Legislature(2021 - 2022)BUTROVICH 205

09/10/2021 03:30 PM Senate HEALTH & SOCIAL SERVICES

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Audio Topic
03:39:28 PM Start
03:40:11 PM SB67
05:35:54 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- To Reconvene at 5:25 pm --
Heard & Held
-- Please Note Time Change --
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       September 10, 2021                                                                                       
                           3:39 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello (via teleconference)                                                                                       
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                                                                           
02/23/21       (S)       Heard & Held                                                                                           
02/23/21       (S)       MINUTE(HSS)                                                                                            
02/25/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/25/21       (S)       -- Public Testimony --                                                                                 
04/15/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/15/21       (S)       Heard & Held                                                                                           
04/15/21       (S)       MINUTE(HSS)                                                                                            
04/20/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/20/21       (S)       Failed to Move Out of Committee                                                                        
04/20/21       (S)       MINUTE(HSS)                                                                                            
09/02/21       (S)       THIRD SPECIAL SESSION BILL                                                                             
09/03/21       (H)       THIRD SPECIAL SESSION BILL                                                                             
09/10/21       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
SARA CHAMBERS, Director                                                                                                         
Division of Corporations, Business and Professional Licensing                                                                   
Department of Commerce, Community, and Economic Development                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 67.                                                                              
ACTION NARRATIVE                                                                                                              
3:39:28 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 3:39 p.m.  Present at the                                                               
call  to  order  were  Senators  Costello  (via  teleconference),                                                               
Hughes,  Reinbold, and  Chair Wilson.  Senator Begich  joined the                                                               
committee thereafter.                                                                                                           
         SB  67-NURSING: LICENSURE; MULTI-STATE COMPACT                                                                     
3:40:11 PM                                                                                                                    
CHAIR  DAVID 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."                                                                                           
CHAIR  WILSON  explained  that  the  bill  failed  to  move  from                                                               
committee  on  April  20,  so it  falls  within  the  committee's                                                               
jurisdiction to take it up again.                                                                                               
3:41:08 PM                                                                                                                    
SENATOR REINBOLD  requested an explanation  of why  the committee                                                               
was taking  the bill up  after it  failed to move  from committee                                                               
and what changes had been made since that time.                                                                                 
CHAIR  WILSON  responded  that  the bill  was  still  within  the                                                               
committee's  purview,  so  there  was  no  need  to  rescind  the                                                               
previous action.                                                                                                                
SENATOR REINBOLD  asked why  the committee  was hearing  the bill                                                               
now when  members chose not to  move the bill from  committee [on                                                               
CHAIR WILSON stated that Ms. Chambers would answer the question.                                                                
3:42:04 PM                                                                                                                    
CHAIR WILSON moved  to adopt the work  draft committee substitute                                                               
(CS) for SB 67, work order 32-GS1603\B as the working document.                                                                 
3:42:16 PM                                                                                                                    
SENATOR HUGHES objected for purposes of discussion.                                                                             
CHAIR WILSON  explained that the  CS includes the  amendments the                                                               
members  passed previously,  although  the bill  did not  advance                                                               
from committee. The  three amendments that were  adopted were A.5                                                               
[2], A.6 [3],  and A.7 [4], which are incorporated  into the work                                                               
draft.  The CS  also  contains an  additional  amendment for  the                                                               
members to consider.                                                                                                            
SENATOR  HUGHES   asked  for  a   recapitulation  of   the  three                                                               
amendments that were adopted.                                                                                                   
3:43:22 PM                                                                                                                  
At ease                                                                                                                         
3:43:39 PM                                                                                                                  
CHAIR WILSON  reconvened the meeting and  reviewed the amendments                                                               
that  were  adopted  on  4/15/21 and  4/20/21.  Amendment  2  was                                                               
related  to  the  employment  of   nurses  holding  a  multistate                                                               
SENATOR HUGHES asked if Amendment  2 addressed the maintenance of                                                               
an out-of-state nurse registry.                                                                                                 
CHAIR WILSON replied yes.                                                                                                       
CHAIR  WILSON  explained  that Amendment  3  was  clarifying  and                                                               
conforming   language  regarding   the  privilege   to  practice.                                                               
Amendment  4 was  regarding two  hours of  Alaska Native  culture                                                               
3:46:10 PM                                                                                                                    
At ease.                                                                                                                        
3:48:11 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.  He explained that Amendment                                                             
2 [added  a new bill  section that] required employers  to notify                                                               
the   nursing  board   of  an   out-of-state  nurse's   hire  and                                                               
termination within  30 days.  In addition,  the board  of nursing                                                               
would create regulations  regarding items in the  database and be                                                               
responsible for informing  employers. [This is Section  21 in the                                                             
CS.] The CS also adds a new  subsection (e) to Section 21 on page                                                               
