SB 83-PROFESSIONAL LICENSING; TEMP PERMITS  2:14:39 PM CHAIR BJORKMAN reconvened the meeting and announced the consideration of SENATE BILL NO. 83 "An Act relating to professional licensing; relating to temporary licenses for some professions; and providing for an effective date." 2:15:13 PM SYLVAN ROBB, Director, Division of Corporations, Business and Professional Licensing (CBPL), Department of Commerce, Community and Economic Development (DCCED), Juneau, Alaska, introduced SB 83 on behalf of the administration. 2:15:40 PM MS. ROBB advanced to slide 2 to explain universal temporary licensure (UTL) and the three ways to qualify. A universal temporary license aims to get people to work faster in Alaska. She reviewed slide 2: What is Universal Temporary Licensure?  Universal Temporary Licensure (UTL) is a measure that establishes a pathway for limited reciprocity for qualified professionals who: • Hold substantially equivalent licenses in other U.S. and Canadian jurisdictions or • Have demonstrated substantial compliance with licensing requirements in Alaska but live in a U.S. jurisdiction or Canadian territory/province where the profession is not licensed or • Meets the qualifications for Alaska licensure through military education, training, and service and does not already hold a license in another jurisdiction 2:16:58 PM MS. ROBB turned to slide 3, "How Does One Qualify for UTL?" She relayed the following information: Applicant cannot:  • Be the subject of disciplinary action related to their profession or be the subject of ongoing review or disciplinary proceeding by the professional licensing entity in another jurisdiction or • Have committed an act in another jurisdiction within the past 10 years that would have constituted grounds for denial or revocation of a license in Alaska at the time the act was committed Applicant must:  • Submit application and provide documents required to verify: • Licensure in good standing in another jurisdiction • Lack of licensure in their jurisdiction of residence and proof of meeting Alaska's qualifications or • Proof of meeting Alaska's qualifications with military education, training, and service per AS 08.01.064(a) • Undergo a criminal history background check if required for that profession in Alaska • Pay all required fees MS. ROBB said professionals cannot obtain a UTL if they are from a jurisdiction with substantially different licensing requirements, which further ensures these professionals are safe to practice in Alaska. 2:18:32 PM MS. ROBB advanced to slide 4, "How Does UTL Work?" and reviewed the following: • Temporary licenses are valid for up to 180 days • Applicants can apply for one 180-day extension (approved at the department's discretion) MS. ROBB explained the 180-day extension applies to temporary licensees who show they are working towards permanent licensure but still need to meet the requirements because a required class was not available or extenuating life circumstances prevented them from submitting final, permanent licensure items. • Temporary license holders are authorized to temporarily practice the profession for which the license was granted in compliance with Alaska's laws MS. ROBB emphasized UTL holders are required to comply with statutes and regulations that cover their practice in Alaska, not the state laws of the jurisdiction from which they came. 2:19:40 PM CHAIR BJORKMAN drew attention to the bullet point at the bottom of slide 3 regarding a criminal history background check. He remarked that people report long wait times for background checks. He inquired about the efficiency of this when the bill aims to expedite licensure. MS. ROBB replied that a handful of professions require a criminal background check. The division's standard operating procedure is to issue a temporary license as soon as fingerprint cards are submitted to the Department of Public Safety (DPS). CBPL does this to ensure background checks do not hold up the licensing process. Permanent licenses are not issued until DPS returns background check results. 2:21:16 PM SENATOR BISHOP sought clarification about the process, asking who takes the fingerprints. MS. ROBB replied that local law enforcement offices have standard fingerprint cards and can take prints. Individuals submit their cards to CBPL. The cards are available elsewhere, and she expressed her belief an individual could download the cards from the division's website. SENATOR BISHOP expressed alarm. He sought confirmation that after a UTL applicant's fingerprint cards are submitted to DPS and while that agency runs a criminal background check, the applicant is issued a temporary license. MS. ROBB replied this is correct, but she said to bear in mind the applicant must have a license in good standing from another jurisdiction with substantially similar licensing requirements to qualify for a UTL. She emphasized that if Alaska requires a criminal background check, the other licensing jurisdiction must also require it. 2:22:51 PM MS. ROBB returned to slide 4: How Does UTL Work? [continued]: • The department has the authority to revoke a temporary license if the license was secured under deceit, fraud, or intentional misrepresentation MS. ROBB said three professions in Alaska require Alaska- specific knowledge and are not covered by this statute: • Temporary license provisions do not apply to: • AS 08.48: