Legislature(2015 - 2016)BARNES 124
01/25/2016 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| Overview: Department of Commerce, Community and Economic Development, Division of Banking and Securities | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 53 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
January 25, 2016
3:17 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Shelley Hughes, Vice Chair
Representative Jim Colver
Representative Gabrielle LeDoux
Representative Cathy Tilton
Representative Andy Josephson
Representative Sam Kito
MEMBERS ABSENT
Representative Mike Chenault (alternate)
COMMITTEE CALENDAR
SENATE BILL NO. 53
"An Act relating to advanced practice registered nursing;
relating to certified direct- entry midwifery; and providing for
an effective date."
- MOVED HCS SB 53(L&C) OUT OF COMMITTEE
OVERVIEW: DIVISION OF BANKING & SECURITIES, DEPARTMENT OF
COMMERCE, COMMUNITY & ECONOMIC DEVELOPMENT
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 53
SHORT TITLE: ADVANCED PRACTICE REGISTERED NURSES
SPONSOR(s): SENATOR(s) GIESSEL
02/18/15 (S) READ THE FIRST TIME - REFERRALS
02/18/15 (S) L&C, HSS
03/10/15 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/10/15 (S) Heard & Held
03/10/15 (S) MINUTE(L&C)
03/12/15 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/12/15 (S) Moved SB 53 Out of Committee
03/12/15 (S) MINUTE(L&C)
03/13/15 (S) L&C RPT 4DP 1NR
03/13/15 (S) DP: COSTELLO, GIESSEL, MEYER, STEVENS
03/13/15 (S) NR: ELLIS
04/08/15 (S) HSS AT 1:30 PM BUTROVICH 205
04/08/15 (S) Heard & Held
04/08/15 (S) MINUTE(HSS)
04/10/15 (S) HSS AT 1:30 PM BUTROVICH 205
04/10/15 (S) Moved SB 53 Out of Committee
04/10/15 (S) MINUTE(HSS)
04/11/15 (S) HSS RPT 4DP
04/11/15 (S) DP: STEDMAN, STOLTZE, GIESSEL, ELLIS
04/11/15 (S) FIN REFERRAL ADDED AFTER HSS
04/14/15 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/14/15 (S) Heard & Held
04/14/15 (S) MINUTE(FIN)
04/15/15 (S) FIN RPT 5DP 1NR
04/15/15 (S) DP: MACKINNON, MICCICHE, BISHOP,
DUNLEAVY, HOFFMAN
04/15/15 (S) NR: OLSON
04/15/15 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/15/15 (S) Moved SB 53 Out of Committee
04/15/15 (S) MINUTE(FIN)
04/16/15 (S) TRANSMITTED TO (H)
04/16/15 (S) VERSION: SB 53
04/16/15 (H) READ THE FIRST TIME - REFERRALS
04/16/15 (H) L&C
01/25/16 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
SENATOR CATHY GIESSEL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduce SB 53, as prime sponsor.
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Speaking on behalf of Senator Giessel,
sponsor, provided a sectional analysis of SB 53.
LAURA SARCONE, Certified Nurse-Midwife
Co-Chair, APRN Alliance
Anchorage, Alaska
POSITION STATEMENT: During the hearing of SB 53, answered a
question.
JEFF WORRELL, Certified Registered Nurse Anesthetist
Anchorage, Alaska
POSITION STATEMENT: During the hearing of SB 53, testified and
answered a question.
JANEY HOVENDEN, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: During the hearing of SB 53, answered a
question.
JULIE GILLETTE, Chair
Alaska Board of Nursing
Fairbanks, Alaska
POSITION STATEMENT: Speaking as the chair of the Alaska Board
of Nursing, testified in support of SB 53.
KEVIN ANSELM, Director
Division of Banking and Securities
Anchorage Office
Department of Commerce, Community & Economic Development
Anchorage, Alaska
POSITION STATEMENT: Provided an overview of the functions of
the Division of Banking and Securities, Department of Commerce,
Community and Economic Development.
ACTION NARRATIVE
3:17:53 PM
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:17 p.m. Representatives Olson,
Hughes, Colver, Tilton, Kito, and Josephson were present at the
call to order. Representative LeDoux arrived as the meeting was
in progress.
SB 53-ADVANCED PRACTICE REGISTERED NURSES
3:18:24 PM
CHAIR OLSON announced that the first order of business would be
SENATE BILL NO. 53, "An Act relating to advanced practice
registered nursing; relating to certified direct-entry
midwifery; and providing for an effective date."
