Legislature(2023 - 2024)BELTZ 105 (TSBldg)

05/01/2024 01:30 PM Senate LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 237 TEMPORARY PERMIT FOR LAPSED NURSE LICENSE TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+= HB 97 SELF-STORAGE UNITS: LIENS; SALES TELECONFERENCED
Moved SCS CSHB 97(L&C) Out of Committee
+= HB 29 INSURANCE DISCRIMINATION TELECONFERENCED
Moved SCS CSHB 29(L&C) Out of Committee
-- Public Testimony <Time Limit May Be Set> --
*+ HB 226 PHARMACIES/PHARMACISTS/BENEFITS MANAGERS TELECONFERENCED
<Pending Referral>
Scheduled but Not Heard
-- Testimony <Invitation Only> --
*+ HB 309 DELEGATION OF ROUTINE OPTOMETRY SERVICES TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
*+ HB 285 MAMMOGRAMS: INSURANCE COVERAGE TELECONFERENCED
<Bill Hearing Canceled>
-- Testimony <Invitation Only> --
*+ HB 254 BLOCK PORNOGRAPHY TO MINORS; SOCIAL MEDIA TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
        HB 309-DELEGATION OF ROUTINE OPTOMETRY SERVICES                                                                     
                                                                                                                                
4:20:18 PM                                                                                                                    
CHAIR BJORKMAN announced the consideration  of HOUSE BILL NO. 309                                                               
"An Act  relating to the  practice of optometry; and  relating to                                                               
the delegation of routine services of optometry."                                                                               
                                                                                                                                
4:20:55 PM                                                                                                                    
JAMES  SEXTON,  Staff,  Representative Justin  Ruffridge,  Alaska                                                               
State Legislature,  Juneau, Alaska, gave  a brief overview  of HB
309 and it's beneficial impacts on optometry practices.                                                                         
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
MR.  SEXTON moved  to slide  2, and  explained that  a review  of                                                               
optometric  practices  revealed  that  there  was  not  statutory                                                               
language allowing delegation of optometric tasks.                                                                               
                                                                                                                                
     Issue                                                                                                                    
                                                                                                                                
       • Optometric practices do not have current statute                                                                       
        language to allow the Board of Examiners of                                                                             
        Optometry to regulate delegation of routine tasks to                                                                    
        Optometric Technicians and Assistants                                                                                   
                                                                                                                                
        • Delegation of basic routine tasks are standard                                                                        
        practice in other health professions licensed in                                                                        
       Alaska, as well as optometric practices nationwide                                                                       
                                                                                                                                
        • Without this authority, Optometrists would be                                                                         
        required to perform all preliminary and ancillary                                                                       
        testing on each patient, which would greatly                                                                            
        restrict access to care.                                                                                                
                                                                                                                                
4:22:16 PM                                                                                                                    
MR. SEXTON  moved to  slide 3,  and discussed  a partial  list of                                                               
occupations  whose   boards  grant  them  the   ability,  through                                                               
statute, to  delegate routine tasks.  He noted that the  field of                                                               
ophthalmology was granted the ability  to delegate routine tasks,                                                               
but  somehow  optometry was  not  included  in statute  regarding                                                               
routine medical duties.                                                                                                         
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Other Healthcare professions in Alaska:                                                                                  
                                                                                                                                
     • Professions in Alaska that have solved this problem                                                                      
        with incorporating delegation authority include:                                                                        
                                                                                                                                
       • Medical Doctors, Doctor of Osteopathic Medicine,                                                                       
        Podiatry, Physician Assistants (08.64.106)                                                                              
                                                                                                                                
     • Dental (08.32.346)                                                                                                       
                                                                                                                                
     • Veterinary (08.98.050 (9,B))                                                                                             
                                                                                                                                
     • Pharmacy (08.80.030,(9))                                                                                                 
                                                                                                                                
     • Chiropractic (08.20.168)                                                                                                 
                                                                                                                                
