HB 160-LICENSING OF ATHLETIC TRAINERS  4:04:59 PM CHAIR OLSON announced that the final order of business would be HOUSE BILL NO. 160, "An Act relating to the licensing and regulation of athletic trainers." 4:05:04 PM REPRESENTATIVE STEVE THOMPSON, Alaska State Legislature, speaking as sponsor, stated that HB 160 would amend current statutes to establish licensing and regulation of athletic trainers in Alaska. He explained that athletic trainers are health care professionals who collaborate with physicians to ensure the practice of sports medicine clients. He said that this profession plays a significant role in the management, prevention, recognition, and rehabilitation of injured athletes under the supervision of a licensed physician. Trainers are a vital resource in administrating injury prevention and treatment programs as well as immediate emergency care for the support in the athletic community. He reported that Alaska is one of two states without licensure of athletic trainers. He related that HB 160 will require athletic trainers to have a license to practice in the state and will hold them accountable to the rigorous standards of the Board of Certification, Inc. (BOC), which is a national agency created to certify health care professionals and assure protection of the public. As Alaskans become increasingly active, the need for properly trained and licensed athletic trainers becomes imperative. 4:06:40 PM BRODIE ANDERSON, Staff, Representative Steve Thompson, Alaska State Legislature, provided a section-by-section analysis of HB 160. He stated that Section 1 would add a new paragraph to license athletic trainers. Section 2 would add a new chapter, chapter 7, for athletic trainers, AS 08.07.010, outlining the licensing requirements and exemptions. MR. ANDERSON referred to a new section, AS 08.07.020, that identifies the qualifications, fees, and renewal process for athletic trainers. He said that AS 08.07.030 adds a new section that identifies the scope of practice for athletic trainers. He identified that AS 08.07.040 outlines the regulations for athletic trainers that the department will need to adopt. He stated that AS 08.07.049 provides definitions and AS 09.65.300 inserts athletic trainers to the list of health care providers. MR. ANDERSON explained the final two sections, Sec. 4 and 5, amends AS 47.17.290 (13) adds an athletic trainer to "practitioner of the healing arts" and adds a new section of uncodified law outlining the applicability of the bill. 4:08:41 PM REPRESENTATIVE HERRON asked for the catalyst for introducing the bill. REPRESENTATIVE THOMPSON answered that some athletic trainers asked him to assist them in obtaining certification and licensure since 48 states currently offer it. 4:09:14 PM REPRESENTATIVE HERRON asked whether any recent incidents highlight the need for the bill due to lack of skills. REPRESENTATIVE THOMPSON said that he is aware of some but did not have sufficient information to discuss. MR. ANDERSON anticipated testimony by Lynn Young, Treasurer for the Alaska Athletic Trainers Association (AATA). He said the Association came forward since Alaska is one of the few states that don't regulate athletic trainers. Concerns have previously been expressed that people might take a couple of online courses and then hold themselves out as athletic trainers. CHAIR OLSON answered that this concept has been a work in progress for several years. He commended the current version as being "the cleanest" version to date. MR. ANDERSON explained the fiscal note dated 3/28/14. He reported that in FY 15 $48.1, and for each consecutive year for FY 16-20 at $5.0 thousand to establish the licensing program. 4:11:40 PM REPRESENTATIVE CHENAULT asked whether adding athletic trainer costs associated with injuries will be passed on to insurance companies. MR. ANDERSON answered that he didn't know, but he offered to check and report back to the committee. 4:12:38 PM LYNN YOUNG, Secretary/Treasurer, Alaska Athletic Trainers Association (ATTA), stated that she is also the chair for the governmental affairs committee and is a certified athletic trainer. She explained that athletic trainers are highly trained multi-skilled professionals who are part of the allied health care profession. She reported that athletic trainers work, collaborate, and work under the direction of physicians. She stated that services provided by athletic trainers are prevention, emergency care, clinical assessment, therapeutic intervention, and rehabilitation of injuries and medical conditions. Individuals who wish to become athletic trainers must earn a degree from an accredited athletic training curriculum, and sit for the national board of certification exam, and upon passage can call themselves a certified athletic trainer. Athletic trainers must adhere to 50 hours biennial continuing education approved by the national BOC, of which 10 hours must be part of an evidenced based curriculum. Additionally, athletic trainers must obtain a current certification in emergency cardiac care at a minimum of a professional rescuer level or above. She reported that Alaska is one of two states to not yet license athletic trainers. She indicated that the trainers are proactive in asking for this. She was not aware of any improper behavior; however, they do not want to wait [until an issue occurs] and be reactive. In 2011, athletic trainers also testified on HB 15, which relates to concussions, and athletic trainers are one of the health care providers who can assist with the prevention, recognition, and proper care of concussions. Due to the severity and risk of concussions, athletic trainers do not want anyone holding themselves out to be an athletic trainer and putting school age children at risk. She urged members to regulate athletic trainers to ensure at a minimum that people calling themselves athletic trainers have the basic education and qualifications. 