Legislature(2023 - 2024)BELTZ 105 (TSBldg)

02/17/2023 01:30 PM Senate LABOR & COMMERCE

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Audio Topic
01:32:04 PM Start
01:32:55 PM Presentation(s): Workforce Challenges in Alaska from the Perspective of the Alaska Municipal League
02:29:53 PM SB55
02:41:10 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Testimony <Invitation Only> --
Workforce Challenges in Alaska
from the Perspective of Alaska Municipal League
Presentation from Nils Andreassen, Executive
Director
*+ SB 55 EXTEND STATE MEDICAL BOARD TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
**Streamed live on AKL.tv**
               SB  55-EXTEND STATE MEDICAL BOARD                                                                            
                                                                                                                                
2:29:53 PM                                                                                                                    
CHAIR  BJORKMAN   reconvened  the   meeting  and   announced  the                                                               
consideration  of  SENATE  BILL  NO. 55  "An  Act  extending  the                                                               
termination date  of the State  Medical Board; and  providing for                                                               
an effective date."                                                                                                             
                                                                                                                                
He invited Kali Spencer to present  the bill on behalf of Senator                                                               
Wielechowski.                                                                                                                   
                                                                                                                                
2:30:28 PM                                                                                                                    
KALI  SPENCER, Staff,  Senator  Bill  Wielechowski, Alaska  State                                                               
Legislature, Juneau, Alaska,  gave a brief overview of  SB 55 and                                                               
its purpose. She paraphrased the sponsor statement:                                                                             
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     SB 55  will extend  the termination  date of  the State                                                                    
     Medical Board to June 30, 2031.                                                                                            
                                                                                                                                
     The  State Medical  Board (board)  effectively licensed                                                                    
     physicians,   osteopaths,  and   podiatrists.  However,                                                                    
     emergency  courtesy licenses  for physician  assistants                                                                    
     were  not issued  in accordance  with state  law during                                                                    
     the COVID-19  pandemic. This  was remedied  in November                                                                    
     2021  when  corrective  action  was  taken  by  sending                                                                    
     letters  to non-compliant  licensees. Furthermore,  the                                                                    
     board developed and adopted  regulations to protect the                                                                    
     public,  improve  the  licensing  process,  and  expand                                                                    
     access  to  care  during  the  COVID-19  public  health                                                                    
     emergency.                                                                                                                 
                                                                                                                                
                                                                                                                                
2:31:23 PM                                                                                                                    
     The last  extension of the  board was in 2020  when the                                                                    
     Division  of Legislative  Audit proposed  a termination                                                                    
     date  that was  three  years less  than the  eight-year                                                                    
     maximum  allowed  per  statute.   The  Senate  Labor  &                                                                    
     Commerce Committee then amended  the bill to reduce the                                                                    
     termination  date  by an  additional  two  years for  a                                                                    
     sunset date  of June  30, 2023.  Since 2020,  the board                                                                    
     has  addressed all  recommendations  from the  previous                                                                    
     audit by adopting regulations to  guide the process for                                                                    
     registering with the  Controlled Substance Prescription                                                                    
     Database   (CSPD);  developed   procedures  to   ensure                                                                    
     licensees with a  Drug Enforcement Administration (DEA)                                                                    
     number  register  in  the CSPD;  and  worked  with  the                                                                    
     Division  of  Corporations, Business  and  Professional                                                                    
     Licensing's   (DCBPL)   director   to   establish   and                                                                    
     implement  procedures  to   ensure  the  board  reports                                                                    
     disciplinary actions in accordance with state law.                                                                         
                                                                                                                                
     As a  result of  these successful  implementations, the                                                                    
     Division  of Legislative  Audit proposed  in July  2022                                                                    
     that  the legislature  extend  the board's  termination                                                                    
     date to June  30, 2031, which is  the maximum extension                                                                    
     allowed per statute.                                                                                                       
                                                                                                                                
     I respectfully  request support  from my  colleagues to                                                                    
     pass SB 55 in a timely manner.                                                                                             
                                                                                                                                
