Legislature(2021 - 2022)BUTROVICH 205

02/23/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

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01:33:14 PM Start
01:33:38 PM SB67
03:04:29 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 23, 2021                                                                                        
                           1:33 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello                                                                                                            
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 67                                                                                                              
"An Act relating to the licensure of nursing professionals;                                                                     
relating to a multistate nurse licensure compact; and providing                                                                 
for an effective date."                                                                                                         
     - HEARD & HELD                                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  67                                                                                                                  
SHORT TITLE: NURSING: LICENSURE; MULTISTATE COMPACT                                                                             
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
02/03/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/03/21       (S)       HSS, L&C                                                                                               
02/23/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
JULIE ANDERSON, Commissioner                                                                                                    
Department of Commerce, Community, and Economic Development                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Introduced SB 67 on behalf of the Senate                                                                  
Rules Committee, sponsor by request.                                                                                            
SARA CHAMBERS, Director                                                                                                         
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
POSITION STATEMENT: Introduced SB 67 on behalf of the Senate                                                                  
Rules Committee, sponsor by request.                                                                                            
ROSE LAWHORNE, Chief Nursing Officer                                                                                            
Bartlett Regional Hospital                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 67.                                                                            
DANETTE SCHLOEDER, Chair                                                                                                        
Alaska Board of Nursing                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 67.                                                                            
TAMMIE PERREAULT, Northwest Regional Liaison                                                                                    
U.S. Department of Defense                                                                                                      
Washington, D.C.                                                                                                                
POSITION STATEMENT: Testified in support of SB 67.                                                                            
BRIAN NORTON, R.N., Manager                                                                                                     
Cook Inlet Dialysis Fresenius Kidney Care                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 67.                                                                            
REBECCA FOTSCH, Director                                                                                                        
State Advocacy & Legislative Affairs                                                                                            
National Council of State Boards of Nursing                                                                                     
Chicago, Illinois                                                                                                               
POSITION STATEMENT: Offered to answer questions about the Nurse                                                               
Licensure Compact.                                                                                                              
ACTION NARRATIVE                                                                                                              
1:33:14 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:33 p.m.  Present at the                                                               
call to order  were Senators Begich, Costello,  Hughes, and Chair                                                               
Wilson. Senator Reinbold joined shortly thereafter.                                                                             
         SB  67-NURSING: LICENSURE; MULTISTATE COMPACT                                                                      
1:33:38 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 67                                                                  
"An  Act  relating to  the  licensure  of nursing  professionals;                                                               
relating to  a multistate nurse licensure  compact; and providing                                                               
for an effective date." He stated  his intent to hear an overview                                                               
of  the   bill  and   take  invited   testimony.  He   called  on                                                               
Commissioner  Anderson and  Director  Chambers  to introduce  the                                                               
1:35:23 PM                                                                                                                    
JULIE ANDERSON, Commissioner,  Department of Commerce, Community,                                                               
and Economic  Development (DCCED),  Anchorage, Alaska,  said that                                                               
SB 67  will allow Alaska  to become  part of the  Nurse Licensure                                                               
Compact  (NLC).  SB  67  is   a  pro  healthcare,  pro  military,                                                               
bipartisan piece  of legislation. By joining  the NLC, registered                                                               
and  practical  nurses  are  able  to  practice  in  any  of  the                                                               
participating  states  in the  NLC.  The  standards to  obtain  a                                                               
multistate  license  are high.  Alaska  has  hundreds of  nursing                                                               
vacancies and  projections show that  the vacancy rate  will only                                                               
increase over the  next decade. The Board of  Nursing will retain                                                               
full regulatory  authority over nurses  practicing in  the state.                                                               
Alaska nurses and healthcare facilities  across the state support                                                               
this legislation,  as does  the U.S.  Department of  Defense. The                                                               
military  has   clearly  stated  that  license   reciprocity  for                                                               
military spouses is a key  factor in basing decisions. Nursing is                                                               
one  of  the  most  common   professions  for  military  spouses.                                                               
Enacting the NLC  in Alaska will not only  improve Alaskan access                                                               
to  healthcare and  allow mobility  for Alaskan  nurses but  will                                                               
also  increase  economic  opportunities  for  the  state  through                                                               
potential military expansion.                                                                                                   
MS.  ANDERSON said  her team  did  a wonderful  job handling  the                                                               
hundreds  of  applications  for  new  nurse  licenses  that  were                                                               
necessary  once COVID-19  hit Alaska,  but  had the  NLC been  in                                                               
place at that time, the  response efforts could have been quicker                                                               
and  more   cost  effective  for   all  parties   involved.  This                                                               
legislation is win-win for Alaska.                                                                                              
1:38:29 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development  (DCCED),  said  the NLC  is  a  voluntary,                                                               
multistate agreement  that allows highly qualified  practical and                                                               
registered   nurses   to   practice   nursing   in   any   member                                                               
jurisdiction. Becoming  a member of  the NLC would  be especially                                                               
timely for Alaska because it solves several problems.                                                                           
MS.  CHAMBERS  said that  the  NLC  eliminates additional  costs,                                                               
delays and bureaucracy from the  delivery of healthcare services.                                                               
The  purpose   of  occupational  licensure  is   to  ensure  that                                                               
individuals meet minimal,  jurisdictional requirements to perform                                                               
a professional  service. The licensing  takes time, money,  and a                                                               
lot of paperwork.  In Alaska an initial nursing  license can cost                                                               
up to  $500 and take  many weeks  to complete. During  this time,                                                               
the applicant cannot work as a  nurse in the state. The applicant                                                               
loses income  and a clinic  or hospital cannot provide  a certain                                                               
level of care  to its patients while the  position goes unfilled.                                                               
When  emergencies  like  an earthquake  or  pandemic  affect  the                                                               
state, the demand for nurses  goes up, creating additional delays                                                               
in processing  licenses and delaying the  delivery of healthcare.                                                               
When the state needs nurses the  most, they are more difficult to                                                               
MS. CHAMBERS said that failure  to participate in the NLC affects                                                               
the state's  military community.  The U.S. Department  of Defense                                                               
recognizes the difficulty military  families face when relocating                                                               
and has  declared that economic  decisions such as  base location                                                               
and  expansion  will  rely  heavily   on  state  policies  toward                                                               
military  spouse  employment.  The  NLC is  considered  the  gold                                                               
standard in license reciprocity.                                                                                                
1:41:15 PM                                                                                                                    
MS.  CHAMBERS said  that Alaska's  ability  to keep  up with  the                                                               
demand for healthcare  has been at crisis levels  even before the                                                               