3:18:35 PM
REPRESENTATIVE HUGHES moved to adopt the proposed House
committee substitute (HCS) for SB 53, labeled 29-LS0043\P,
Bruce, 1/20/16. There being no objection, Version P was before
the committee.
3:18:52 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, speaking as the
sponsor of SB 53, directed attention to the chart found in the
committee packet entitled, "APRN ALLIANCE" which illustrated the
current related Alaska statute and the statute changes proposed
in SB 53. Senator Giessel said the bill would change the title
of Advanced Nurse Practitioner (ANP) and Nurse Anesthetist (NA)
to that of Advanced Practice Registered Nurse (APRN). She
explained the change would bring the state into compliance with
the national title conformity that is recommended by the
National Council of State Boards of Nursing in order to
eliminate the confusion of consumers and insurance entities.
Nationally, interested parties agreed that APRN would be the
"umbrella title." The aforementioned chart showed the current
state situation which has Nurse Practitioner (NP), Certified
Nurse Midwife (CNM), and Certified Clinical Nurse Specialist
(CNS) included under the title of ANP, and a separate title for
NAs. The bill creates a uniform title of APRN, under which all
four of the clinical specialties would function, thus clarifying
the specialties for consumers and insurers. Senator Giessel
assured the committee that the bill does not change the scope of
practice for any of the specialties; in fact, the bill is simply
a title change, although it is lengthy because nurse
practitioners serve in multiple aspects of health care, and the
title corrections must be cited in many sections of statute.
She offered to provide further testimony by staff and supporters
of the bill.
CHAIR OLSON invited Senator Giessel's staff to provide a
sectional analysis of the bill.
3:22:44 PM
REPRESENTATIVE COLVER noted that SB 53 is simply an update of
the descriptions of nursing practices and asked, "Would you be
fighting off any attempts to hijack your bill to like insert
different agendas ... we can be assured that you're committed to
this clean bill."
SENATOR GIESSEL responded yes.
REPRESENTATIVE HUGHES asked whether a nurse practitioner would
be referred to as a nurse practitioner, or an APRN. She opined,
the title "practitioner" depicts a higher level of scope of
practice among members of the public.
3:24:48 PM
SENATOR GIESSEL agreed that nurse practitioners, nurse
anesthetists, clinical nurse midwives, and nurse specialists are
titles known to the public and will still be used; however, for
credentialing purposes such as signing a prescription, the new
titles will apply.
CHAIR OLSON expressed his belief that "hijacking bills" this
early in the session is unacceptable.
3:25:57 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, provided a sectional analysis of SB 53 on behalf of
Senator Giessel. She informed the committee that 26 sections of
the bill are conforming amendments that only change the previous
titles to that of APRN. The sectional analysis was as follows:
section 1 allows APRNs to use their titles and initials on
documents, signs, and advertising; sections 2-4 are conforming
amendments; section 5 requires APRN regulations to apply to one
who is a CRNA, CNS, CNP, or CNM, and makes conforming
amendments; section 6 adds APRN to a list of licenses issued,
and changes the term "professional nursing" to "registered
nursing"; section 7 adds a new subsection that sets out the
qualifications for an APRN license; section 8 repeals and
reenacts AS 08.68.190 concerning license examinations to
establish separate examinations for registered practitioners and
APRNs; section 9 is a conforming amendment; section 10 requires
the of Department of Commerce, Community & Economic Development
(DCCED) to set fees, and deletes the term "vocational nursing";
section 11 removes licensed professional nurse from titles;
section 12 is a new subsection authorizing the use of CRNA, CNS,
CNP, and CNM, under that section; section 13 adds APRN as a
person who can supervise a practical nurse; sections 14 and 16
are related to the impersonation of an APRN; section 15 requires
institutions that are applying for accreditation to provide
certain information; sections 17-19 are related to unlicensed
practice; section 20 adds APRN to licensees who may delegate
certain duties; section 21 is a conforming amendment; section 22
defines the practice of APRN nursing; sections 23 through 25 are
conforming amendments; section 26 adds APRNs to persons who are
considered justified in conduct that would otherwise be
considered the use of force when delivering emergency medical
care; sections 27 and 28 are conforming amendments; section 29
adds APRNs to licensees immune from civil liability while
escorting an injured or sick person; section 30 is a conforming
amendment; section 31 adds APRNs to practitioners authorized to
draw blood for tests of persons charged with sex offenses;
sections 32 and 33 are conforming amendments; section 34
clarifies that nurse-midwives and direct entry midwives are
certified; sections 35 through 38 are conforming amendments;
section 39 changes the term "registered professional nursing" to
"registered nursing"; section 40 clarifies that nurse-midwives
must be certified to be a provider in a hospital under AS 21.87;
section 41 is a conforming amendment; sections 42 and 43 clarify
that nurse-midwives are certified and make other technical
amendments; sections 44 through 46 are conforming amendments;
section 47 adds APRNs to the definition of health care provider
in statutory provisions regarding prisons; section 48 is a
conforming amendment; section 49 adds APRNs to licensees with
specific training who may assess a child with respect to a
waiver related to children and disabled persons under the
Medicaid waiver; section 50 is a conforming amendment; section
51 adds APRNs to practitioners who are not liable for providing
information to the Department of Health and Social Services
(DHSS) for hearing screenings; sections 52 through 54 allow
APRNs concerning mental health commitment determine if a person
may be administered psychotropic medication without consent;
section 55 adds APRNs to practitioners who may review a health
care plan for an assisted living home resident; sections 56
through 59 are conforming amendments; section 60 repeals certain
redundant statutes; and section 61 sets a new effective date.
