Legislature(2021 - 2022)ADAMS 519
04/14/2022 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB239 || SB240 | |
| HB265 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 265 | TELECONFERENCED | |
| + | HB 409 | TELECONFERENCED | |
| + | HB 410 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | SB 239 | TELECONFERENCED | |
| + | SB 240 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
April 14, 2022
1:33 p.m.
1:33:14 PM
CALL TO ORDER
Co-Chair Merrick called the House Finance Committee meeting
to order at 1:33 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Kelly Merrick, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative Ben Carpenter
Representative Bryce Edgmon
Representative DeLena Johnson
Representative Andy Josephson
Representative Bart LeBon
Representative Sara Rasmussen (via teleconference)
Representative Adam Wool
MEMBERS ABSENT
Representative Steve Thompson
ALSO PRESENT
Jhonny Meza, Commercial Analyst, Division of Oil and Gas,
Department of Natural Resources; Representative Ivy
Spohnholz, Sponsor.
PRESENT VIA TELECONFERENCE
John Crowther, Deputy Commissioner, Department of Natural
Resources; Doug Chapados, ASRC, Petro Star, Anchorage;
Casey Sullivan, Marathon Petroleum, Anchorage; Lance
Johnson, Norton Sound Health, Nome; Winn Davis, Senior
Policy Analyst, Alaska Native Health Board, Anchorage;
Emily Nenon, American Cancer Society, Cancer Action
Network, Anchorage; Sara Chambers, Director, Division of
Corporations, Business and Professional Licensing,
Department of Commerce, Community and Economic Development.
SUMMARY
HB 265 HEALTH CARE SERVICES BY TELEHEALTH
CSHB 265(FIN) was REPORTED out of committee with
six "do pass" recommendations and two "no
recommendation" recommendations and with one new
zero fiscal note by Department of Health, one new
fiscal impact note by the Department of Commerce,
Community and Economic Development, and two new
fiscal impact notes by the Department of Health.
SB 239 APPROVE PETRO STAR INC. ROYALTY OIL SALE
SB 239 was REPORTED out of committee with nine
"do pass" recommendations and with one new fiscal
impact note by the Department of Natural
Resources.
SB 240 APPROVE MARATHON PETRO ROYALTY OIL SALE
SB 240 was REPORTED out of committee with nine
"do pass" recommendations and with one new fiscal
impact note by the Department of Natural
Resources.
Co-Chair Merrick reviewed the agenda for the meeting.
SENATE BILL NO. 239
"An Act approving and ratifying the sale of royalty
oil by the State of Alaska to Petro Star Inc.; and
providing for an effective date."
SENATE BILL NO. 240
"An Act approving and ratifying the sale of royalty
oil by the State of Alaska to Marathon Petroleum
Supply and Trading Company LLC; and providing for an
effective date."
1:33:57 PM
JHONNY MEZA, COMMERCIAL ANALYST, DIVISION OF OIL AND GAS,
DEPARTMENT OF NATURAL RESOURCES, introduced the PowerPoint
presentation: "The Process for the Sale of ANS Royalty Oil
In-Kind and the Proposed Contracts with Marathon and Petro
Star SB 239 AND SB 240." He indicated the beginning of
the presentation would be provided by Mr. John Crowther.
1:34:50 PM
JOHN CROWTHER, DEPUTY COMMISSIONER, DEPARTMENT OF NATURAL
RESOURCES (via teleconference), emphasized that the royalty
oil in-kind sales had been an important element in the
state's use and development of natural resources. It had
also been an important part in supporting the in-state
refining capacity, which benefited consumers through fuel,
supply, and security, and also benefited the broader
economy. It had also provided additional value over and
above the general royalty and value sales. He began with
slide 2 of the presentation which stated that it was
critical that the proposed contracts be executed by April
22, 2022. The slide showed a summary of the steps needed in
order to effectuate the contract and an explanation of why
the Department of Natural Resources (DNR) and the
administration was seeking an expedited review.
1:36:24 PM
Mr. Meza turned to slide 4 of the presentation and shared
that he would be reviewing some of the contract terms for
the companies Marathon and Petro Star. The slide showed a
table reflecting the recent history of the royalty oil in-
kind contracts. He explained that the state had received
royalty oil from the North Slope both in-kind and in-value.