pandemic. The Alaska State Hospital  and Nursing Home Association                                                               
(ASHNHA) reported 670 nursing vacancies  in 2019. Even before the                                                               
pandemic there  were not enough  skilled nurses to  meet Alaska's                                                               
healthcare needs.  Since July 2020,  the Alaska Board  of Nursing                                                               
issued 324 emergency courtesy licenses  to keep up with the COVID                                                               
pandemic. These  licenses were  created by  emergency regulations                                                               
by the board  last year and represent the  additional help needed                                                               
to  keep up  with  the  crisis. The  Bureau  of Health  Workforce                                                               
estimates that Alaska  will need 23 percent more  nurses by 2030.                                                               
That is 5,400 more registered  nurses (RN) when the state already                                                               
has vacancies  for almost  700 nurses.  An additional  measure of                                                               
concern is that RN and  APRN (Advanced Practice Registered Nurse)                                                               
licenses expire this  Sunday in Alaska and 25  percent of nurses,                                                               
more than 4,500 nurses, have not renewed their licenses.                                                                        
MS. CHAMBERS  said that  the NLC is  a voluntary  agreement among                                                               
state legislatures  that sets high,  mutual standards  for nurses                                                               
who wish to receive a  multistate license. The multistate license                                                               
is optional for resident nurses, but  it allows nurses to work in                                                               
any  member state  without  having to  apply  for licensure  each                                                               
time.  Each state  board of  nursing retains  authority over  the                                                               
practice of  nursing in its  state. The practice  standards don't                                                               
change. Violations of practice  standards prohibit offenders from                                                               
further practice  in the state  and any violation is  reported to                                                               
the  home  state  board  of   nursing  for  disciplinary  action.                                                               
Healthcare vacancies can be filled  quickly at little expense for                                                               
the facility, the nurse, or  the state government. The multistate                                                               
license is  attractive to Alaska  nurses. The ability to  work in                                                               
member states  is attractive  to Alaska  nurse graduates  who are                                                               
leaving the state because of  lack of this automatic reciprocity.                                                               
So  far, 35  states  and  territories have  adopted  the NLC  and                                                               
another 11 have introduced legislation to join.                                                                                 
1:44:16 PM                                                                                                                    
SENATOR HUGHES asked of the  324 emergency courtesy licenses, how                                                               
many were coming from out of state.                                                                                             
MS. CHAMBERS replied that they were all from out of state.                                                                      
CHAIR WILSON  asked how  many nurses  were expedited  to graduate                                                               
early through the University of Alaska.                                                                                         
MS. CHAMBERS answered that she would get that information.                                                                      
MS. CHAMBERS said that the benefits  joining the NLC are many. If                                                               
Alaska  had joined  the NLC  when legislation  was introduced  in                                                               
January   2020,  expenses   to  healthcare   facilities,  private                                                               
individuals,  and  state  government  could  have  been  reduced.                                                               
Alaska nurses would not have had  to bear the great burden during                                                               
the COVID surge  last fall. An Anchorage Daily  News article from                                                               
November  28  captured  the  desperation  and  burnout  faced  by                                                               
Alaskan nurses  during the height  of the surge. In  the article,                                                               
the  labor  representative  for the  Alaska  Nursing  Association                                                               
urged administrators  to do more  to increase nurse  numbers. The                                                               
NLC is one of the tools  facilities need most in their employment                                                               
MS.  CHAMBERS  said  that  the   NLC  requirements  to  obtain  a                                                               
multistate license are rigorous  and exceed the current standards                                                               
under Alaska  law. The Board  of Nursing retains  jurisdiction to                                                               
oversee and  enforce nursing practice  in Alaska. The  board does                                                               
not  lose any  ability to  defend the  public's right  to a  safe                                                               
nursing  workforce.  Alaska   would  have  a  vote   on  the  NLC                                                               
commission and  multistate license  fees will  pay for  their own                                                               
program expenses. A single state  Alaska license will continue to                                                               
function  as it  currently  does. Perhaps  most importantly,  the                                                               
standards  enacted  in the  NLC  cannot  be changed  without  the                                                               
agreement  of the  Alaska  State Legislature.  It  is a  contract                                                               
among state leaders.                                                                                                            
1:47:41 PM                                                                                                                    
SENATOR  BEGICH  said  that Director  Chambers  stated  that  NCL                                                               
requirements  are rigorous  and exceed  Alaska's. He  asked about                                                               
the  possibility that  someone who  might have  had a  multistate                                                               
license before the NLC changed  could be grandfathered in and not                                                               
have to meet the current NLC standards.                                                                                         
MS.  CHAMBERS replied  that there  is no  grandfathering in  this                                                               
agreement. All  states have to  meet the same  standards. Several                                                               
years ago  there was a  first attempt at  a compact that  did not                                                               
have  that same  level of  agreement,  but it  was abandoned  and                                                               
states  have to  agree  through their  legislatures  on the  same                                                               
standards. There  is no  one who will  hold a  multistate license                                                               
who does not meet these high standards.                                                                                         
SENATOR BEGICH  asked if  that is  why Pennsylvania  endorsed the                                                               
MS. CHAMBERS responded  that at least one state  had been working                                                               
from the past  NLC language and is working to  rejoin because its                                                               
legislature would finally agree  to those higher standards. There                                                               
were states that would not join  the original compact but who are                                                               
determining  that now  is  the  time because  some  of these  old                                                               
problems have been addressed.                                                                                                   
MS. CHAMBERS  reviewed the many  benefits for Alaska  joining NLC                                                               
on slide 7:                                                                                                                     
   • Reduces cost and burden on employers in Alaska.                                                                            
   • Expedites disaster relief.                                                                                                 
   • Increases access to care for Alaskans.                                                                                     
   • Increases telehealth options for Alaskans.                                                                                 
   • Adds options to keep Alaskan-trained nurses in state.                                                                      
   • Expands employment opportunities for Alaskan nurses.                                                                       
   • Facilitates online education.                                                                                              
   • Offers seasonal employee flexibility.                                                                                      
   • Eases costs and burden for military families.                                                                              
   • Increases economic opportunities for military base                                                                         
     selections or expansions.                                                                                                  
   • Reduces cost and burden on nurses moving or                                                                                
     transferring to Alaska.                                                                                                    
MS. CHAMBERS  presented a table  on slide 8 illustrating  how NCL                                                               
requirements  exceed Alaska  requirements.  The  Alaska Board  of                                                               
Nursing  has  flexibility  considering  past  civil  or  criminal                                                               
violations,  the  NLC has  zero  tolerance  for risks  to  public                                                               
safety. Alaska  nurses could keep  the single state  license, but                                                               
any  nurse who  holds a  multistate license  would be  subject to                                                               
this rigorous level of scrutiny.                                                                                                
MS.  CHAMBERS said  that holding  a multistate  license would  be                                                               
optional if  Alaska entered the compact,  but nurses overwhelming                                                               
want that opportunity  to make that decision. In  a December 2019                                                               