3:34:16 PM
REPRESENTATIVE HUGHES directed attention to section 7, page 5,
beginning line 15, which read:
Sec. 7. AS 08.68.170 is amended by adding a new
subsection to read:
(c) An applicant for a license to practice advanced
practice registered nursing shall submit to the board,
on forms and in the manner prescribed by the board,
written evidence, verified by oath, that the applicant
(1) is licensed as a registered nurse in the state;
and
(2) has successfully completed an advanced practice
registered nurse education program that meets the
criteria established by the board under AS 08.68.100.
REPRESENTATIVE HUGHES asked why the new subsection was
necessary.
MS. CONWAY responded that this is the criteria to qualify for an
APRN license.
REPRESENTATIVE HUGHES restated her question.
3:36:12 PM
LAURA SARCONE, Certified Nurse-Midwife; Co-Chair, APRN Alliance,
explained that the current section relates to the qualifications
of registered or practical nurse applicants; new section 7 adds
a subsection that "pulls out the advanced practice registered
nurse as a separate category from registered nursing and
vocational nurses."
3:37:30 PM
REPRESENTATIVE JOSEPHSON remarked:
There is in the packet, there's a reference to - sort
of a rebuttal - to Dr. Joshua Stream and I didn't see
his letter. Can you give me a sense of what criticism
he had?
[Neither of the aforementioned documents were provided.]
MS. CONWAY informed the committee that Dr. Stream provided
written testimony which questioned whether nurse anesthetists
were qualified to practice without doctor supervision. However,
since 2003, nurse anesthetists in Alaska have practiced without
doctor supervision, as this is decided by each state. She
advised that Dr. Stream's comments were not germane to the bill.
[CHAIR OLSON and his staff recalled that Dr. Stream's written
testimony was not received by any committee member.]
REPRESENTATIVE JOSEPHSON asked about the role of an
anesthesiologist when a nurse anesthetist is present.
3:39:52 PM
JEFF WORRELL, Certified Registered Nurse Anesthetist, informed
the committee he is past president of the Alaska Association of
Nurse Anesthetists, and currently works independently at a large
Anchorage hospital.
REPRESENTATIVE JOSEPHSON restated his question as to the need
for an anesthesiologist and a nurse anesthetist.
MR. WORRELL explained that in current practice both specialties
are qualified to provide anesthesia services in a variety of
settings; however, the training differs: a CRNA is trained first
as a nurse, followed by three years of specialty training, and a
physician anesthesiologist is initially trained as physician,
followed by anesthesia training. He advised that the titles are
different but the work is the same.
REPRESENTATIVE HUGHES directed attention to the fiscal note and
asked whether the fees for individual licenses would change; the
sponsor indicated they would not.
3:43:22 PM
JANEY HOVENDEN, Director, Division of Corporations, Business,
and Professional Licensing, DCCED, answered that the fiscal note
identifies three programs in her division that would be affected
by the changes proposed in SB 53. The average cost would be
$2,500 per regulation project, thus the fiscal note totals
$7,500. Her division would attempt to garner savings by
combining this work with other ongoing regulation projects.
REPRESENTATIVE HUGHES asked whether there would be an adjustment
of the fees charges to licensees.
MS. HOVENDEN said the licensing fees for the nursing program
would not be affected.
3:45:04 PM
CHAIR OLSON opened public testimony on SB 53.