11, line 28.  It states that a  fine of $1,500 may  be imposed if                                                               
an employer fails to report  the information to the Department of                                                               
Commerce,  Community   and  Economic  Development   (DCCED).  The                                                               
legislature may  appropriate the money  from these fines  back to                                                               
DCCED  to  offset investigative  costs.  A  registry provides  an                                                               
accurate  accounting of  out-of-state nurses  working in  Alaska,                                                               
making the investigation of a complaint easier.                                                                               
3:50:46 PM                                                                                                                    
SENATOR HUGHES asked  if he would support a  conceptual change to                                                               
make the  registry public on  the Board of Nursing  website; this                                                               
would hold businesses accountable for hiring Alaska residents.                                                                  
CHAIR WILSON  deferred the question  to Ms. Chambers; he  did not                                                               
know if that information was public.                                                                                            
3:51:55 PM                                                                                                                    
SARA CHAMBERS,  Director, Division of Corporations,  Business and                                                               
Professional  Licensing, Department  of Commerce,  Community, and                                                               
Economic Development, Juneau, Alaska,  answered yes; an Alaskan's                                                               
licensing information  is available on the  department's website.                                                               
It  would be  possible to  make  a separate  public registry  for                                                               
multistate licensed nurses.                                                                                                     
3:52:23 PM                                                                                                                    
SENATOR HUGHES  asked if  she would support  specifying in  SB 67                                                               
that DCCED would publicly post the registry for compact nurses.                                                                 
MS. CHAMBERS replied  that the addition to the bill  would not be                                                               
a problem for DCCED.                                                                                                            
3:53:00 PM                                                                                                                    
SENATOR BEGICH joined the committee.                                                                                            
3:53:08 PM                                                                                                                    
CHAIR  WILSON   asked  Senator  Hughes  if   she  maintained  her                                                               
objection to adopting the CS.                                                                                                   
3:53:14 PM                                                                                                                    
SENATOR HUGHES removed her objection.                                                                                           
CHAIR  WILSON  found no  further  objection,  and version  B  was                                                               
3:53:24 PM                                                                                                                    
At ease.                                                                                                                        
3:55:37 PM                                                                                                                    
CHAIR WILSON reconvened the meeting. He asked Ms. Chambers why                                                                  
the administration asked the committee to reconsider SB 67 and                                                                  
what had changed since the committee last heard the bill.                                                                       
3:56:42 PM                                                                                                                    
MS.  CHAMBERS  expressed  appreciation   for  the  invitation  to                                                               
comment. She  explained the urgent  need for the  Nurse Licensure                                                               
Compact  (NLC)  and the  reason  for  adding  it to  the  Special                                                               
Session call. She read the following prepared testimony:                                                                        
     Due  to the  surge of  COVID 19  across Alaska  and the                                                                    
     healthcare  workforce shortage,  it is  imperative that                                                                    
     we  find  a solution  to  allow  competent and  capable                                                                    
     nurses  to  fill  vacancies  and  provide  services  to                                                                    
     Alaskans.  The most  immediate and  safest solution  is                                                                    
     for Alaska to join the Nurse Licensure Compact.                                                                            
     We all have read the  daily headlines about the current                                                                    
     status  of Alaska's  health  care situation.  "Crisis,"                                                                    
     "dire," and "disaster mode" are  just some of the words                                                                    
     that have been used to  describe what it is like within                                                                    
     hospitals  and  long-term care  facilities.  Healthcare                                                                    
     providers are pleading for relief.                                                                                         
     In  response, the  Alaska  State  Hospital and  Nursing                                                                    
     Home Association has  requested assistance through DHSS                                                                    
     in expediting recruitment of  298 registered nurses and                                                                    
     105 certified nurse aides through  a request to FEMA to                                                                    
     fill vacancies  across the  state. We  anticipate these                                                                    
     nurses could be  here as soon as the end  of the month.                                                                    
     While  this influx  of  much  needed healthcare  worker                                                                    
     assistance would  be welcomed, this requires  the Board                                                                    
     of Nursing staff  to vet and process  licenses for each                                                                    
     individual  arriving.   I  cannot  stress   enough  the                                                                    
     enormous burden  this will place on  our already maxed-                                                                    
     out  staff, and  the effect  a delay  in getting  those                                                                    
     nurses  into hospitals  due to  licensure will  have on                                                                    
     already maxed-out health care facilities.                                                                                  
     So, is the NLC really the best solution?                                                                                 
3:58:28 PM                                                                                                                    
MS. CHAMBERS continued reading:                                                                                                 
     Our division,  which is responsible for  licensing more                                                                    
     than  90,000  professionals   to  provide  services  to                                                                    
     Alaskans, has bent over backwards,  with a lot of help,                                                                    
     to identify  every tool that  could possibly  be placed                                                                    
