SB 21-LICENSE MOBILE INTENSIVE CARE PARAMEDICS  2:09:44 PM CHAIR WILSON reconvened the meeting and announced the consideration of 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." He states his intent to hear an overview of the bill and take invited testimony. He asked the staff of bill sponsor Senator Revak to introduce the bill. He noted a number of people available online to answer questions. 2:10:43 PM DIRK CRAFT, Staff, Senator Josh Revak, Alaska State Legislature, said that SB 21 seeks to consolidate oversight of the Emergency Medical Services (EMS) system under a single agency to better provide better peer and professional oversight. This has been years in the making through a deliberative process that involved hundreds of stakeholders throughout the EMS community. It has been unanimously supported by the State Medical Board and has broad support from paramedics around the state. Currently EMS oversight is split between the State Medical Board within the Department of Commerce and the EMS section of the Department of Health and Social Services (DHSS). This bill will transfer all paramedic licensure to the Alaska Emergency Medical Services in DHSS, which currently is responsible for certifying EMTs (Emergency Medical Technicians), EMT instructors, EMT training, ground ambulance and medevac services, paramedic instructors, and paramedic training. The split arose because paramedics did not exist in Alaska before 1974. After 1974, the term mobile intensive care paramedic was created for the new scope of practice in the Anchorage and Fairbanks fire departments. EMS within DHSS did not exist in Alaska code until 1981 when the responsibility to license and credential paramedics was placed under the State Medical Board. In 1984 the EMS section became fully functional; however, the paramedic licensure still stayed under the State Medical Board. MR. CRAFT said that SB 21 will not change the scope of practice, license requirements, or fee structure for the approximately 600 paramedic licenses in Alaska. Medical direction will be provided by the existing DHSS chief medical officer and the EMS medical director's committee comprised of 11 members specializing in emergency medicine, five of whom are required to have paramedic experience. The EMS existing data systems are able to incorporate paramedic licensure, making the move a seamless transition. Transferring oversight and licensure of mobile intensive care paramedics from the State Medical Board to DHSS will fully integrate the EMS system and ensure it is robust, sustainable, and resilient. Aligning all EMS services under a single agency better promotes public health and safety while also providing efficiencies through peer and professional oversight. 2:13:11 PM SETH DUGGAN, Staff, Senator Josh Revak, Alaska State Legislature, Juneau, Alaska, presented the sectional analysis: 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 subsection 18.08.082(a)(5), Issuance of certificates; designations, to add regulation of paramedic licensure to DHSS. (See also Sec. 1.) 2:14:40 PM Sec. 9 amends 18.08.082(b), Issuance of certificates; designations, to clarify that DHSS is the central certifying and licensing agency for all 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 license because they are certified. This means it provides immunity in 08.02, which includes paramedics. They are not liable for civil damages unless it's gross negligence. Sec. 12 18.08.089(a) is amended to allow a paramedic to pronounce someone's death if the paramedic falls under one of the three categories. 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. Emergency Medical Services are already under this, this section just clarifies Mobile Intensive Care Paramedics. MR. DUGGAN noted that Section 14 is only for voluntary EMS staff. 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 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. 12). Sec. 17 amends the uncodified law to provide transitional authorities: (a) A current paramedic license issued before January 1, 2021 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, 2021, 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. 2:16:55 PM SENATOR BEGICH said that anecdotally he has heard that the process for EMT licensure takes a long time. He asked if this will this speed up that process. He noted the blank pages in the fiscal notes and asked if the bill would lead to any cost savings. MR. CRAFT replied that speeding up the process was one of the primary reasons for introducing the legislation, as well to house all these emergency medical personnel under one professional licensing statute. The fiscal notes are zero because the department can absorb any potential change in cost but he would defer to the department. 2:18:24 PM CLINT FARR, Deputy Director, Division of Public Health, Department of Health and Social Services (DHSS), Juneau, Alaska, said that DHSS can absorb any costs associated with the transfer of paramedics to his division. The division already has certification/licensure processes in place and licenses thousands of EMTs annually, so with the number of paramedics, the office can absorb that with current staffing and processes. SENATOR BEGICH asked when jurisdiction transfers from the State Medical Board, if there is a provision for public comment about any issues with EMS services. MR. FARR replied that the public has a way to comment through the regulatory process. He deferred to Todd McDowell. 