4:16:06 PM REPRESENTATIVE MILLETT asked which sports have the highest incidence of concussions. MS. YOUNG answered that football has the highest incidence, and she added girls' soccer, boys' soccer, girls' basketball, and boys' basketball; however, not enough data exists for ice hockey since not every state has ice hockey programs. She surmised that ice hockey probably would rank as high as football. 4:16:44 PM REPRESENTATIVE MILLETT asked whether helmet design has improved, if they are helpful, or if it is just the nature of sports. MS. YOUNG answered that helmets are "marketed," as concussion- proof; however, the anatomy of the brain is such that it sits in fluid and nothing can prevent concussions. She noted that skull fractures or structural problems can be minimized, but the brain will slosh against the skull, which can cause concussions when injured. She offered her belief that "concussion proof" helmets help prevent skull fractures help but they will not eliminate the risk of concussions. 4:17:36 PM REPRESENTATIVE JOSEPHSON asked for examples of what an athletic trainer does. MS. YOUNG explained that the traditional setting for athletic trainers is on the sidelines of sporting events. Some military and other employers hire athletic trainers to minimize injuries. She stated that athletic trainers provide education and provide emergency health care and assess whether the treatment falls within their scope of practice. Athletic trainers can provide post-surgery therapeutic exercises and provide rehabilitation to safely return them to their sports activities. 4:19:20 PM REPRESENTATIVE JOSEPHSON asked why California does not currently have regulation for licensed athletic trainers. MS. YOUNG answered that California is a big state with significant licensure of professions so the state is trying to figure out the athletic trainer's role. She said that she has held discussions with California's governmental affair's agency, and their director indicated that it is in part due to the size of the state, but also due to the politics involved. 4:20:02 PM REPRESENTATIVE SADDLER asked her to discuss the national BOC and the relationship to athletic trainers and if the BOC certifies other professions. MS. YOUNG answered that the BOC is the board for the national Athletic Trainers' Association. It regulates and certifies athletic trainers and ensures that competencies are met. The BOC establishes the basic educational and clinical components necessary to show competency in order for applicants to sit for the exam. The BOC outlines the practice standards, code of professional responsibility, ethics, and establishes continuing education. Athletic trainers must maintain 50 hours of continuing education biennially and the DOC assesses, documents, and certifies the athletic trainers have met continuing education. 4:21:26 PM REPRESENTATIVE SADDLER asked how this bill will affect athletic trainer's income or reimbursement rate. MS. YOUNG answered it probably will not have much impact in terms of insurance and fees, but HB 160 will improve youth safety. She related that currently athletic trainers are looking nationally at reimbursement, but she thought that will take years to implement. Currently, athletic trainers are employed by schools, orthopedic groups, or hospitals to help ensure safety of their clients. She said some athletic trainers work in the capacity of physician extenders so the athletic trainer services would be billed similar to a medical assistant, under the license of a physician. 4:22:40 PM REPRESENTATIVE REINBOLD related her own experience when her son played football. She said she bought an expensive concussion- proof helmet, but her son suffered a concussion anyway. She asked if there was a website parents can go to for information. MS. YOUNG answered that some sites, such as the centers for disease control and the national athletic trainers' websites acknowledged that good helmets decrease the risk of skull fractures, but they do not endorse statements that helmets will prevent concussions. She acknowledged that unfortunately marketing will make claims; however, she said it is likely that she decreased a worst-case scenario, in which her son may have avoided a skull fracture. 4:24:56 PM SARA CHAMBERS, Director, Professional Licensing, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community, & Economic Development (DCCED), asked to discuss the fiscal note and the basic process of licensing fees. She said that the fiscal note estimates $180 for the first year, followed by $100-$150 per year for an biennial license fee. 4:27:02 PM REPRESENTATIVE SADDLER asked whether any economy of scale exists to set up two boards at the same time. MS. CHAMBERS answered that she would need to ponder it; however, AS 08.01.065 dictates how the division sets licensing fees. She explained that this statute requires each cost must be borne by the licensees. She described it as a fairly rigorous process to identify costs that directly support individual programs. She suggested it is unlikely there would be substantial savings to do so. 4:28:16 PM REPRESENTATIVE SADDLER remarked that several new licensing programs are likely headed her way. MS. CHAMBERS answered that it is possible potential savings could occur if multiple licensing programs share work. She offered to check into it for the committee. 