survey,  92  percent of  Alaska  licensed  respondents said  they                                                               
support Alaska joining  the NLC; 89 percent  of these respondents                                                               
have primary residency in Alaska  and 87 percent of supporters of                                                               
the  NLC are  members of  a nursing  union. The  NLC is  good for                                                               
residents  and   the  workforce  and  Alaska   nurses  want  this                                                               
employment option.                                                                                                              
SENATOR  BEGICH commented  that  it  is good  to  see the  survey                                                               
results. He asked if any of  the unions responded directly to her                                                               
in support of the legislation.                                                                                                  
MS. CHAMBERS  replied that her  department has not been  in touch                                                               
with the union this year on this bill.                                                                                          
CHAIR  WILSON asked  which  union as  there  are several  nursing                                                               
SENATOR BEGICH clarified that he  was asking about any union, but                                                               
he thinks  that Director  Chambers is stating  that no  union has                                                               
submitted a letter of support.                                                                                                  
MS. CHAMBERS replied that the  department has not been in contact                                                               
with any of the unions of any  type about the NLC this year. Last                                                               
year  a  union representing  a  fraction  of nurses,  the  Alaska                                                               
Nurses  Association,   had  some  concerns  about   the  proposed                                                               
legislation,  and the  department  addressed  all those  concerns                                                               
with them in hearings. The department  is happy to do so again if                                                               
concerns are raised.                                                                                                            
SENATOR  BEGICH  clarified that  he  meant  to  ask if  they  had                                                               
received any opposition from unions  and the answer he is hearing                                                               
is no.                                                                                                                          
MS. CHAMBERS answered that they have not.                                                                                       
1:54:54 PM                                                                                                                    
SENATOR  COSTELLO  asked  what  percentage  of  the  total  nurse                                                               
population responded to the survey.                                                                                             
MS. CHAMBERS  answered about  22 percent  of nurses  responded. A                                                               
standard  survey  response is  2  or  3 percent.  The  department                                                               
surveyed over 16,000 nurses and received over 3,500 responses.                                                                  
MS.  CHAMBERS presented  a  list  on slide  10  of supporters  of                                                               
Alaska joining  the NLC. The  list includes  economic development                                                               
organizations, military  stakeholders, and  healthcare providers.                                                               
This is just a partial list  of Alaska groups supporting the NLC.                                                               
The list  of national  supporters is  much longer  and a  link is                                                               
available from the Alaska Board of Nursing's NLC web page.                                                                      
MS.  CHAMBERS  thanked  the  committee  for  the  opportunity  to                                                               
present and asked for their support.                                                                                            
1:56:31 PM                                                                                                                    
At ease                                                                                                                         
1:57:11 PM                                                                                                                    
SENATOR BEGICH  thanked DCCED legislative liaison  Glen Hoskinson                                                               
and Sara  Chambers for  meeting with him  to address  concerns he                                                               
had last  year about a  similar bill. The  department's interests                                                               
and  his are  fundamentally the  same. They  want to  ensure that                                                               
Alaskan  are safe  and  getting  the highest  level  of care.  It                                                               
appears that  the compact has a  high level of care  for those in                                                               
it,  but there  is  a  potential economic  impact  for the  state                                                               
because the  $500 will  not come  to the state.  He asked  how to                                                               
address the impact of the bill on the Board of Nursing funding.                                                                 
MS.  CHAMBERS replied  that all  professional licensing  programs                                                               
are  self-funded. State  law  requires that.  Now  the state  has                                                               
single state  licenses. As  the board  receives funding  to cover                                                               
the cost for  single license, the state will  see similar funding                                                               
for multistate  applications. A  fee is  shifting to  a different                                                               
type of  license. Applicants will  pay for either a  single state                                                               
license  or  the  multistate  license.   This  is  a  fundamental                                                               
question that  many states have  had. None  of the 35  states and                                                               
territories that  have joined the  compact have seen  an economic                                                               
downturn  because of  the shift  in cost.  The administration  is                                                               
committed  to  making sure  entering  the  NLC  will not  have  a                                                               
detrimental impact  on any  other nursing  license type  and will                                                               
continue  to follow  state  law  to make  sure  licenses pay  for                                                               
SENATOR BEGICH said  that the initial nurse license  fee can cost                                                               
up to $500. He asked what the cost is for the NLC license.                                                                      
MS. CHAMBERS responded that the $500  is the ceiling for a new RN                                                               
license. That accounts for several  costs such as fingerprinting.                                                               
The multistate  license will be  set by the board  and department                                                               
using the  same economic fee-setting  structure that is  used now                                                               
to determine the  license cost. There is not a  set national cost                                                               
for the NLC. That fee is set at the state level.                                                                                
SENATOR BEGICH asked  if it is reasonable to assume  that the NLC                                                               
license will be around $500.                                                                                                    
MS. CHAMBERS responded  that it is highly  likely. The department                                                               
has to take into account  many factors, including how many nurses                                                               
will want  multistate licenses. Once  the legislature  adopts the                                                               
NLC, that will be done  through the public regulation process. It                                                               
should be  about the same as  a regular license because  a lot of                                                               
the  processes are  similar. The  savings comes  when people  who                                                               
hold  a  multistate  license  come  to Alaska  to  work  or  when                                                               
Alaskans want to  use a multistate license outside  of the state.                                                               
They  only pay  a fee  one  time and  do not  have to  accumulate                                                               
licenses from various states.                                                                                                   
2:03:28 PM                                                                                                                    
SENATOR BEGICH  said that  it should say  that an  initial Alaska                                                               
nurse  license can  cost over  $500 for  those already  holding a                                                               
multistate  license,  but  the  consequence  would  if  they  are                                                               
already  holding  a multistate  license  they  will not  pay  the                                                               
Alaska fee.                                                                                                                     
MS. CHAMBERS answered that is correct.                                                                                          
SENATOR COSTELLO said that a  federal law requires that if nurses                                                               
change facilities, in  the same state or a  different state, that                                                               
they  are  responsible for  getting  a  new set  of  fingerprints                                                               
processed. She  asked who would  pay for the  fingerprinting that                                                               
is required by federal law for  those nurses who come from out of                                                               
state to take a position.                                                                                                       
MS. CHAMBERS  replied that  her agency and  the Board  of Nursing                                                               
are responsible for  state licensing and are  not responsible for                                                               
employment-related  requirements  for fingerprinting.  People  in                                                               
healthcare  facilities  often  have   to  get  multiple  sets  of                                                               
fingerprints   because  federal   law   prohibits  sharing   that                                                               
fingerprinting. That is between employees and employers.                                                                        
SENATOR COSTELLO said that in  the governor disaster declaration,                                                               
he  asked for  a  six-month delay  for  fingerprinting for  those                                                               