2:20:11 PM TODD MCDOWELL, EMS Program Manager, Division of Public Health, Department of Health and Social Services (DHSS), Juneau, Alaska, answered that the medical director's committee has biannual meetings open to the public for comment. SENATOR REINBOLD asked if the governor's executive order to split DHSS into two departments takes effective, which commissioner would EMS be under. CHAIR WILSON answered the Division of Public Health. He clarified with Mr. Farr. MR. FARR replied that is correct. SENATOR REINBOLD suggested that if DHSS is bifurcated, the bill should have conforming language. She shared that the Chugiak Fire Department is so important to her community and asked that they be allowed to weigh in. She would love to hear from them and their views on the bill. SENATOR HUGHES said that when the classification was first created, the only place to put it was under the State Medical Board. She asked why the change has taken so long. MR. CRAFT replied there is a long history. Brian Webb who was a paramedic around that time can explain. 2:23:57 PM BRIAN WEBB, representing self, Anchorage, Alaska, said he was a former regional EMS training coordinator. He has been involved with this for many years. One of the issues with his generation of medics was a feeling if they switched from licensure to certification that would somehow diminish their stature and them as a medical practice as a whole. His era has retired or died off. The newer generation is looking at streamlined and easier ways of doing things because the paramedic licensure process in Alaska is a dramatic affair. He has been working on this for the past 20 years. He started this process with Senator Birch over three years ago. The paramedics have tried to do this in different ways over the years and finally the nexus came to be to do it legislatively. SENATOR HUGHES said she will try to help them get it across the finish line. Her husband was in Vietnam as a medic and was an EMT and then a paramedic. She asked what the difference is between an EMT and a paramedic. She observed the fiscal note that moving the paramedics over will create a smoother pathway for career advancement for EMTs. MR. WEBB said that the Office of EMS is already staffed by paramedics who already manage the training and certification as mentioned. That will streamline process, especially for people from out of state. It will simplify a lot of things. The subject matter experts are already at the Office of EMS who know the process and can streamline it for folks in the future. SENATOR HUGHES asked him to explain an EMT vs a paramedic. MR. WEBB said that an EMT I requires 110-160 hours of training with no clinical experience required before certification. An EMT I can become an EMT II with another 50-80 hours of training, plus some additional skills and patient care verification. To become an EMT III requires 50-80 hours of additional training and a test. Paramedics are in classrooms for over 1,000 hours and then after graduating from a paramedic program they spend about 650 hours in the lower 48 riding along with an advanced life support ambulance service. Then they take the national registry test and apply for state licensure. It is a much longer road with advanced skill sets compared to EMTs. 2:29:03 PM CHAIR WILSON opened public testimony. 2:29:14 PM WILMA VINTON, representing self, Fairbanks, Alaska, said that she is a mobile intensive care paramedic (MICP) since 2007 and an EMT since 1979. She is an assistant chief of EMS for Steese Volunteer Fire Department. She is an EMS instructor and past adjunct faculty for the University of Alaska Fairbanks paramedic program. She assists EMTs and MICPs with acquiring and maintaining their certifications and licenses. She has personally gone through both processes. This move from the Medical Board to EMS in DHSS is an excellent way to streamline the licensing process. EMTs and MICPs work side by side, but when she is assisting members with certifying and recertifying, she is working with two different agencies and processes. The state Office of EMS is already providing certification to EMTs in an efficient and effective manner. EMTs are regularly certified within a week of testing but definitely within 20 days. She sees no problems with MICPs being licensed in that same timeline. The licensing under the State Medical Board can take several months. The board only meets four times a year. The Office of EMS has staff who work on this on a daily process. This shortened timeframe is especially important for someone trying to get job in Alaska as a paramedic. It will be a seamless move and will align the MICPs with EMS as they are in many states. This will benefit students, military leaving the service, and those in the lower 48 seeking jobs in Alaska as paramedics. 2:32:06 PM RICHARD ETHERIDGE, Alaska Fire Chiefs Association, Juneau, Alaska, said the Fire Chiefs Association supports SB 21. Paramedics often have to be hired from out of state. It often takes several months to get licensed in Alaska because of licensure through the Medical Board. The delay places a burden on a community trying to get paramedics to serve. Sometimes it takes six to eight months. Transitioning paramedics to EMS will shorten the timeframe of getting licenses or certificates. There will be no decrease in quality control. It is beneficial for fire chiefs to have one state agency to work with for continuing education and certification. The State Medical Board voted to support this transition and the Office of EMS is wiling to accept the program. 2:33:56 PM MICHAEL LEVY, M.D., EMA Medical Director, Anchorage, Alaska, was not able to testify because of sound problems. CHAIR WILSON asked him to submit his testimony to shss@akleg.gov. 2:35:53 PM CHAIR WILSON closed public testimony. SENATOR REINBOLD noted that the next committee of referral is Labor and Commerce and asked that the chair to get the feedback of the Chugiak Fire Department. CHAIR WILSON replied that the bill is not moving out of committee today. The bill sponsor will try to get in touch with the fire department before the bill moves out of committee. SENATOR COSTELLO added that her staff has been in touch with the fire department and will work to make sure their concerns are heard. 2:36:49 PM CHAIR WILSON held SB 21 in committee.