4:22:52 PM                                                                                                                    
MR.  SEXTON   moved  to   slide  4,   and  discussed   the  tasks                                                               
optometrists routinely delegate, noting  that the optometrists do                                                               
not delegate  the reading and  interpretation of test  results to                                                               
support staff and  that HB 309 would not  absolve the optometrist                                                               
of their responsibilities.                                                                                                      
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Examples of routine tasks                                                                                                
                                                                                                                                
     • Initial patient medical history and reason for visit                                                                     
                                                                                                                                
    • Initial    assessment    of   vision    and   current                                                                     
        prescription verification                                                                                               
                                                                                                                                
     • Blood pressure screenings and automated measurements                                                                     
        of the eye                                                                                                              
                                                                                                                                
     • Ocular photography and digital imaging for review by                                                                     
        the doctor                                                                                                              
                                                                                                                                
     • Assisting in medication refills                                                                                          
                                                                                                                                
    • Performing     peripheral    vision    testing    for                                                                     
        interpretation by the doctor                                                                                            
                                                                                                                                
4:23:24 PM                                                                                                                    
MR. SEXTON moved to slide 5 and said HB 309 seeks to correct the                                                                
omission of delegation authority for optometrists in statutory                                                                  
language in order to maintain efficiency and effectiveness of                                                                   
normal optometric office visits.                                                                                                
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Current challenges                                                                                                       
                                                                                                                                
       • In the absence of the ability to delegate tasks,                                                                       
        Optometry will be less efficient and effective at                                                                       
        meeting the demand of patient care that exists in                                                                       
        the state currently.                                                                                                    
                                                                                                                                
     • Optometry is projected to grow in the future.                                                                            
                                                                                                                                
     • Adding a logistical and financial burden to current                                                                      
        and future Optometrists may contribute to the                                                                           
        shortage of healthcare professionals.                                                                                   
                                                                                                                                
4:23:38 PM                                                                                                                    
MR. SEXTON moved to slide 6 and discussed the expected impacts                                                                  
of HB 309.                                                                                                                      
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     HB 309 impacts                                                                                                           
                                                                                                                              
      • This bill will have no impact on billing practices                                                                      
        and will not increase costs to the patient                                                                              
        population.                                                                                                             
                                                                                                                                
      • The impact of passing this bill will be to ensure                                                                       
        that patients continue to receive appropriate and                                                                       
        effective care supervised by licensed Optometric                                                                        
        Physicians in Alaska.                                                                                                   
                                                                                                                                
4:23:57 PM                                                                                                                    
MR. SEXTON moved to slide 7 and described support for HB 309,                                                                   
which would allow delegation of routine tasks for optometry as                                                                  
is statutorily supported for other health professions.                                                                          
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Support                                                                                                                  
                                                                                                                                
       • The Alaska Optometric Association supports this                                                                        
        legislative approach and action.                                                                                        
                                                                                                                                
     • HB 309 brings Optometrists in line with other health                                                                     
        related professions in Alaska.                                                                                          
                                                                                                                                
4:24:30 PM                                                                                                                    
CHAIR BJORKMAN announced invited testimony for HB 309.                                                                          
                                                                                                                                
4:24:41 PM                                                                                                                    
BRADLEY  CROSS, Chair,  State Board  of  Examiners in  Optometry,                                                               
Soldotna, Alaska,  gave invited testimony  in support of  HB 309.                                                               
He said  optometry was  responsible for  the majority  of primary                                                               
eye care in  the state of Alaska, and optometrists  have grown as                                                               
a  profession to  accommodate the  needs of  Alaskans, urban  and                                                               
rural.   He   said   remote   eye   care   necessitated   skilled                                                               
practitioners who have a scope  of practice that ensured adequate                                                               
care. He stated that the  optometric profession, the state board,                                                               
the  state association,  and  state  legislators, understand  and                                                               
believe that statement and that  Optometry had shown itself to be                                                               
economically  beneficial to  our population,  [as well  as] safe,                                                               
sustainable and directly accountable to  the State Board, who, in                                                               
turn, is accountable to the legislature.                                                                                        
                                                                                                                                
