SENATE BILL NO. 38 "An Act extending the termination date of the State Medical Board; and providing for an effective date." 9:11:12 AM Senator Olson appreciated the committee hearing the bill and stated that it was important to the state's medical profession. DAVID SCOTT, STAFF, SENATOR DONNY OLSON, stated that the bill extended the sunset of the Alaska State Medical Board from June 30, 2013 to June 30, 2020. He discussed the makeup of the Alaska State Medical Board and shared that it was responsible for the licensing, regulation, and discipline of physicians, podiatrists, physician's assistants, and paramedics in Alaska. He related that an audit, which had recently been conducted through the Division of Legislative Audit had recommended that the sunset be extended. He indicated that there was someone present from the division to answer questions regarding the change. 9:13:41 AM Co-Chair Kelly MOVED to ADOPT the proposed committee substitute for SB 38, WORK DRAFT 28-LS0391\U (Martin, 3/12/13). There being NO OBJECTION, the CS was ADOPTED as a working document. KRIS CURTIS, LEGISLATIVE AUDITOR, DIVISION OF LEGISLATIVE AUDIT, stated that during the past year, the division had conducted a sunset audit (copy on file) of the Alaska State Medical Board with the purpose of determining whether the board was serving the public's interest and should be extended. She indicated to the committee that her manager would continue reading her talking points. DIANE BURNHAM, AUDIT MANAGER, DIVISION OF LEGISLATIVE AUDIT, stated that the division recommended that the Alaska State Medical Board's termination date be extended 7 years until June 30, 2020. The recommendation was 1 year less than the 8-year maximum in recognition of 1 new finding related to continuing medical education (CME) reviews. She shared that during the audit period, the medical board had gone through 2 bi-annual licensing cycles and that in 1 of those cycles, the Division of Corporations, Business and Professional Licensing (DCBPL) had failed to review CME requirements in accordance with the regulations; regulations had required that 208 or 5 percent of licensees be reviewed, but the staff had only reviewed 172, or 4 percent of licensees. She expounded that the division recommended that the DCBPL director ensure that the quantity of licenses selected for review meet the minimum required by regulations. Ms. Burnham stated that the report also included two ongoing recommendations, the first of which was associated with deficiencies in the DCBPL investigative case management system; the deficiencies were noted in several FY11 special audits and sunsets audits; this audit had found that several investigative cases reviewed for the medical board were missing key information in the system such as priority codes, case open dates, and resolutions codes. She continued that the deficiencies in the case management system hampered the division's ability to provide adequate investigative support to the board and shared that the division had also taken steps to make improvements by forming a task forum to identify necessary corrective action. Ms. Burnham shared that the report's second ongoing recommendation was for the DCBPL director to implement procedures to ensure that board disciplinary actions were reported in accordance with state and federal law; the law required that disciplinary actions be reported to national data banks. She expounded that a previous audit had found that not all disciplinary actions were being reported and that some were being reported after the 30-day limit. She explained that the division's review had found some improvement in that all the disciplinary actions that it reviewed were report to the data banks; however, none were reported within the 30-day limit. Senator Olson surmised that the existence of a CME issue did not necessarily compromise any licensee or health care provider and inquired if that was correct. Ms. Curtis replied that the Division of Legislative Audit's recommendation had been addressed to the DCBPL staff to review the applications for renewal and did not indicate that there was any type of abuse occurring. Senator Olson commented that the Alaska State Medical Board and DCBPL had done a superb job in the last 12 years. Co-Chair Meyer CLOSED public testimony. 9:18:54 AM Co-Chair Meyer noticed that the bill proposed an increase for the Alaska State Medical Board's executive secretary. He noted that the increase would be program receipt supported and that was not too concerned about it if the sponsor was not; however he requested an explanation of the increase. Mr. Scott responded that the sponsor had been approached by the president of the Alaska State Medical Board's regarding the increase. He related that the scope and volume of the work being done by the executive director was not on parody with other similar boards and that the state medical board had requested the sponsor to offer the increase. He stated that Ed Hall, who was the president of the state medical board, should be online to answer questions. Vice-Chair Fairclough inquired what the current salary scale was for the position, as well as what the proposed increase was. Mr. Scott replied that the current salary was a range 17 and that it was being increased to a range 23. Vice-Chair Fairclough noted that the difference in pay from a range 17 to a range 23 was a big jump and inquired what that increase represented in dollar terms. She noted that the increase would use program receipts and queried if the the president was acting on behalf of the state medical board when he had made the request. She observed that the position was for a full-time executive secretary and not an executive director. Senator Olson clarified that the president of board would be the best suited to answer the question. 