coming into the state in  the nursing profession. The argument is                                                               
that this brings nurses on  more quickly, but the committee needs                                                               
to learn more about the  fingerprinting process. If there will be                                                               
a delay anyway, then it may not  be accurate to say this will get                                                               
nurses on the frontlines more quickly.                                                                                          
MS.  CHAMBERS  responded  that  they  are  different  topics  and                                                               
different  types of  fingerprinting. As  a licensing  agency, her                                                               
department used  the provision  in SB 241  that then  was carried                                                               
through  the  governor's  health  orders.  It  was  hard  to  get                                                               
fingerprints done  in person  during COVID;  it was  difficult to                                                               
get  hand-rolled  fingerprints.  The agency  worked  through  the                                                               
National  Fingerprinting Compact  to  get a  grace  period to  do                                                               
name-only checks  and followed up with  fingerprints later. There                                                               
is no delay in fingerprinting at this time.                                                                                     
2:07:03 PM                                                                                                                    
SENATOR  HUGHES asked  if there  is  a nursing  shortage here  in                                                               
Alaska, is there is a national shortage.                                                                                        
MS. CHAMBERS  replied that it  depends on the state.  Many states                                                               
have  an increasing  older  population,  which increases  nursing                                                               
needs. Some states are projected to  have a surplus of nurses and                                                               
some are projected  to have a deficit. It is  nuanced. It depends                                                               
on location, age, and availability.                                                                                             
SENATOR HUGHES  asked if  Alaska nurses  want to  be part  of the                                                               
compact, will  they need the  Alaska and the  multistate licenses                                                               
or just the multistate license.                                                                                                 
MS. CHAMBERS  answered that they  would only need  the multistate                                                               
license.  That  would be  their  pass  to all  states,  including                                                               
SENATOR  HUGHES asked  if  enforcement by  the  Board of  Nursing                                                               
would  only be  for  Alaska  nurses, whether  they  have only  an                                                               
Alaskan  or   multistate  license,   or  would  the   board  have                                                               
jurisdiction when  an out-of-state nurse  comes to Alaska  with a                                                               
multistate license and action must be taken against the nurse.                                                                  
MS.  CHAMBERS said  that  is an  important  question. The  Alaska                                                               
Board  of Nursing  would retain  jurisdiction  over nurses  whose                                                               
home state is  Alaska and the practice of nursing  in Alaska that                                                               
occurs  in Alaska.  That would  include multistate  licensees who                                                               
are practicing  in Alaska.  It depends on  the location  of where                                                               
services  are  being  delivered.  If someone  with  a  multistate                                                               
license is  not an Alaskan  came to  Alaska and did  something to                                                               
violate  state statutes  or regulations  or  state practice  act,                                                               
then the Board  of Nursing would have a  responsibility under the                                                               
compact to  take action to  prohibit that person  from continuing                                                               
to practice.  The board would  also have to report  the violation                                                               
to the  compact administration. Then the  commission reports that                                                               
to the home state and the  multistate license is suspended in all                                                               
states  until it  is unencumbered  again. It  maintains the  same                                                               
level of governance over anyone practicing nursing in Alaska.                                                                   
SENATOR HUGHES  commented that  that is  helpful because  she was                                                               
hearing  misinformation  which said  that  the  Board of  Nursing                                                               
would not have that jurisdiction.                                                                                               
2:12:07 PM                                                                                                                    
SENATOR  REINBOLD  asked  if  any  nurses  have  been  furloughed                                                               
because of  COVID. The unemployment  numbers are high.  She wants                                                               
to get that information about  what nurses are unemployed at this                                                               
time before the state gets people from Outside.                                                                                 
MS. CHAMBERS  replied that the  Board of Nursing does  not employ                                                               
nurses and does not have  those numbers. Employment numbers would                                                               
need to come from employers.                                                                                                    
SENATOR REINBOLD said that she  wants to see those numbers before                                                               
engaging in  this discussion about  this bill. She wants  to know                                                               
if there  is a  surplus of  nurses anywhere  in the  state. Local                                                               
hire is important.                                                                                                              
MS. CHAMBERS said the ASHNHA  survey showed 670 vacancies in 2019                                                               
prior  to  COVID  and  the  board  issued  almost  400  emergency                                                               
licenses  during COVID.  The numbers  show it  is heading  in the                                                               
other direction.                                                                                                                
CHAIR  WILSON said  someone  from ASHNHA  is  online and  perhaps                                                               
could provide that information.                                                                                                 
SENATOR REINBOLD  said that she  has heard that many  nurses have                                                               
been laid off and that some  offices and clinics have closed. She                                                               
wants  to look  at  the landscape  of who  is  already out  there                                                               
before making any significant changes.                                                                                          
CHAIR WILSON called on Rose  Lawhorne to address the unemployment                                                               
2:14:45 PM                                                                                                                    
ROSE   LAWHORNE,  Chief   Nursing   Officer,  Bartlett   Regional                                                               
Hospital, Juneau,  Alaska, said she  was also speaking  on behalf                                                               
of ASHNHA.  Multiple nurses are working  in various environments.                                                               
She  is  not  aware  of  any  furloughed  nurses,  especially  in                                                               
Southeast,  who  were  not repurposed  in  other  jobs.  Bartlett                                                               
Hospital worked hard  to provide employment to  nurses whose jobs                                                               
were  temporarily suspended  because  of  the pandemic.  Training                                                               
needs to be  in place prior to repurposing a  nurse from one area                                                               
to another.  The licensure requirements  are the same,  but there                                                               
are  specialty certifications  required before  a nurse  can work                                                               
safely in specialty  areas. Her colleagues in  Anchorage said the                                                               
facilities worked hard to provide  jobs to nurses whose jobs were                                                               
affected by the pandemic.                                                                                                       
SENATOR  REINBOLD  said  she  wants   to  make  sure  no  one  is                                                               
unemployed. She prefers Alaska preference.                                                                                      
SENATOR BEGICH said  he had a question about page  26 of the bill                                                               
about indemnity but  responded to the chair's  suggestion to wait                                                               
until the sectional.                                                                                                            
SENATOR  COSTELLO  asked about  the  nurse  hotline. A  nurse  in                                                               
Alaska who  wants to help  administer the COVID vaccine  can call                                                               
the hotline  to find a  position. She  asked how many  nurses are                                                               
waiting to administer the vaccine.                                                                                              
MS. CHAMBERS  replied that the  hotline would be  administered by                                                               
the Department  of Health and  Social Services (DHSS).  The Board                                                               
of Nursing  is not  engaged with  the hotline  but will  get that                                                               
CHAIR WILSON asked Director Chambers to present the sectional.                                                                  
MS.  CHAMBERS said  that  before going  into  the sectional,  she                                                               
wanted  to  point  out  that  Sections 1-22  and  24-36  are  all                                                               
conforming amendments. She will go  through the sectional for the                                                               
new parts  of the law,  AS 08.69. She  will focus on  Section 23,                                                               
which would establish the compact.  These articles are uniform to                                                               
all states  in the compact  and are mandatory  for participation.                                                               
