SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE  4:05:55 PM CHAIR DUNBAR reconvened the meeting and announced the consideration of SENATE BILL NO. 89 "An Act relating to physician assistants; relating to collaborative agreements between physicians and physician assistants; relating to the practice of medicine; relating to health care providers; and relating to provisions regarding physician assistants in contracts between certain health care providers and health care insurers." 4:06:12 PM SENATOR LÖKI TOBIN, District I, Alaska State Legislature, Juneau, Alaska, sponsor of SB 89 introduced herself. 4:06:20 PM MACKENZIE POPE, Staff, Senator Löki Tobin, Alaska State Legislature, Juneau, Alaska, provided the sectional analysis for SB 89. She introduced herself. 4:06:24 PM SENATOR TOBIN explained that the legislation was reintroduced to address barriers to care in Alaska, particularly through a pathway to independent licensure for physician assistants (PAs). She shared that she is currently studying public policy and recently researched U.S. healthcare policy, noting it has historically been ad hoc and shaped by competing interest groups since the 1942 Stabilization Act. She emphasized that Alaska faces the highest healthcare costs in the nation, and while SB 89 will not fix all systemic issues, it is a necessary step toward increasing access to care. 4:08:00 PM SENATOR TOBIN stated that SB 89 aims to establish a pathway to independent licensure for physician assistants. She emphasized that Alaskans face difficulty accessing preventative care and basic medical support for common ailments. She explained that physician assistants play a key role in patient care by assessing conditions and consulting their networks for complex cases outside their scope. She underscored the importance of recognizing and elevating the professional experience of physician assistants. 4:08:31 PM SENATOR TOBIN explained that many may be unaware of the rigorous education and training required for physician assistants. She noted that the profession began in the 1970s on battlefields, evolving into a formal education system for PAs. She stated that applicants to accredited physician assistant programs typically have over 3,000 patient contact hours prior to entering a 27- month graduate-level program, which includes 2,000 hours of clinical rotations alongside medical students. She added that Alaska requires continuing medical education every two years and a comprehensive exam every ten years for physician assistants to maintain licensure. 4:09:38 PM SENATOR TOBIN stated that SB 89 differs from previous iterations due to stakeholder input and reflects a compromise addressing their concerns. She explained that SB 89 permits physician assistants to pursue independent licensure after completing 4,000 hours under a collaborative agreement, in addition to the initial 2,000 clinical hours. She added that if a physician assistant changes specialties, the State Medical Board may require up to 4,000 more contact hours, totaling up to 10,000 hours before independent licensure when there is a change in specialty. She acknowledged that this differs from the process for nurse practitioners but emphasized that the bill seeks to balance professional advancement with stakeholder concerns. 4:10:47 PM SENATOR TOBIN stated that maintaining collaborative agreements has proven burdensome for physician assistants. She noted that last year 12 percent of collaborating physicians lived outside Alaska, a number that has since increased to 14.5 percent. She emphasized that physician assistants often must pay to maintain these agreements despite providing quality care under remote supervision. She concluded by stating that SB 89 preserves State Medical Board oversight, restricts independent surgery, maintains care standards, and creates a pathway to independent licensure to expand access to affordable, community-based preventative care. 4:12:40 PM SENATOR HUGHES stated she had no conflict of interest, although her husband is a retired physician assistant who served on the Vietnam battlefield, where the profession originated. She shared that her husband often worked remotely in villages with minimal contact from the collaborating physician. She said when her husband's rural patients went to Anchorage and Fairbanks for care, often physicians consulted with her husband because he was familiar with the patient. She expressed support for SB 89 but asked for clarification on the required hours, summarizing 3,000 clinical hours before program entry, 2,000 during clinical rotations, and 4,000 under a collaborative agreement before independent licensure. She asked whether any additional hour requirements apply. 4:13:50 PM SENATOR TOBIN clarified that the 3,000 clinical hours mentioned prior to entering a physician assistant program are not a formal requirement but reflect the average experience of individuals pursuing a graduate-level degree in the field. 4:14:34 PM MS. POPE provided the sectional analysis for SB 89: [Original punctuation provided.] Senate Bill 89: Sectional Analysis  Section 1. Removes state medical board (SMB) reference to AS 08.64.107 Regulation of Physician Assistants which is repealed and reenacted in a later section. Section 2. Repeals and reenacts 08.64.107 to restructure the physician assistant authorizing statutes. Subsection (a) directs the SMB to adopt regulations related to the acts within the practice of medicine that physician assistants (PAs) may perform, which must allow for PA practice of acts they are generally educated and trained to perform. This subsection specifically prevents PAs from performing surgery without supervision. This subsection also directs the SMB to promulgate regulations for PAs who switch specialty, and the methods by which a collaborating physician will assess a PA.   Subsection (b) establishes that a PA with less than 4,000 postgraduate clinical hours may only practice under a collaborating agreement. These collaborative agreements must be in writing and describe the specialty the hours are completed within, as well as the oversight methods.   Subsection (c) outlines that assessment for PAs practicing in rural areas can be done telephonically or via video. Subsection (d) outlines the process for a PA to notify the SMB if they begin to practice a new specialty. Subsection (e) requires a copy of the collaborative agreement be provided to the SMB. At such a time as the PA reaches the required postgraduate hours, they shall notify the SMB and complete an attestation provided by the SMB. Subsection (f) directs the SMB to assess whether that specialty will require additional requirements or hours. For specialty change, or in other regulation change, the requirements are not to exceed the clinical hours required in subsection (b). 