HB 237-INTERSTATE MEDICAL LICENSURE COMPACT  4:36:23 PM CHAIR SEATON brought the committee back to order. CHAIR SEATON announced that the final order of business would be HOUSE BILL NO. 237, "An Act relating to an interstate compact on medical licensure; amending the duties of the State Medical Board; and relating to the Department of Public Safety's authority to conduct national criminal history record checks of physicians." 4:36:55 PM TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State Legislature, reported that proposed HB 237 was model legislation, already entered into by 12 states with 11 other states considering it, and passage would enter Alaska into the Interstate Medical Licensure Compact. She stated that the purpose of this compact was to create another venue into medical licensure by joining other compact states in creating an expedited license process for qualified physicians, as well as creating an interstate commission to administer the compact and maintain all the necessary information. CHAIR SEATON asked for an explanation to the necessity of the proposed bill. MS. HANSEN shared that the proposed bill was a result of the delays in the licensure process, and she directed attention to a letter from Aaron Kusano [Included in members' packets] which listed specific changes for improvement to the process. Upon investigation, she shared that awareness of the Interstate Medical Licensure Compact became an option. She relayed that the basic premise of the compact, that physicians in a compact state could verify eligibility within the state of primary licensure, and then, if eligible, register with the interstate commission and list the other states in which they requested licensure. These states would then be notified of the physician's eligibility, and upon receipt of the licensing fees, the doctor would be licensed. This would allow a physician to work through the compact for verification instead of through each state individually, thereby avoiding the duplicative process. CHAIR SEATON pointed out the need for physicians, emphasizing that these were medical licenses, and noted that there was also a nurses licensing compact, which was not included in this proposed bill. MS. HANSEN expressed agreement, reiterating that a goal was to ensure that the state had enough providers to address all the health care needs, which was "a real concern in some communities, that we do have a shortage of health care providers." 4:41:03 PM REPRESENTATIVE VAZQUEZ directed attention to the FAQ, page 1, [Included in members' packets] and read: "possess specialty certification or be in possession of a time unlimited specialty certificate." She asked for clarification about whether a general practitioner would be eligible for participation. MS. HANSEN acknowledged that they would "take feedback from the medical board and practitioners as to who would be eligible." She shared that her research indicated that almost 80 percent of physicians would currently be eligible for the expedited license under the current definitions, and that the other physicians would still be able to apply for a license in the State of Alaska. She declared that this did not supersede the licensing procedure in Alaska, it only provided another venue. REPRESENTATIVE VAZQUEZ reiterated that this appeared that only doctors with a specialty certification would be allowed to use the compact mechanism. MS. HANSEN deferred the question to the medical board, noting that the bill defined the specialty certifications. REPRESENTATIVE VAZQUEZ declared her support for the goal of the proposed bill. Noting that it was necessary for 7 states to join the compact for it be launched, she asked how many states had currently joined the compact. MS. HANSEN replied that there were already 12 states in the compact, although no licenses had yet been awarded. She reported that the interstate commission had met on December 18, 2015, and would meet again in the near future, in order to establish the by-laws. REPRESENTATIVE WOOL asked if this was also designed for physicians practicing telemedicine in multiple states. MS. HANSEN explained that it would still depend on the specific statutes on an eligible physician for telemedicine in Alaska, although eligibility would also be dependent on being licensed in the State of Alaska. REPRESENTATIVE VAZQUEZ asked if this was a step toward more use of telemedicine. CHAIR SEATON explained this was a step that would permit this, but it would not institute it, as a person had to be licensed and pay the licensing in the state. He clarified that it was necessary for an expedited license in each state, and that the compact did not create a single license for use in all compact states. 4:46:15 PM REPRESENTATIVE VAZQUEZ directed attention to the FAQ, page 2, and read: "have successfully completed a graduate medical education (GME) program." She said that she would have a question about this, opining that it was a question for the medical board. She directed attention to another requirement on page 2, of the FAQ, and read: "have passed the USMLE or COMLEX within three attempts." She acknowledged that these were both technical questions. MS. HANSEN explained that the examination requirement was similar to what was currently in the medical statutes, and that there was a similarly worded requirement for having passed an approved GME program. She noted that the approving bodies in Alaska were different than those approving bodies in the compact, and she deferred to the state medical board for further discussion. She directed attention to the letter dated January 13, 2015, from the Director of the Division of Corporations, Business and Professional Licensing detailing interest by the Department of Commerce, Community & Economic Development but not indicating any current reservations. 4:48:17 PM MS. HANSEN referenced the Sectional Analysis of HB 237, [Included in members' packets] explaining that Sections 1 - 6 were Alaska specific language to include the Interstate Medical Licensure Compact; whereas, Section 7, the main body of the proposed bill, was the model language to enter into the Compact, and could not be substantially changed if Alaska desired to be a part of the Compact. She reported that Section 8 of the Sectional Analysis was also Alaska specific language. She paraphrased from the Sectional Analysis of HB 237, which read: Section 1- Amends AS 08.64.101, duties of the state medical board, to include implementation of the Interstate Medical Licensure Compact. Section 2- Adds to AS 08.64.190 to require a physician applying for an expedited license under this compact to submit the fingerprints and fees necessary for a criminal background check. Statute does not currently require physicians licensed in Alaska to have a background check. Section 3- Requires the medical board to waive licensure requirements if a physician is eligible for expedited licensure under the Interstate Medical Compact. Section 4- Authorizes the Department of Commerce, Community, and Economic Development to set fees for the issuance or renewal of expedited licenses. Section 5- Clarifies in AS 08.64.370 the exceptions to licensure requirements under chapter 08.64. Section 6- Amends the definition of the "practice of medicine" or "practice of osteopathy" to allow for the definition under the Interstate Medical Licensure Compact. 