Section 23  is not  flexible language. All  states must  agree to                                                               
that language if they want to adopt the compact.                                                                                
2:20:24 PM                                                                                                                    
MS. CHAMBERS began the sectional analysis:                                                                                      
     Section 23: Creates AS 08.69, Multistate Nurse                                                                             
     Licensure Compact. These articles are uniform to all                                                                       
     34 other states within the compact and mandatory for                                                                       
     Article 1: Establishes the legislature's findings of                                                                       
     the need for the compact and its declaration of the                                                                        
     compact's purpose in Alaska.                                                                                               
     Article 2: Establishes definitions and terminology for                                                                     
     use in this section.                                                                                                       
     Article 3: Establishes the general provisions for                                                                          
     multistate licensure common across all participating                                                                       
        • It clarifies that partner states have                                                                                 
          jurisdiction to take adverse action against                                                                           
          multistate licensure privilege and requires                                                                           
          states to notify the administrator of the                                                                             
          coordinated licensure system when adverse                                                                             
          action against a multistate license occurs.                                                                           
        • It enforces that a nurse practicing in a                                                                              
          partner state must comply with the practice                                                                           
          laws of the state in which the client is                                                                              
          located at the time the service is provided.                                                                          
        • It clarifies that nothing in the compact                                                                              
          shall affect the requirements established by                                                                          
          a partner state for the issuance of a                                                                                 
          single-state license.                                                                                                 
     Article 4: Creates uniform standards for applications                                                                      
     for multistate licensure.                                                                                                  
     Article 5: Provides licensing boards with the power                                                                        
        • Take action against a nurse's privilege to                                                                            
          practice in that partner state;                                                                                       
        • Complete pending investigations of a nurse                                                                            
          who changes primary residency and to report                                                                           
          those actions to the administrator of the                                                                             
          coordinated licensure system;                                                                                         
        • Obtain and submit fingerprints to the FBI                                                                             
          for criminal background checks and to use                                                                             
          those results for the purpose of licensure;                                                                           
        • If permitted by state law, to recover from                                                                            
          the affected nurse the costs of                                                                                       
          investigations and disposition of cases                                                                               
          resulting from adverse action taken against                                                                           
          that nurse; and                                                                                                       
        • Deactivate the multistate privilege if                                                                                
          adverse action is taken in the home state                                                                             
          until such time that all encumbrances are                                                                             
          removed from the license.                                                                                             
     Article 6: Establishes the rules for a coordinated                                                                         
     licensure information system and provides for exchange                                                                     
     of information among partner states, including                                                                             
     provisions for ensuring the privacy of information                                                                         
     contained in such system.                                                                                                  
     Article 7: Creates the Interstate Commission of Nurse                                                                      
     Licensure Compact Administrators, which is the body                                                                        
     overseeing the function of the multistate license.                                                                         
        • Each state shall have only one                                                                                        
          administrator, who is a voting member of the                                                                          
        • With few exceptions as allowed by law,                                                                                
          meetings will be open to the public and                                                                               
          publicly noticed. Meetings held in executive                                                                          
          session will be noticed, the cause for a                                                                              
          closed meeting will be stated, and all                                                                                
          resulting actions will be taken in public.                                                                            
        • This article confers certain administrative                                                                           
          powers to the Commission, which do not                                                                                
          impinge upon the sovereignty of partner                                                                               
2:24:00 PM                                                                                                                    
SENATOR BEGICH said that he wanted clarification about Sections                                                                 
2 and 3 on page 26, Qualified Immunity, Defense and                                                                             
Indemnification, "the administrators, officers, executive                                                                       
director, employees and representatives of the Commission shall                                                                 
be immune from suit and liability." He described that as                                                                        
standard language, but he asked if Alaska would then be                                                                         
potentially liable if the commission were to pass down fines or                                                                 
settlements to individual states.                                                                                               
MS. CHAMBERS  replied that  she will  explore that  question with                                                               
the Department  of Law. This indemnification  language is similar                                                               
for  board members  in Alaska.  If acting  within the  reasonable                                                               
scope of  state law they  are protected  by Alaska state  law and                                                               
not  held  personally responsible.  To  her  this language  seems                                                               
similar  to that.  She  will  ask the  Department  of  Law for  a                                                               
SENATOR BEGICH said a simple  response from the Department of Law                                                               
would be satisfactory.                                                                                                          
MS. CHAMBERS continued the sectional:                                                                                           
     Article 8: Establishes a transparent and public                                                                            
     rulemaking process to carry out the powers in the                                                                          
     previous article.                                                                                                          
     Article 9: Establishes the agreement for oversight,                                                                        
     dispute resolution, and enforcement of the compact.                                                                        
     Article 10: Sets an effective date for the compact,                                                                        
     the process for a state legislature's withdrawal from                                                                      
     the compact, and the process of amendment of the                                                                           
     compact through statutory changes in each member                                                                           
     Article 11: Reinforces the primacy of the                                                                                  
     constitutions of each party state and codifies                                                                             
     additional interpretation of the construction and                                                                          
     severability of the compact.                                                                                               
     Sections 24-36: Amend statutes to add AS 08.69                                                                             
     (created by Section 23 of this Act) to the definitions                                                                     
     of nursing as found throughout state law:                                                                                  
     Section 37: Allows the department to adopt regulations                                                                     
     necessary to implement the changes made by this Act,                                                                       
     to take effect under AS 44.62 on the effective date as                                                                     
     noted in Section 38.                                                                                                       
