CS FOR SENATE BILL NO. 92(FIN) "An Act relating to dental hygienists, dentists, dental assistants, dental hygiene, and dentistry." 9:31:35 AM DANA OWEN, STAFF, SENATOR DENNIS EGAN, discussed that the proposal for the legislation had been brought to the sponsor by a committee of dentists and dental hygienists. He explained that the related statutes had not been reviewed or revised in over 20 years; during that time there had been significant changes in dentist practices and regulation. He relayed that Dr. David Logan, former president of the dental board was present to provide detail. He furthered that due to the bill's high level of detail it had been amended in each committee of referral. Co-Chair Stoltze asked for a general overview of the legislation. Mr. Owen observed that it was unusual to have two groups such as dentists and hygienists come together on a single bill; groups that overlapped in their practice were frequently at odds over their scope of practice. Co-Chair Stoltze had detected some tension between the dentists and hygienists on prior iterations of the legislation; both groups would have a chance to testify during the meeting. DAVID LOGAN, LEGISLATIVE CHAIR, ALASKA DENTAL SOCIETY, thanked the sponsor's office for all of its work on the legislation. He shared that the society had reached out to the Alaska State Dental Hygienists' Association (ASDHA) in recognition that the bill affected both groups of professions. He relayed that a substantial amount of time had gone into the development of the legislation, given the numerous necessary changes. He explained that under the legislation the dental board investigator position would be increased from part-time to full-time, which would result in an increase of licensure fees for license holders. The legislation accomplished multiple items including, the determination of who was eligible to own a dental practice, the ability for a practice to transition out following the death of a practitioner, and significant language cleanup. 9:36:31 AM Representative Wilson asked what the increase in licensure fees would be. Mr. Logan responded that the fee increase would be determined by the Division of Corporations, Businesses and Professional Licensing (CBPL). He had heard estimates of a potential $100 increase. Representative Guttenberg referred to a former constituent who had been licensed and practiced dentistry in New Zealand for 10 years; the individual had not been able to obtain a license to practice in Alaska. He wondered whether the legislation would address the issue. Mr. Logan responded that the bill revised the section on qualifications for licensure and the ability to obtain a license through a credentialing process based on a dentist's previous practice and history. He observed that there were dentists credentialing in frequently from other countries. He deferred the question to the director of CPBL for additional detail. Representative Guttenberg replied that the individual had been told that he would need to go back to school in order to obtain a license in the state. He would discuss the matter with the CBPL director. Vice-chair Fairclough asked whether the bill altered past legislation that allowed dental hygienists to travel and work in rural areas without the supervision of a dentist. Mr. Logan replied that there was one section clarifying allowed procedures, but that no substantial change had been made. Vice-chair Fairclough asked for the specific section in the legislation. Mr. Logan pointed to Section 13, page 8. He expounded that the bill would insert the word "licensed" in front of the words "dental hygienist." 9:39:27 AM Representative Doogan surmised that the bill would allow other entities to own dental practices including municipalities and higher education facilities. Mr. Logan responded in the affirmative; Section 37.08.367 defined who could own a dental practice. Representative Doogan wondered why the ability to own a dental practice would be expanded to other entities. Mr. Logan replied that an entity may want to own a facility to provide care for poor people. Co-Chair Stoltze surmised that examples would include neighborhood health clinics or the Department of Corrections. Mr. Logan replied in the affirmative. Representative Doogan believed the provision opened the door for multiple dentists to take a share in a larger facility and to expand the number of people licensed in a particular place. 9:41:23 AM Mr. Logan replied that there was currently no size restriction on the number of dentists or hygienists allowed to work in one practice. Representative Doogan asked whether the bill would set up a situation in which a number of dentists could create a "Crowns R Us" practice. Mr. Logan replied that the bill would not limit the ability for dentists to open a "Crowns R Us" practice. Representative Neuman asked whether the bill strengthened or weakened hygiene requirements. Mr. Logan responded that the bill would only clean up any antiquated language related to dental hygienist requirements. He furthered that current statute referred to a state exam; however, the exam had not been conducted for approximately 20 years. Qualifications remained the same and included graduation from hygiene school, passing a national written test, and a regional practical board. 