SB 21-LICENSE MOBILE INTENSIVE CARE PARAMEDICS  4:12:37 PM CO-CHAIR SNYDER announced that the final order of business would be SENATE BILL NO. 21, "An Act relating to mobile intensive care paramedics; relating to duties of the State Medical Board and the Department of Health and Social Services; and providing for an effective date." 4:13:17 PM SENATOR JOSH REVAK, Alaska State Legislature, as the prime sponsor, presented SB 21. He reported that licensure oversight of Alaska's approximately 600 licensed paramedics is currently split between two separate agencies - the State Medical Board under the Department of Commerce, Community, and Economic Development (DCCED), and the Emergency Medical Services Office under the Department of Health and Social Services (DHSS). He stated that the purpose of SB 21 is to help Alaska's paramedics by consolidating the emergency medical service system under a single agency, DHSS, to improve peer and professional oversight. Unanimously supported by the State Medical Board, it also has broad support from first responders and paramedics around the state. SENATOR REVAK explained that SB 21 would transfer all paramedic licensure to the Emergency Medical Services Office. He noted that, currently, paramedics are the only one of their kind under DCCED, all other emergency medical services are already under DHSS, which is responsible for certifying all emergency medical technicians (EMTs) and intensive care paramedics. The bill would not change the scope of practice, the licensure requirements, or the fee structure. The medical direction would be provided by the existing DHSS Chief Medical Officer and the EMS Medical Directors Committee. He further noted that the bill would have zero fiscal impact and that DHSS's existing data systems are already able to incorporate paramedic licensure, making the move a seamless transition. Aligning all EMS services under a single agency would promote public health and safety, he continued, while also providing efficiencies through peer and professional oversight. The bill has bipartisan support and passed unanimously on the Senate floor. 4:15:25 PM SETH DUGGAN, Staff, Representative Josh Revak, Alaska State Legislature, provided the sectional analysis for SB 21 on behalf of Senator Revak, prime sponsor. He paraphrased from the written document titled, "SECTIONAL ANALYSIS, Senate Bill 21," which read [original punctuation provided except for some minor formatting changes]: Sec. 1 amends 08.64.107, State Medical Board/ Regulation of physician assistants and intensive care paramedics, to remove regulation of paramedic licensure from the Medical Board. (See also Sec. 8.) Sec. 2 amends 08.64.170(a), License to practice medicine, podiatry, or osteopathy, allowing paramedics to practice medicine to render emergency lifesaving service under "another law" instead of under the Medical Board's authority. (See also Sec. 6) Sec. 3 amends 08.64.360, Penalty for practicing without a license or in violation of chapter, to remove paramedics. (See also Sec. 10) Sec. 4 amends 08.64.369(d), Health care professionals to report certain injuries, to change paramedics licensed under the Medical Board to those licensed under DHSS, for health care providers who must report certain injuries to the Department of Public Safety. Sec. 5 amends 12.55.185(11), Sentencing and Probation, to change paramedics licensed under the Medical Board to those licensed under DHSS. Sec. 6 amends 18.08.075, Authority of emergency medical technician, to allow paramedics to provide emergency medical care. (See also Sec. 2.) Sec. 7 amends 18.08.080, Emergency Medical Services/ Regulation, to require DHSS to adopt regulations establishing standards for paramedic licenses. Sec. 8 adds a new paragraph 18.08.082(a)(5), Issuance of certificates; designations, to add regulation of paramedic licensure to DHSS. (See also Sec. 1.) Sec. 9 amends 18.08.082(b), Issuance of certificates; designations, to clarify that DHSS is the central certifying and licensing agency for emergency medical services. Sec. 10 amends 18.08.084(a), Certificate required, to prohibit a person from practicing as a paramedic without a license. (See also Sec. 3.) Sec. 11 amends 18.08.086(a), Immunity from liability, Adding the term license. Provides civil immunity to licensed or certified emergency medical providers who are providing emergency medical service. They are not liable for civil damages unless [it's] gross negligence. Sec. 12 18.08.089(a) is amended to clarify a paramedic is allowed to pronounce someone dead in certain circumstances. Sec. 13 adds a new paragraph (14) to 18.08.200, Emergency Medical Services/Definitions, to add the definition of "mobile intensive care paramedic". (See also Sec. 14.) Sec. 14 Amends 29.45.050(r) to include mobile intensive care paramedics in a municipal property tax exemption. Sec. 15 amends 37.05.146(c)(77)(F), Definition of program receipts and non-general fund