3:45:17 PM
JULIE GILLETTE, Chair, Alaska Board of Nursing, informed the
committee she is the chair of the Alaska Board of Nursing, which
is fully in support of the bill.
MR. WORRELL said adopting the APRN title allows for the
portability of licensure across state lines, and for conformity
to billing standards with other states.
3:47:03 PM
CHAIR OLSON, after ascertaining no one else wished to testify,
closed public testimony.
3:47:26 PM
REPRESENTATIVE HUGHES moved to report the HCS for SB 53, labeled
29-LS0043\P, Bruce, 1/20/16, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, HCS SB 53(L&C) was reported out of the House Labor
and Commerce Standing Committee.
3:47:47 PM
The committee took an at ease from 3:47 p.m. to 3:50 p.m.
^OVERVIEW: DEPARTMENT OF COMMERCE, COMMUNITY and ECONOMIC
DEVELOPMENT, DIVISION OF BANKING AND SECURITIES
OVERVIEW: DEPARTMENT OF COMMERCE, COMMUNITY and ECONOMIC
DEVELOPMENT, DIVISION OF BANKING AND SECURITIES
3:50:46 PM
CHAIR OLSON announced that the final order of business would be
a presentation by the Division of Banking and Securities,
Department of Commerce, Community & Economic Development
(DCCED).
3:51:03 PM
KEVIN ANSELM, Director, Division of Banking and Securities,
Anchorage Office, DCCED, informed the committee the mission of
the Division of Banking and Securities is: to protect consumers
of financial service and promote safe and sound financial
systems. In addition, the division supports the mission of
DCCED, which is to promote a healthy economy, support strong
communities, and protect consumers in Alaska [slide 2]. Ms.
Anselm said duties of her division include:
· Charter, license and register financial entities,
institutions, salespersons and products and accept filings
· Examine licensees for compliance and investigate complaints
relating to regulated industries and persons
· Provide financial education and information to consumers,
industry, small businesses, and investors [slide 3]
MS. ANSELM continued to explain that her division regulates
about twelve different programs - which are not limited to
banking and securities - but also include premium finance
companies, mortgage lenders, originators, money service
businesses, investment advisors, broker-dealers, proxy
solicitations for the Alaska Native Claims Settlement Act
(ANCSA), and others [slide 4]. In response to Chair Olson, she
said payday loan institutions are included in her division's
purview, but pawn brokers are not. In response to
Representative LeDoux, she said she would find out who regulates
pawn brokers.
MS. ANSLEM further explained that in 2015 the division regulated
over 94,000 licensees, processed over 7,000 filings, and
received about $15 million, of which $3.6 million are used to
fund its operations, with the remainder going into the general
fund (GF) [slide 5]. Also in fiscal year 2015 (FY 15), the
division issued 35 final orders in securities, mortgage lending,
payday lenders, and ANCSA proxy solicitations. Information
regarding orders is available on the DCCED web site [slide 6].
3:55:32 PM
REPRESENTATIVE JOSEPHSON asked for an example of an action that
would cause an enforcement order to be issued.
MS. ANSELM gave examples of final orders against an applicant
who does not meet the criteria, a securities order against an
unlicensed company and an out-of-state stock broker, and a final
order against a company.
3:56:54 PM
REPRESENTATIVE LEDOUX expressed her belief that securities law
is federal law and asked how, besides ANCSA, state securities
laws differ from federal laws.
MS. ANSELM responded that federal law relates to interstate
transactions and state laws, AS 45.55, regulate any salesperson
and firm that sells to Alaskans. In fact, there are 1,200
brokerage firms that must be licensed in Alaska, although many
are not located here. In addition, there are state investment
advisors that are only in Alaska that are state-regulated; a
bifurcation in federal law allows any investment advisory firm
that has over $100 million in assets under management to be
federally regulated, and any investment advisor that has less
than $100 million under management to be state-regulated.
CHAIR OLSON asked about the division's involvement in proposed
marijuana taxes.
MS. ANSELM said that because her division regulates banking, and
many service businesses, it will be involved in the legal money
that will be made by marijuana businesses. Due to current
federal law, which identifies marijuana as a scheduled drug, it
is difficult for banks and credit unions to handle funds from
marijuana businesses. In further response to Chair Olson, she
agreed that taxes from marijuana businesses may have to be
collected in cash, which leads to public safety issues.
4:01:16 PM
REPRESENTATIVE COLVER asked how [marijuana] entrepreneurs
process credit cards or debit cards.
