HOUSE FINANCE COMMITTEE March 22, 2024 1:35 p.m. 1:35:26 PM CALL TO ORDER Co-Chair Foster called the House Finance Committee meeting to order at 1:35 p.m. MEMBERS PRESENT Representative Neal Foster, Co-Chair Representative DeLena Johnson, Co-Chair Representative Julie Coulombe Representative Mike Cronk Representative Alyse Galvin Representative Sara Hannan Representative Andy Josephson Representative Dan Ortiz Representative Frank Tomaszewski MEMBERS ABSENT Representative Bryce Edgmon, Co-Chair Representative Will Stapp ALSO PRESENT Representative Dan Saddler, Sponsor; Representative Mike Prax, Sponsor; Dr. Natalie Wiggins, Alaska Association of Naturopathic Doctors, Juneau; Representative Justin Ruffridge PRESENT VIA TELECONFERENCE Melodie Wilterdink, Staff, Representative Saddler, Anchorage; Duane Mayes, Director, Division of Vocational Rehabilitation, Department of Labor and Workforce Development, Anchorage; Mystie Rail, Executive Director, Assisted Technology of Alaska, Anchorage; Dr. Carrie Baldwin-Sayre, Associate Vice President, Advancement and Community Engagement, Alaska Naturopathic Doctors Association, Portland, Oregon; Dr. Sean Higgins, Emergency Room Doctor, Anchorage; Dr. Clyde Jensen, Professor of Pharmacology, Naturopathic Association, St. George, Utah; Dr. Robert Downey, Family Practice Physician, South Peninsula Hospital, Homer; Dr. Roxanne Jones, Alaska Academy of Family Physicians, Anchorage; Dr. Hillary Johnson-Jahngir, American Society for Dermatologic Surgery, Iowa; Dr. Kristin Mitchell, President Elect, Alaska State Medical Association, Soldotna; Dr. Scott Ferguson, Board of Trustees, American Medical Association, West Memphis, Arkansas; Bruce Campbell, Self, Fairbanks; Bart Grabman, Self, Anchorage; Karen Gonne-Harrell, Self, Anchorage; Dr. Tim Birdsall, Alaska Association of Naturopathic Doctors, Anchorage; Pam Ventgen, Executive Director, Alaska State Medical Association, Anchorage; SUMMARY HB 219 REPEAL ASSISTIVE TECHNOLOGY LOAN PROGRAM HB 219 was HEARD and HELD in committee for further consideration. HB 115 NATUROPATHS: LICENSING; PRACTICE HB 115 was HEARD and HELD in committee for further consideration. Co-Chair Foster reviewed the meeting agenda. HOUSE BILL NO. 219 "An Act repealing the assistive technology loan guarantee and interest subsidy program; and providing for an effective date." 1:38:00 PM REPRESENTATIVE DAN SADDLER, SPONSOR, Introduced HB 219 // he argued that the best part of living in Alaska was the people // there was an assisted technology guarantee fund // he was hoping to realize the original mission of the grants 1:40:22 PM MELODIE WILTERDINK, STAFF, REPRESENTATIVE SADDLER, ANCHORAGE (via teleconference), offered the sectional analysis of the bill (copy on file) Section 1 Page 1, Line 4 Section 1 repeals AS 23.15.125 the assistive technology loan guarantee and interest subsidy program which established the "assistive technology loan guarantee fund." The fund can be used to guarantee the principal amount or subsidize the interest rate of a loan for purchasing assistive technology that enables an individual to obtain or maintain employment or live more independently. Section 2 Page 1, Lines 5-9 Section 2 adds conditional language to Alaska's uncodified law stipulating that this act only takes effect if the Legislature reappropriates the balance of the assistive technology loan fund for the purpose of improving access to assistive technology. Section 3 Page 1, Line 10 Section 3 provides for an immediate effective date. Co-Chair Foster asked // Ms. Wilterdink // there was drafted language and the amendment to the operating budget could happen in the finance committee// 1:43:16 PM Representative Josephson asked // how the fund avoided being swept Representative Saddler deferred the question to a member of the department // 1:43:47 PM DUANE MAYES, DIRECTOR, DIVISION OF VOCATIONAL REHABILITATION, DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT, ANCHORAGE (via teleconference), responded // Representative Saddler added that he was not sure if there was evidence that // Representative Hannan asked how much money was available. Representative Saddler // Mr. Mayes responded that the balance of the fund was 447,000 and the life experience with the fund // identified that there may be Representative Saddler// subside loans // there had been a period of low interest rates // Representative Hannan asked // the initial 291,000 was federal money // she asked if there were any restrictions or tied it from Representative Saddler // Mr. Mayes // with the change in statute work// there had been discussion with federal partners // many states had experienced the same thing // 1:49:09 PM Representative Hannan asked if the leg wanted to move the initial amount that was capitalized // she asked if there was cart blanche Mr. Mayes // responded that the implementing agency was // the division