When selling royalty oil in-value, the state received a
share of the proceeds from the producers according to its
royalty rate in the oil and gas contracts. When the state
elected to receive its royalty oil in-kind, the majority of
the oil produced would come from in-state refineries. The
state had a history of entering into royalty in-kind
contracts from the beginning of production of oil in the
North Slope.
Mr. Meza explained that the contracts with Marathon and
Petro Star were highlighted on the slide. The fourth column
on the slide showed the way in which the department and the
buyers agreed to value the royalty oil, specifically
following the netback methodology. He explained that DNR
sold its royalty oil at the field; therefore, the price of
royalty oil was calculated by "netting back" the price of
Alaska North Slope (ANS) oil at the U.S. West Coast to the
field. The netback methodology was essentially the same
process as in-value pricing, with the exception of royalty
in-kind differential. This was a negotiated term between
the department and the in-state refineries. The last column
showed the values of the negotiated terms and the royalty
in-kind differential throughout the history of the
contracts.
Representative Johnson asked if it was better for the state
to receive oil in-kind or in-value.
Mr. Meza replied that when the state entered into a royalty
in-kind contract, regulations required the price be at
least as high as the in-value price. From 2008 to 2021, the
department obtained an average premium of $0.93 per barrel
in addition to a royalty in-value oil.
Representative Johnson asked whether the difference between
royalty in-kind and royalty in-value related to the chain
of events that happened throughout the selling process.
Mr. Meza responded that there was a process for selecting
royalty in-kind and that generating a premium over royalty
in-value was one of the requirements.
Representative Wool asked whether royalty in-kind was
another deduction in the price that would be offered to the
state. He understood it to represent the normal price of
oil plus another deduction.
Mr. Meza responded that Representative Wool was correct.
The royalty in-kind was another deduction in the price, but
even so, a premium was still generated over royalty in-
value.
1:41:41 PM
Mr. Meza moved to slide 5 and explained that the slide was
a visual representation of the differences between the
determination of the price of royalty in-value oil and the
price of royalty in-kind oil. The processes were similar in
that the netback methodology was applied to both. He
indicated that when the state elected to receive royalty
ANS oil in-value, producers typically sold that oil outside
of Alaska. When the state elected to receive royalty ANS
oil in-kind, it typically sold the oil inside of Alaska.
There were some deductions related to the transportation of
royalty in-value oil, such as the marine transportation
costs. The royalty in-kind oil did not have transportation
cost deductions; therefore, the royalty in-kind
differential was employed. The department used the
deductions and the royalty in-kind differential to
determine the oil premium.
Mr. Meza continued to slide 6 which showed some historical
information related to the previous graph on slide 5. The
graph on slide 6 showed the historical value of the royalty
in-kind differential and the marine transportation costs.
He explained that the blue line showed the weighted average
marine transportation allowance, the green line showed DNR
location differential, and the grey line showed the
weighted average royalty in-kind differential. He
elaborated that the difference between the blue and grey
lines was the source of the premium that the department
obtained by entering into royalty in-kind contracts.
Another consideration was that the department provided
supplies to the refineries, but it was not the only
supplier. It was important to consider whether the royalty
oil was competitive as compared to other suppliers.
1:45:04 PM
Representative Edgmon asked Mr. Meza to address the revenue
difference for the state.
Mr. Meza jumped to slide 9 which showed how much the state
had been able to generate in terms of additional revenues.
The current Marathon contracts estimated between $3 million
and $4 million in revenue, and the Petro Star contracts
estimated between $17 million and $19 million in revenue.
The revenue estimates were in excess of what would have
been received had the state elected to receive 100 percent
of the royalty oil in-value.
Representative Edgmon suggested that there was a reason for
the public process. He was a strong supporter of the
legislation.
1:46:49 PM
Co-Chair Merrick asked Mr. Meza to review the fiscal note
for SB 239 with a control code EPVzv.