     in our toolbox to  safely and efficiently get qualified                                                                    
     nurses to workparticularly  in the  last 18 months that                                                                    
     we have responding to COVID demands.                                                                                       
     Last  fall, the  Board of  Nursing adopted  regulations                                                                    
     creating  an  emergency   courtesy  licenseor   ECLfor                                                                     
     registered nurses.  Since November 2020, our  staff has                                                                    
     issued  hundreds  of   ECLs,  which  receive  expedited                                                                    
     review,  are valid  for a  limited time,  and are  only                                                                    
     issued for  emergency purposes. Since then,  the demand                                                                    
     for  longer-term  licensure  has  also  increased.  Our                                                                    
     nursing  program issued  14  percent  more licenses  in                                                                    
     FY21 than the previous year.                                                                                               
     3:59:29 PM                                                                                                               
     For high-volume  programs like nursing, ECLs  cannot be                                                                    
     expedited any more  than they are right now.  If just a                                                                    
     handful  of applications  are received,  it only  takes                                                                    
     our staff  a few  days to issue  ECLs, once  a complete                                                                    
     and correct  application is  submitted. However,  if we                                                                    
     receive hundreds  of nursing ECL applications  at once-                                                                    
     as we  have over  the last eighteen  months and  we are                                                                    
     expecting through  the FEMA  request later  this month                                                                     
     these  will  take weeks  to  process  due to  the  high                                                                    
     volume and  our current capacity. We  don't expect this                                                                    
     trend to slow down any time soon.                                                                                          
     We  are  hiring  additional   staff  and  are  offering                                                                    
     overtime  to  current  staff; however,  the  demand  to                                                                    
     perform  this   work  has  dramatically   outpaced  our                                                                    
     ability  to hire,  train, and  supervise the  number of                                                                    
     people needed  to properly vet applications  for health                                                                    
     care licenses.                                                                                                             
     As of  today, forty-four percent of  nurses licensed by                                                                    
     the  Alaska board  hold an  address of  record that  is                                                                    
     outside  Alaska. Traveling  nurses are  always in  high                                                                    
     demand since  Alaska nursing programs  do not  have the                                                                    
     capacity to  produce the  thousands of  nurses required                                                                    
     to  meet Alaska's  healthcare needs,  especially during                                                                    
     The   only  way   to   further  expedite   professional                                                                    
     licensure is to bypass it, and  the only way to do that                                                                    
     without creating a potential  risk to public health and                                                                    
     safety  is by  joining the  Nurse Licensure  Compact so                                                                    
     nurses can get to work immediately.                                                                                        
4:01:01 PM                                                                                                                    
MS. CHAMBERS continued reading:                                                                                                 
     Multi-state-licensed  nurses  have  been  vetted  at  a                                                                    
     higher standard  than our  own law  requires, standards                                                                    
     that  are  written directly  into  SB  67. The  compact                                                                    
     legislation   before   you   spells   out   the   legal                                                                    
     responsibilities  of the  Alaska board  to enforce  and                                                                    
     report unsafe  nurses, just as  they do  now. Embedding                                                                    
     the  compact into  Alaska law  ensures these  standards                                                                    
     cannot be  changed without an  act of the  Alaska State                                                                    
     Legislature,  and it  guarantees the  Board of  Nursing                                                                    
     retains full authority over the  practice of nursing in                                                                    
     our  state.  The  Alaska State  Board  of  Nursing  and                                                                    
     89percent  of Alaska-resident  nurses  support the  NLC                                                                    
     for these very reasons.                                                                                                    
     As with  any state law,  the legislature has  the power                                                                    
     to  repeal  this  legislation  at   any  time  if  it's                                                                    
     determined the NLC is not the best fit for Alaska.                                                                         
     To  summarize,   Legislative  adoption  of   the  Nurse                                                                    
     Licensure   Compactor    NLCis   the   only   immediate                                                                    
     solution to  safely allow  qualified nurses  to provide                                                                    
     desperately needed healthcare services to Alaskans.                                                                        
     This  is brought  to your  attention right  now because                                                                    
     the  governor does  not  have the  power  to write  and                                                                    
     adopt  or  amend  state  law,  even  under  a  disaster                                                                    
     declaration.  Because the  effort  needed  to help  our                                                                    
     hospitals  and   nursing  homes   requires  substantive                                                                    
     changes  to  state  law, the  governor  is  asking  the                                                                    
     legislature  to  put  political motivations  aside  and                                                                    
     pass   this   critical,   beneficial   legislation   to                                                                    
     immediately relieve Alaska's health care network.                                                                          
     Chair   Wilson  and   members  of   the  committee,   I                                                                    
     appreciate   your  time   and  consideration   of  this                                                                    
     important  and urgent  piece of  legislation today.  On                                                                    
     behalf  of the  governor, I  urge you  to consider  the                                                                    