program receipts, to add fees for licensure of paramedics to the list of fees collected by DHSS. Sec. 16 repeals 08.64.366, Liability for services rendered by a mobile intensive care paramedic (See Sec. 11, 18.08.086, Immunity from liability, under DHSS). Repeals 08.64.380, Medicine/Definitions to remove (3) "emergency lifesaving service" and (4) "mobile intensive care paramedic" (See also Sec. 13). Sec. 17 amends the uncodified law to provide transitional authorities: (a) A current paramedic license issued before January 1, 2022 remains valid until it expires under the Medical Board, is suspended or revoked, or is converted to a license under DHSS. (b) The Department of Commerce, Community and Economic Development and the Medical Board will transfer to DHSS on January 1, 2022, files of all pending paramedic-related records and proceedings, applications, and disciplinary actions. (c) Authority for DHSS to adopt regulations which shall include the conversion of unexpired paramedic licenses issued under the Medical Board. Sec. 18 provides an immediate effective date for DHSS to adopt regulations. Sec. 19 provides an effective date of January 1, 2022. 4:18:45 PM REPRESENTATIVE SPOHNHOLZ noted that most of the licensing for health care professionals is done in DCCED. She remarked that there seems to be an exception here, wherein SB 21 is seeking to consolidate licensure for EMTs and paramedics into one spot. She asked why [the sponsor] chose to go with DHSS rather than, for example, staying with DCCED and creating a new board. SENATOR REVAK answered that all the EMS services are already housed under one roof within DHSS. The split between the two occurred at the time when intensive care mobile paramedics were created, and [this split] has caused some significant challenges to licensure. So, [consolidating EMTs and paramedics] is a cleanup measure. REPRESENTATIVE SPOHNHOLZ said she understands the rationale for moving paramedics from under the Medical Board. It used to be that everything was under the Medical Board, she continued, but now it has been realized that health care providers who have different expertise can regulate and manage their own licensure, and paramedics should be allowed to do that. However, she pointed out, most licensure in the state of Alaska is done in DCCED and the choice is being made here to move paramedics under DHSS as opposed to moving EMTs under DCCED. She inquired about the rationale for doing that. SENATOR REVAK deferred to the agency to answer the question. 4:21:58 PM BRIAN WEBB, Emergency Medical Services Officer, Division of Public Health, Department of Health and Social Services (DHSS), noted he is one of a remaining few who were on the ground at the time this whole thing was started. He stated that there are no emergency medicine or paramedical subject matter experts in DCCED, plus emergency medicine and paramedical professionals do not have much input into changing regulations for their craft. So, paramedics always seem to be left behind. However, the Emergency Medical Services Office, with all its in-house paramedics, would have the ability to develop and change regulations and keep up to date with new procedures in the craft. Changes to education requirements, standards, and procedures are easily done within the Emergency Medical Services Office, yet it is exceedingly hard to do for the Medical Board. [Paramedics] have tried for years to have a seat on the Medical Board because there are over 655 paramedics in Alaska. However, [paramedics] have been repeatedly told they will not have a seat on the Medical Board because that would mean somebody else would have to give up a seat. One reason why [paramedics] have requested this, Mr. Webb continued, is to have some control over their craft and their future. Another impetus comes from the 2014 National Highway Transportation Safety Administration's (NHTSA's) reassessment of emergency medical services in Alaska, which recommended that the Alaska State Legislature transfer the licensing of paramedics from the State Medical Board to DHSS. A footnote to this recommendation, he added, is that only four states have a similar regulatory split; most states have their personnel under their semblance of an Emergency Medical Services Office. REPRESENTATIVE SPOHNHOLZ said she understands the issue of wanting to move out from underneath the State Medical Board it doesn't make any sense that paramedics be licensed and decisions about licensing for paramedics be done by the State Medical Board, particularly if there isn't space for paramedics to sit on that board. But, she continued, most of the other health care practitioners have their own boards that are made up of peers of their own choosing and they make the regulations and licensing standards, and they sit under DCCED's Division of Corporation, Business, and Professional Licensing. All other health care items, health care licensing and facility licensing, sit at DHSS, but the practitioners themselves are governed, licensed, and managed under DCCED. She asked whether consideration was given to creating a board of paramedics that was made up of paramedics and which would be responsible for managing licensure under the DCCED. 