2:32:47 PM                                                                                                                    
CHAIR BJORKMAN invited Kris Curtis to put herself on the record                                                                 
and begin her review of the audit.                                                                                              
                                                                                                                                
2:33:03 PM                                                                                                                    
KRIS CURTIS, Legislative Auditor,  Division of Legislative Audit,                                                               
Alaska  State Legislature,  Juneau, Alaska,  reviewed the  sunset                                                               
audit during the hearing on  SB 55. She paraphrased the following                                                               
prepared statement:                                                                                                             
                                                                                                                                
     The Division  of Legislative  Audit conducted  a sunset                                                                    
     audit of  the State Medical  Board. The audit  is dated                                                                    
     July 2022.  A sunset  audit determines whether  a board                                                                    
     or commission  serves the public's interest  and should                                                                    
     be extended.                                                                                                               
                                                                                                                                
     The audit concludes that the  board serves the public's                                                                    
     interest by developing  and implementing regulations to                                                                    
     protect the public, improve  the licensing process, and                                                                    
     expand  access  to   healthcare  during  the  pandemic.                                                                    
     Further,  the board  serves  the  public's interest  by                                                                    
     effectively   licensing  physicians,   osteopaths,  and                                                                    
     podiatrists; however,  emergency courtesy  licenses for                                                                    
     physician  assistants  were  only sometimes  issued  in                                                                    
     accordance with state law.                                                                                                 
                                                                                                                                
2:33:48 PM                                                                                                                    
     The  Division of  Legislative Audit  found the  board's                                                                    
     workload  increased  significantly   during  the  audit                                                                    
     period  due to  the  COVID-19 pandemic.  The board  met                                                                    
     frequently,  sometimes  weekly, to  consider  pandemic-                                                                    
     related regulations.  Further, the number  of licensing                                                                    
     applications  that the  board  considered increased  by                                                                    
     approximately  28 percent  when compared  to the  prior                                                                    
     2019  sunset  audit. The  increase  was  the result  of                                                                    
     practitioners moving  to Alaska  to help meet  the need                                                                    
     for healthcare services  and out-of-state practitioners                                                                    
     providing  services via  technology (commonly  referred                                                                    
     to as  telehealth). The  dramatic increase  in workload                                                                    
     occurred  immediately after  the governor  replaced all                                                                    
     the board  members. Board  turnover and  vacancies were                                                                    
     common during the audit period.                                                                                            
                                                                                                                                
     Even   with  these   challenges,  the   board  operated                                                                    
     effectively,  and the  division recommends  the maximum                                                                    
     extension, which is eight years.                                                                                           
                                                                                                                                
2:34:47 PM                                                                                                                    
     She  walked the  committee through  the standard  audit                                                                    
     information,  stating page  8 of  the audit  report has                                                                    
     the schedule  of licensing activity. As  of March 2022,                                                                    
     there were 5,878 active  licenses and permits. Licenses                                                                    
     increased  by  28  percent compared  to  FY  2019.  The                                                                    
     schedule of  revenues and expenditures  is on  page 10.                                                                    
     The prior 2019 audit found that  at the end of FY 2018,                                                                    
     this  board had  a deficit  of approximately  $800,000.                                                                    
     Licensing fees  increased in FY  2019, and  the deficit                                                                    
     decreased to  approximately $488,000  by the end  of FY                                                                    
     2020.                                                                                                                      
                                                                                                                                
     License  revenues increased  substantially  due to  the                                                                    
     increased number  of applications  during FY  2021. The                                                                    
     board  was allotted  approximately $215,000  in general                                                                    
     funds to replace revenue lost  due to the licensing fee                                                                    
     freeze that the governor  mandated to help mitigate the                                                                    
     financial impact  of the pandemic. Due  to the increase                                                                    
     in  revenues  and  the general  fund  allocation,  this                                                                    
     board  had a  surplus of  approximately $506,000  as of                                                                    
     March 2022.  The board's  schedule of  fees is  on page                                                                    
     11.                                                                                                                        
                                                                                                                                