CHAIR OLSON said credit and debit cards are not accepted, but in
Colorado vendors have cash machines.
MS. ANSELM advised that if a financial institution follows the
[Cole Memorandum on Medical Marijuana issued by the office of
the U.S. Attorneys, U.S. Department of Justice] and files the
required reports, it can handle the money albeit with risk and
expense.
REPRESENTATIVE LEDOUX said she has heard that banks in
Washington or Oregon are accepting money [from marijuana
businesses].
MS. ANSELM confirmed that in Washington and Oregon, certain
institutions are taking risks and are charging large fees to
open accounts [for marijuana vendors].
REPRESENTATIVE COLVER asked whether any state chartered
institutions are exempt from federal regulations.
MS. ANSELM said no. All Federal Deposit Insurance Corporation
(FDIC) insured institutions, even if state chartered, must
follow federal requirements.
REPRESENTATIVE LEDOUX asked whether any national banks in Alaska
have decided to "take the risk."
MS. ANSELM said she was aware of none.
4:04:35 PM
REPRESENTATIVE KITO questioned whether there was an opportunity
for an organization, such as a Native corporation, to establish
a state bank, not subject to federal rules, to handle marijuana
transactions.
MS. ANSELM responded:
Not that I'm aware of. There's really no way to get
around the federal anti-money laundering FinCEN
[Financial Crimes Enforcement Network] U.S. treasury
requirements.
REPRESENTATIVE HUGHES said he has heard that marijuana
businesses in Denver are using banks.
MS. ANSELM suggested it was possible with the Securities
Exchange Commission (SEC) and the state, that an entity could
file a securities offering to raise money, although those funds
may have to be put into escrow.
CHAIR OLSON agreed the marijuana issue has no easy answers.
4:06:56 PM
MS. ANSELM returned to her presentation, noting her division
provides educational outreach to consumer groups, small and
large businesses, and others. Outreach in FY 2015 included:
financial fitness fairs with other agencies;
military/federal/state employee education regarding protections
against fraud; 360 North investor protection programs broadcast
on television in a partnership with AARP, and paid for by
grants; an open house for ANCSA corporations and shareholders; a
webinar for financial institutions about working with marijuana-
related businesses [slide 7]. Ms. Anselm provided a comparison
of the division's securities workload, to its budget and number
of positions, over the past ten years [slide 8]. Also presented
was a comparison of the division's non-securities registrations,
filings, and licenses workload, to its budget and number of
positions [slide 9]. She pointed out that the financial
services industry in Alaska has significantly increased in the
last ten years. A third graph was a comparison of the
division's enforcement orders and exams for all programs, to its
budget and number of positions [slide 10]. Ms. Anselm provided
an organizational chart of her division and advised that over
the last eighteen months her division has streamlined and
focused on areas of the highest activity: examinations,
licensing, and enforcement and outreach. Some positions are
being reclassified to meld with others and better reflect the
division's work; in fact, most financial services are now
blended, and thus financial institution examiners and securities
examiners are trained in various disciplines, including money
laundering. For example, trust companies deal with bank
deposits and securities, and therefore examiners need to
"crossover"; this also allows for better utilization of the
division's limited staffing [slide 11]. She then turned to the
division's movement from a spreadsheet-based reporting system to
a database system - including access to national registries -
which is helpful since most licensees are out-of-state. The
division also uses technology to perform exams remotely when it
is possible. Finally, she said the division is challenged in
its mission to serve Alaskans because of Alaska's out-of-date
financial services laws, which do not address the newest
technologies, such as whether the division should regulate
virtual currency [slide 12].
4:14:13 PM
REPRESENTATIVE JOSEPHSON asked whether the U.S. Attorney
contacts the division for information.
MS. ANSELM said yes, the division works closely with federal and
state law enforcement.
REPRESENTATIVE KITO asked whether there are concerns with payday
loan lenders, or if the state has adequate protections against
predatory lending practices that use collateral for high-
interest loans.
MS. ANSELM cautioned that the state does not have adequate
protections; in fact, there are problems with payday lenders.
However, payday lenders do not usually take collateral.
REPRESENTATIVE LEDOUX asked whether Alaska has usury laws.
MS. ANSELM was unsure and said she would provide that
information to the committee.
REPRESENTATIVE JOSEPHSON inquired as to the division's
recommended FY17 budget.
MS. ANSELM said the commissioner of DCCED recommended budgeting
her division for twenty-three positions in FY17. She added that
the division lost one position at the end of last year.
4:16:53 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:16 p.m.