Architects, Engineers, Land Surveyors, and Landscape Architects; • AS 08.54: Big Game Guides and Related Occupations; or • AS 08.62: Marine Pilots 2:24:14 PM MS. ROBB advanced to slide 5, stating SB 83 allows CBPL to streamline and expedite the licensure process to get qualified professionals working in Alaska faster. She reviewed the need for universal temporary licensure on slide 5: Why is UTL Needed? • Boards were given the authority to create temporary licenses under AS 08.01.062, but many still have not • Processing times are long for many programs due to increased workloads • Increase of 64% in the number of professional licenses (FY12-FY22) • Allows the department to issue qualified professionals a temporary license as part of the permanent licensure process once the required items for the temporary license have been received • Allows qualified professionals to begin working more quickly • Limits the additional work created by making the temporary license part of the permanent licensure process (if the applicant wants a permanent license) MS. ROBB said the universal temporary licensure concept gives CBPL one more tool to address the division's licensing challenges. Eighteen other states have a temporary licensing option. CBPL wants this option to get vetted professionals to work faster. 2:25:39 PM MS. ROBB spoke to professionals seeking permanent licensure. She said the department would issue a temporary license automatically if and when an applicant meets the qualifications for temporary licensure as part of the permanent licensure process. This reduces the need for multiple applications and reduces the number of documents the division processes. The bill gets people into the workplace quicker without increasing the number of license applications. MS. ROBB said all boards have the option to offer temporary licenses, but only some actually do. Some boards offer multiple temporary licenses. The division wants to streamline the UTL process by offering just one standardized temporary license to communicate that Alaska is open for business. 2:28:41 PM MS. ROBB advanced to slide 6: How Do We Know UTL Will Help? • The Alaska State Medical Board and Alaska Board of Nursing led the way in making temporary permits part of the permanent licensure process MS. ROBB said temporary licensure requires additional tracking and communication beyond what is necessary for permanent licensure, but it eliminates the need for applicants to submit and licensing staff to review multiple applications. This streamlines the process for licensing staff and makes it easier for the license applicant. • These temporary permits allow physicians, physician assistants, registered nurses, and licensed practical nurses to get to work quicker while we wait on items from third-parties (such as verifications of work experience, verifications of hospital privileges, etc.) MS. ROBB explained that many licenses require primary source verifications. CBPL must receive source documents directly from schools, employers, and other entities, not the applicant. These documents include employment verifications and transcripts. She said the primary source verification requirement aims to protect the division from people manipulating documents and falsifying records. Former employers do not always prioritize employment verifications, which can delay documentation. SB 83 alleviates these types of temporary document delays. • Previously, applicants would have to specify if they wanted a temporary license when submitting their application for a permanent license or apply for it separately from the permanent license 2:30:48 PM MS. ROBB said standardizing the process across all programs would reduce processing times. For example, out of 1,000 temporary nursing licenses in the last eight months, 200 applicants did not submit any paperwork to get a permanent license. It was helpful for licensing staff to know they did not need to communicate with those applicants about permanent license paperwork requirements. • Medical and nursing professionals, hospitals, and health care facilities are happier under this current process • We currently have similar provisions available to active-duty military members and their spouses under AS 08.01.063 (due to SB 21 passed last year) MS. ROBB said military spouses have the option of getting a UTL or a military courtesy license. CBPL is required to issue military courtesy licenses within 30 days. 2:31:59 PM SENATOR DUNBAR sought confirmation that the temporary licensing process already exists for nurses through the Alaska Board of Nursing. MS. ROBB said that is correct. SENATOR DUNBAR commented that the committee heard testimony previously that one justification for the Nurse Licensure Compact (NLC) is the length of time it takes to get a nurse up and running with a temporary license. He said CBPL has already implemented and operates under an improved, faster temporary license process, yet the division recently requested an NLC because the process is not fast enough. He asked why the committee should consider the proposed standardized UTL for other professions when it does not seem to have helped the nurse's temporary licensure situation. MS. ROBB replied that the standardized UTL process for nursing clearly identifies which applicants do not want a permanent license, thus saving time with the following tasks: - reviewing applications to see what is missing to obtain a permanent license, - communicating that to the applicant, and - following up on notification deadlines. SENATOR DUNBAR sought confirmation that a temporary license is available through the Board of Nursing now, but SB 83 takes it a little further and is a little different. MS. ROBB replied that is correct. She said SB 83 repeals temporary licensure language for boards with that provision and replaces it with standard temporary license language. A standard temporary license is easier for applicants and staff. 