2:36:13 PM                                                                                                                    
     The audit makes two  recommendations that begin on page                                                                    
     14.   First,   the   Division  of   Legislative   Audit                                                                    
     recommends  the board's  executive director  ensure all                                                                    
     board  meetings   have  adequate  public   notice.  The                                                                    
     division  reviewed 32  meetings held  during the  audit                                                                    
     period and found six were  either not public noticed or                                                                    
     not  public   noticed  correctly.  Second,   the  audit                                                                    
     recommends  the  board   ensure  emergency  regulations                                                                    
     comply with statute. The  Division of Legislative Audit                                                                    
     found  the courtesy  license  regulation for  physician                                                                    
     assistant  emergency failed  to require  the applicants                                                                    
     have   a  collaborative   plan  with   the  supervising                                                                    
     physician  as  required  by statute.  DCBPL  identified                                                                    
     this deficiency  within seven  months of  its effective                                                                    
     date and took corrective action.                                                                                           
                                                                                                                                
     Management's response  to the audit begins  on page 25,                                                                    
     and  general  management  concurred with  the  report's                                                                    
     conclusion and recommendations.                                                                                            
                                                                                                                                
2:37:30 PM                                                                                                                    
CHAIR BJORKMAN invited Sylvan Robb to put herself on the record                                                                 
to answer questions.                                                                                                            
                                                                                                                                
2:38:06 PM                                                                                                                    
SYLVAN  ROBB, Director,  Division of  Corporations, Business  and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic Development, Juneau, Alaska, introduced herself.                                                                       
                                                                                                                                
2:38:10 PM                                                                                                                    
CHAIR  BJORKMAN  asked whether  DCBPL  had  the number  of  staff                                                               
necessary  and the  infrastructure  in place  for  this board  to                                                               
handle the increased workload throughout the pandemic.                                                                          
                                                                                                                                
MS.  ROBB  replied  that  the   division  suffered  severe  staff                                                               
shortages  during  the   pandemic,  especially  the  professional                                                               
licensing team,  with up  to a 35  percent vacancy.  The division                                                               
was short-staffed,  and it was  very challenging to  get licenses                                                               
out.                                                                                                                            
                                                                                                                                
CHAIR BJORKMAN asked if the situation is substantially fixed.                                                                   
                                                                                                                                
MS.  ROBB replied  that the  division has  made great  strides in                                                               
getting  back  to  adequate  staffing  levels.  The  professional                                                               
licensing team has gone from a high  of more than 35 percent to a                                                               
20  percent vacancy  rate. The  division has  about a  14 percent                                                               
vacancy rate today and is hiring  people daily. She said that the                                                               
division is getting on top of it.                                                                                               
                                                                                                                                
2:39:25 PM                                                                                                                    
CHAIR BJORKMAN  asked if she sees  interstate telehealth services                                                               
substantially  changing  the   division's  workload  and  license                                                               
processing as it relates to the State Medical Board.                                                                            
                                                                                                                                
MS. ROBB  answered that the division  has not seen a  huge change                                                               
recently. The division is gathering  baseline data to see how the                                                               
telehealth bill  the legislature  passed last year  affects DCBPL                                                               
over time.                                                                                                                      
                                                                                                                                
2:40:20 PM                                                                                                                    
CHAIR BJORKMAN held SB 55 in committee.                                                                                         

Document Name Date/Time Subjects
02.17.23 AML Presentation to SL&C.pdf SL&C 2/17/2023 1:30:00 PM
AML Presentation to SL&C 02.17.23
SB 55 Version A.PDF SL&C 2/17/2023 1:30:00 PM
SB 55
SB 55 Sponsor Statement Version A.pdf SFIN 3/7/2023 9:00:00 AM
SL&C 2/17/2023 1:30:00 PM
SB 55
SB 55 Fiscal Note-DCCED-CBPL 01.10.23.pdf SL&C 2/17/2023 1:30:00 PM
SB 55
SB 55 Supporting Document - State Medical Board Audit, July 2022.pdf SFIN 3/7/2023 9:00:00 AM
SL&C 2/17/2023 1:30:00 PM
SB 55