4:26:07 PM SARA CHAMBERS, Director, Division of Corporation, Business, and Professional Licensing, Department of Commerce, Community, and Economic Development (DCCED), replied that the bill was originally, and continues to be, presented not as a "let's solve a problem with a variety of options;" rather, this is the proposal. She stated that the division did not explore deeply the idea of creating a new board, or proposing that the legislature create a new board, because DHSS is already so well resourced and already has all the staff and the programming set up for emergency services that it didn't make sense from an efficiency standard to try to recreate that or something similar on DCCED's side. She said DCCED's model of governance through a board is very different than the EMS management model with paramedics already on staff who are working to govern those regulations through the public process. Of these two processes, DHSS is far better resourced than DCCED to provide the value to paramedics and consistency with the [Emergency Medical Services Office]. REPRESENTATIVE SPOHNHOLZ asked whether paramedics are governed, regulated, and licensed this same way in other states or whether paramedics tend to sit in the same department as nurses, physician assistants, doctors, and other health care providers. MR. WEBB responded that four states have this same split and are currently trying to solve that as well. Therefore, the majority are through their semblance of a state EMS office. In further response, he agreed to provide written details. 4:29:27 PM CO-CHAIR SNYDER opened public testimony on SB 21. 4:29:48 PM WILMA VINTON, testified in support of SB 21. She related that she is the assistant chief of EMS for the state's volunteer fire department, which is responsible for ensuring that folks are certified, and she is also an instructor for the State of Alaska and teaches many EMTs throughout the Interior. She said she assists EMTs and Mobile Intensive Care Paramedics (MICPs) with acquiring and maintaining their certifications and licensure. She stated she has personally gone through both processes, first becoming certified as an EMT in Alaska from Montana in 1979 and then becoming an MICP in 2007, and it is her opinion that moving from the State Medical Board to the Emergency Medical Services Office in DHSS is an excellent way to streamline the licensing and certification process. MS. VINTON pointed out that EMTs and MICPs work side by side, yet certification and recertification requires working with two different agencies and two different processes. She said the Emergency Medical Services Office currently certifies EMTs within 7-20 days of testing, and she doesn't see a problem with MICPs being licensed in the same timeline. Currently, the MICP licensing process under the State Medical Board can take several months because the board only meets quarterly to approve licenses, causing a backup in receiving certifications and licenses. The Emergency Medical Services Office, however, has staff whose daily job is to provide licensing and certification. They have honed the process and will be as thorough as the State Medical Board's process, albeit in a shorter amount of time. This shortened timeframe is important to someone who is trying to get a paramedic job in Alaska. Ms. Vinton offered her strong belief that it would be a seamless move and would align the MICPs with EMS like in many other states. She concluded by urging the committee to support SB 21. 4:33:01 PM CO-CHAIR ZULKOSKY offered her understanding that SB 21 would create an intensive care paramedic in addition to an EMT. SENATOR REVAK replied that it doesn't create a new one, it moves the paramedics from DCCED over to DHSS with the rest of EMS. SENATOR REVAK returned to an earlier question by Representative Spohnholz and explained that when initially looking at this problem this seemed to be the easiest path that made the most sense since EMS is already running seamlessly under DHSS. 4:34:15 PM CO-CHAIR SNYDER closed public testimony on SB 21. CO-CHAIR ZULKOSKY asked whether adopting this legislation would have any downstream impacts for people who are currently paramedics in Alaska. SENATOR REVAK responded that SB 21 should not affect the scope of service in any way. MS. CHAMBERS responded that DCCED has pledged to DHSS that it would be a seamless transition and there are no proposed or anticipated changes other than to potentially receive augmented services through the new department. She said DCCED is working behind the scenes to make this as coordinated as possible. REPRESENTATIVE MCCARTY expressed his support for SB 21. [SB 21 was held over.]