Mr. Meza explained the fiscal note from DNR aimed to
decompose the values he had just given for the Marathon and
Petro Star contracts. He relayed that 74.5 percent of the
revenues for each fiscal year would be allocated to the
general fund, 24 percent would be allocated to the
Permanent Fund, and 0.5 percent to the school fund.
Co-Chair Merrick noted that there was a typo in the fiscal
note that would be corrected before it moved from
committee. She asked Mr. Meza to address the fiscal note
for SB 240 with control code gjwMS from DNR.
Mr. Meza explained that the process was the same as the
previous fiscal note. The main differences were the revenue
estimates and the proposed amount of royalty oil dedicated
to Marathon.
1:48:34 PM
Representative Carpenter noticed a discrepancy on the back
page of the fiscal note.
1:48:50 PM
AT EASE
1:55:46 PM
RECONVENED
Representative Wool asked about for more information on the
difference between the grey line and the green line in the
prior graphic on slide 6.
Mr. Meza explained that he was comparing the blue line on
the top with the grey line on the bottom. This was the
important comparison because regulation dictated that the
royalty in-kind price had to be at least equal to the
royalty in-value price. The royalty in-value price was
represented by the blue line.
Representative Wool had a question regarding slide 5. He
asked how the oil was transported.
Mr. Meza relayed that DNR was not in charge of the
transportation of oil. The state transferred the royalty
title at the field. The purpose of including the deduction
in the graph on slide 5 was because the price of ANS oil
began at the West Coast of the United States and the
royalty oil was sold at the field.
1:58:16 PM
Representative Wool understood that the oil went through
the pipeline, then into a terminal, then into a boat. He
did not think the oil went directly to Marathon or Petro
Star and wondered where their oil came from.
Mr. Meza responded that Representative Wool was correct. He
furthered that Petro Star obtained royalty oil and other
types of oil from other producers. Marathon obtained
royalty oil from Valdez and it was barged to Nikiski.
Representative Wool thought it made sense that Marathon
picked the oil up from Valdez and it was then sold at the
field.
Representative Josephson understood that Marathon was
located in Nikiski and asked where Petro Star was located.
Mr. Meza responded that Petro Star had a refinery in North
Pole and another in Valdez.
Co-Chair Merrick asked Mr. Meza to review Fiscal Note 1 by
DNR for SB 239.
Mr. Meza explained the fiscal note with the control code
ezbNE. He indicated that the note showed that the
allocation to the general fund and other funds were done
uniformly. He reminded members that 74.5 percent would be
allocated to the general fund, 24 percent to the Permanent
Fund, and 0.5 percent to the school fund.
Representative Carpenter requested a brief "At ease."
2:00:41 PM
AT EASE
2:01:59 PM
RECONVENED
Representative Carpenter asked about the oil flowing
through the pipeline on slide 5. He wondered if there was
an impact on the property taxation on the oil when it had a
royalty in-kind status. He wondered if there was any
difference in taxation.
Mr. Meza thought there was no difference.
2:02:53 PM
Co-Chair Merrick OPENED public testimony for SB 239 and
SB 240.
DOUG CHAPADOS, ASRC, PETRO STAR, ANCHORAGE (via
teleconference), spoke in favor of SB 239. He relayed that
Petro Star was the state's only Alaskan-owned refinery. In
addition to operating a variety of field terminals located
around the state, Petro Star also operated two of the
state's three commercial refineries. Both refineries drew
crude oil from the pipeline. He thought that the
legislation was essential to Petro Star's continued
operations. Petro Star's oil was used for things like jet
fuel, heating oil, and diesel fuel. The royalty in-kind
contract would maximize the revenues generated from
Alaska's royalties from oil. It would also help maintain
the refining industry in the state.
Representative LeBon thanked the testifier for calling in.
He appreciated the information about Petro Star's important
role in the state.
2:06:01 PM
Representative Edgmon asked for more information on the
Alaskan hire percentages in his district.
Mr. Chapados indicated that all but two of Petro Star's 275
employees were Alaska residents.
