  naturopaths are                                                               
not allowed to  use the term physician. Any  naturopath using the                                                               
term should  make sure they are  within the present scope  of the                                                               
2:55:37 PM                                                                                                                    
CLYDE  JENSEN,   State  Naturopathic  Medical   Association,  St.                                                               
George, Utah,  testified by invitation  on SB 38. He  stated that                                                               
he  has  a PhD  in  Pharmacology  and  has  taught and  been  the                                                               
president of  various schools of  medicine. He  currently teaches                                                               
pharmacology to  students of  osteopathic medicine  and physician                                                               
assistants.  He shared  three observations.  He  stated that  the                                                               
pharmacology content  that NDs,  MDs and DOs  study is  the same.                                                               
NDs are  taught far more  pharmacology content than APs  and NPs.                                                               
Regarding  residency, he  acknowledged that  NDs receive  roughly                                                               
the  same amount  of clinical  experience during  their four-year                                                               
degree program as MDs and DOs.  Less of the experience is devoted                                                               
to   clinical  supervision   with  the   use  of   drugs  because                                                               
naturopathic students  study more nutrition, lifestyle  and other                                                               
clinical interventions  than MDs and  DOs. NDs are  more inclined                                                               
to use nutrition  than prescriptive drugs in  their practice. The                                                               
number  and  the scope  of  drugs  used  by NDs  is  considerably                                                               
narrower and involves few drugs than  those used by MDs, DOs, PAs                                                               
and  NPs. He  commented that  it is  not uncommon  for healthcare                                                               
professions  that  prescribe  less  frequently  to  consult  with                                                               
professionals who  prescribe more  frequently. He  concluded that                                                               
there  is no  reason for  Alaska naturopathic  physicians to  not                                                               
prescribe a limited scope of drugs.                                                                                             
2:59:22 PM                                                                                                                    
VICE CHAIR HUGHES called on David Schleich.                                                                                     
2:59:38 PM                                                                                                                    
DAVID  SCHLEICH,   Retired  President,  National   University  of                                                               
Natural Medicine,  Saskatchewan, Canada, testified  by invitation                                                               
on SB 38.  He stated has been a  post-secondary and post-graduate                                                               
education administrator for thirty-five  years. His doctoral work                                                               
and  research have  been in  policy and  theory, with  particular                                                               
interest in how healthcare professional  formations take place in                                                               
civil society.                                                                                                                  
MR.  SCHLEICH   stated  that  the  clinical   doctorate  for  the                                                               
naturopath profession is a rigorous  program of quality. Over the                                                               
past twelve  years the program has  grown significantly. Research                                                               
activity in  the field  of natural medicine  has been  robust. He                                                               
named the  Helfgott Research Institute  in the United  States and                                                               
the Cancer Research Institute in  Canada as exemplary. The number                                                               
of states  licensing and registering naturopathic  physicians has                                                               
also  increased dramatically  in  the last  decade. He  mentioned                                                               
that  the  increase  is  due  to  naturopaths'  outreach  to  the                                                               
communities  they  serve  and  the rigor  and  quality  of  their                                                               
educational background.                                                                                                         
He  stated   the  regional   and  programmatic   accreditors  for                                                               
naturopathic  medicine are  the same  as for  other primary  care                                                               
practitioners  and   physicians.  He  then  clarified   that  the                                                               
accreditors, accredit  the institutions. The amount  of education                                                               
to become  a naturopath  is quite  substantial relative  to other                                                               
healthcare professions.  He stated  the 4100 hours  that includes                                                               
pharmacology and  clinical training  are a case  in point.  At an                                                               
institute where  he was  president, 140  term credit  hours (TCH)                                                               
were required in pharmacology.                                                                                                  
Mr. Schleich commented that  naturopathic doctors historically do                                                               
not work in hospitals and do  not have access to annual residency                                                               
matching;  they  receive  extensive residency  experience  though                                                               
clinical rotations during  their final years in  the program. The                                                               
statutory  framework of  the Division  of Corporate  and Business                                                               
and Professional  Licensing does  not align appropriately  to the                                                               
healthcare professional status of naturopathic doctors.                                                                         
The  presence  of  naturopathic   doctors  in  clinical  care  is                                                               
increasing  in   the  United  States  and   Canada.  The  largest                                                               
naturopathic degree  granting institution in North  America has a                                                               
robust  research   institute  in  natural  medicine   and  strong                                                               
affiliations    with   functional    and   integrated    medicine                                                               
practitioners.  He recommended  the  legislature  adopt the  bill                                                               
with alacrity.                                                                                                                  
3:03:09 PM                                                                                                                    
VICE CHAIR HUGHES opened public  testimony on SB 38; finding none                                                               
she closed public testimony.                                                                                                    
SB 38 was held in committee.                                                                                                    

Document Name Date/Time Subjects
SB 38 version A.PDF SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 sponsor statement.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 sectional 3.30.21.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 Fiscal Note 1 DEED.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 Fiscal Note 2 DPS.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 Naturopathic Medicine Presentation SHSS.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 ND_Prescribing_Rights_by_State_01.2021.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 White Paper on Modernizing the Scope of Practice for NDs.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 Background on Naturopathic Medicine.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 nd-vs-md (1) (002).pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 AKANP Response Letter.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 38 AANP Support SB38 Response to AMA.pdf SHSS 4/8/2021 1:30:00 PM
SB 38
SB 26 - Bipartisan Governor's Blueprint for Improving Our Nation's Health System Performance - February 2018.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 Senate DHSS Committee - Reforming Americas Healthcare System Through Choice and Competition 2018.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 - Alaska Commercial Healthcare Prices - MIlliman Report - November 2016.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 - CON - Policymakers' Decisions - Mercatus Center - 2020.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 SOA - Div of Insurance - Provider Reimbursement Rate Summary - 2018.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 - CON suspended laws - Mississippi Center for Public Policy - 2020.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 - CON - Maternal and Infant Care Rural Communities - Mercatus Center - 2019.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 ASHNHA Letter Providing Senate HSS Regulatory Recommendations 3-29-21.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 ASHNHA Letter re CON Standards & Methodologies 7-12-18.pdf SHSS 4/8/2021 1:30:00 PM
SB 26
SB 26 ASHNHA Letter re Potential CON Reg Changes 6-29-18.pdf SHSS 4/8/2021 1:30:00 PM
SB 26