2:34:03 PM MS. ROBB advanced to slide 7, stating the division seeks legislative help with UTL and NLC as tools to accelerate processing times. She said the division views NLC as the best option; it would reduce the number of applications submitted to CBPL. UTL complements the nursing compact. There are 39 compact states. UTL creates a pathway for a temporary license for professionals who are not in a compact state. She said NLC is a great option for improvement. She added that many of the division's professions do not offer a temporary license option, so people cannot work until licensing staff process their documents. Universal temporary licensure and compact criteria are listed on slide 7: UTL vs. Compacts  Universal   Licensure Interstate   Recognition Licensure   Laws Compacts  Criteria  Requires practitioners to abide by the scope of Yes Yes practice of the state in which they are practicing Allows for expeditious interstate movement of Yes Yes practitioners during emergencies Reduces barriers for out-of-state practitioners Yes 1 Yes aiming to practice within a state Reduces barriers for in-state practitioners No Yes intending to practice in other state(s) Allows military spouses to maintain a single home No Yes 2 state license for the duration of the service member's active duty, regardless of relocations, without submitting a separate application to each state's licensure board Allows practitioners to work in multiple state, No Yes both in person and via telehealth/telework, without submitting a separate application to each state's licensure board, requiring verification of the current license or obtaining a new background check Brings together a coalition of states to establish No Yes consistent and enforceable interstate licensure standards tailored to the public protection requirements of a given profession Enhances public protection by creating a multistate No Yes database of licensure information to facilitate collaboration on license verification and investigations of potential misconduct Allows multistate practice without requiring Sometimes 1 Yes 3 practitioners to change state of residence Allows practitioners to work in multiple states No Yes while adhering to only one state's continuing education requirements and license renewal schedule 1 Some statessuch as Arizona and Iowahave universal licensure recognition laws that require practitioners to reside in the state, while otherssuch as Colorado and Idahodo not 2 This is true only if practitioners relocate to a compact member state. License verification is based on practitioners complying with compact criteria for privilege to practice in another member state. 3 This is applicable when practitioners travel from one compact member state to another. 2:35:53 PM MS. ROBB advanced to a map on slide 8 that shows which states enacted some type of universal recognition policy for out-of- state licensed professionals as of May 2022. The Council of State Governments (CSG) identified the following 18 states as having UTLs: Montana, Idaho, Nevada, South Dakota, Wyoming, Utah, Arizona, Colorado, New Mexico, Iowa, Kansas, Oklahoma, Missouri, Mississippi, Pennsylvania, New Jersey, Vermont, and New Hampshire. 2:36:21 PM MS. ROBB completed the presentation and offered to answer questions. 2:36:30 PM SENATOR GRAY-JACKSON asked if she is aware of any opposition to SB 83. MS. ROBB said none that the division is aware of now. Boards are aware of the bill and are looking at it. CHAIR BJORKMAN invited her to present the sectional analysis. 2:37:17 PM MS. ROBB introduced the sectional analysis. It is available on The Alaska State Legislature website under the bill "Documents" tab. She addressed the following points from the sectional analysis: Section 1:  Repeals and reenacts AS 08.01.062 temporary license to allow the Department of Commerce, Community, and Economic Development ("department") to issue a temporary license if the applicant: • Is licensed in another U.S. jurisdiction or province/territory of Canada that has license requirements substantially equivalent or greater than Alaska's, or authorizes a scope of practice substantially equivalent to the scope of practice for the license in Alaska; • Meets the qualifications and requirements of a license in Alaska and resides in a U.S. jurisdiction or province/territory of Canada that does not license the respective profession; or • Meets the qualifications and requirements for the Alaska license through military education, training, and service under AS 08.01.064(a) and doesn't already hold a license in another jurisdiction. 