4:28:52 PM CARY KELLER, Orthopedic Surgeon, stated that he has offices in Fairbanks and Sitka. He said that he probably has more experience than anyone in Alaska in terms of athletic trainers. He related that he has cared for collegiate and high school athletes and has worked closely with athletic trainers. He currently is the chair of Alaska State Activities Association Sports Medicine advisory committee and he has served nationally on the National Federation of High Schools' sports medicine advisory committee. He explained that the national federation is the National Collegiate Athletic Association (NCAA) of high school sports. He indicated that he is a former trustee and fellow of the American College of Sports Medicine. He has also served as the team physician for the University of Alaska Fairbanks and for the schools in the Fairbanks North Star Borough School District for 30 years. He offered his belief that athletic trainers are incredibly important in the school setting and also a tremendous help to persons outside the school setting. It has become increasingly clear that the public schools and university have responsibility to student athletes to help prevent injuries, evaluate injuries when they occur, and to care for those injuries - both the acute care and the rehabilitation as Ms. Young described. He offered his belief that it has been clear since the months following the state's passage of concussion legislation that schools are poorly prepared to take on the responsibility in the absence of athletic trainers in the schools. Therefore, the AATA and the schools have worked together to establish protocols for taking care of and protecting concussed athletes. 4:31:53 PM DR. KELLER offered his belief that the schools that do the best job with concussions are ones with athletic trainers and other schools have difficulty finding substitutes. He suggested the best substitute is the school nurse. Concussions are just one example since athletes obtain all kinds of injuries, and the schools are poorly prepared to take care of all of the injuries. He recalled that in the 1980s he performed a study in Alaska of all injuries in two seasons in the FNSBSD. Once athletic trainers were added another study was conducted over two years. He concluded that with the presence of athletic trainers, a 70 percent reduction of injuries happened and the associated medical costs decreased by 50 percent. He said the statistics emphasize the value of the athletic trainers. He has worked closely with ASAA, and its board passed a motion recommending all schools have athletic trainers and they further recommended that the University of Alaska develop a curriculum to train athletic trainers to meet the needs of the state. He complimented the sponsor and encouraged passage of HB 160. 4:34:33 PM CHRISTOPHER DEAN, Certified Athletic Trainer; President, Alaska Athletic Trainers Association (AATA), thanked members for the opportunity to address the committee. He explained that athletic trainers are allied health care professionals who serve communities at many levels, including youth competitive teams through high school, collegiate, and professional athletic teams. He reiterated that Alaska and California are the only states that do not license athletic trainers. He asked the 49th state to be the 49th state to pass licensure. He acknowledged that some confusion exists between personal trainer and athletic trainers. He said Ms. Young has highlighted the role, qualifications, and duties of athletic trainers. He emphasized that athletic trainers are not personal trainers. MR. DEAN offered his belief that the greatest consideration for licensure is public safety. He recalled that House Bill 15 was enacted in 2011 and specifically named athletic trainers as a qualified health care provider who can evaluate, manage and treat concussions; however, currently in Alaska, anyone could call his/herself an athletic trainer. The Alaska State Activities Association (ASAA), the Anchorage School District, and the FNSB School District have worked hard to promote concussion education and awareness and identify athletic trainers as a qualified health care provider to treat concussed student athletes. Further, a parent, student, and coach should be assured that the athletic trainer is a certified trainer and has the necessary education and competency to provide quality health care. Earlier, a question was asked about any negative events in Alaska regarding athletic trainers. He related a scenario in which a 14-year-old student who suffered a concussion that took 3.5 weeks to heal. The student completed the return-to-play protocol as defined by ASAA, which is standard in the medical community and returned to full participation on a Wednesday. He played again and suffered another concussion, was helped off the field by the coaches, and sat on the sideline in pain for 30 minutes. At the end of the game the mother was informed that her son was simply scared, but the coach insisted her son did not have a concussion. Although she asked whether the coach was an athletic trainer and qualified to make the determination and he said he was, he was not. The scenario highlights an instance in which someone represented himself incorrectly and placed a student athlete at risk, he said. 4:39:06 PM MR. DEAN, in response to an earlier question, related that insurance billing is an area he would like to pursue. Currently, athletic trainers cannot bill because they are not licensed providers. He said his number one priority after obtaining licensure will be to ask insurers to recognize them, as other states have, to identify them as health care providers. In further response to a question on employment opportunities, he indicated one physical therapist's office has the authorization to hire five athletic trainers once this bill is passed. He emphasized that this bill will help, and he thanked members for the opportunity to testify. 4:40:24 PM REPRESENTATIVE REINBOLD surmised that injuries likely happen more often since coaches need players to win and may not "have the will" to identify the injury. She suggested that it is better to have a more objective person make these decisions. She thanked him for his testimony. CHAIR OLSON, after first determining no one else wished to testify, closed public testimony on HB 160. 4:41:17 PM REPRESENTATIVE REINBOLD moved to report HB 160 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 160 was reported from the House Labor & Commerce Standing Committee.