Legislature(2017 - 2018)BELTZ 105 (TSBldg)
02/13/2018 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB108 | |
| SB160 | |
| HB18 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 108 | TELECONFERENCED | |
| *+ | SB 160 | TELECONFERENCED | |
| + | HB 18 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD
1:33:10 PM
CHAIR COSTELLO announced the consideration of SB 108.
1:33:36 PM
SENATOR CATHY GIESSEL, Alaska State Legislature Juneau, Alaska,
sponsor of SB 108, introduced the legislation speaking to the
following sponsor statement:
Senate Bill 108 is a streamlining bill which will
improve the licensing process for physicians in
Alaska. Outdated and overly cumbersome statutes and
regulations are interfering with the ability of our
medical community to meet the needs of Alaskans
because of delays of licensure that negatively impact
both doctors and patients. A fully qualified doctor in
good standing should not be required to wait months to
obtain a license to serve our state.
The Alaska State Medical Board has requested this
legislation so they may expeditiously and responsibly
issue licenses to physician applicants.
SB 108 gives the executive secretary of the State
Medical Board expanded authority to review and issue
licenses to applicants with uncomplicated
applications. With a better system in place DCCED and
the State Medical Board will be able to respond more
efficiently at a time when healthcare access is of
great concern in our state.
SB 108 will authorize the board's executive secretary
to grant licenses to qualified applicants for a
permanent medical license, a temporary permit, or a
locum tenens permit. It will also authorize the board
to designate a board member to grant temporary permits
to qualified applicants. [Sections 10 and 11] The bill
outlines exceptions to that authority such as a
suspended or revoked license or other special
circumstances that would necessitate a full board
review.
The bill creates a new category of certified medical
assistants who will perform additional duties in
medical settings. The Board will set criteria for
educational requirements, certification, renewal and
revocations for Certified Medical Assistants.
The bill provides for physician delegation of
specific, routine activities to unlicensed personnel
working in physician offices. [Sections 3, 6, and 13]
SENATOR GIESSEL advised that licenses are currently issued
within two months but just five percent of the applications are
complete when they're submitted. That has contributed to the
current backlog of about 290 applications. Also, the number of
applicants has increased markedly, largely due to telemedicine
applicants. She reminded members that any physician who provides
care through telemedicine must be licensed in the state.
1:40:41 PM
SENATOR GIESSEL explained that the request for the new category
of "certified medical assistant" came from pain management
doctors who need an assistant in the office who can look at the
prescription drug monitoring program (PDMP) for them. She
reminded members that when the legislature crafted the opioid
bill it required licensure to look at the database. In practice
this takes a lot of time in a physician's day. Certifying
medical assistants provides a solution. The board will outline
the criteria for certification in regulation. [Sections 4 and 5]
Section 12 provides a penalty for anyone practicing as a CMA
without a license.
SENATOR GIESSEL said the State Medical Board and DCCED's
Division of Corporations, Business and Professional Licensing
support the bill.
1:43:27 PM
CHAIR COSTELLO recognized that Senator Meyer joined the
committee some time ago.
SENATOR MICCICHE asked if it's typical that Section 3 leaves the
definition for "routine medical duties" to the board instead of
putting it in the bill.
SENATOR GIESSEL said it's logical; similar authority is given to
the Board of Nursing that also delegates to unlicensed assisted
personnel. The board knows exactly which routine medical duties
would be appropriate for an unlicensed person to do.
SENATOR MICCICHE asked if the statutes allow an applicant who
meets the qualifications to receive a temporary permit.
SENATOR GIESSEL said yes. The bill allows the executive
administrator or a board designee to issue the temporary
license.
1:45:34 PM
SENATOR STEVENS said he assumes the executive administrator
would be carefully chosen, but it sounds a little loose to then
extend authority to another person.
SENATOR GIESSEL said the Board of Medicine in collaboration with
the Division of Corporations, Business and Professional
Licensing hires the executive administrator. It is generally a
rigorous process and there are qualifying criteria for the
individual that's hired. She added that it was the board that
wanted the additional board member who could act if the
executive administrator were absent.
SENATOR STEVENS said he was reading on page 4 where it says,
"allow another person designated by the board." He asked if that
was in the bill because it doesn't say another board member.
1:47:13 PM
At ease
1:47:47 PM
CHAIR COSTELLO reconvened the meeting.
