SB 265-PHYSICIAN ASSISTANTS/NURSE PRACTITIONERS    SENATOR OLSON, sponsor of SB 265, introduced the bill on the advice and request of the Alaska Academy of Physician Assistants. He said he could answer questions on Section 1 and Section 2 but the section that was of most interest was Section 3 under the Committee Substitute (CS). This would allow physician assistants to provide proof of eligibility for a disabled veteran license plate and for issuance of a parking permit for a handicapped or disabled person. Currently physicians, other mid-level practitioners and specifically advanced nurse practitioners provide eligibility. ED HALL, Physician Assistant, Alaska Academy of Physician Assistants, said all three of the issues in Sections 1, 2 and 3 were very important to physician assistants. He said they probably had been excluded because the statutes were written before physician assistants were a recognized presents in Alaska. SUSAN MASON BOUTERSE, Executive Director of Sunshine Community Health Center, expressed her support of SB 265. She addressed the first two statutes being amended to add physician assistants as being critical to health care in Alaska. Sunshine Community Health Center is a mid-level clinic with four physician assistants providing primary health care. They work under a collaborative agreement with a physician in Wasilla. They are critical to health care of residents in the community and the ongoing functioning of the health center. Because the current state statute denies inclusion of physician assistants to the listing of health care providers they periodically have their billing for medical services by those providers denied by third party payers. This represents a significant barrier to health care for individuals that have health insurance as well as for clinics to be able to maximize potential revenue. For all rural health clinics every potential revenue source is critical to ongoing support. CHAIRMAN COWDERY asked Senator Olson to elaborate on duties taken care of by physician assistants. SENATOR OLSON explained physician assistants work with a collaborative physician and do many things a physician would do. Because they do not have the training of a medical doctor they are at times not accorded some of the privileges allowed physicians and in this case advanced nurse practitioners. For example they are not included in some of the medical liability statutes as well as recognition by some third party payment recipients. He said that was the reason the bill was being presented and specifically the CS that has the provision that allows physician assistants to give specially disabled veterans license plates and parking permits for those people that are handicapped. SENATOR TAYLOR said the concern he had was the impact this would have on the ability of physician assistants to get reimbursement. He asked if that was part of the purpose of the bill because the insurance company would recognize them as a full service provider and they can bill directly. SENATOR OLSON said that was exactly what they were specifically trying to do in Section 2. That was the intent of the bill. SENATOR TAYLOR said the bill mentioned medical malpractice. He asked if adding them to the list would require them to provide medical malpractice insurance or did it give them the opportunity to come under the medical malpractice insurance of the hospital or the physician they work with. SENATOR OLSON said that question was part of the whole issue of trying to recognize physician assistants as professionals and with that came responsibility. If they make a mistake they need to be named as a defendant in a malpractice case. That does not mean they are guilty it just means they need to be able to be named by the plaintiff's attorney. He said with this also comes the ability for them to bill. He said being required to have malpractice insurance was not addressed in the bill and not the intent of the sponsor. MR. HALL said the other aspect of Section 2, brought to their attention by an attorney, was when dealing with malpractice claims sometimes there is an arbitration board put together. The definition of who can participate on that arbitration board placed a limitation on physician assistants because they were not listed as a health care provider within that statute. Another reason they were asking to have their name recognized within that statute was so they could avail themselves to be on the arbitration board if called upon. MARY MARSHBURN, Director, Division of Motor Vehicles (DMV), said she had not seen the CS. She had called Senator Olson's office and suggested the CS. She asked Senator Olson if the CS addressed AS 28.10.181 rather than Section 3 from the original bill. SENATOR OLSON said yes, section 3 relating to AS 28.10.181(d) was amended and they did have her concern addressed. MS. MARSHBURN said with that knowledge DMV had no opposition to the bill. They think including physician assistants is a reasonable and good thing. The CS would allow them to have the same authority as physicians, nurse practitioners, and chiropractors in terms of signing the permit for disability placards or plates. If the CS is not substituted the bill in its current form only allowed the physician assistants to sign the evidence for permits and not for plates. DMV felt they should be able to sign for both. SENATOR WILKEN moved to amend the Committee Substitute for SB 265. Hearing no objection, CSSB 265 (TRA) was moved from committee.