     overwhelming  support that  has come  from health  care                                                                    
       stakeholders across the state and enact meaningful                                                                       
     change to address this crisis.                                                                                             
4:03:04 PM                                                                                                                    
CHAIR  WILSON thanked  Ms. Chambers.  He recognized  that Senator                                                               
Begich had  joined the  committee and  that Senator  Costello was                                                               
attending via teleconference.                                                                                                   
SENATOR  BEGICH  said  that  while  Ms.  Chambers  mentioned  not                                                               
wanting  to politicize  the Nurse  Licensure  Compact, using  the                                                               
pandemic to  pass legislation  could be  considered politicizing.                                                               
He stated  he is not convinced  of Ms. Chamber's facts.  He asked                                                               
if SB 67 is a temporary solution to the nursing shortage.                                                                       
MS.  CHAMBERS  replied  that  the  administration  proposed  this                                                               
needed  legislation before  the pandemic.  The shortage  has been                                                               
exacerbated  by   COVID.  DCCED  has  worked   with  departments,                                                               
organizations, and  the administration trying to  find solutions.                                                               
It  has  added  positions  and overtime,  which  takes  time  and                                                               
training. If alternatives  to the NLC could  maintain the safety,                                                               
standards, accountability,  and jurisdiction of the  Alaska Board                                                               
of Nursing,  the department would  consider them. The NLC  is the                                                               
fastest no  sacrifice means to  resolve the  growing pre-pandemic                                                               
nursing shortage crisis.                                                                                                        
SENATOR  BEGICH   responded  that   members  did  not   feel  the                                                               
legislation was  necessary before  the pandemic, had  a different                                                               
opinion from  DCCED, and  did not advance  it. Although  there is                                                               
now  pressure because  of the  pandemic, the  facts do  not merit                                                               
change.  He concluded  that  joining the  compact  would not  fix                                                               
Alaska's shortage problem since the shortage is nationwide.                                                                     
4:07:44 PM                                                                                                                    
MS.  CHAMBERS agreed  that there  is  a greater  need for  nurses                                                               
nationwide. However, Oregon's implementation  of the model, which                                                               
DHSS  has  leveraged  through  requests  from  the  Alaska  State                                                               
Hospital and  Nursing Home Association  (ASHNHA), shows  that 500                                                               
nurses can  be requested and  obtained. The  department's purpose                                                               
is not to impede facilities'  hiring, yet licensing is taking six                                                               
weeks.  There  may  not be  enough  nurses  nationwide.  However,                                                               
providers and  facilities call DCCED  asking for a faster  way to                                                               
get through the  licensing process so people they  have hired can                                                               
begin working.                                                                                                                  
CHAIR  WILSON  announced  online  were  Heidi  Hedburg,  Division                                                               
Director of Public Health; Gene  Wiseman, Section Chief for Rural                                                               
Community Health  Systems, Division  of Public Health;  and Clint                                                               
Farr, Deputy Director for the Division of Public Health.                                                                        
SENATOR BEGICH said we have  emergency regulations that allow for                                                               
expedited and  courtesy licenses.  He suggested  hiring licensing                                                               
staff  for vetting  would  be better  than  creating a  permanent                                                               
statutory change that gives away legislative authority.                                                                         
4:10:43 PM                                                                                                                    
SENATOR  BEGICH  asked why  the  emergency  hire regulations  are                                                               
inadequate and  whether the CS  would make Alaska  ineligible for                                                               
the compact.                                                                                                                    
MS.  CHAMBERS  replied that  the  department  has struggled  with                                                               
staffing for  eighteen months.  COVID has  led some  state agency                                                               
workers and  health care providers  to be exhausted,  and nursing                                                               
board staff have resigned due  to burnout. The administration has                                                               
been generous in authorizing positions,  but not enough qualified                                                               
people have applied  and those hired need  training. Overtime has                                                               
been offered  to examiners. She  said she is carrying  two boards                                                               
to  free up  staff. The  addition of  staff to  address licensing                                                               
needs becomes an expense to licensees.                                                                                          
SENATOR BEGICH  interjected that over  half a billion  dollars in                                                               
COVID relief money and discretionary  money within the Governor's                                                               
Office and  DHSS could legitimately  cover licensing  expenses so                                                               
that fees are not passed to licensees.                                                                                          
MS. CHAMBERS  responded DCCED has  worked with health  and social                                                               
services and  public health  to identify  available money  to use                                                               
for overtime  pay. The COVID  funding that he mentioned  is being                                                               
used for licensing  the 300 nurses requested by  ASHNA, but COVID                                                               
has  been taxing  the department  for eighteen  months. Permanent                                                               
positions will  need to  be added. The  department is  working to                                                               
address  the   nursing  shortage   and  is  open   to  additional                                                               
suggestions that help.                                                                                                          
SENATOR BEGICH asked whether the  CS would make Alaska ineligible                                                               
for the compact.                                                                                                                
MS. CHAMBERS replied  that she has not read the  memo provided to                                                               
the  committee.  However, if  members  support  the CS  with  its                                                               