SENATOR GIESSEL explained that the board requested the language
and may have been thinking of delegating the authority to the
licensing examiner who also scrutinizes applications. She added
that the Board of Medicine is extremely careful about who
receives licensure. She said this pertains to a temporary permit
and she is confident in the board's judgement.
SENATOR STEVENS summarized it is not a willy-nilly appointment
of someone off the street. It's someone with qualifications and
background.
1:49:19 PM
CHAIR COSTELLO opened public testimony for SB 108.
1:49:34 PM
DR. DANNY ROBINETTE, Chief Medical Officer, Fairbanks Memorial
Hospital and Tanana Valley Clinic, Fairbanks, Alaska, advised
that the hospital has experienced periodic delays in getting
physicians licensed. On three occasions in the past two years
this has resulted in physician candidates accepting positions
out of state because they needed a paycheck. A surgeon currently
on staff had to wait eight months for his license. He said each
candidate should be rigorously screened and those with issues
should receive closer scrutiny and take more time. However, the
process should be streamlined so that clean, unblemished
candidates are not unduly held up causing good physicians to
accept positions in other states.
SENATOR STEVENS asked if there could be any justification for
holding up an application for eight months.
DR ROBINETTE said it could certainly be justified in some
instances, but not the case he mentioned.
SENATOR STEVENS asked if his belief was that this would speed
the process while giving the board time to investigate concerns
and red flags.
DR. ROBINETTE said yes; the statute and regulations clearly
define the things that constitute a clean application. There
shouldn't be a timeline that rushes an application that isn't
clean.
1:53:59 PM
SENATOR MICCICHE read questions and answers about processing
times from the legislative research document titled "State
Medical Licensing Timeframes. He said it looks like the
requirements for a temporary permit are the same as the
requirements for a regular license, which makes him wonder about
the timesaving.
DR. ROBINETTE deferred a full answer to the board. He didn't
know all the details for issuing a temporary permit, but
Fairbanks Memorial Hospital typically issues temporary
privileges to someone with a clean application and for exigent
patient care reasons.
SENATOR MICCICHE asked if someone from the board was available.
CHAIR COSTELLO said she didn't see anyone from the board online
but would try to get an answer before the end of the meeting.
1:56:16 PM
KIRA BOYD, Chief Operating Officer, ALGONE, Wasilla, Alaska,
testified in support of SB 108. She explained that the clinic
offers regenerist medicine, interventional pain management, and
dependency therapy with a focus on opioid use disorders. The
clinic regularly treats a high-needs, high-touch patient
population and is faced with high overhead costs, particularly
because specialty providers often require lucrative compensation
packages to lure them to the state.
She said ALGONE has a team of over 40 medical assistants who
team up with the providers to take care of the high-needs, high-
touch patients. However, existing statute relating to opioid
oversight and implementation of the PDMP has made these care
teams dramatically less efficient. ALGON sought immediately to
find the solution and eventually looked at other states that
license medical assistants. They were able to send model
legislation to the sponsor's staff. ALGON fully supports SB 108
and wants the committee to know that the process works.
MS BOYD said the State Medical Board expressed concern about
cost and resources to get medical assistants licensed. However,
the choice is to either create an efficient system for licensing
or require clinics to hire more nurses and pass that cost on to
the already overburdened health care consumers. She said SB 108
is the solution that Alaska needs now.
SENATOR STEVENS asked how many of the 40 currently unlicensed
medical assistants would become certified should SB 108 pass.
MS. BOYD said not all ALGON's medical assistants are unlicensed,
but in a perfect world all their medical assistants would become
certified.
SENATOR STEVENS said he thought that certifying medical
assistants was new.
MS. BOYD clarified that some but not all ALGON medical
assistants are certified. The ones that are not certified are
not currently able to assist providers by looking at the PDMP
database.
2:00:31 PM
At ease
2:01:13 PM
CHAIR COSTELLO reconvened the meeting and continued with public
testimony on SB 108.
2:01:22 PM
BRYAN FARTHING, President, Alaska Academy of Physician
Assistants (PA), Anchorage, Alaska, said he appreciates the work
that's been done on SB 108, but the PA community is concerned
that when physicians and other medical professionals are listed
in the bill physician assistants aren't always included.