     Section 38: Makes Section 37 (Transition Regulations)                                                                      
     effective immediately once the bill is signed.                                                                             
     Section 39: Makes Sections 1-36 of this Act effective                                                                      
     as of July 1, 2022.                                                                                                        
CHAIR WILSON asked if the  compact would create any obstacles for                                                               
state auditors to complete their functions.                                                                                     
2:27:42 PM                                                                                                                    
MS.  CHAMBERS replied  that she  did  not think  so because  this                                                               
compact  and its  agreements  will  be in  Alaska  state law  and                                                               
auditors could  perform the  same fiduciary  responsibilities and                                                               
have access to the same information as they do now.                                                                             
SENATOR BEGICH commented  this has been a  very thorough overview                                                               
and  gave him  a  greater  idea than  last  year  about what  the                                                               
compact  does. He  appreciated that.  She mentioned  something in                                                               
passing about  the expiration  of licenses all  on the  same day,                                                               
this  coming Sunday.  He asked  if nursing  licenses expire  on a                                                               
particular date.                                                                                                                
MS.  CHAMBERS  replied  that  all   of  Alaska  licenses  in  all                                                               
professions  are two-year  licenses. Each  profession expires  on                                                               
the  same date.  This  allows the  agency  efficiency in  helping                                                               
licensees to know that date and to streamline processes.                                                                        
SENATOR  BEGICH commented  that he  recognizes that  is good  for                                                               
notification  but  he guesses  that  creates  a huge  crunch  for                                                               
approval  of licenses  on her  staff.  He clarified  that on  any                                                               
weekend in a two-year period the  state can lose up to 23 percent                                                               
of its nurses.                                                                                                                  
2:29:47 PM                                                                                                                    
MS. CHAMBERS  responded that the  agency starts the  process more                                                               
than three months  ahead of time. The renewal is  all online. The                                                               
renewal is  less onerous  than the  initial license.  Nurses have                                                               
had at least five months to  renew their licenses. The data point                                                               
is interesting because it speaks  to nurses who apparently do not                                                               
intend to  renew their licenses  because they have had  plenty of                                                               
opportunities to  do so.  The agency  looks to  the system  to be                                                               
efficient  to  keep  staffing numbers  low.  All  facilities  and                                                               
nurses  know when  those licenses  expire. It  allows fees  to be                                                               
consistent and  keep costs  lower. The agency  is always  open to                                                               
new ideas and improvement, but  this process seems to have worked                                                               
best for everyone.  No nurse is unaware of  the licenses expiring                                                               
on Sunday.                                                                                                                      
SENATOR  BEGICH said  these have  been  extraordinary times  with                                                               
tremendous burdens  on the  health system.  Extraordinary actions                                                               
have been demanded of nurses  and other medical practitioners. He                                                               
hoped there  would be  some effort at  assessing that  23 percent                                                               
and whether the process should be more lenient at this time.                                                                    
SENATOR HUGHES  asked what  has happened in  other states  with a                                                               
shortage of  nurses that have  entered into the compact  in terms                                                               
of in-state nurses. For example,  Alaska had 670 openings. Alaska                                                               
is graduating  nurses from  the university  system. If  the state                                                               
were  to do  this and  bring in  nurses with  multistate licenses                                                               
from out  of state, she  asked if there  will still be  plenty of                                                               
jobs  for  Alaska nurses.  She  wondered  how that  might  impact                                                               
salaries. She  assumed a hospital would  not pay less to  a nurse                                                               
from  out  of   state.  Even  though  the   survey  indicated  an                                                               
overwhelming number of nurses support  the compact, she has heard                                                               
some concern about that.                                                                                                        
MS.  CHAMBERS  replied  that  she  did  not  want  to  leave  the                                                               
impression that there  are no out-of-state nurses  in Alaska now.                                                               
That 22 percent  of nonrenewing nurses could very well  be all of                                                               
the  out-of-state nurses  who  have been  working  in Alaska  who                                                               
don't intend  to renew in  Alaska. Out-of-state nurses  provide a                                                               
bulk of  employment in the  state now  and they always  have. Her                                                               
agency  licenses anyone  who meets  the criteria  set in  law and                                                               
regulation. Residency is  not a factor in  their employment. This                                                               
bill  reduces  government  barriers   to  hospitals  and  clinics                                                               
bringing in the  nurses they are already bringing  in. They could                                                               
do  that with  less paperwork  and expense.  The nurses  wouldn't                                                               
need to go  through her office. They could just  get to work That                                                               
is good for healthcare in Alaska.  These are nurses who are going                                                               
come to  Alaska one way  or another. It  is not a  recruitment to                                                               
suddenly  pull a  lot of  nurses  from other  states. It  reduces                                                               
government barriers if someone wants to come to work in Alaska.                                                                 
SENATOR  REINBOLD said  that  she and  Senator  Hughes have  been                                                               
saying  the same  thing about  the impact  to Alaska  nurses. She                                                               
would  like to  know the  unemployment numbers  for those  in the                                                               
medical profession,  especially nurses, and changes  in licensure                                                               
from 2019  to 2020 because  COVID has changed the  landscape. She                                                               
would prefer the  2020 numbers. She wants to know  the impact for                                                               
Alaska nurses because unemployment is high in the state.                                                                        
CHAIR WILSON asked if Director  Chambers could help the committee                                                               
get the 2020 data on licensure.                                                                                                 
MS. CHAMBERS  said her  agency maintains  the licensure  data and                                                               
will  work  with  the  Department of  Labor,  DHSS,  ASHNHA,  and                                                               
private  agencies  to locate  the  unemployment  numbers for  the                                                               
nursing sector.                                                                                                                 
SENATOR  HUGHES  asked  that  Director  Chambers  listen  to  the                                                               
meeting recording  to fully understand  her question  and provide                                                               
an answer in writing. Senator Hughes  would like to know what has                                                               
happened with  states that  have had  shortages and  whether that                                                               
will make it  tough for Alaska nurse graduates as  well as nurses                                                               
in the  state. She wants to  understand the impact of  the NLC on                                                               
in-state nurses  and would like  the answer in  writing. Director                                                               
Chambers mentioned the bulk of nurses  are from out of state. She                                                               
asked if that meant the nurses  picked up to fill these vacancies                                                               
or, at  any one  point in  time, are more  nurses working  in the                                                               
state from out of state than in state.                                                                                          
MS. CHAMBERS replied that she will follow up in writing.                                                                        
2:38:35 PM                                                                                                                    
CHAIR WILSON moved to invited testimony.                                                                                        
2:38:55 PM                                                                                                                    
DANETTE  SCHLOEDER, Chair,  Alaska Board  of Nursing,  Anchorage,                                                               
Alaska,  said one  of the  duties of  the board  is licensing.  A                                                               
common belief is  that only the best nurses  get Alaska licenses.                                                               
In  reality, a  license of  any type  is awarded  to someone  who                                                               
meets  the  minimum qualifications  as  established  by law.  All                                                               
nurses graduate  from accredited programs  and sit for  the exact                                                               