had a set of rehabilitation counselors // there were not other implementing agencies // Representative Saddler responded that it was his understanding that // Co-Chair Foster asked // Representative Galvin asked // appreciated that the sponsor found money that needed to be spent // the letters were similar // ATLA remains the // she asked if there were others Representative Saddler asked Representative Galvin // Association of assisted technology programs letter, paragraph 3 Representative Saddler // responded that ATLA// the division of voc rehab// one of a few and not many // 1:54:42 PM MYSTIE RAIL, EXECUTIVE DIRECTOR, ASSISTED TECHNOLOGY OF ALASKA, ANCHORAGE (via teleconference), noted that atla was the only agency in the state // Representative Galvin // asked if the grant was single sourced toward only one purpose, all of her questions were answered Mr. Mayes commented that he had been in the state system for 35 years // he had used atla to identify technology needs // 1:57:17 PM Representative Hannan // there used to be an assisted program for people who were deaf // could there be a person dedicated // Mr. Mayes responded that Ms. Rail would be a better resource Ms. Rail responded // she was not aware of // it was a community rehab provider for the division // ~Mystie Rail, Executive Director, Assisted Technology of Alaska, Anchorage{ Representative Hannan // she had some active deaf constituents and there used to //there was a group of people who had continued to receive the same // Co-Chair Foster // Representative Saddler had some difficulty understanding Ms. Rail // 2:01:07 PM Ms. Rail responded that he was correct// ATLA could // administer additional programs to provide specific types of devices // looking for services beyond assistive technology and beyond what ATLA did // Co-Chair Foster // Ms. Rail added that // the history of ATLA // became a 501c3 (?) in 1994 and became the implementing agency of // under the direction of // the mission was to enhance the quality of life for Alaskans through assisted technology // "twinkle to wrinkle" // she supported the outline and expanded upon Representative Saddler's comment on // assisted technology was defined as any item, piece of equipment // that was used to increase, maintain or improve the functional capabilities of person with disabilities // such as putting rubberized grips on a pen to as high tech as technology like eye gaze, which allowed people to control a computer with only their eyes // assisted technology was not a one size fits all solution // unique to every person // able to live, work and participate in their communities indecently // 2:06:27 PM Ms. Rail continued that ATLA // allowed Alaskans to become familiar with the technologies that could help // also allowed loans to // current funds did not begin to cover // strengthen and maintain the gaps // needed to support // Co-Chair Foster // 2:09:30 PM Representative Saddler // Representative Tomaszewski asked if any interest had been collected // Mr. Mayes responded that there was interest but he did not have the specific numbers // he would follow up Co-Chair Foster // am dead fri march 29 at 5pm HB 219 was HEARD and HELD for further consideration. 2:11:21 PM HOUSE BILL NO. 115 "An Act relating to the practice of naturopathy; establishing the Naturopathy Advisory Board; relating to the licensure of naturopaths; relating to disciplinary sanctions for naturopaths; relating to the Department of Commerce, Community, and Economic Development; and providing for an effective date." Co-Chair Foster 2:12:32 PM REPRESENTATIVE MIKE PRAX, SPONSOR, reminded the committee of the details of the bill // 2:14:38 PM DR. CARRIE BALDWIN-SAYRE, ASSOCIATE VICE PRESIDENT, ADVANCEMENT AND COMMUNITY ENGAGEMENT, ALASKA NATUROPATHIC DOCTORS ASSOCIATION, PORTLAND, OREGON (via teleconference), was supportive of the bill // 2:18:24 PM Representative Josephson asked // naturopaths wanted to practice medicine beyond // asked if naturopaths should be held Dr. Baldwin-Sayre responded // based on the board which included a variety of physicians and public members // Representative Josephson // it seemed like naturopaths wanted to // he asked // Dr. Baldwin-Sayre responded // there was only one way to do certain things // 2:22:05 PM DR. SEAN HIGGINS, EMERGENCY ROOM DOCTOR, ANCHORAGE (via teleconference), allowing doctors to practice to the extent of their training would increase // comparable to all other education // Co-Chair Foster noted that Representative Justin Ruffridge was in the audience Representative Josephson // Dr. Sean Higgins responded curcumin// Representative Josephson // Dr. Sean Higgins responded Representative Josephson // Dr. Sean Higgins responded he was aware of 2:26:55 PM Representative Galvin paramedic and now a physicain with direct clinical care because his knowledge base was not suffienciet // she asked