presented changes,  the department  will see  if changes  need to                                                               
happen in a future committee.                                                                                                   
4:15:24 PM                                                                                                                    
At ease.                                                                                                                        
4:17:06 PM                                                                                                                    
CHAIR WILSON  reconvened the  meeting. He  asked Ms.  Chambers if                                                               
she  recalled  any compact  concerns  with  Amendment 7  when  it                                                               
passed  on 4/20/21.  He noted  that compact  representatives were                                                               
online. He also  asked if she had any comments  on the memo after                                                               
reading it.                                                                                                                     
MS. CHAMBERS  responded that she  recollected that there  was not                                                               
an  additional opportunity  to  speak to  the  amendments. SB  67                                                               
subsequently was  not discussed  further in the  committee. There                                                               
was  no opportunity  to address  Amendment 7's  required cultural                                                               
education training for  compact nurses. She stated  that it would                                                               
prevent Alaska from entering the  compact, and cultural education                                                               
is  not required  for nurses  licensed  in Alaska.  No test  even                                                               
approaches that level of education  for any Alaska nurse or nurse                                                               
among  the   forty-four  percent   applying  for   and  receiving                                                               
licensure in Alaska now.                                                                                                        
4:18:30 PM                                                                                                                    
SENATOR REINBOLD  asked if  the compact had  anything to  do with                                                               
money from the  Federal Emergency Management Agency  (FEMA) or US                                                               
General Services Administration (GSA).                                                                                          
MS. CHAMBERS replied  that the nursing compact has  nothing to do                                                               
with  any federal  agreement or  funding.  It does  not make  the                                                               
state beholding to any federal  contract, and it is separate from                                                               
DHSS efforts, which Ms. Hedburg could address.                                                                                  
SENATOR  REINBOLD asked  if there  are  any vaccine  requirements                                                               
regarding this compact.                                                                                                         
MS. CHAMBERS answered that vaccination  requirements are not part                                                               
of the compact and are not part of DCCED's licensing scheme.                                                                    
SENATOR REINBOLD  asked what the  vaccination status would  be of                                                               
the 300 needed health care providers.                                                                                           
MS.  CHAMBERS  replied that  the  department  does not  know  the                                                               
vaccination status of  any nurse working or who comes  to work in                                                               
4:20:05 PM                                                                                                                    
SENATOR HUGHES  asked if the  Board of  Nursing would be  open to                                                               
the  suggestion  of required  cultural  training  for all  Alaska                                                               
nurses unless they  have lived in Alaska for a  certain amount of                                                               
MS.  CHAMBERS  responded  that  all  the  department's  licensing                                                               
programs  require continuing  education,  and cultural  education                                                               
could become a requirement for all Alaska nurses.                                                                               
4:22:09 PM                                                                                                                    
MS. CHAMBERS said that adding  licensing requirements for compact                                                               
nurses  to  complete  before  they can  begin  work  defeats  the                                                               
purpose of  the compact. Before  compact attorneys  can determine                                                               
whether the additional training  requirement would affect compact                                                               
eligibility,  the National  Council  of State  Boards of  Nursing                                                               
(NCSBN) would need to decide the training specifications.                                                                       
SENATOR  HUGHES  doubted  whether  having  all  nurses  take  the                                                               
training  would  help  compact  eligibility.  She  asked  if  the                                                               
Emergency Courtesy  License (ECL)  requirements are  as stringent                                                               
as Alaska-only  or multistate license requirements.  She asked if                                                               
a multistate license  ensures a safer setup for  patients than an                                                               
MS. CHAMBERS answered that  the legislature originally authorized                                                               
the ECLs in Senate Bill 241.  It was called an expediated process                                                               
because it  had very  few requirements.  The department  looks at                                                               
whether an applicant  has an encumbered license  and whether they                                                               
are  under investigation.  When an  issue  is found,  there is  a                                                               
process  for further  investigation. A  permanent Alaska  license                                                               
has these same two and many other requirements.                                                                                 
The  permanent   Alaska  license   is  less  rigorous   than  the                                                               
multistate  license. The  standards  for  the multistate  license                                                               
would not be  delegated to the board of nursing,  as is currently                                                               
done with  the Alaska license.  The multistate  license standards                                                               
would be  set through  the legislature.  By joining  the compact,                                                               
the state  would be raising  the standards for  licensing without                                                               
ceding  authority and  joining  the compact  would  speed up  the                                                               
hiring process.                                                                                                                 
4:25:07 PM                                                                                                                    
SENATOR  HUGHES summarized  that  the most  stringent license  is                                                               
multistate, and  the least stringent  license is ECL.  She stated                                                               
she believes this  is an important realization because  it is the                                                               
responsibility  of  legislators  to   think  about  patients  and                                                               
safety.  She   reiterated  that   DCCED  is   short-staffed,  has                                                               
positions  open  and  money  to hire  but  not  enough  qualified                                                               