same  national licensing  examination.  Licensing and  competency                                                               
are not synonymous. The licensing  requirements under the NLC are                                                               
stricter than  Alaska's current requirements.  In August  of 2019                                                               
the board voted to support the  NLC after listening to nurses and                                                               
employers.   The  board   examined  the   current  evidence-based                                                               
literature and nursing  practice trends in Alaska  and across the                                                               
nation. The  board also considered  the experiences of  boards of                                                               
nursing that enacted the NLC.                                                                                                   
MS. SCHLOEDER said  that the previous version of the  NLC may not                                                               
have been  a good fit  for Alaska, but  the current NLC  with its                                                               
uniform  licensing  requirements  is  a  good  fit.  The  federal                                                               
government  projects over  200,000  new nurse  positions will  be                                                               
created  in   the  years  2016-2026.  The   committee  has  heard                                                               
information  about the  current vacancies  in Alaska.  Nationally                                                               
about  33  percent  of nurses  engage  in  telehealth  activities                                                               
across state lines.  The Alaska Board of Nursing met  a nurse who                                                               
holds 17  single state licenses  to do her job.  Holding multiple                                                               
licenses  does  not   make  her  a  better  nurse   but  adds  an                                                               
unnecessary barrier to nursing practice.  The NLC was first heard                                                               
by this  committee in February  2020. At  that time no  one could                                                               
have predicted  the events  that unfolded.  The Board  of Nursing                                                               
issued  emergency regulation  for  the  courtesy licensing.  That                                                               
emergency regulation  allowed courtesy  licenses to be  issued to                                                               
any  nurse with  an unencumbered  nursing license  in any  state.                                                               
Although the board  issued almost 400, it was not  enough to meet                                                               
the ongoing need.                                                                                                               
MS. SCHLOEDER  said that  nurses have choices  of where  to work,                                                               
whether it is a permanent  move or a temporary assignment. Nurses                                                               
are drawn  to NLC  states because  they can  immediately practice                                                               
nursing  without  delay   or  cost.  Nurses  have   been  at  the                                                               
frontlines of this pandemic. They  are asked to work extra shifts                                                               
every  day. They  have all  seen images  of these  nurses in  the                                                               
media.  The  pandemic  has  shown   the  skill,  compassion,  and                                                               
resiliency of these  amazing nurses. In February  2021, the Board                                                               
of Nursing  unanimously reaffirmed  its complete support  for the                                                               
NLC. The bill will help  the mobility of the profession, simplify                                                               
the licensing process, and help healthcare move forward.                                                                        
2:43:48 PM                                                                                                                    
TAMMIE PERREAULT, Northwest Regional  Liaison, U.S. Department of                                                               
Defense,  Washington,  D.C.,  said  that on  behalf  of  military                                                               
families and the  Department of Defense (DOD),  she is supporting                                                               
SB 67. One  of the DOD key  quality of life issues  is working to                                                               
help enact  interstate compacts to improve  licensure options for                                                               
military spouses,  veterans, and service members.  Easy licensure                                                               
transition is very  important for military spouses  as 68 percent                                                               
of service members reported that  the ability of their spouses to                                                               
maintain  a  career  impacts  their decision  to  remain  in  the                                                               
military.  Compacts such  as the  NLC are  beneficial for  the 53                                                               
percent of  military spouses who work  in healthcare professions.                                                               
The DOD has  partnered with the National Council  of State Boards                                                               
of Nursing to  support the NCL, which allows  military spouses to                                                               
use their  state of legal  resident as  their home state  for the                                                               
privilege  to practice.  Joining the  NLC is  a benefit  to those                                                               
military  spouses  who  are  Alaska  residents.  By  joining  the                                                               
compact,  Alaska  spouses have  the  benefit  to practice  in  34                                                               
states  when  stationed  away  from  their  homes.  These  allows                                                               
military  spouses  from  Alaska  a seamless  way  of  maintaining                                                               
careers  when  changing  duty  stations  and  then  returning  to                                                               
Alaska. Many  service members retain multistate  license allowing                                                               
them to work in a  federal facility. However, they cannot conduct                                                               
training, seamlessly  support emergencies, or  provide additional                                                               
hours  of  service  to  maintain their  skills  in  a  nonfederal                                                               
facility. By joining the NLC,  Alaska would benefit from military                                                               
members  being  available to  train  and  provide care  in  their                                                               
communities. The percentage of military  spouses in Alaska is the                                                               
second  highest  in the  nation  with  nearly 8,000  active  duty                                                               
spouses. Thirty-four  percent of  those spouses in  the workforce                                                               
are  in   licensed  occupations.  Seventy  percent   of  surveyed                                                               
military  spouses   who  hold   an  occupational   licenses  have                                                               
encountered challenges  maintaining them.  SB 67 is  a tremendous                                                               
step forward  for the state to  ease the burden of  licensure for                                                               
military spouses, military members, and veterans.                                                                               
2:47:26 PM                                                                                                                    
MS.  LAWHORNE   said  that   healthcare  facilities   in  Alaska,                                                               
particularly  those in  isolated  areas, would  benefit from  the                                                               
NLC.  Bartlett  Hospital  is  a  small  community  hospital  with                                                               
limited  resources  that  experiences  staffing  challenges.  The                                                               
prepandemic healthcare burnout was  real. Currently nursing staff                                                               
is  experiencing  postpandemic  burnout.  Bartlett  has  10  open                                                               
nursing positions.  The cost of  filling these with  travelers is                                                               
double  that  of  permanent  nurses.  Their  contracts  typically                                                               
extend for  13 weeks. That is  much time and effort  for 13 weeks                                                               
of  nursing care.  Bartlett  hired 12  travelers  last year  when                                                               
volumes were down due to  restrictions on elective procedures and                                                               
the hesitancy of patients to seek  medical care. In the two years                                                               
prior,  Bartlett   hired  20   travelers  per   year.  Cumbersome                                                               
licensing   processes  reduce   Bartlett's  ability   to  provide                                                               
uninterrupted  care  to  patients  without  overloading  existing                                                               
staff.  Exhausted staff  trying to  fill staffing  gaps leads  to                                                               
reductions in  quality of care, increased  errors, susceptibility                                                               
to illness,  and creates additional  vacancies. Patient  flow and                                                               
safety  and  hospital  capacity   are  negatively  impacted  with                                                               
typical  licensure  processing  time. Temporary  licensing  still                                                               
causes  delays. Maintaining  multiple  licenses is  costly and  a                                                               
deterrent  for  nurses  selecting  work  destinations.  Specialty                                                               
areas  experience additional  recruitment  challenges related  to                                                               
certification   requirements.   During  disasters   and   disease                                                               
outbreaks,  like   COVID-19,  rapid  mobilization   of  qualified                                                               
nursing staff is essential for  continuity of operations. The NLC                                                               
will  help  fill  gaps  in  nursing  resources  and  serve  as  a                                                               
recruitment  tool. It  is  not  uncommon for  nurses  to come  to                                                               
Juneau temporarily  and decide to  stay. In the growing  world of                                                               
telemedicine,   licensure  compacts   facilitate  effective   and                                                               
efficient use  of nursing resources. The  NLC promotes interstate                                                               
educational opportunities  in hospitals that wish  to collaborate                                                               
but don't  due to licensure  restrictions. The demand  for nurses                                                               