9:43:40 AM GAIL WALDEN, MEMBER, ALASKA STATE DENTAL HYGIENISTS ASSOCIATION, WASILLA (via teleconference), supported the bill. She was on the committee that had worked to review, update, and condense the Dental Practice Act that was addressed in the legislation before the committee. She stated that the bill maintained the current high dental hygiene standards, licensure, and practice. She added that the bill updated a significant amount of outdated information in statute. Co-Chair Stoltze believed that the process that had gone into developing the legislation was notably better than in prior attempts because dentists and hygienists had worked together. Representative Neuman pointed to Section 3 related to dental hygienist qualifications. He asked for verification that the bill only provided cleanup language and did not hinder the ability of existing hygienists to practice in Alaska. Ms. Walden responded that ASDHA felt strongly that the language would not make changes that would affect dental hygienists or impact care. She emphasized the association's support for the wording included in the bill. Representative Guttenberg asked about the goal of proposed language in Section 21: "the board may delegate the board's power to act here and decide matters." Mr. Logan replied that the mechanism allowed the board to delegate some of the administrative capacities to the division. The day-to- day paperwork would be virtually impossible for the practicing professionals on the board. 9:46:42 AM Representative Guttenberg asked for verification that the bill would give some of the board's responsibility to the department. Mr. Logan replied that the board was assigned certain powers under the central statutes and it was necessary to have the ability to delegate items to the division from a practical standpoint; decisions would still be made by the board. Ms. Walden thanked the committee for hearing the bill. Co-Chair Stoltze CLOSED public testimony. Representative Wilson asked about current licensure fees and how much they would increase under the proposed legislation. DON HABEGER, DIRECTOR, CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, replied that currently a dental license fee renewal cost approximately $290 to $300; renewal for a dental hygienist license was $120. There were a number of factors included in the determination of a new fee; a new position would be created to meet the mandate of the legislation. There was currently a part-time dental investigator; the work would be shifted and other professions would pick up the 30 percent to 50 percent cost. Professionals would not pick up the entire cost; on the high-end the increase would be approximately $80 on top of the current price. He did not believe the analysis would show the high-end increase because the board had a $100,000 roll-forward that may be used. A discussion and decision on the fees would take place with the board and once determined the detail would be set in regulation. Vice-chair Fairclough asked whether the increase would be proportionately raised between the dentist and dental hygienist licensees. Mr. Habeger answered that CBPL was required to have the discussion with the board prior to setting the fees; therefore, he did not know whether the increase would be directly proportional or equal. Vice-chair Fairclough wondered who was sitting on the board in order to determine how the fees would be allocated between the two groups. 9:51:17 AM Ms. Walden replied that ASDHA understood that the fees would be up for discussion. She believed the board would factor in that there were more investigations related to dentistry than dental hygiene. Representative Doogan noted that the initial fiscal note of $113,000 was reduced to $107,000 [in subsequent fiscal years]. He wondered whether the remainder represented the leftover cost after the fee increase. He asked whether the fiscal note would be zeroed out. Mr. Habeger responded that the initial $113,000 recognized necessary startup costs for items such as office equipment; because those items would not be needed in subsequent years the cost had been reduced [after FY 13]. Representative Doogan asked whether the note should be zero [after FY 13]. Mr. Habeger replied that the startup costs would be reduced to zero in subsequent years. Representative Doogan pointed to the annual $107,000 cost that extended out beyond the first year. Mr. Habeger replied that certain costs would continue and were factored into the $107,000 including, the investigator salary, transportation costs of approximately $2,000 per year, contractual costs such as the involvement of the Department of Law if an investigation went to a hearing, and other. Representative Doogan surmised that the additional cost was related to law enforcement and not salary. Mr. Habeger replied in the affirmative. He specified that costs included in the $107,000 subsequent to FY 13 would be for the investigator, and support services (including telephone and internet). Representative Doogan thought that the fiscal increase resulting from the legislation would be covered by dentists and dental hygienists; he no longer believed that was the case. Co-Chair Stoltze noted that Representative Doogan's initial understanding was correct. 