2:03:10 PM
FRED PARADY, Deputy Commissioner, Department of Commerce,
Community and Economic Development (DCCED), said the workload of
the State Medical Board has increased dramatically, primarily
due to telemedicine legislation. In 2015 the application
processing backlog reached an average of six months.
Telemedicine companies were coming in to license 100 doctors at
a time. Complaints came in from applicants and medical companies
and the responding to those complaints was time consuming.
MR. PARADY said the division processed 22 percent more medical
licenses and 31 percent more nursing licenses last year than the
year before and they've already received more this fiscal year
to date than the entire previous year. Through the budget
process and previous legislation, the division has been able to
devote more staff to these programs. They have added two new
PCNs that are paid by licensing fees and they went through a
triage process to reduce the backlog. They also initiated a
strategic planning process to streamline the application process
for health care professions. That was identified as the highest
priority. He shared the results of that hard-working team.
The strategic planning process included a comprehensive
examination of the application process to identify barriers or
obstacles ("rubs"). Twenty-seven were identified. He directed
attention to a handout and explained that the department
requires applicants to send certified and true copies of their
diploma and all certificates. The question the team asked was
whether certified and true copies were necessary when
verification was already required. He said rub 17 is
specifically germane to the bill; it is the requirement that
every application needs to be approved by the executive
administrator. Considering the number of applications the
department moves forward, waiting for approval can be time
consuming both at the executive director and at the board level.
The board might meet just once every three months. Rub 22 is
that the board needs to review every file, even those that have
no discrepancies. What SB 108 proposes is to delegate that
authority. In answer to Senator Steven's question about
delegation, he clarified that is an active delegation of
authority to another board member or the director or deputy
director of the division.
CHAIR COSTELLO asked Mr. Parady to send a copy of the handout to
the committee aide.
MR. PARADY agreed. He continued to explain that the strategic
planning process continued as the team evaluated the cause of
each problem, determined whether it served a public safety need,
and whether the process needed to be updated or simplified. In
response to those 27 rubs the department initiated a three-
pronged approach to implement solutions that would streamline
the licensure process. The first prong was to make small changes
through board regulations. Specific to SB 108, the State Medical
Board proactively scrubbed its regulations. He cited an example
of a regulation that served no public safety need.
The second prong of the streamlining strategy adds two features
to the technology platform. The first makes the online
application process like the one used for the permanent fund
dividend. The user cannot advance until the question is
answered. The second implements a tracker so the applicant can
see the progress of their application and what a holdup might
be. Rollout of this technology enhancement is anticipated in
March.
The third prong of the streamlining strategy is a change in the
statutes that would improve license processing times while
continuing to ensure public safety. The minor changes in SB 108
will allow the State Medical Board to grant additional authority
to the executive administrator to issue licenses that meet the
strictest guidelines and allow further delegation to supervisors
to expedite and issue temporary licenses. The bill also closes
the loop with the prescription drug monitoring program (PDMP) by
certifying medical assistants so they are eligible to access
that database for the doctor.
MR. PARADY concluded his comments emphasizing that the
department is focused and attentive to these issues. "We've been
hard at work on those granular details where we can better serve
the public and, ultimately, better serving these professionals
better serves Alaska citizens."
2:13:00 PM
SENATOR MICCICHE asked 1) why there is a temporary permit and 2)
if the temporary permit satisfies the requirements of the other
permits why it is still considered temporary.
2:13:20 PM
JANEY MCCULLOUGH, Director, Corporations, Business &
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, said a temporary
permit is a way of getting an applicant to work as fast as
possible. Currently the executive administrator can approve a
temporary license and the formal full license is issued after
the board meets and approves every license.
SENATOR MICCICHE said his point is that other than the board
action, the requirements are no less rigorous for a temporary
license.
MS. MCCULLOUGH confirmed that other than the board approval, the
criteria for a temporary license is the same as for a full
license.
CHAIR COSTELLO asked Mr. Parady if he shared the creative new
application tracking process with other departments.
MR. PARADY said he'd be happy to share but he wanted to make
certain it operates correctly first. If it's successful, it will
next be rolled out across the department's 43 license groups.
2:15:51 PM
CHAIR COSTELLO closed public testimony on SB 108.
2:16:09 PM
SENATOR MEYER moved to report SB 108, version U, from committee
with individual recommendations and attached fiscal note(s).
CHAIR COSTELLO announced that without objection, SB 108 moves
from the Senate Labor and Commerce Standing Committee.