9:21:28 AM ED HALL, PHYSICIAN ASSISTANT AND FORMER PRESIDENT, ALASKA STATE MEDICAL BOARD, ANCHORAGE (via teleconference), stated that the medical board had collectively discussed the range increase and recognized that the responsibilities that had been placed on the board's executive administrator had continually increased; furthermore, over this time, the range of the position had not been increased. He understood that the position was currently at a range 18 and related that the Board of Public Accountancy (CPA Board) had passed a bill to bring its executive administrator to a range 23. He offered that a range 18 was the equivalent of a legislative front desk receptionist and conveyed that the board had collectively agreed that its executive administrator's responsibilities far exceeded that of a receptionist's; furthermore, the position's responsibilities and the number of licensees were increasing and the board had concerns regarding retention of the medical providers in the state. He expounded that the medical board needed to continue to keep up pace with the processing of applications, which the executive administrator was an integral part of. He related that the fiscal costs for the increase would be paid by the licensees, but that he did not think it would represent a significant hit to the licensing fees. He pointed out that for the past several years, the board had been rolling over more than $1 million, which was why it was comfortable asking for the range increase. He discussed the need for the medical board to maintain a quality executive administrator and shared that licensing examiners' salaries were not on parody either; DCBPL was trying to improve the examiners' salaries to address retention issues and high attrition rate. 9:25:56 AM Vice-Chair Fairclough pointed out for the record that it was her experience that front desk positions in the legislature were usually around a range 14. Co-Chair Meyer inquired how many staff members there were total and observed that the fiscal note showed 2. Mr. Scott responded that there were two staff members, but that there was other support that the board received through DCBPL and the Department of Commerce, Community and Economic Development. He added that Mr. Habegar, who was the director of DCBPL, could probably answer the question better. Senator Olson stated that some of the support staff included investigators. 9:27:49 AM AT EASE 9:29:13 AM RECONVENED 9:29:21 AM Vice-Chair Fairclough pointed to page 8 of the Division of Legislative Audit's report and inquired if Mr. Hall had the report on hand. Mr. Hall replied that he did not have the document in front of him. Vice-Chair Fairclough read from a paragraph on page 8 of the report: ..Deficiencies in the division's investigative case management system have not been addressed. Vice-Chair Fairclough continued to discuss page 8 of the Division of Legislative Audit's report. She related that the report discussed a medical board special audit and pointed out that while the board was coming into compliance slowly, it appeared as if there were still a few issues being raised; she inquired if Mr. Hall could speak to those issues. Mr. Hall replied that investigative processes had changed and that the board had a better system of checks and balances to make sure that reporting to the National Practitioner Data Bank had improved. He observed that Mr. Habegar may be better suited to speak to investigative staff issues. Vice-Chair Fairclough noted that it was specifically recommended on page 8 of the legislative audit report that the state medical medical board establish regulatory timeliness for processing complaints and inquired if the board had discussed this. Mr. Hall responded that the issue had been addressed and that timely reporting was another responsibility that had been given to the board's executive administrator. Vice-Chair Fairclough inquired if the same individual who had been the executive administrator in the past would be continuing forward in the position with a pay raise. Mr. Hall replied that the board hoped that was the case and added that he did not think that the person was planning on moving on soon despite what the board saw as a disparity in the position's pay-range level. Vice-Chair Fairclough inquired if the position's hours were being expanded. Mr. Hall replied that he was not certain if the position's hours had been expanded, but that the board did have that individual attend the Federation of State Medical Boards' meeting, which was an annual occurrence, as well as other appropriate trainings that were necessary. 9:32:43 AM Vice-Chair Fairclough stated that she did not have a problem with the advancement of the medical board's executive assistant's pay range; however, if the issue was that the same person who was working the same amount of hours could not accomplish the task because they were not being paid enough, then she had problem with that. She observed that someone should be doing their job regardless and wondered if, given the limited number of hours in the day and the large raise, the board might need another staff member; however, she supported the board's extension and would leave it up to the board itself and Senator Olson to make sure the appropriate tools were available to address the issues that auditors had identified as weaknesses in the program. Senator Olson agreed with Vice-Chair Fairclough's line of questioning and noted that he was also cautious because from his perspective, the salary raise would represent an increase to his annual fees and licensure costs. He understood that there was turnover within the "department" because the salary was not commensurate with other executive administrators and inquired if that was one of the reasons that the increase had been requested. Mr. Hall responded that during his tenure, the medical board had two executive administrators and that the recognition of the position's work for the board was continually increasing. Mr. Hall addressed Vice-Chair Fairclough's comments regarding hours spent. He shared that, unofficially, the person currently in that position did their job within the 8-hour work day, but also worked beyond that. He surmised that the board's executive administrator had not "seen an 8-hour day" in quite a while. He stated that regarding turnover, both of the executive administrators during his tenure had been very dedicated to the medical board and its business and explained that despite a dissatisfaction with the range level, the employees had been committed for other reasons. 9:36:03 AM Co-Chair Kelly MOVED to REPORT SB 38 out of committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. CSSB 38(FIN) was REPORTED out of committee with a "do pass" recommendation and with a previously published fiscal impact note: FN1(CED). 9:36:39 AM AT EASE 9:39:56 AM RECONVENED