9:55:29 AM Vice-chair Fairclough pointed to the Department of Commerce, Community and Economic Development Fiscal Note 3. She explained that for personnel services, costs would be funded by receipts received by professionals. The fiscal note included funds for travel, services, and commodities. Commodities began at $6,000 in FY 13 and were reduced to $1,000 from FY 14 to FY 18. The department was requesting $112,900 in FY 13 from receipts collected from dental and dental hygiene licensing; the figure was reduced to $107,000 annually from FY 14 through FY 18. There was one full-time position that would be hired in perpetuity to be supported by licensing fees. Co-Chair Stoltze MOVED to ADOPT Amendment 1 (by request of the sponsor): Page 15, following line 27: Insert a new bill section to read: "* Sec. 30. AS 08.36.234 is amended by adding a new subsection to read: (d) A dentist applying for licensure without examination shall be interviewed in person by the board or by a member of the board before a license is issued. The interview must be recorded. If the application is denied on the basis of the interview, the denial shall be stated in writing, with the reasons for it, and the record shall be preserved." Renumber the following bill sections accordingly. Co-Chair Thomas OBJECTED for discussion. Mr. Owen explained that the amendment addressed an item that had been overlooked earlier in the bill process. He asked Dr. Logan to explain the intent of the amendment. Mr. Logan communicated that dentists and hygienists could obtain a license by taking an exam at one of the regional boards or hygienists could use their past five years of practice history as a basis. He furthered that the board felt that there were not really any meaningful questions to ask during the hygienist licensure process; similarly there was not much to ask dentists coming out of school because they had no practice experience or track record. He detailed that the amendment would make it mandatory for dentists who were credentialing into the state to interview with the board because they did have a past track history. Representative Costello asked about the decision to include the language "or by a member of the board." She believed that the responsibility for the people applying for licensure in the state should be taken on by the entire board. Mr. Logan replied that the decision had been made by Legislative Legal Services with the goal of giving the board flexibility. He was agreeable to the change that would include the board in its entirety. Representative Costello MOVED to AMEND Amendment 1 on line 5 to delete "or by a member of the board." Representative Guttenberg OBJECTED for discussion. He asked whether a decision by one member of the board would have to be ratified by the entire board. Mr. Logan replied that each application for credentialing was ratified by the majority of the board. Representative Guttenberg asked for verification that Amendment 1 would allow the examination of a dentist credentialing into the state to be conducted by a single board member and the change under the amendment to Amendment 1 would require the examination to be conducted by the entire board. Mr. Logan responded in the affirmative. Representative Gara agreed that all of the board members should have the opportunity to ask questions during an examination of a dentist credentialing into the state. He asked for verification that his understanding was the intention of the amendment to Amendment 1. Representative Costello replied in the affirmative. Co-Chair Stoltze observed that there may be occasions when the board was not able to get together for a couple of months, which could delay an interview. He did not want to cripple the board's ability to conduct interviews. Vice-chair Fairclough wondered how the change would impact a dentist who moved to an isolated location for service; the person may be required to travel to a board meeting. She asked how often the board met. Mr. Logan replied that the board met quarterly. He relayed that jurisprudence examinations occurred at board meetings; therefore, interviewees would be required to attend a meeting for their interview. 10:02:52 AM Representative Joule wondered whether the amendment to Amendment 1 would require all members of the board to be present at the board meeting to conduct an interview. Mr. Owen replied that the quorum to do business would be sufficient. 10:04:55 AM  RECESSED 2:21:11 PM RECONVENED Co-Chair Stoltze indicated that an amendment to Amendment 1 had been discussed earlier in the morning. He asked if there were any amendments to Amendment 1. Representative Edgmon asked whether the earlier contemplated amendment was no longer part of Amendment 1. Co-Chair Stoltze indicated there were no amendments to Amendment 1. Co-Chair Thomas WITHDREW objection. There being NO further OBJECTION Amendment 1 was adopted. Co-Chair Thomas MOVED to report HCS CSSB 92(FIN) out of committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. HCS CSSB 92(FIN) was REPORTED out of committee with a "do pass" recommendation and with previously published fiscal impact note: FN3 (CED). 2:23:45 PM AT EASE 2:26:40 PM RECONVENED