SENATE BILL NO. 25 "An Act extending the termination date of the Board of Dental Examiners; and providing for an effective date." 1:31:52 PM SENATOR DAVID WILSON, BILL SPONSOR, thanked the committee and apologized for being held up with other state business. He reviewed the bill sponsor statement: Senate Bill 25 extends the termination date for the Board of Dental Examiners until June 30th, 2027. The Board of Dental Examiners is composed of nine members: six dentists, two dental hygienists, and one public member. Legislative Audit conducted their review of this board and determined that "The audit concludes that the board operated in the public's interest by effectively licensing and regulating dentists, dental hygienists, and dental assistants. The board monitored licensees and worked to ensure only qualified individuals practiced in Alaska. Furthermore, the board was active in amending regulations to improve the industry. In accordance with AS 08.03.010(c)(7), the board is scheduled to terminate on June 30, 2019. We recommend that the legislature extend the board's termination date eight years to June 30, 2027." The Board of Dental Examiners serves an important role in adopting regulations to carry out the laws governing the practice of dentistry and dental hygiene in Alaska. The continuation of this board plays an important role in ensuring high standards of dental care are offered throughout the state. Senator Wilson reported that Legislative Audit made 2 recommendations to the board. He read the recommendations from the sunset review: Recommendation 1: The Board of Dental Examiners (board) president should take steps to correct a regulation error. A 2016 change to a dental radiological equipment regulation resulted in regulations referring to a repealed section of regulations. Specifically, 12 AAC 28.965 states: (b) The inspection of dental radiological equipment must (1) be performed by an inspector who is on the list maintained under (d) of this section; However, section 12 AAC 28.965(d) was repealed March 2016. Senator Wilson reported that the board had corrected the error. Recommendation 2: Division of Corporations, Business and Professional Licensing's chief investigator, in consultation with the board, should implement controls to ensure the appropriate entities are notified when a licensee's prescription authority is suspended or revoked. Senator Wilson explained that although the investigations were done in a timely manner, Legislative Audit found that there were no procedures and notified the Board of Pharmacy or the Federal Drug Enforcement Administration when a licensees prescription authority had been suspended or revoked. The Division had immediately addressed the issue by implementing controls to ensure that the entities were appropriately notified. Senator Wilson drew members' attention to the fiscal note. The note reflected a spend of $35,100 which paid for expenses for board travel, attending meetings, advertising, and board and conference fees. Professional licensing programs within the Division of Corporations, Business and Professional Licensing were funded by Receipt Supported Services with designated general funds. Licensing fees were covered by the costs of the board. Senator Wilson reviewed the sectional analysis: Section 1. AS 08.03.010(c)(7) is amended to read: (7) Board of Dental Examiners (AS 08.36.010) - June 30, 2027 [2019]; Sec. 2. This Act takes effect immediately under AS 01.10.070(c). Senator Wilson reviewed the available testifiers and urged members support. Co-Chair Wilson invited Kris Curtis to the table. 1:35:59 PM KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF LEGISLATIVE AUDIT, indicated the purpose of the sunset audit, dated April 2018 (copy on file), was to determine whether a board or commission was serving the public's interest and whether it should be extended. She read from the audit report: The audit concludes that the board operated in the public's interest by effectively licensing and regulating dentists, dental hygienists, and dental assistants. The board monitored licensees and worked to ensure only qualified individuals practiced in Alaska. Furthermore, the board was active in amending regulations to improve the industry. In accordance with AS 08.03.010(c)(7), the board is scheduled to terminate on June 30, 2019. We recommend that the legislature extend the board's termination date eight years to June 30, 2027. Ms. Curtis directed members to turn to page 6 regarding licensing activity. She relayed that as of January 2018 there were 2,399 active licenses. On page 7 there was a schedule of board revenues and expenditures. It showed that as of March 2018 the board had a deficit of $36,000. She reported that there was a fee analysis planned for 2018. The schedule of fees was on page 8. Ms. Curtis continued that the audit had two recommendations administrative in nature. The first recommendation was a regulation error which should be easy to address. A 2016 regulation change resulted in one regulation referencing a repealed recommendation. The second recommendation was an issue the auditor also found with the Board of Nursing. She explained that when a licensee's prescription authority was suspended or revoked, there were no procedures to notify the Board of Pharmacy or the Federal Drug Enforcement Administration (DEA). In the audit period she found two licensed dentists that had their prescription authority revoked and the information was not communicated to the proper entities. Ms. Curtis reported that the response to the audit was on page 21. The board agreed with both recommendations and planned to take corrective action. Representative LeBon mentioned there had been discussion about a level of dental practice that would allow a practitioner to serve the public in rural areas providing basic dental services. He asked if a discussion had ensued. Ms. Curtis responded that the audit did not look at the issue. However, she thought Dr. Neilson, the chairman of the board, could field the question. 