2:06:48 PM
CASEY SULLIVAN, MARATHON PETROLEUM, ANCHORAGE (via
teleconference), thanked the committee for hearing the
bill. He shared support for SB 240. The flexibility and
stability of the contract would help Marathon optimize the
ongoing operations of the Kenai refinery. The Kenai
refinery was one of Alaska's longest in-state manufacturers
of fuel and had been operating since 1969. The refinery
could produce up to 68,000 barrels per day. He noted that
much of the oil produced at the refinery was used in
Alaska, and all of the company's employees were Alaskans.
The company was seen as an economic engine for communities,
and it offered careers, not just jobs. He added that while
much of the contract was a renewal, it was result of
dialogue and negotiations between Marathon and the Division
of Oil and Gas. In conclusion, Marathon was committed to
safely and reliably creating quality fuels for Alaskans. He
encouraged support for SB 240.
2:10:32 PM
Co-Chair Merrick CLOSED public testimony for SB 239 and
SB 240.
Co-Chair Merrick noted that SB 239 and SB 240 were
companion bills to HB 409 and HB 410.
Representative Wool returned to slide 9 which gave
information on the additional revenue to the state. He
applauded DNR and the administration for looking into all
revenue streams, no matter how small.
2:11:57 PM
Co-Chair Foster MOVED to report SB 239 out of committee
with individual recommendations and the accompanying fiscal
note.
There being NO OBJECTION, it was so ordered.
SB 239 was REPORTED out of committee with nine "do pass"
recommendations and with one new fiscal impact note by the
Department of Natural Resources.
2:12:24 PM
Co-Chair Foster MOVED to report SB 240 out of committee
with individual recommendations and the accompanying fiscal
note.
There being NO OBJECTION, it was so ordered.
SB 240 was REPORTED out of committee with nine "do pass"
recommendations and with one new fiscal impact note by the
Department of Natural Resources.
2:12:40 PM
AT EASE
2:13:58 PM
RECONVENED
Co-Chair Merrick indicated that the committee would stand
at-ease to the call of the chair.
2:14:05 PM
AT EASE
[RECESSED TO A CALL OF THE CHAIR.]
4:12:42 PM
RECONVENED
Co-Chair Merrick indicated the committee had heard the HB
265 previously on March 29, 2022. There were three proposed
amendments.
HOUSE BILL NO. 265
"An Act relating to telehealth; relating to the
practice of medicine; relating to medical assistance
coverage for services provided by telehealth; and
providing for an effective date."
4:12:51 PM
Co-Chair Merrick gave the bill sponsor the opportunity to
make opening comments but Representative Spohnholz
declined.
Co-Chair Merrick OPENED public testimony.
4:13:44 PM
AT EASE
4:14:10 PM
RECONVENED
LANCE JOHNSON, NORTON SOUND HEALTH, NOME (via
teleconference), spoke in support of HB 265. He noted that
the COVID-19 pandemic highlighted the positive impact of
telehealth. He emphasized the importance of keeping audio-
only services accessible. Some people preferred to access
treatment via telephone because they could engage in an
appointment in an environment of their choosing. He shared
that many patients indicated they would elect to not
receive care rather than have to make video or in-person
appointments. Reducing access to audio-only care would
create unnecessary barriers for people in need of care.
Providers had also been able to provide a Medicaid covered
crisis intervention service via telephone for over ten
years. If providers could stabilize a person in-crisis at
their most vulnerable over the phone, it should certainly
be possible to offer other effective treatments in the same
manner.
4:17:09 PM
WINN DAVIS, SENIOR POLICY ANALYST, ALASKA NATIVE HEALTH
BOARD, ANCHORAGE (via teleconference), supported HB 265. He
spoke of the benefits of expanded behavioral health
services in Alaska with the option of telehealth access.
Continued access to telehealth would decrease travel costs
and decrease the frequency of no-shows at appointments.
Many Alaskans who lived in villages did not have reliable
access to the internet which meant that access to telephone
services was vital. He emphasized the importance of
continuing to allow the telehealth services to be
reimbursable through Medicaid. There would also be
increased burn-out rates for providers having to travel to
provide care. He suggested Alaskans were at risk without
extending telehealth services. He urged members to support
the bill.
4:20:53 PM
Co-Chair Merrick CLOSED public testimony.
4:21:01 PM
AT EASE
4:21:50 PM
RECONVENED
Co-Chair Merrick RE-OPENED public testimony due to
technical difficulties.