if there needed to be a change // the ability to prescribe medications sooner Dr. Sean Higgins responded that once a person finished frour years of medical school // he understood that // he would challenge the question // he thought Representative Galvin understood that the bill would give doctors the authority to // Dr. Sean Higgins responded// Representative Galvin // Dr. Sean Higgins responded Representative Galvin // if there was enough background // Dr. Sean Higgins responded it was part of the training to // people were typically referred to specialists // 2:33:23 PM DR. CLYDE JENSEN, PROFESSOR OF PHARMACOLOGY, NATUROPATHIC ASSOCIATION, ST. GEORGE, UTAH (via teleconference), the training was identical to that given to doctors // needed to understand the relationship between drugs and // he opined that naturopathic doctors were capable of confidently and conservatively prescribing medications commonly used in care practices // Representative Josephson asked why the bill would // Dr. Jensen responded // Representative Josephson commented that he had not felt // should be able to // asked why it was ok that naturopathy // decades after a doctor was accredited, Dr. Jensen responded // the reason was because residencies were not available to naturopaths // privately funded by hospitals// Representative Josephson Dr. Jensen responded that a collaborative relationship between a new and prescribing // was not a bad idea// he received a call earlier in the day // the inclusion of pharmaceuticals // if a collaborative relationship were to be established, there should be a finite time period // would / 2:43:11 PM Representative Coulombe asked / Dr. Jensen responded // many naturopaths did not have access // Representative Galvin asked // if there was differce between pharmacology and // she understood that it was an ever evolving science and // continuing education given that the options available for medicines chagned constatnly / Dr. Jensen responded / naturopaths had continuing medical education requirements that were similar to // continuing \\\ \ 2:48:41 PM Representative Hannan asked // the pharmacological exam Dr. Jensen // Representative Hannan // Representative Ortiz // Dr. Jensen // 2:54:42 PM DR. ROBERT DOWNEY, FAMILY PRACTICE PHYSICIAN, SOUTH PENINSULA HOSPITAL, HOMER (via teleconference), /// grant doctors prescribing privileges // naturopaths would prescribe the same way // important botanical without downsides or safety concerns // 3:00:40 PM Representative Galvin // she found // 15 hours of continuing education over a five year period // Dr. Downey responded // details beyond familiarity // any perso who valued the power had a respect for what could go awry // there were already prscriptions// he was // separate issues around the pharmacutical industry // 3:05:17 PM Co-Chair Foster // 3:06:26 PM DR. ROXANNE JONES, ALASKA ACADEMY OF FAMILY PHYSICIANS, ANCHORAGE (via teleconference), testified in opposition to the bill // she pracitced medicine in the Norton sound region // she had since transitioned to anchorage // she worked in a primary care clinic where they accepted Medicare and medicaid// she did not have intimate knowledge of the training / she did not support full prescriptive authority // formalize pathway to licensure // other qualified individuals // accreditation was a good tool for // not similar to the standards for physicians // specifically noted that the goal was to train primary care or general practice // same accrediting agency as neurosurgery // pharmacology was included // thousands of hours // the basement was // medical students had completed 300 horus // 3:14:08 PM DR. HILLARY JOHNSON-JAHNGIR, AMERICAN SOCIETY FOR DERMATOLOGIC SURGERY, IOWA (via teleconference), certified in // worked with medical professional organizatrions and weighed in on policy that impacted dermatology // was the lesion benign or would it lead to // her parents moved to iowa // her pre-diabetes went unnoticed // she reviewed the patient's entire medical history // Co-Chair Foster // 3:18:10 PM DR. KRISTIN MITCHELL, PRESIDENT ELECT, ALASKA STATE MEDICAL ASSOCIATION, SOLDOTNA (via teleconference), certified by the board of internal medicine // her concern was about patience safety // malpractice implication and // keep in mind that any action was reviewed by the board // she would expect that naturopaths be held to the same standard as medical physicians // she was concerned that it was not// circuim was a supplement // the bill would not change the current ability of naturopaths to infuse circuim //it would be difficutl for // it was unlawful for 3 states // there should not be an equivilance // 3:26:21 PM DR. SCOTT FERGUSON, BOARD OF TRUSTEES, AMERICAN MEDICAL ASSOCIATION, WEST MEMPHIS, ARKANSAS (via teleconference), noted that he was a previous legislator // naturopathic education was different from a medical education // there were crucial gaps in education // must complete clinical training // credication expenditure // patients in any age or condition // there was no // open up the door for naturopaths to prescribe any medications // principals and theraputics that lacked a foundation in medical evidence // he urged that legislators take the risk of patients seriously // there were fewer than 50 naturopathic doctors in Alaska// 3:32:14 PM Co-Chair Foster OPENED public testimony. 