4:16:23 PM MS. POPE continued the sectional analysis for SB 89: [Original punctuation provided.] Section 3. Amends 08.64 to add a new section laying out the qualifications for physician assistant qualifications for licensure. Section 4. Amends 08.64.230 to add an additional section directing the SMB or it's executive secretary to grant a license to qualified applicants. Section 5. Amends the existing statute to include physician assistants in the list of medical practitioners whose licensure we recognize from other states and provinces of Canada. Section 6. This amends 08.64.250 to include PAs in the existing temporary licensure process and reference the new applicable section 08.64.206.   4:16:48 PM  MS. POPE continued the sectional analysis for SB 89: [Original punctuation provided.] Section 7. This section amends the existing statute to include physician assistants alongside the other medical practitioners in the list of temporary licensure and substitute roles in different medical facilities.   Section 8: Adds a subsection to include PAs in the fee requirement when applying for a license.   Section 9: Amends the section to include PAs in the existing statute regarding the SMBs parameters for evaluating any extenuating circumstances to waive certain requirements for meeting licensure qualifications. Section 10. This section amends AS 08.64.326 subsection (a) to include PAs in the existing statutes regarding the process for being sanctioned for crime, misrepresentation, and failure to pay fees, to name a few of the examples given in the statute. Section 11. This amends the existing statute to include PAs in the existing voluntary surrender provisions in AS 08.64.334. Section 12. This amends the existing statute to include PAs in the process for medical practitioners who treat fellow licensed medical practitioners for alcoholism, drug addiction, and mental/emotional disorders who might constitute a danger to their patients or themselves, to report to the SMB. 4:17:56 PM MS. POPE continued the sectional analysis for SB 89: [Original punctuation provided.] Section 13. Grants immunity in civil liability for PAs who submit a report in good faith to the SMB relating to addictive substances abuse. Section 14. Amends statute so that PAs cannot refuse to submit a report to the SMB or withhold evidence on the grounds that it is under doctor-patient confidentiality. Section 15. Updates the statute covering all state licensees under this chapter, including PAs, to specify that if they practice without a valid license, they are guilty of a class A misdemeanor. Section 16. Amends the statute to include PAs in the list of medical providers who can support a licensed physician in another state, in the support of the regular medical service of the United States Public Health Service, or volunteering services to the armed services of the US among other unique medical support situations. Section 17. Amends the statute to allow physicians assistants to show their PA credentials to communicate their qualifications. Section 18. Amends 08.64.380 to include PAs as providers who can accept concurrent referrals for systemic disease treatment. Section 19: Amends the definition of practitioner to include physician assistant in the statute. 4:19:10 PM MS. POPE continued the sectional analysis for SB 89: [Original punctuation provided.] Section 20: Puts in statute the definition of physician assistant. Section 21: Amends the statute referenced to be in line with the repealed statutes removed by previous sections. Section 22: Adds a section under AS 21.07.010 to prevent any requirements within a health care insurance policy from being more restrictive than or inconsistent with the practice, education, or collaboration provisions outlined in AS 08.64. 4:19:32 PM MS. POPE continued the sectional analysis for SB 89: [Original punctuation provided.] Section 23: Updates the definition of licensed physician assistants to remove the supervision requirement allowing for PAs who have completed their postgraduate clinical requirements and are no longer subject to a collaborating physician agreement to continue their practice. Section 24: Amends the statute to include physician assistant in the definition of health care provider in statute. 4:19:52 PM CHAIR DUNBAR stated that he initially believed the 4,000 hours mentioned in SB 89, Section 2(f), were required for a new specialty. He sought clarification, asking whether the State Medical Board has discretion to set additional hours up to 4,000. He asked if the Board could reduce the hours depending on the specialty. 4:20:40 PM MS. POPE replied that an initial 4,000 hours are required. She explained that if a physician assistant chooses to switch to a different specialty, the State Medical Board may require additional hours, not to exceed 4,000. 4:21:07 PM SENATOR HUGHES noted that definitions for surgery vary widely. She observed that some definitions include minor procedures like stitching a wound, which physician assistants commonly perform without direct supervision. She contrasted this with major procedures such as heart surgery. She asked if "surgery" is defined elsewhere in statute or if clarification is needed. 4:21:42 PM SENATOR TOBIN responded that her office would follow up on the definition of "surgery." She stated that the current language was recommended by Legislative Legal Services, based on her intent to align physician assistants' scope of practice with standards accepted across all 50 states. 4:22:07 PM CHAIR DUNBAR stated that [surgery] was a point of contention last year with some groups interested in the bill and emphasized that it is an issue that needs to be clearly defined. 4:22:21 PM SENATOR TOBIN thanked the committee for hearing SB 89 and reiterated the goal of addressing concerns from stakeholders, associations, and groups. She emphasized the importance of creating a pathway to independent licensure, noting that an unfair system arbitrarily limits the ability of qualified individuals to provide quality care. She stated that reintroducing the bill reflects a policy decision she believes is the right course of action. 4:22:57 PM CHAIR DUNBAR held SB 89 in committee.