is expected  to increase in  coming years. The  nursing workforce                                                               
deficit will  grow and jeopardize  patient care unless  the state                                                               
acts  now to  draw nurses  to  Alaska. The  NLC supports  healthy                                                               
workforce and  offers a broad  resource pool for  recruitment and                                                               
selection of nurses.                                                                                                            
2:51:44 PM                                                                                                                    
BRIAN  NORTON,  R.N.,  Manager,  Cook  Inlet  Dialysis  Fresenius                                                               
Kidney Care,  Anchorage, Alaska,  said that Fresnius  Kidney Care                                                               
serves 330  patients in  Anchorage, Fairbanks,  Juneau, Soldotna,                                                               
and  Wasilla.  Dialysis  nursing  is a  very  specialized  field.                                                               
Because Fresenius  is a large  company, it relies on  the ability                                                               
to bring  dialysis-trained nurses from  other states in  times of                                                               
need. The Centers for Medicare  and Medicaid Services have strict                                                               
requirements for  registered nurses in the  dialysis setting that                                                               
make it  difficult to use  nurses who  do not have  experience to                                                               
fill in  during shortages.  If nurses  give two-week  notice when                                                               
they  are leaving,  the clinic  can  go from  stable staffing  to                                                               
instability  quickly. Fresenius  currently  has  10 openings  for                                                               
permanent RN  positions. It takes an  average of 75 days  to fill                                                               
them. According to a study, by  2030 Alaska will have the highest                                                               
percentage of  nursing vacancies at 23  precent. Twelve Fresenius                                                               
dialysis  nurses used  emergency temporary  licensing allowed  by                                                               
the Board  of Nursing. For  dialysis patients,  interruptions and                                                               
delays   in   treatment  schedules   are   more   than  just   an                                                               
inconvenience, it  is critical. It  is vital to have  a permanent                                                               
way  to  bring  dialysis  nurses from  other  states  immediately                                                               
during any disaster.  The compact has a history  of working well.                                                               
In  2018  the  original  26  states  passed  the  enhanced  Nurse                                                               
Licensing Compact.  Additional states  have joined. In  2020, the                                                               
Pennsylvania state nurses association  surveyed 15 compact states                                                               
and found that  concerns such as lost revenue to  state boards of                                                               
nursing  and public  safety concerns  had  not materialized.  The                                                               
association changed  from opposing the compact  to supporting it.                                                               
He asked the committee to support the NLC.                                                                                      
SENATOR BEGICH  shared that  he had  met some  of his  staff last                                                               
year  who  talked  about  Fresenius   efforts  to  develop  local                                                               
workforce. He asked Mr. Norton to  share the work his company has                                                               
done with local workers.                                                                                                        
MR. NORTON replied  that work frequently in  community to promote                                                               
ways  of  helping  patients who  receive  dialysis.  The  company                                                               
engages nurses in other facilities to coordinate care.                                                                          
2:55:46 PM                                                                                                                    
REBECCA FOTSCH,  Director, State Advocacy &  Legislative Affairs,                                                               
National Council  of State Boards of  Nursing, Chicago, Illinois,                                                               
said she  had called in  to answer any technical  questions about                                                               
the compact or any other questions.                                                                                             
CHAIR  WILSON responded  that  there were  no  questions at  this                                                               
time. He  clarified with  Director Chambers  that any  changes to                                                               
the compact must be approved by  the legislature. He asked if any                                                               
there were  any anticipated changes  with the compact  that would                                                               
need  action  from the  legislature  that  would possibly  hinder                                                               
participation in the compact.                                                                                                   
MS. CHAMBERS asked for clarification.                                                                                           
CHAIR WILSON said  perhaps Ms. Fotsch could  answer whether there                                                               
have been any  changes to the compact that all  the states had to                                                               
agree to.                                                                                                                       
MS. CHAMBERS  responded that her  understanding is that  if there                                                               
is a  change that must  happen to Section  23, all of  the states                                                               
would have to ratify the same  kind of change. That would only be                                                               
for  the multistate  license and  not affect  any changes  to the                                                               
state license.                                                                                                                  
MS. FOTSCH  said that has happened  once. All of the  states came                                                               
together because  they knew they needed  to make a change  in the                                                               
language. That old compact was in  existence for 15 years and had                                                               
25 members.  The old NLC language  stalled at 25 members,  so the                                                               
NLC states  changed it so that  all states could be  members. All                                                               
the compact  states had to agree  to it. She hopes  there will be                                                               
no change any time soon. The  intent of the compact states is not                                                               
to have to do that.                                                                                                             
SENATOR COSTELLO said  that is important to her  that Alaska grow                                                               
its own in  Alaska, such as engineers, teachers,  and nurses. She                                                               
has  observed nurse  graduation ceremonies  in Anchorage.  If the                                                               
NLC  requirements  are  more stringent  than  the  state  license                                                               
requirements,  the  multistate  license  gives  individuals  more                                                               
flexibility, she asked  if that license will be  valued more than                                                               
an  Alaska  license.  She  asked  if  there  any  concerns  about                                                               
displacing Alaskans who are committed  to living here with nurses                                                               
from outside of the state.                                                                                                      
MS.  CHAMBERS  responded  that  the intent  is  to  provide  more                                                               
flexibility  and mobility  for nurses  to meet  healthcare needs.                                                               
Her agency  has talked one  constituency group,  those graduating                                                               
nurses, who  are leaving the  state because Alaska does  not have                                                               
the  compact.  They  want  to   pay  for  one  license  and  have                                                               
flexibility to travel. The agency  is responding to the desire of                                                               
graduating  nurses  to have  that  flexibility.  The question  of                                                               
whether a multistate  is more valuable than an  Alaska license is                                                               
an interesting  question. That is  a question for  each employer.                                                               
There  is  no change  in  what  a  registered nurse  or  licensed                                                               
practical nurse  could do  with either an  Alaska license  or the                                                               
multistate license. The Alaska Practice  Act governs the practice                                                               
of  nursing. The  agency is  trying to  retain Alaskan  homegrown                                                               
nurses and  make sure they don't  want to leave Alaska  by adding                                                               
this attractive tool in their toolbox.                                                                                          
3:04:00 PM                                                                                                                    
CHAIR  WILSON held  SB  67 in  committee.  He encouraged  written                                                               
testimony be sent to shss@akleg.gov.                                                                                            
3:04:29 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 3:04 p.m.                                                                                         

Document Name Date/Time Subjects
SB 67 version A.PDF SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 Transmittal Letter to the Senate (1.29.21).pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 Sectional Analysis for (S)HSS.pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 FN 1 DCCED.pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 FN 2 DHSS.pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 FN 3 DPS.pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 NLC Fast Facts (NCSBN).pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 NLC States Map (NCSBN).pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 USAF Support of Military Families - Professional Licensure Portability in Basing Decisions (Feb 2020).pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 Supporting Doc - Nurse Licensure Compact One-Page Summary (2.5.21).pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 - DCCED Nurse Licensure Compact Presentation (2.19.21).pdf SHSS 2/23/2021 1:30:00 PM
SB 67
SB 67 Letters of Support 2.22.21_Redacted.pdf SHSS 2/23/2021 1:30:00 PM
SB 67