4:22:21 PM
EMILY NENON, AMERICAN CANCER SOCIETY, CANCER ACTION
NETWORK, ANCHORAGE (via teleconference), encouraged members
to make HB 265 a reality. The bill would make a huge
difference for cancer patients. When the COVID-19 emergency
declaration ended, she had to start calling Alaska patients
to cancel their telehealth appointments. Many of these
patients did not have other options without extensive
travel. She shared an example of a rural patient receiving
an introductory educational appointment about radiation
treatment via telehealth. The telehealth appointment made
it possible for the patient to be able to consult with
their family and determine that they wanted to go forward
with the radiation treatment. By the time the patient
arrived in Anchorage, all of the necessary prep work had
already been completed. She looked forward to increasing
access to care.
4:25:18 PM
Co-Chair Merrick CLOSED public testimony.
4:25:25 PM
Representative Josephson MOVED to ADOPT Amendment 1, 32-
LS0754\D.4, (Foote, 4/9/22) (copy on file):
Page 9, line 2, through page 10, line 7:
Delete all material and insert:
""' Sec. 8. This Act takes effect immediately under AS
01.10.070(c)."
Representative Carpenter OBJECTED for discussion.
Representative Josephson explained the amendment. He
indicated the bill sponsor had asked him to offer the
amendment to expedite and simplify the intent of the
legislation. There would be a gap of a year before the
effective date took hold, and the amendment would make the
act take effect immediately. The bill did not need to delay
its effective date.
Representative Carpenter WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 1 was ADOPTED.
4:28:49 PM
Representative Rasmussen MOVED to ADOPT Amendment 2, 32-
LS0754\D.2 (FOOTE, 4/12/22) (copy on file):
Page 1, following line 9:
Insert a new subsection to read:
"(b) A physician licensed in another state may
provide health care services through telehealth
to a patient located in the state as provided in
this subsection, subject to the investigative and
enforcement powers of the department under AS
08.01.087, and subject to disciplinary action by
the State Medical Board under AS 08.64.333. The
privilege to practice under this subsection
extends only to ongoing treatment or follow-up
care related to health care services previously
provided by the physician to the patient and
applies only if
(1) the physician and the patient have an
established physician-patient relationship;
and
(2) the physician has previously conducted
a physical examination of the patient in
person."
Reletter the following subsections accordingly.
Page 2, line 16:
Delete "(d) and (e)"
Insert "(e) and (f)"
Page 2, line 28, following "means":
Insert "(A)"
Page 3, line 8, following "08.95;":
Insert "or
(B) a physician licensed in another state;"
Page 3, following line 10:
Insert a new bill section to read:
"* Sec. 2. AS 08.64 is amended by adding a new
section to read:
Sec. 08.64.333. Disciplinary sanctions: physician
licensed in another state. (a) The board may
sanction a physician licensed in another state
who provides health care services through
telehealth under AS 08.01.085(b) if the board
finds after a hearing that the physician
(1) committed an act that constitutes grounds to
sanction a physician licensed in this state under
AS 08.64.326(a)(1) - (13);
(2) exceeded the scope of the physician's
privilege to practice in this state under AS
08.01.085; or
(3) prescribed, dispensed, or administered
through telehealth to a patient located in the
state a controlled substance listed in AS
11.71.140 - 11.71.190.
(b) If the board finds grounds to sanction a
physician under (a) of this section, the board may
(1) permanently prohibit the physician from
practicing in the state;
(2) prohibit the physician from practicing in
the state for a determinate period;
(3) censure the physician;
(4) issue a letter of reprimand to the
physician;
(5) place the physician on probationary status
under (d) of this section;
(6) limit or impose conditions on the
physician's privilege to practice in the state;
(7) impose a civil fine of not more than
$25,000;
(8) issue a cease and desist order prohibiting
the physician from providing health care services
through telehealth under AS 08.01.085(b); an
order issued under this paragraph remains in
effect until the physician submits evidence
acceptable to the board showing that the
violation has been corrected;
(9) promptly notify the licensing authority in
each state in which the physician is licensed of
a sanction imposed under this subsection.