2:38:19 PM SENATOR BISHOP asked who decides what qualifies as substantially equivalent. He wondered if the boards decide that for themselves. MS. ROBB replied the department makes that determination with the help of a paralegal. She said that substantially equivalent is many states' standard language to compare professional licensing. She elaborated, stating: - a person might have graduated from a college accredited by an entity different from that listed in a profession's threshold qualifications, or - a profession might require 250 hours of experience in Alaska, but another jurisdiction only needs 240 to meet their qualifications. She said listing substantially equivalent qualifications for every profession in every jurisdiction would be impossible. For professions with a board, CBPL seeks board guidance to ensure safe practitioners are licensed in Alaska if the applicant's credentials are uncomfortably shy of qualification thresholds. SENATOR BISHOP said his goal is to protect Alaskans and he asked the question to ensure due diligence. MS. ROBB said that the division's first and foremost goal is to ensure licensed service providers have the education, training, and skills necessary to provide safe services to Alaskans. 2:40:21 PM MS. ROBB continued the sectional analysis, addressing the following points: Section 1 [continued]:  To qualify for a temporary license, the applicant cannot: • Be the subject of disciplinary action related to the profession in another jurisdiction or be the subject of an ongoing review or disciplinary proceeding by the profession's licensing entity in another jurisdiction. • Have committed an act in another jurisdiction within the 10 years before the application that would have constituted grounds for denial or revocation of a license in Alaska at the time the act was committed. To qualify for a temporary license, the applicant must: • Pays all required fees • Undergo a criminal history background check if the department or applicable board requires such for the professional license. • Disclaimer: The department may consider an application and grant a temporary license before obtaining any resulting report. If the department subsequently receives criminal record information that would authorize the department or board to take disciplinary action, that authority shall be exercised. Temporary licenses are valid for up to 180 days. Applicants can apply for one 180-day extension, which the department approves at its discretion. Temporary license holders are authorized to practice the profession for which the license was granted temporarily. The department has the authority to revoke a license issued under this section if secured under deceit, fraud, or intentional misrepresentation. Temporary license provisions under this section do not apply to AS 08.48 (Architects, Engineers, Land Surveyors, and Landscape Architects), AS 08.54 (Big Game Guides and Related Occupations), or AS 08.62 (Marine Pilots). Section 2:  Amends AS 08.01.063(a) under military courtesy licenses to change the term "temporary courtesy license" to "temporary military courtesy license", and to refer to a "license or certificate" versus just a license. 2:42:19 PM MS. ROBB said sections 3-27 are conforming changes. Section 28:  Adds a TRANSITION: REGULATIONS section under the uncodified law to allow DCCED to adopt regulations necessary to implement the changes made by this Act. Section 29:  Adds a TRANSITION: SAVINGS CLAUSE section under the uncodified law to: • Provide for litigation, hearings, investigations, appeals, and other proceedings pending under a law amended or repealed by this Act to continue and completed notwithstanding a transfer or amendment or repeal provided in the Act. • Allow certificates, orders, permits, licenses, and regulations issued or adopted under the authority of a law amended or repealed by this Act to remain in effect for the term issued or until revoked, vacated, or otherwise modified under the Act's provisions. • Allow contracts, rights, liabilities, and obligations created by or under a law amended or repealed by this Act and in effect as of the date of the Act to remain in effect. 2:43:36 PM Section 30:  Provides an immediate effective date for Sections 28- 29. Section 31:  Provides for a July 1, 2024, effective date for Sections 1-27. 2:43:50 PM CHAIR BJORKMAN asked if there were questions. 2:44:04 PM CHAIR BJORKMAN opened public testimony on SB 83. 2:44:48 PM ERICK CORDERO, Vice President of Operations, Alaska Policy Forum (APF), Palmer, Alaska, testified in support of SB 83. He said that according to the Goldwater Institute, a quarter of all jobs in the United States require an occupational license, essentially a government-issued permit to work. Licensed individuals may find it difficult to move to another state to work because of additional testing or training requirements and extra fees to obtain a new license. He said that licensure can sometimes be excessive, limit competition, raise consumer prices and impact minorities and low-income residents unequally. Temporary licensure of individuals who previously completed training or testing requirements in another state would eliminate costly, time-consuming, and often unnecessary barriers to employment. There is a shortage of skilled workers in Alaska, such as school bus drivers, speech pathologists, construction and transportation services workers, and healthcare professionals. Universal licensing may benefit businesses and organizations dependent on these professionals. States like Arizona adopted universal licensing reforms, and there was a growth in the number of professionals working in diverse fields, such as medicine and engineering. Reducing licensing barriers and increasing occupational mobility can increase competition, lower prices, and boost economic growth. 