SB 175-PRACTICE OF NATUROPATHY  1:34:24 PM CHAIR EGAN announced consideration of SB 175 and said that some committee members had questions. [CSSB 175(L&C), 27-LS1230\B, was before the committee.] DON HABEGAR, Director, Division of Corporations, Business and Professional Licensing, in the Department of Commerce, Community and Economic Development (DCCED), introduced himself. SENATOR PASKVAN asked Mr. Habegar to review the department's position on the recent restrictions put upon naturopaths that no one could identify the origin of and explain why nothing had been done. MR. HABEGAR replied that he had done a lot of digging in trying find the mileposts on this issue and found that the department has had a consistent interpretation of the statutes and regulations about it: one was that naturopaths don't have prescriptive authority. He found several complaints over the last 18 years during which naturopaths have been practicing. The first was dismissed because of lack of evidence. The second one brought the issue to the forefront and ended up with a consent agreement. The division has maintained that naturopaths don't have prescriptive authority, and that was the issue in this particular case. As it unfolded, pharmacies started asking the department about what prescriptive authority means and said they weren't supplying legend drugs to naturopaths. That is what led to the discussion before them today and the question of what the division is going to do. If legislation is not passed to correct the situation, he said the division is in a position to go out with regulations to clear up what is confusing language to all. Those regulations won't go out until after going through the process. How they proceed past that is yet undetermined. SENATOR PASKVAN asked him to precisely state, assuming legislation didn't pass, whether the regulations will be drafted allowing the practice that has existed over the last 18 years or not. MR. HABEGAR replied that because the division has interpreted statute to mean that no prescriptive authority has been granted by the legislature, regulations will be developed to comport to that. SENATOR PASKVAN said he understood that anecdotal issues have arisen - one a consent decree and the other dismissed - but it begs the issue that directors have let a practice exist for 18 years without doing anything. He was troubled about why all of a sudden they decided to do a 180 degree turn in terms of its application, whatever the interpretation is. 1:40:24 PM MR. HABEGAR said he recognized that there have been numerous interpretations and that some pharmacists have prescribed in response to written prescriptions, and if legislation is not passed, they would give the issue careful consideration. He believes it is important for regulations to support statute and not confuse licensees. SENATOR PASKVAN asked if he is supporting the legislation's passage to remove any uncertainty about interpretation. MR. HABEGAR replied yes, but SB 175 needs more clarity. For instance, hydro-therapy means the use of water in all forms. Is that the physical state of water that is deemed a liquid or is it hydrotherapy with all its various components, i.e. saline solution? And clarifying this language would help the division immensely. 1:43:07 PM CHAIR EGAN said this is the fourth meeting on this bill and the department should have offered an amendment a couple of meetings ago if it had issues. Testimony the committee has received indicates that this legislation clarifies what has been done for 18 years; it isn't changing anything. MR. HABEGAR responded that he had a fiscal note and part of it was about getting a group of professionals together and help them to hammer out the details. The mix of professionals wasn't specified, but certainly MDs should be part of the process and someone from the Board of Pharmacy. SENATOR DAVIS asked if he truly understands what SB 175 does. For 18 years naturopaths had the authority to prescribe medicines from pharmacies and all of a sudden something happened to take that authority away and the director just told them the division plans to write regulations in support of that. So this legislation won't do anything. MR. HABEGAR responded that he thinks SB 175 takes regulation that was supporting their interpretation of statute, which was no prescriptive authority, and adds that prescriptive authority. There is room for clarification through the regulatory process and he would do that with the help of experts. 1:46:13 PM SENATOR MENARD joined the committee. SENATOR DAVIS asked if he had shared his idea of clarity with anyone, because they had been working on this bill for a long time; he had even testified on it. Now today when they are getting ready to move it, he is saying it needs more clarification and doesn't have anything to suggest. MR. HABEGAR apologized for being remiss in addressing the committee's concerns, but it is an ongoing process. 1:47:28 PM SENATOR GIESSEL said her concern and the concern of her colleagues is that a professional license with its accompanying scope of practice is a property right and it sounds like the division has plans to arbitrarily change it. Even if they do pass this bill some tweaking will be done to it. Another of her concerns was the $127,000 fiscal note for travel expenses for two naturopath prescription drug task force meetings that she didn't think would be needed. Another concern she had was the task force consists of naturopaths, the medical board, the pharmacy board and the division personnel, but this scope of practice applies to naturopaths only, not the other two professions. She was also concerned about the $36,000 fiscal note each month for filling 100 Medicaid prescriptions. She didn't think this bill needed a fiscal note. MR. HABEGAR replied that the fiscal note isn't from his department; it came from HSS. The $16,000 fiscal note was in response to the original bill, and if it needs to be changed as results of changes to the bill he would withdraw it. CHAIR EGAN thanked him and announced other people on line who could also answer fiscal note questions. 