(c) In a case involving a physician alleged to have
committed an act under AS 08.64.326(a)(13), the final
findings of fact, conclusions of law, and order of the
authority that suspended or revoked a license or
certificate constitute a prima facie case that the
license or certificate was suspended or revoked and
the grounds under which the suspension or revocation
was granted.
(d) The board may place a physician on probation
under this section until the board finds that the
deficiencies that required the imposition of a
sanction have been remedied. The board may require a
physician on probation to
(A) report regularly to the board on matters
involving the reason for which the physician was
placed on probation;
(B) limit the physician's practice in the state to
those areas prescribed by the board;
(C) participate in professional education until the
board determines that a satisfactory degree of skill
has been attained in areas identified by the board as
needing improvement.
(e) The board may summarily prohibit a physician from
practicing in the state under AS 08.01.085(b) if the
board finds that the physician, by continuing to
practice, poses a clear and immediate danger to public
health and safety. A physician prohibited from
practicing under this subsection is entitled to a
hearing conducted by the office of administrative
hearings (AS 44.64.010) not later than seven days
after the effective date of the order prohibiting the
physician from practicing. The board may lift an order
prohibiting a physician from practicing if the board
finds after a hearing that the physician is able to
practice with reasonable skill and safety. The
physician may appeal a decision of the board under
this subsection to the superior court.
(f) The board may recover from a physician the cost
of proceedings resulting in a sanction under (b) of
this section, including the costs of investigation by
the board and department, and hearing costs.
(g) The board may prohibit a physician from
practicing in the state upon receipt of a certified
copy of evidence that a license to practice medicine
in another state or territory of the United States or
province or territory of Canada has been suspended or
revoked. The prohibition remains in effect until a
hearing can be held by the board.
(h) The board shall be consistent in the application
of disciplinary sanctions. A significant departure
from earlier decisions of the board involving similar
situations must be explained in findings of fact or
orders made by the board."
Renumber the following bill sections accordingly.
Page 9, line 7:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 14:
Delete "sec. 2"
Insert "secs. 2 and 3"
Page 9, line 17:
Delete "secs. 4 - 7"
Insert "secs. 5 - 8"
Page 9, line 21:
Delete "Section 5"
Insert "Section 6"
Page 9, line 25:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 27:
Delete "sec. 5"
Insert "sec. 6"
Page 10, line 2:
Delete "sec. 5"
Insert "sec. 6"
Page 10, lines 3 - 4:
Delete "sec. 10(b)"
Insert "sec. 11(b)"
Page 10, line 5:
Delete "Section 9"
Insert "Section 10"
Page 10, line 6:
Delete "secs. 11 and 12"
Insert "secs. 12 and 13"
Co-Chair Merrick OBJECTED for discussion.
Representative Rasmussen explained she was offering the
amendment at the request of the bill sponsor. Many Alaskans
sought treatment for cancer care out-of-state that was not
available within the state. The amendment would allow
patients to avoid unnecessary travel expenses while still
getting the care they need. Alaska had not joined any
inter-state healthcare compacts and the amendment was a
significant step forward in modernizing Alaska's healthcare
access via telehealth.
4:29:56 PM
Representative LeBon asked if an out-of-state provider was
required to have an Alaska license.
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, replied that the
very narrow exclusion that was being advanced was for
follow-up care for medical providers who had already
delivered in-person care. In the particular example
provided by Representative Rasmussen, it was not required
that the provider be licensed in Alaska. The language was a
result of a compromise to ensure that Alaskans could get
access to specialty care without unnecessary travel, but
also without reducing Alaska's state sovereignty. It would
not reduce Alaska's ability to enforce sanctions against
potential bad actors.
4:32:01 PM
Representative Carpenter asked how an accused physician
would be afforded due process.
Representative Spohnholz deferred to Ms. Chambers.
4:32:44 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT (via teleconference),
explained the amendment allowed the board the ability to
work with the Division of Corporations, Business and
Professional Licensing to investigate and gather
information regarding a complaint filed against a physician
that did not have an Alaska license. The process would
ultimately culminate in a decision by the Medical Board to
determine whether the physician should be relieved of the
ability to practice under the proposed exemption. It would
be the same process that was currently in place.