4:50:20 PM MS. HANSEN moved on to explain that Section 7 of the proposed bill was the model legislation, and that the first seven sections of Section 7 dealt with the ground rules for entry into the Compact. She paraphrased from Section 7, which read: Section 08.64.500- Enacts and enters Alaska into the Interstate Medical Licensure Compact as created in the following sections. Section 08.64.510- States that the purpose of the compact is to provide a streamlined licensure process that enhances portability while complementing existing state license authority. Maintains the jurisdiction of individual state medical boards. Section 08.64.520- Defines terms to be used throughout the compact, including definitions of "expedited license" and "physician" for the purpose of qualification for an interstate expedited license. Section 08.64.530- Declares that a physician must meet the eligibility requirements defined in 08.64.520(11) to receive an expedited license. Allows that a physician that does not meet these requirements may obtain an individual state license if all state laws and requirements are met. Section 08.64.540- Directs a physician to designate a compact member state as the state of principal licensure to register for an expedited license and defines what qualifies as a principal state of licensure. 4:52:28 PM MS. HANSEN moved on to the next section, which outlined how to get an expedited license, and read: Section 08.64.550- Outlines how a physician shall apply for an expedited compact licensure through an application with the medical board of the physician's state of principal license. The board shall evaluate the physician's eligibility under the compact, including through primary source verification and criminal background checks. If determined eligible, the physician shall then register with the Interstate Commission, select states of licensure, and pay any necessary fees to each selected member state before receiving licenses in those states. A physician must follow all applicable laws and regulations of the issuing state. REPRESENTATIVE WOOL asked whether a physician arriving in Alaska from a state not participating in the Compact could simply fulfill the Alaska requirements, although this would take longer. 4:54:50 PM MS. HANSEN expressed her agreement. She returned attention to the Sectional Analysis, which read: Section 08.64.560- Allows compact member states to impose a fee for expedited licensure and authorizes the Interstate Commission to develop rules regarding these fees. Section 08.64.570- Describes how a qualified physician may seek renewal of an expedited license through the Interstate Commission. States that the physician shall comply with any continuing education requirements of any member state where they seek a renewed license, and that member states may charge renewal fees through the Interstate Commission. Section 08.64.580- Establishes a database of all physicians licensed through the Interstate Commission and describes what information compact member states must report. Section 08.64.590- Outlines how compact member boards may participate in joint investigations. Section 08.64.600- States that any disciplinary action taken by one member board may be acted upon or imposed by other member states, that if a license is revoked by the state of principal license all other member state licenses are automatically revoked, and that if the license is revoked by a state that is not the principal state of license all other licenses are automatically suspended for 90 days for investigation by each member board. 4:57:23 PM MS. HANSEN described the last sections of the model legislation, which read: Section 08.64.610- Creates the Interstate Medical Licensure Compact Commission to administer the Interstate Medical Licensure Compact and describes the voting members and meeting procedures of the commission. Each member state shall have two voting representatives. Section 08.64.620- Describes the powers and duties of the Interstate Commission. Section 08.64.630- Authorizes the Interstate Commission to levy an assessment against member states to cover its costs and requires certain financial restrictions of the commission. Section 08.64.640- Sets out the organization and operation of the Interstate Commission including the adoption of bylaws, the election of officers, and the immunity and liability of commission directors and employees. Section 08.64.650- States that the Interstate Commission shall promulgate reasonable rules for the administration of the compact and describes a petition against a commission rule. Section 08.64.660- Declares that all branches of a state government shall enforce the Compact and maintains that the Compact shall not override existing state authority to regulate medicine. Section 08.64.670- Provides guidelines for how the Interstate Commission may take legal action to enforce the provisions and the rules of the Compact. Section 08.64.670- Outlines procedures of the Interstate Commission should a member state default in its obligations under the Compact. Section 08.64.690- Allows the Interstate Commission to promulgate rules for dispute mediation and resolution at the request of a member state or states. The following sections relate to the effective date, withdrawal proceedings, and other construction questions relating to the Compact. 4:59:35 PM MS. HANSEN paraphrased from the Compact, that for any change to the Compact, the member states would have to give unanimous consent, which read: Section 08.64.700- Declares that the Compact shall be effective and binding on member states once enacted by no less than seven states, that nonmember states shall be invited to participate as a non-voting member, and that a proposed amendment to the Compact shall not become binding unless enacted by unanimous consent of the members states. Section 08.64.710- Provides that a member state may withdraw from the Compact one year after the effective date of a statute repealing the Compact in that state. Section 08.64.720- States that the Compact and the Interstate Commission shall dissolve if the Compact membership is reduced to one member state. Section 08.64.730- Allows that the provisions of the Compact are severable, should any one provision be deemed unenforceable. Section 08.64.740- Details the interaction between the Compact and other laws of member states, including that laws in conflict with the Compact are supersede to the extent of the conflict and that Compact provisions that are in conflict with a state constitution shall be ineffective to the extent of the conflict. Section 08.64.750- Allows the state medical board to designate a compact administer to facilitate that administration of the Compact across state departments and agencies. 5:00:35 PM MS. HANSEN reviewed the final section, Section 8, which read: Section 8- Amends existing Alaska statute AS 12.62.400 to allow the Department of Public Safety to submit fingerprints to the Federal Bureau of Investigation to obtain a national criminal background check for physicians applying for expedited licensure. [HB 237 was held over]