1:50:43 PM DR. WARD HURLBURT, Director of the Division of Public Health, and Chief Medical Officer for the Department of Health and Social Services (DHSS), Anchorage, Alaska, said he understood that clarification was needed and the language in this version of SB 175 would expand the naturopathic scope of practice and the fiscal note was based on the cost associated with expanding that prescriptive practice. For instance, the manufacturer of capsicum, a tincture of cayenne pepper that is used medicinally, made it a prescription item. In allopathic medicine, if you ask someone to take ibuprofen or Advil, the over-the-counter form is 200 milligrams and very few insurance policies would cover that. Whereas a physician could prescribe an 800 milligram tablet and it would likely be covered. The bill's language notes that the prescriptive authority is for drugs that are derived from natural substances and his recent research and experience indicated that 25-50 percent of pharmaceutical agents requiring a prescription are derived from natural substances. That is the reason for the concern that it would expand the scope and therefore expand the cost of health care for items that are not now covered by insurance. 1:53:14 PM SENATOR GIESSEL asked what the prescriptive cost to Medicaid has been under existing regulations for the last 18 years. DR. HURLBURT said he didn't have that information, but would get it. SENATOR GIESSEL said she was not interested in speculating about expansion, but was only asking about practices for the past 18 years. 1:54:10 PM SENATOR PASKVAN asked if he ever protested what the naturopaths were doing in the last 18 years - even one time, because someone is protesting now, and he was wondering what it was about. DR. HURLBURT said he had been in his current position for 2.5 years and during that time he hadn't protested what naturopathic doctors had been doing. 1:55:08 PM CHAIR EGAN asked Dr. Hurlburt if any other chief medical officers had protested naturopathic practices in the last 18 years. DR. HURLBURT replied that he didn't know but would find out. 1:55:46 PM JON SHERWOOD, Medicaid Special Projects, Medicaid and Health Care Policy, Department of Health and Social Services (DHSS), said Medicaid has two fiscal notes and that this issue has stayed beneath their radar. He understood that naturopaths do not have prescriptive authority and they are not included in the Medicaid program, and since he doesn't pay them, they have not had to enroll in the Medicaid program. Changes to Medicaid under the Affordable Care Act require that any prescriber that Medicaid is paying for a prescription needs to enroll in the program so that their provider number can be captured. A one- time cost for creating a way for them to enroll in the program and $36,000 a year for 100 prescriptions per month was estimated. But he emphasized that was only an estimate and that a wide variety of medicines are prescribed, and it would help to have a clearer understanding of what substances they would be talking about. SENATOR DAVIS asked him to explain the two fiscal notes. MR. SHERWOOD explained that the Medicaid Assistance Administration has a one-time cost of $75,000, $18,800 of which would come from general funds; the other one is $36,000 per year for health care Medicaid services and that is 50 percent federal, 50 percent state general funds. The $16,000 fiscal note is from the Department of Commerce, Community and Economic Development (DCCED). 2:00:02 PM SENATOR GIESSEL asked Dr. Jasper if naturopaths have national provider identifier (NPI) numbers. DR. JASPER answered yes. SENATOR GIESSEL asked if they are reimbursed by insurance companies. DR. JASPER answered yes; Alaska statute provides for that coverage in its group health policies. SENATOR GIESSEL asked if any Alaska naturopaths have enrolled in Medicaid or are Medicare providers. DR. JASPER replied that naturopaths are not eligible to enroll. Eligibility for Medicare is determined by federal laws, and the eligibility for Medicaid is determined by state law; neither has authorized naturopathic doctors to participate in Medicare or Medicaid. 2:01:29 PM DR. JASPER also added that hydrotherapy is the application of hot and cold water packs to the body and shouldn't result in any prescription expenses; it's not IV water or saline injections. Maybe it would help Mr. Habegar to have that clarified. 2:02:32 PM SENATOR PASKVAN moved to report CSSB 175(L&C), version B, from committee with individual recommendations and attached fiscal note(s) although he hoped the fiscal note would be removed. There were no objections, and it was so ordered. SB 175-PRACTICE OF NATUROPATHY  2:30:35 PM CHAIR EGAN reconvened the meeting and returned attention to SB 175. SENATOR PASKVAN moved to rescind the committee's previous action to report SB 175 out of committee and restated the motion as follows: to report CSSB 175(L&C), version \B from committee with a restated Labor and Commerce fiscal note of zero with individual recommendations. There were no objections and it was so ordered.