4:34:03 PM
Representative Carpenter asked what the process would be
for a doctor that was practicing from out-of-state. He did
not see how the doctor would be allowed a rebuttal to the
accusations.
Ms. Chambers replied that there was a process under the
Administrative Procedures Act that was echoed on page 3,
line 22 of the amendment. A physician had the ability to
have a hearing for a short period of time up to seven days.
It was already in statute and was not superseding other
areas of statute. It reinforced the physician's ability to
have a hearing if the board reached a decision that might
relieve them of their ability to practice in Alaska. The
act also included an appeals process that allowed a
physician the chance to challenge the decision. There was a
robust process in place with which the amendment aligned.
Representative Carpenter asked whether the process of
notifying the licensing authority of each involved state
occurred before or after the appeals process had completed.
Ms. Chambers replied that once there was a sanction
proposed by the board, the board was bound by existing
statute and federal requirements to make sure that other
states were notified. It was consistent with the current
processes.
4:37:01 PM
Representative Spohnholz thought that the amendment would
create a process that exactly mirrored the process already
used for license holders in Alaska. It was a narrow
exception that would only apply to providers who were not
licensed in Alaska and were providing follow-up care.
Representative Rasmussen asked for members' support.
Co-Chair Merrick WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 2 was ADOPTED.
4:38:21 PM
Vice-Chair Ortiz MOVED to ADOPT Amendment 3, 32-LS0754\D.3
(Foote, 04/12/22) (copy on file):
Page 2, line 11, following "AS 08.64.364":
Insert "and any federal law governing the
prescription, dispensing, or administering of a
controlled substance"
Page 2, line 15, following "AS 08.68.710":
Insert "and any federal law governing the
prescription, dispensing, or administering of a
controlled substance
Page 2, line 17:
Delete "or in another state"
Page 3, following line 20:
Insert a new bill section to read:
"* Sec. 3. AS 08.68.l0O(a) is amended to read:
(a) The board shall
(1) adopt regulations necessary to implement
this chapter, including regulations
(A) pertaining to practice as an
advanced practice registered nurse, including
requirements for an advanced practice
registered nurse to practice as a certified
registered nurse anesthetist, certified
clinical nurse specialist, certified nurse
practitioner, or certified nurse midwife;
regulations for an advanced practice
registered nurse who holds a valid federal
Drug Enforcement Administration registration
number must address training in pain
management and opioid use and addiction;
(B) necessary to implement AS 08.68.331
- 08.68.336 relating to certified nurse aides
in order to protect the health, safety, and
welfare of clients served by nurse aides;
(C) pertaining to retired nurse status;
[AND]
(D) establishing criteria for approval
of practical nurse education programs that
are not accredited by a national nursing
accrediting body; and
(E) establishing guidelines for
rendering a diagnosis, providing treatment,
or prescribing, dispensing, or administering
a prescription drug to a person without
conducting a physical examination under AS
08.68.710; the guidelines must include a
nationally recognized model policy for
standards of care of a patient who is at a
different location than the advanced practice
registered nurse;
(2) approve curricula and adopt standards
for basic education programs that prepare persons
for licensing under AS 08.68.190;
(3) provide for surveys of the basic nursing
education programs in the state at the times it
considers necessary;
(4) approve education programs that meet
the requirements of this chapter and of the
board, and deny, revoke, or suspend approval of
education programs for failure to meet the
requirements;
(5) examine, license, and renew the licenses
of qualified applicants;
(6) prescribe requirements for competence
before a former registered, advanced practice
registered, or licensed practical nurse may
resume the practice of nursing under this
chapter;
(7) define by regulation the qualifications
and duties of the executive administrator and
delegate authority to the executive administrator
that is necessary to conduct board business;
(8) develop reasonable and uniform standards
for nursing practice;
(9) publish advisory opinions regarding
whether nursing practice procedures or policies
comply with acceptable standards of nursing
practice as defined under this chapter;
(10) require applicants under this chapter
to submit fingerprints and the fees required by
the Department of Public Safety under AS
12.62.160 for criminal justice information and a
national criminal history record check; the
department shall submit the fingerprints and fees
to the Department of Public Safety for a report
of criminal justice information under AS 12.62
and a national criminal history record check
under AS 12.62.400;
(11) require that a licensed advanced
practice registered nurse who has a federal Drug
Enforcement Administration registration number
register with the controlled substance
prescription database under AS l 7.30.200(n)."