DR. CROSS  said the need for  an addition to the  State Board [of                                                               
Examiners  in Optometry]  statutes was  discovered during  a 2023                                                               
regulation project  relating to  telehealth. He  acknowledged the                                                               
help of  Representative Ruffridge  and staff  to create  a simple                                                               
and clear  solution. HB  309 will spell  out that  an optometrist                                                               
can delegate ancillary  testing to an assistant  or a technician.                                                               
He  compared  HB  309 with  similar  legislation  for  dentistry,                                                               
medicine, chiropractic,  veterinary medicine and others.  He said                                                               
it was commonplace  in optometry practices across  the country to                                                               
utilize technicians in  the daily patient flow  allowing for more                                                               
efficient use of resources within  the practice thereby improving                                                               
access  to care.  He  noted  that the  population  in Alaska  was                                                               
aging, and the  number of providers was decreasing;  HB 309 would                                                               
allow optometrists  to practice  at an  efficient level.  He said                                                               
this  was  more  important  than  ever  before;  with  our  older                                                               
population, more  diseases were  present requiring  more imaging,                                                               
more  visual  field  testing  and more  frequent  visits  than  a                                                               
younger population would demand. He  said the inclusion of HB 309                                                               
will ensure that optometrists have  the backing of state statutes                                                               
to provide a high  level of care for the patient  base that is in                                                               
most need of these services.  As training and demographics change                                                               
over time, optometrists practice more  and more medical eye care.                                                               
He  said to  catch  up with  the  change in  the  dynamic of  how                                                               
optometry  is functioning,  it's  time  to specifically  delegate                                                               
these tasks to optometric technicians  in our statutes. On behalf                                                               
of the Board  of Examiners in Optometry he  thanked the committee                                                               
for considering HB 309.                                                                                                         
                                                                                                                                
4:27:40 PM                                                                                                                    
DAMIEN   DELZER,   O.D.,   President-Elect,   Alaska   Optometric                                                               
Association,  Fairbanks,   Alaska,  gave  invited   testimony  in                                                               
support of  HB 309. He said  the bill was requested  by the board                                                               
of examiners  and optometry due  to a recent research  opinion by                                                               
the Department  of Law. The  opinion was that the  statute needed                                                               
clarification regarding ongoing  delegation of routine pretesting                                                               
by  optometric  assistants.  He   explained  that  Optometry  has                                                               
utilized  assistants  as standard  of  care  and as  an  industry                                                               
standard   practice   for   decades,   preceding   his   graduate                                                               
professional education.  He said  he utilized assistants  for the                                                               
entirety  of his  30  years plus  career in  Alaska,  as well  as                                                               
previously in  the armed forces.  He said many  states recognized                                                               
this long  standing industry standard  and the use  of assistants                                                               
is  a  foregone conclusion  in  the  delivery  of eye  care,  not                                                               
requiring  any   specific  statute  language.  In   many  states,                                                               
including  other states  where he  held licenses,  such as  North                                                               
Dakota  and Montana,  it was  an implied  practice, much  like we                                                               
have done  here for many decades  in Alaska. He pointed  out that                                                               
assistants improve  access to all  types of medical care,  as was                                                               
earlier  presented and  specific Alaska  statutes addressed  this                                                               
across nearly all  healthcare fields. He said  the utilization of                                                               
optometric   assistants   is  universal   throughout   optometric                                                               
practices in  all states, helping  to decrease costs  and improve                                                               
patient  access.  He  noted   optometric  assistants  will  often                                                               
perform  routine pre-testing  tasks  under the  supervision of  a                                                               
licensed  doctor.  These  tasks  include things  such  as  visual                                                               
acuity,  like you  might have  done  at the  Department of  Motor                                                               
Vehicles,  glasses,   measurements,  documentation   and  medical                                                               
issues,  current and  past, as  well  as medications,  allergies,                                                               
photography  and  other  non-invasive tests.  Assistants  receive                                                               
nearly   all  their   training  on-the-job   under  the   careful                                                               
supervision  of licensed  professionals as  well as  seasoned and                                                               
experienced  supervisors,   similar  to   most  trades.   As  the                                                               
assistant  demonstrates  their   safety  and  proficiency,  their                                                               
responsibilities  slowly expand,  while always  remaining subject                                                               
to continuous oversight of the licensed doctor.                                                                                 
                                                                                                                                