3:33:05 PM DR. NATALIE WIGGINS, ALASKA ASSOCIATION OF NATUROPATHIC DOCTORS, JUNEAU, was a naturopathic doctor in Anchorage // had a scope of practice that reflected her level of traingin // scheduled and non controlled medication // she had heard comments in areas of concerns // annual req was 30 hours of cmes (?) which was the standard of practice // broad prescriptive authority was not requested // the request was for things like antibiotics // medicine was constantly changing // could direct some of the concerns // there are many possible situations // there was some // safety was well illustrated // Co-Chair Foster // Dr. Wiggins // 3:37:28 PM Representative Galvin thanked Dr. Wiggins for her time // referred to a chart amendment a Dr. Wiggins // 3:40:23 PM Representative Ortiz had heard arguments that it would help alleviate the shortage of access to primary care physicians, however Medicaid and Medicare would not cover naturopaths Dr. Wiggins replied the need was extensive // she had kept track of how many // the 12 patients had to get 12 more medical care visits to have the needs taken care of// Representative Tomaszewski noted that there had been prior testimony that stated // the inference was that // Dr. Wiggins responded in the affirmative // Representative Tomaszewski // fill the prescriptions for patients // create more need // Dr. Wiggins responded // 3:44:06 PM Representative Galvin there was significant correspondence around the amount of continuing education not having parity Dr. Wiggins responded // 50 hours every two years // other states were in excess// 3:45:36 PM BRUCE CAMPBELL, SELF, FAIRBANKS (via teleconference), testified in support of HB 115 and he believed it was an update // he was on medicare and his provider worked with // had received care from nurse practicioners // he had to go to another doctor // there would be a five week to six week // it was an added cost and impediment to care // the bottom line was that he determined / 3:48:28 PM BART GRABMAN, SELF, ANCHORAGE (via teleconference), opposed HB 115 // he was a resident physician // although it did not address // school included 4000 hours of training and hands on clinical education // by the time // required for all MDs // still not allowed to // the bill would allow naturopaths prescriptive authority // the focus and training was different // 3:51:45 PM KAREN GONNE-HARRELL, SELF, ANCHORAGE (via teleconference), his medical doctor was a pediatrician // urged support of the bill in a safe manner 3:54:39 PM DR. TIM BIRDSALL, ALASKA ASSOCIATION OF NATUROPATHIC DOCTORS, ANCHORAGE (via teleconference), relayed that naturopaths were not asking to be considered the same as MDs// increased both the scope of practice and responsibility// proposed language that would require // license would allow them to do brain surgery// one of the leaders in the nation in granting nurse practioners independent pracitce authority // the disciplinary 3:59:51 PM PAM VENTGEN, EXECUTIVE DIRECTOR, ALASKA STATE MEDICAL ASSOCIATION, ANCHORAGE (via teleconference), noted that the association supported many sections in HB 115 // minor surgery and prescribing authority // there were fewer than 50 practicing naturopaths // did not cover naturopathic services // no federally endorsed training programs // faulty argument// the other thing to consider was that most insurance plans only covered what was in state statute // if the scope of practice was expanded //increase the overall cost of health care// urged not to pass 115 as written // 4:04:00 PM Co-Chair Foster CLOSED public testimony. Representative Ortiz asked whether the bill had two Representative Prax// Representative Ortiz asked if there were // Representative Prax responded that there were initially but then the original intent Representative Ortiz asked if the amendments were adopted Representative Prax responded that the bill started all over again // got away from the intent of the bill // Representative Ortiz asked if the amendments dealt with some of the concerns that had been raised // Representative Prax responded in the affirmative // 4:07:38 PM Representative Prax // it was difficult to cover a statute that covers every situation // 4:11:23 PM Co-Chair Foster reviewed the agenda for the following meeting. HB 115 was HEARD and HELD in committee for further consideration. ADJOURNMENT 4:12:00 PM The meeting was adjourned at 4:11 p.m.