SB 186-EXTEND BOARD OF EXAMINERS IN OPTOMETRY  3:19:12 PM CO-CHAIR FIELDS announced that the first order of business would be SENATE BILL NO. 186, "An Act extending the termination date of the Board of Examiners in Optometry; and providing for an effective date." 3:19:25 PM SENATOR GARY STEVENS, Alaska State Legislature, as the prime sponsor, presented SB 186 and urged that the Board of Examiners in Optometry be extended. He stated that optometrists provide most of the eye care to patients across Alaska, plus an in- person examination by a Doctor of Optometry is recognized as the standard for ensuring healthy vision. He pointed out that over 270 serious health conditions can be detected through eye exams, including diabetes, high blood pressure, autoimmune diseases, and cancers. The Board of Examiners in Optometry is essential to the practice of optometry in Alaska, he continued. It is self-funded and is the regulatory body that helps protect the public by implementing standards of care, ongoing education, and training in the field of optometry. The board, he reported, received an overall favorable audit indicating its work is an important public service. 3:21:16 PM CO-CHAIR FIELDS opened invited testimony on SB 186. 3:21:29 PM KRIS CURTIS, CPA, CISA, Legislative Auditor, Division of Legislative Audit, provided invited testimony on SB 186. She spoke from the written audit report in the committee packet titled "A Sunset Review of the Department of Commerce, Community, and Economic Development, Board of Examiners in Optometry (board)," dated 6/9/21. She stated that, overall, the audit concluded [pages 5-8 of the report] that this board conducted it meetings in compliance with state laws, effectively licensed optometrists, and actively amended regulations to address statutory changes and improve the licensing function. However, she specified, the audit also found that the Division of Corporations, Business and Professional Licensing (DCBPL) staff did not serve the public's interest by not consistently recording the existence of a [federal] Drug Enforcement Administration (DEA) number in the DCBPL database, by not ensuring continuing education audits were conducted timely, and by not monitoring licensees' compliance with continuing education in pain management and opioid use and addictions. Ms. Curtis said the division is therefore recommending a six-year extension for this board, two years less than the eight-year maximum allowed under statute, reflecting the need for more timely oversight given the audit findings. MS. CURTIS drew attention to page 9 [Exhibit 2] of the audit report and noted that as of [1/31/21] there were 218 licensed optometrists, an 18 percent increase since the board's last sunset date of 2013. She then drew attention to page 10 [Exhibit 3] depicting the board's schedule of revenues and expenditures and discussed the board's deficit of approximately $52,000 as of 1/31/21. She said a fee increase recommended in April 2020 was not made due to the governor's direction not to increase the fees of occupational boards to help mitigate the financial impact of the COVID-19 pandemic. MS. CURTIS reviewed the audit recommendations on pages 13-15 of the audit report. The first recommendation, she related, is that the DCBPL director dedicate resources to ensure that the existence of a DEA license number is accurately reported in the DCBPL database. This information, she explained, is important to allow electronic crossmatch with the controlled substance prescription database to monitor the requirement to register with the controlled substance prescription database. Staff were provided instructions on how to do this, she noted, but did not follow the instructions. According to DCBPL management, she continued, regular turnover in the board's licensing examiner and supervisor positions contributed to this. She said the second recommendation is that the board chair and DCBPL director should change the license renewal form to allow the board to monitor compliance with continuing education requirements. A change effective July 2018, she explained, required licensees to obtain two hours of continuing education in pain management and opioid use and addiction. This change was two years prior to license renewal, but auditors found that the December 2020 license renewal form was not changed to require licensees to report compliance with this new requirement. The third recommendation, Ms. Curtis stated, is that DCBPL's director should ensure adequate resources are available to perform continuing education audits. These audits, she explained, are DCBPL's main internal control to ensure that licensees comply with continuing education requirements. The audit found that it took two and a half years to complete the continuing education audits that were due during the audit period, which was due to multiple licensing staff vacancies and turnover. MS. CURTIS concluded with a review of the management's response to the audit on pages 25-27 of the audit report. She stated that the DCBPL commissioner concurs with the conclusions and recommendations. She said the commissioner noted that the licensing examiner for this board turned over five times during the three-and-a-half-year audit period and the supervisor position turned over four times. That turnover, Ms. Curtis added, contributed to all the findings. She related that the board chair's response states that the deficiencies in the application of the renewal form will be corrected before the next renewal cycle. 3:25:34 PM CO-CHAIR SPOHNHOLZ inquired about the reason for the staffing turnover. MS. CURTIS replied that she doesn't recall a reason. CO-CHAIR SPOHNHOLZ remarked that it is a significant turnover occurring on a routine basis and it undermines the board's ability to function. She stated that for some licensing boards the salaries are defined in statute, but she doesn't remember if this is one of those boards. MS. CURTIS deferred to the DCBPL director to provide an answer. 3:26:11 PM SARA CHAMBERS, Director, Division of Corporations, Business and Professional Licensing (DCBPL), Department of Commerce, Community, and Economic Development (DCCED), answered that DCBPL regularly has turnover as well as challenges in adequate resourcing. She explained that this position is especially difficult because the Board of Examiners in Optometry does not warrant the workload of a full position control number (PCN), so it is a part of a PCN and, as part of a PCN, this position sometimes gets moved around. However, she explained further, the work this examiner does is deep, so the audit, which is complex in some of the statutory compliance elements, requires supervisory oversight. The day-to-day work for this board is not especially challenging but when routine issues come up, like renewal and audits every two years, then more hands-on is needed and those things require more institutional memory and training. This is endemic to some of the challenges that the committee has been talking about with the division, Ms. Chambers added. She further advised that these are classified positions as opposed to established in statute. 