applicants. She  asked if ECL  nurses are hired from  outside the                                                               
MS.  CHAMBERS  responded  yes;  ECL  nurses  are  recruited  from                                                               
outside the state and offered  a position by an Alaskan facility.                                                               
At  the facility's  request, the  department tries  to fast-track                                                               
the applicant using the ECL standards. The ECL is a limited 180-                                                                
day  license  with an  additional  180  days  possible. It  is  a                                                               
shorter-term  license,  but once  a  person  has been  issued  it                                                               
twice, they need to obtain a permanent license.                                                                                 
SENATOR HUGHES  surmised that the  licensing options  for solving                                                               
the nursing shortage in Alaska are either bringing in out-of-                                                                   
state  nurses at  a  less  stringent standard  using  the ECL  or                                                               
bringing  in out-of-state  nurses  at a  more stringent  standard                                                               
using the multistate  license. Staff to promptly  process ECLs is                                                               
lacking. She  stated she  wants every Alaskan  nurse to  have the                                                               
first  chance at  a job  opening. The  registry for  nurses hired                                                               
outside the state will hold  employers accountable for hiring in-                                                               
state nurses when possible. She  stated her belief that safety is                                                               
essential,  and nurses  employed  from outside  the state  should                                                               
meet high standards.                                                                                                            
4:28:05 PM                                                                                                                    
SENATOR   COSTELLO  questioned   whether  the   higher  standards                                                               
required  of  the  multistate license  would  put  state-licensed                                                               
Alaskans at a disadvantage for employment.                                                                                      
MS. CHAMBERS  replied that she  is not implying the  Alaska Board                                                               
of Nursing  has low standards.  Under state standards,  there are                                                               
optional  elements to  licensing that  the Board  of Nursing  has                                                               
control over.  There are no  optional elements to  the multistate                                                               
license  because   the  compact  states  universally   adopt  the                                                               
standards. The purpose  of the multistate license  is to expedite                                                               
hiring and  ensure nurses meet  or exceed state  standards. State                                                               
nursing  boards  decide  individually if  a  nursing  misdemeanor                                                               
disqualifies  a  nurse  from   being  state-licensed.  Under  the                                                               
compact, a  nurse who has had  a nursing misdemeanor will  not be                                                               
eligible for  a multistate license.  The standard  is universally                                                               
established by all states who are in the compact.                                                                               
4:30:13 PM                                                                                                                    
Healthcare  providers  are  desperate for  anyone  qualified  and                                                               
safe. The  department is  seeing health  care providers,  such as                                                               
ASHNA and  its members, supporting the  NLC. Alaska has a  lot of                                                               
great nurses,  but there  are not enough  of them.  Employers are                                                               
not  looking  at  a  tiered  system. They  are  looking  to  hire                                                               
employees they desperately need.                                                                                                
SENATOR COSTELLO  stated that a  process to  expedite emergencies                                                               
was  contemplated  and  put  into place  because  the  state  has                                                               
struggled with nursing shortages.  She suggested the better long-                                                               
term  solution  would be  reassigning,  training,  and using  the                                                               
established emergency licensing process.                                                                                        
MS. CHAMBERS  replied that those  tools are being  fully utilized                                                               
and  are not  adequate  to meet  the surge  in  demand caused  by                                                               
COVID. She reiterated that she is open to new ideas.                                                                            
4:32:45 PM                                                                                                                    
SENATOR BEGICH  responded that  it is  misleading to  say members                                                               
have two  options for  bringing nurses into  the state;  in fact,                                                               
there are no nurses available.  Getting nurses licensed under the                                                               
less stringent ECL requirements is  the easier path. He asked how                                                               
a more stringent multistate licensing  pathway fixes the shortage                                                               
if there are not enough nurses using the easier pathway.                                                                        
Alaska's  continuing education  standards  exceed  those of  many                                                               
compact states. He  voiced aversion to giving  the Alaska nursing                                                               
board's local  discretion to a  compact managed by  consensus and                                                               
unfamiliar  with Alaska's  needs. He  sought confirmation  of the                                                               
state's ability to change laws that conflict with the compact.                                                                  
MS. CHAMBERS answered that there is  no handing over or ceding of                                                               
power. The  compact would  be state  law. The  Alaska Legislature                                                               
would make  decisions about standards.  Alaska could be  a member                                                               
of  the compact  and still  have an  Alaska-only state  licensing                                                               
process. Nurses could choose to  have an Alaska-only license. The                                                               
department does not  want to get rid of the  existing process and                                                               
laws. The compact  is a different licensing path  that the Alaska                                                               
Legislature  could  put into  law.  The  legislature could  align                                                               
state licensing  standards with compact licensing  if it chooses;                                                               
the  Alaska license  is  a  separate purview.  The  compact is  a                                                               
business agreement that says all  participating states agree to a                                                               
specified  set of  standards  for a  specified  license that  has                                                               
specified  benefits.  All  compact   states  participate  in  the                                                               
national state legislature change  process when any state desires                                                               