1:39:21 PM DR. DAVID NEILSON, MEMBER, ALASKA BOARD OF DENTAL EXAMINERS (via teleconference), thought Representative LeBon was referencing the Dental Health Aide Therapist. He wondered if he was right. Representative LeBon responded in the affirmative. Dr. Neilson relayed that the particular provider was not regulated by the state or the board. They were regulated by Indian Health Service and supervised by dentists that work in the villages. It was difficult for him to comment except to say that it seemed to be working. Representative LeBon asked how common the program was throughout the state. He wonder how many practitioners were in the state. Dr. Neilson did not have the information. The best way to obtain the information would be through Alaska Native Tribal Health Consortium (ANTHC) or the tribes. Since the board did not license them, he did not know the numbers or where they were practicing. Co-Chair Wilson asked if Mr. Neilson had additional testimony. Dr. Neilson was available for questions. He supported the extension. Co-Chair Wilson asked if any regulations had been brought forward to make it easier for out-of-state dentists to provide service in Alaska. Dr. Neilson responded affirmatively. The board's goal was to accept all generally equivalent regional licensing exams. The board had a current regulation project that addressed the issue. He reported that it was just signed by the Lieutenant Governor's Office and should be in effect approximately by May 1, 2019. It should be in effect for the upcoming exam season. Co-Chair Wilson appreciated the information he provide over the interim. 1:42:31 PM DAVID LOGAN, ALASKA DENTAL SOCIETY, ANCHORAGE (via teleconference), reported that the Alaska Dental Society had worked with the board for several years to bring a change in place where dentists graduating from U.S. schools could take any regional board and apply for an Alaska dental license. The society was very glad to see the project come to an end. He conveyed that the Alaska Dental Society supported the board extension. 1:43:36 PM Co-Chair Wilson OPENED Public Testimony. 1:43:50 PM Co-Chair Wilson CLOSED Public Testimony. Co-Chair Wilson asked Ms. Chambers to review the fiscal note associated with the bill. SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT (via teleconference), reported that the fiscal note reflected all receipt supported services to continue the work of the board if extended through the recommended amount of time. All expenses were paid through license fees. There were no undesignated general funds. If the board was sunset there would not be expenses for maintaining the activity of the board. If the board was extended expenses would be incurred. She estimated about $35,000 per year for the activities of the board. If the bill was not successful and the board were not to continue, the division would assume all the responsibilities for the licensing program without the benefit of the wisdom of the board. Co-Chair Wilson understood the fiscal note reflected what the department would incur if the board was not in place. She wondered if the fees would drop down without the infrastructure of the board in place. Ms. Chambers responded that it was unlikely that the division would see a significant savings by simply discontinuing the board. The board was a group of experienced volunteers that provided service at no salary cost to the division. The division would likely have to obtain expert witnesses at a much higher cost to provide the expertise in regulations and advising regarding investigations. The real benefit went far beyond $35,000 per year to gather the board together to meet. Co-Chair Wilson did not object to the extension of the board. Rather, she was trying to be transparent with the fiscal note. She referred to page 7 of the audit which showed the state's direct expenditures for the board and the money collected. She thought the fiscal note should include the amount if board was extended. She thought the fiscal note currently reflected the amount if the board was not extended. Ms. Chambers replied that if the bill passed, the division would require $35,000 to continue the activities of the board. If the bill did not pass, the expense would not be part of the division's expenditures for the fiscal year. Co-Chair Wilson asked why the board was being given $145,216 in program receipts to do its business, but it was not reflected in the fiscal note. Ms. Chambers responded that the only thing that changed with the bill was the existence of the board. The rest of the program did not change. The division would continue to perform all licensing and investigative functions for the program. The fiscal note, per the legislature, reflected what the bill accomplished, not all of the expenses associated with the entire licensing program. Co-Chair Wilson suggested that if the board no longer existed there would still be fees incurred to regulate the profession. She asked if she was correct. Ms. Chambers responded positively. Co-Chair Wilson suggested that the fiscal note needed work. Representative Knopp tried to clarify Co-Chair Wilson's comment. He wondered if he understood correctly. Ms. Chambers responded in the affirmative. Co-Chair Wilson wanted to make sure when people were looking at the fiscal note they did not think the amount listed was all that the program was spending. SB 25 was HEARD and HELD in committee for further consideration.