3:28:08 PM CO-CHAIR SPOHNHOLZ asked what the [division] is planning to do to ensure that the issue is not experienced again in another six years if the sunset extension is approved as proposed in SB 186. MS. CHAMBERS responded that, except for the audit, the first two findings were related to the new prescription drug monitoring program (PDMP) legislation. She explained that DEA registration and opioid education were new statutes being implemented for this board at this moment for the first time; those will not come up again because that work has already been done. She related that the division has now put into place several steps to have a fail-safe with continuing education audit training and calendaring. She said oversight by the division's paralegal has been added to ensure that in addition to the supervisor, there are eyes on this program's audits as well as all program audits. So, she advised, all these findings have been resolved. CO-CHAIR SPOHNHOLZ recalled legislation in 2018 that expanded the legal scope of optometrists to be consistent with the training of optometrists. She asked whether adopting the regulations to implement that legislation was part of the issue. MS. CHAMBERS replied that the board has not had any issues implementing the elements of that law. The findings of the audit, she explained, are administrative oversight or problems that are the responsibility of the division rather than concerns over scope of practice or elements that the board is held responsible for, so they are not at all related. 3:31:11 PM REPRESENTATIVE MCCARTY inquired whether licensees were asked to engage a DEA number. He further inquired whether a biennial license is done online and, if so, whether there is room for the licensee to provide a DEA number along with other information to expedite the process for the division. MS. CHAMBERS answered that the problem relevant to DEA numbers was that the division had to make changes to its system to accommodate and implement the new PDMP law. The division had to change its procedures in the database, she continued, and while DCBPL had published instructions and supervisors had issued instructions to examiners, the examiner did not make that change and the old way was not sufficient to meet the new standards of the PDMP. The DEA information was being collected but was being deposited in a different part of the database which made it hard to reconcile. That has been rectified, she specified. REPRESENTATIVE MCCARTY restated his question about the ability to renew a license online and whether the licensee can provide the information in a manner that expedites going into the state system and bypasses the examiner having to manually enter that information. MS. CHAMBERS replied yes, the division has online renewals for all 43 of its licensing programs, and this would be included. REPRESENTATIVE MCCARTY asked whether the DEA number is in the online request or must still be added to that. MS. CHAMBERS responded that the DEA number is collected in the initial application, but she doesn't recall whether the DEA number must be asked for again at renewal. She said she doesn't think DEA numbers change, but if it was required to be on the renewal the online application would mirror the paper application, so all the questions about opioid education, DEA, prescribing, and dispensing would be online as well as on paper. The online would make it more efficient to enter that data automatically. REPRESENTATIVE MCCARTY asked whether this could be expedited by removing the paper process and making it all online so that the licensee would be doing everything, so less load on staff to re- enter things. MS. CHAMBERS responded that the division is currently working on technology improvements to automate more of what the division is providing to its consumers and put that more in the hands of the applicant so it would bypass manual data entry. The division is looking forward to implementing that type of technology for all its programs, she said. 3:35:41 PM CO-CHAIR FIELDS [continued] invited testimony. 3:35:50 PM DAMIEN DELZER, OD, DipABO, Chair, Board of Examiners in Optometry, Division of Corporations, Business and Professional Licensing (DCBPL), Department of Commerce, Community, and Economic Development (DCCED), provided invited testimony on SB 186. He stated he has practiced optometry in Alaska for nearly 29 years and has served eight years on the Board of Examiners in Optometry, serving as chair for the last three. DR. DELZER explained that the board is charged with commission of public protection through vetting of new applicants, assuring appropriate continuing competency of licensees, addressing inquiries from the public, investigating any complaints, and crafting and enforcing regulations to implement legislative statutory change. The board implemented nearly 20 regulatory changes over the past three years, he related, including issues such as continuing education requirements like opioid education, scope of practice, military exemptions, specialty designations, modernizing the law examination, modernizing prescription requirements, and modifying emergency regulation during the recent COVID-19 pandemic. DR. DELZER noted there have been no reported PDMP violations during his eight years on the board. The board is self-funded through license fees, he said, and board travel expenses have been minimized through exclusive use of Zoom meetings over the past three years. The board chair, he added, participates in bi-weekly board chair meetings and bi-weekly PDMP meetings. 3:37:41 PM JESSICA GIESEY, OD, Alaska Eyecare Center, provided invited testimony in support of SB 186. She stated she has been practicing optometry in Alaska for eight years. She said the Board of Examiners in Optometry is vital to the practice of optometry in Alaska, acting to protect the public by ensuring that only qualified practitioners are licensed in Alaska and making sure that all optometrists licensed in Alaska follow continuing education guidelines. The board, she continued, regularly updates regulations ? (indisc. audio interruption) training from accredited schools and colleges of optometry. 3:38:36 PM REPRESENTATIVE MCCARTY asked whether optometrists are having difficulty getting their continuing education units (CEUs) post- COVID-19. DR. DELZER replied that he has not seen any issues with that. After the audit findings, he related, a continuing education audit was done in a very timely manner, and it does not appear that anyone is having difficulty finding appropriate virtual or live CEUs. [SB 186 was held over.]