a  change.  Alaska  would  then decide  whether  to  continue  to                                                               
participate in the compact.                                                                                                     
The ECL is  an emergency response tool that the  board adopted to                                                               
process nurses faster.  The compact could be another  tool of the                                                               
legislature that  can do more  than the department has  the legal                                                               
authority to do.                                                                                                                
4:37:19 PM                                                                                                                    
SENATOR BEGICH  asked if  the state  would be  able to  collect a                                                               
licensing fee from compact nurses.                                                                                              
MS.  CHAMBERS explained  that DCCED  would be  able to  offer the                                                               
compact multistate  license to Alaskan  nurses. There  are almost                                                               
10,000 Alaska  licensed nurses who  have an address of  record in                                                               
Alaska. These  nurses could choose  to keep their  Alaska license                                                               
and apply for a multistate  license; Alaska would receive the fee                                                               
if they did. Each state  retains its own receipting. Alaska would                                                               
not  accept  funds for  multistate  licensed  nurses coming  into                                                               
Alaska. Alaska multistate licensed  nurses likewise would not pay                                                               
a fee to work in another compact state.                                                                                         
SENATOR BEGICH sought clarification  and stated his understanding                                                               
that Alaska will receive compact  fees for nurses who are Alaskan                                                               
residents that choose to obtain  multistate licenses. Alaska will                                                               
not  collect a  compact  licensing fee  from  nurses coming  from                                                               
outside the state.                                                                                                              
MS. CHAMBERS replied, correct.                                                                                                  
4:39:35 PM                                                                                                                    
SENATOR HUGHES asked if any  part of a nurse's multistate license                                                               
causes the state or the Board of Nursing to sacrifice autonomy.                                                                 
MS.  CHAMBERS replied  that  there is  no  sacrifice of  autonomy                                                               
coming  to or  while  working  in Alaska.  The  board of  nursing                                                               
retains complete jurisdiction over  nurses operating in the state                                                               
regardless of their  license type. The board  of nursing, through                                                               
DCCED,  can take  away  a multistate  licensed  nurse's right  to                                                               
practice in Alaska when complaints are reported.                                                                                
When  complaints  are  reported  against  a  multistate  licensed                                                               
nurse,  DCCED files  a  report  to a  national  database and  the                                                               
nurse's  home  state. Revoking  the  nurses   practice in  Alaska                                                               
consequently  revokes  their  practice in  other  compact  states                                                               
until the  home state completes an  investigation. Licensing fees                                                               
paid to  the home state  help pay  for the investigation  done by                                                               
the home state. The home  state issues the multistate license and                                                               
determines if the  license should be revoked  or disciplined. The                                                               
Alaska Board  of Nursing  solely determines  whether a  nurse can                                                               
practice in Alaska.                                                                                                             
SENATOR  HUGHES recalled  hearing that  DCCED is  backlogged with                                                               
ECL  applications. She  asked if  the state  joined the  compact,                                                               
were some nurses in the  backlog holding multistate licenses, and                                                               
if so, could they be put to work immediately.                                                                                   
4:42:23 PM                                                                                                                    
MS.  CHAMBERS  answered  that the  department  receives  multiple                                                               
applications a day for ECL  nurses that are desperately needed in                                                               
hospitals  and long-term  care  facilities.  Regardless of  where                                                               
they  are  from, ECL  applicants  must  submit documentation  and                                                               
await review.                                                                                                                   
She  presumed that  since there  are thirty-eight  compact states                                                               
and  the department  accepts ECL  applications  from all  states,                                                               
many of the  nurses in the backlog would be  from compact states.                                                               
DCCED  does  not  ask  ECL applicants  if  they  have  multistate                                                               
licenses  because  Alaska  is  not   a  compact  state,  and  the                                                               
department  does not  have  a  way to  bypass  the paperwork.  If                                                               
Alaska  were to  become  a  compact state,  any  nurse holding  a                                                               
multistate  license would  be  able to  start  work. An  employer                                                               
would only  need to  register them within  30 days.  Until Alaska                                                               
enters  the compact,  every applicant  will be  processed through                                                               
the backlog that existed prior to and made worse by COVID.                                                                      
SENATOR HUGHES  asked if it  is correct that  eighty-nine percent                                                               
of nurses in Alaska want to be part of the compact.                                                                             
4:44:05 PM                                                                                                                    
MS.  CHAMBERS replied  yes; the  department  did a  comprehensive                                                               
statistically sound  study in 2019  and provided  the methodology                                                               
to the  legislature. In the  study, ninety-two percent  of nurses                                                               
want the  Nurse Licensing Compact (NLC),  and eighty-nine percent                                                               
of those respondents are Alaska-based nurses.                                                                                   
SENATOR  COSTELLO  asked if  there  is  information available  on                                                               
nursing shortages  in compact  states. Idaho  is a  compact state                                                               
that is experiencing  a nursing shortage. She said  she is unsure                                                               
if joining the compact will provide the needed result.                                                                          
MS.  CHAMBERS replied  that  she would  give  information to  the                                                               