Renumber the following bill sections accordingly.
Page 9, line 7:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 17:
Delete "secs. 4 - 7"
Insert "secs. 5 - 8"
Page 9, line 21:
Delete "Section 5"
Insert "Section 6"
Page 9, line 25:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 27:
Delete "sec. 5"
Insert "sec. 6"
Page 10, line 2:
Delete "sec. 5"
Insert "sec. 6"
Page 10, lines 3-4:
Delete "sec. l0(b)"
Insert "sec. 11(b)"
Page 10, line 5:
Delete "Section 9"
Insert "Section 10"
Page 10, line 6:
Delete "secs. 11 and 12"
Insert "secs. 12 and 13"
Representative Carpenter OBJECTED for discussion.
Vice-Chair Ortiz explained the amendment would clean up the
controlled substance language per the recommendations of
the sponsor and of Ms. Chambers, who was online for
additional questions. It ensured that the bill complied
with federal law and ensured regulatory equity with the
Medical Board and the Board of Nursing on tele-prescribing
controlled substances.
4:39:34 PM
Representative Carpenter asked for an example of cleaned up
language.
Ms. Chambers asked for clarification of Representative
Carpenter's question.
Representative Carpenter restated his question.
Ms. Chambers responded that she had be working with the
sponsor to clean up language that ensured that the state
was aligning with federal law. A previous version of the
bill might have gone too far in superseding the federal
law. On page 3, line 20 of the amendment, there was an edit
to give the Board of Nursing additional authority which
would allow and require the board to establish guidelines
for the prescribing of drugs. The guidelines were currently
unclear in statute and the amendment would add clarity.
4:41:41 PM
Representative Spohnholz added that the amendment was of
significant importance because it clarified that controlled
substances in Alaska could only be prescribed in compliance
with the state's drug enforcement statute. It would not
allow prescription of an opioid without an in-person visit.
Inadvertently, she had excluded the Board of Nursing from
the ability to adopt prescribing regulations in an earlier
draft of the bill. The amendment would give the Board of
Nursing the necessary authority.
4:42:32 PM
Representative Carpenter asked who identified the
oversight.
Representative Spohnholz responded, "Director Chambers."
Representative Carpenter suggested that the amendment was
significant. It was a policy decision that he did not
understand.
4:43:25 PM
AT EASE
4:44:21 PM
RECONVENED
Vice-Chair Ortiz provided wrap-up comments. He indicated
that Amendment 3 would ensure that the bill aligned with
federal law. It fixed language which could be interpreted
to open out-of-state tele-prescribing authority. It deleted
the phrase "In another state" which clarified that only
providers licensed in Alaska could tele-prescribe
controlled substances. There was a federal law for a Drug
Enforcement Administration (DEA) registered practitioner to
conduct an in-person examination in order to tele-prescribe
controlled substances, which was waived during the COVID-19
pandemic. However, there was federal interest to change the
in-person requirement, and if it was changed, it was
important to ensure the bill aligned with any changes in
federal law while limiting state barriers to telehealth.
Representative Carpenter WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 3 was ADOPTED.
Co-Chair Foster MOVED to report CSHB 265(FIN) out of
committee with individual recommendations and the
accompanying fiscal notes.
There being NO OBJECTION, it was so ordered.
CSHB 265(FIN) was REPORTED out of committee with six "do
pass" recommendations and two "no recommendation"
recommendations and with one new zero fiscal note by
Department of Health, one new fiscal impact note by the
Department of Commerce, Community and Economic Development,
and two new fiscal impact notes by the Department of
Health.
4:48:31 PM
AT EASE
4:49:15 PM
RECONVENED
Co-Chair Merrick announced the agenda for the following
meeting at 1:30 p.m. on Friday.
ADJOURNMENT
4:49:34 PM
The meeting was adjourned at 4:49 p.m.