4:30:10 PM                                                                                                                    
DR.  DELZER  said this  thoughtful  and  simple legislation  will                                                               
provide  the   statute  clarification   as  recommended   by  the                                                               
Department of  Law to allow  the crafting of  regulatory language                                                               
by the  board to  carefully regulate  this ongoing  delegation of                                                               
safe,  supervised, non-invasive  assistance  for busy  practices,                                                               
which in  turn continues to  improve access for the  residents of                                                               
Alaska  to   much  needed  eye  care.   Fortunately,  the  simple                                                               
legislation   would  accomplish   this  in   a  manner   that  is                                                               
recommended by  Director Robb at no  cost to the state,  nor cost                                                               
to the patients or their  insurers. He said the Alaska Optometric                                                               
Association and  its membership fully  support HB 309  and remain                                                               
grateful to  the sponsor, Representative  Ruffridge, and  to this                                                               
distinguished committee  for the opportunity to  promptly address                                                               
this issue.                                                                                                                     
                                                                                                                                
4:31:25 PM                                                                                                                    
ELIZABETH   STEVENS,   Executive  Director,   Alaska   Optometric                                                               
Association,  Anchorage,   Alaska,  gave  invited   testimony  in                                                               
support of HB 309. She  appreciated the opportunity to testify on                                                               
behalf  of  over  100  optometric   physicians  who  provide  the                                                               
majority of  primary eye care  statewide in both rural  and urban                                                               
communities.  The  Alaska  Optometric  Association  strongly  and                                                               
enthusiastically  supports HB  309 which  would grant  the Alaska                                                               
Board  of   Examiners  in  Optometry   the  authority   to  draft                                                               
regulations  regarding  the   delegation  of  routine  optometric                                                               
services.                                                                                                                       
                                                                                                                                
4:32:29 PM                                                                                                                    
CHAIR BJORKMAN held HB 309 in committee.                                                                                        
                                                                                                                                

Document Name Date/Time Subjects
HB29 Draft Proposed Blank Amendment U.A.1.pdf SL&C 5/1/2024 1:30:00 PM
HB 29
HB237 Ver A.pdf SL&C 5/1/2024 1:30:00 PM
HB 237
HB237 Sponsor Statement Ver A 03.24.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 237
HB237 Fiscal Note DCCED-CBPL 01.26.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 237
HB237 Letter of Support-Dawn Hughes 03.21.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 237
HB237 Letter of Support Board of Nursing 01.31.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 237
HB309 ver A.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB309 Sponsor Statement.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB309 Sectional Analysis.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB309 Sponsor Presentation to SLAC 04.29.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB309 Fiscal Note DCCED_CBPL 03.15.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB309 DOL-Memo regarding Delegation Authority.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB309 Public Testimony-Letter_AAO Letter 03.25.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 309
HB254 ver U.A.pdf SL&C 5/1/2024 1:30:00 PM
HB 254
HB254 Sponsor Statement ver U.A.pdf SL&C 5/1/2024 1:30:00 PM
HB 254
HB254 Fiscal Note CS(JUD)AM FCS-AS 04.26.24.pdf SL&C 5/1/2024 1:30:00 PM
HB 254
HB254 Sectional Analysis ver U.A.pdf SL&C 5/1/2024 1:30:00 PM
HB 254