2:46:45 PM TINA REIN, Nursing Home Administrator, Foundation House Partners, Denali Center, Fairbanks, Alaska, testified in support of SB 83. She spoke of the difficulties associated with getting licensed staff. She said Alaska does not have a supply of nurses to fill vacant positions. This is evident in the number of applicants and the length of time positions stay open. She said the facility employs traveling nurses and nurses relocating with the military to fill the vacancy gap. She said 40 percent of the job offers extended to applicants were not accepted because the applicants found jobs in other states while waiting for Alaska licensure. She said the average license processing time exceeds eight weeks and sometimes takes over 15 weeks. The Denali Center and other long-term care facilities lose candidates to licensure delays; applicants find jobs elsewhere. As a result, facilities cannot accept new residents due to staffing shortages. She said the issue causes a healthcare system domino effect, creating a backup of patients in the hospital medical-surgical units, intensive care, and emergency rooms. It affects Alaskans who end up traveling out-of-state for critical care needs. She asked the committee to pass SB 83 to support her staff and the elders at the Denali Center, who need the safe care that adequate staffing provides. 2:49:40 PM COLLEEN KOWALCHUK, Nursing Director, Wound and Ostomy Care Clinic, Foundation Health Partners, Fairbanks, Alaska, testified in support of SB 83. She said Fairbanks is experiencing unprecedented nursing vacancies for various reasons; licensing delays are one of the biggest hurdles. The hospital uses travel nurses more than normal, and there is sometimes fierce competition for them. Many travel nurses indicate the Alaska licensure process is slow and choose to work in other states. This affects the ability to provide safe care without asking permanent staff to work additional shifts. Extra shifts increase the risk of burnout. It creates a chain reaction. Fairbanks has a small dialysis program and has experienced delays with travel nurse licensure, so much so that the inpatient program was put on hold while nurses awaited their Alaska licenses. This is a critical problem. It is common for licensing to take longer than ten to twelve weeks. She said having flexible nurses who can obtain immediate licensing would benefit patient care in Alaska. 2:51:29 PM JESSICA STRUBINGER, representing self, Fairbanks, Alaska, testified in support of SB 83. She said she had been a licensed nurse for 22 years. She had worked at Fairbanks Memorial Hospital for the last 8.5 years. She said that she returned to bedside nursing Monday through Friday at the tail end of the COVID surge and worked extra shifts on the weekend to help her nursing brothers and sisters in the medical-surgical unit. She said the workload is unsustainable, nurses work all the time, and there is no work-life balance. She fears a shortage of nurses will interrupt Fairbank's way of life. Nurses wait 6 - 12 weeks while CBPL processes their licenses; it is soul-crushing for those waiting to go to work and unsafe for patients. Patients are not turned out in the street because nurses are picking up the slack and caring for the dying, tending to the elderly who await placement and have nowhere else to go, for babies and mothers that just gave birth, and for patients just out of surgery. Hospitals need to fill position vacancies, so the nurses carrying the extra load can be with their families and take time off. Nurses are tired. Alaska needs to figure out how to bring nurses to Alaska, license them, and get them working. She said SB 83 needs to pass for Foundation Health Partners staff and patients. 2:54:56 PM LEAH HOPPES, Senior Manager/Nurse, Emergency Department (ED), Fairbanks Memorial Hospital, Fairbanks, Alaska, testified in support of SB 83. She said the long wait for a temporary Alaska license had affected staff morale and the safety of patients and staff. The Emergency Department has lost traveling nurses who could have filled vacancies and closed the gap on many open shifts. The hospital has seen: - staff burnout and turnover from working short and picking up extra shifts to alleviate staff shortages, and - increased wait times for a patient to see a provider due to throughput issues. MS. HOPPES said throughput issues occur either because inpatient units are short-staffed and cannot take a patient to the Emergency Department or because ED is short-staffed and the time to complete a task takes longer than usual. MS. HOPPES said the University of Alaska Fairbanks (UAF) produces 15 to 20 nurses each year and that ED might get two or three of those nurses. A new ED nurse takes a full year to gain the skills and confidence to care for the sickest patients independently. A quarter of the nurses left the ED in 2022, and with them, the department lost knowledge and skills, which take time to replace. The Emergency Department needs to be able to recruit and onboard from outside Alaska promptly. SB 83 would help, and she asked for favorable consideration of the bill. 2:57:00 PM CHAIR BJORKMAN held SB 83 in committee with public testimony open.