SENATOR BEGICH  said he would  like to  address Article V  of the                                                               
compact.  It says  only  the home  state has  the  power to  take                                                               
adverse  action against  a nurse's  multistate license.  He asked                                                               
whether it  is correct that the  nursing board can ask  the nurse                                                               
to leave  [not practice] but  cannot take adverse  action against                                                               
MS. CHAMBERS replied that adverse action  on a license is a legal                                                               
action that  restricts the  license itself.  Included in  the CS,                                                               
the  privilege  to practice  does  not  legally alter  a  nurse's                                                               
license,  and  it  is  not   an  adverse  action  or  discipline.                                                               
Privilege to practice  enables the nursing board to  tell a nurse                                                               
they may not  practice in Alaska. For example,  a 17-year-old may                                                               
not lose his license, but the  mother has the privilege to say he                                                               
may not drive her car.                                                                                                          
SENATOR BEGICH  questioned how an  adverse action is  conveyed to                                                               
the home state if Alaska cannot take adverse action.                                                                            
4:48:08 PM                                                                                                                    
MS. CHAMBERS said the department would  send a report to the home                                                               
state  and the  national  nurse discipline  database. The  notice                                                               
informs  the  home state  that  there  is  a problem.  Under  the                                                               
awareness  of  all  states,  the   home  state  would  work  with                                                               
investigators  and act  on the  license.  If it  were an  adverse                                                               
action  like a  felony, the  license would  be revoked.  The home                                                               
state would report the action taken to the national database.                                                                   
CHAIR WILSON said the  CS adds to SB 67 relating  to a $1500 fine                                                               
per  infraction by  any employer  who  does not  comply with  the                                                               
registry reporting  requirements. Fees collected will  be used by                                                               
licensing  to  offset  costs   associated  with  maintaining  the                                                               
database  and   carrying  out  investigations.  It   changes  the                                                               
effective date from January 1, 2022, to immediately.                                                                            
4:50:17 PM                                                                                                                    
CHAIR  WILSON recessed  the  meeting to  five  minutes after  the                                                               
floor session ends.                                                                                                             
5:27:55 PM                                                                                                                    
CHAIR WILSON  reconvened the meeting.  He asked Ms.  Chambers for                                                               
her closing comments.                                                                                                           
MS.  CHAMBERS thanked  the  committee for  considering  a way  to                                                               
address Alaska's  immediate health  care need. She  restated that                                                               
ninety-two percent  of Alaska licensed  nurses are  supportive of                                                               
the NLC. Eighty-nine percent of  those are Alaskan residents, and                                                               
eighty-seven  percent are  union members.  Nurses are  asking for                                                               
MS.  CHAMBERS said  she received  a text  during recess  from the                                                               
Board  of Nursing  Chair [Danette  Scholeder],  who stated  every                                                               
nurse wanting  to work in Alaska  would have a job  because there                                                               
are not enough Alaska  nurses to fill the need. The  NLC is a new                                                               
concept for  Alaska that members should  continue learning about.                                                               
The NLC  is a logical,  reasonable, small government  approach to                                                               
getting health care providers to Alaska with no risk.                                                                           
5:30:30 PM                                                                                                                    
SENATOR  REINBOLD stated  concern with  SB 67.  She has  a letter                                                               
from the Alaska  Nurses Association stating that  1,500 nurses in                                                               
Alaska are opposed to SB 67.  She opined that the 2019 survey Ms.                                                               
Chambers mentioned  is outdated  and taken  out of  context. Many                                                               
individuals  and the  AFL-CIO oppose  the legislation.  She asked                                                               
that  members read  the  letters of  opposition.  She stated  she                                                               
believes in  holistic care, supports  Alaskan workers  first, and                                                               
hopes SB 67 is tabled.                                                                                                          
SENATOR  BEGICH  stated  that  Alaska  does  not  produce  enough                                                               
nurses. The state  has a high-quality nursing  program, but there                                                               
is a  waitlist to get in.  He suggested the state  should do more                                                               
to  build  Alaska's  workforce  of  nurses.  He  recommended  the                                                               
legislature  determine the  amount of  funding it  would take  to                                                               
move Alaska's first-class  nursing school to a place  where it is                                                               
producing so many  nurses that a shortage is no  longer an issue.                                                               
He stated  he hopes legislators  join him in making  this broader                                                               
solution happen. It is a better long-term solution for Alaska.                                                                  
5:35:06 PM                                                                                                                    
CHAIR WILSON stated  he would hold SB 67 in  committee for future                                                               
5:35:54 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 5:35 p.m.                                                                                         

Document Name Date/Time Subjects
SB 67, DCCED, Alaska's COVID Response & the NLC - 9.7.21.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67, DCCED, Addressing Claims Against the NLC - 9.7.21.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67 Amendment A.5 Wilson (Adopted).pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67 Amendment A.6 Begich (Adopted).pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67 Amendment A.7 Begich (Adopted).pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67, Letter of Support, Redacted 9.8.21.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
Sb 67, Letter of Support Fresenius 9.9.21.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67, Letter of Opposition 9.9.21.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67, Letter of Support 9.10.21.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67, CS version B, legal memo.pdf SHSS 9/10/2021 3:30:00 PM
SB 67
SB 67, CS 32GS -1603.B.pdf SHSS 9/10/2021 3:30:00 PM
SB 67