ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 7, 2008
3:04 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Wes Keller
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE CONCURRENT RESOLUTION NO. 13
Establishing and relating to the Education Funding District Cost
Factor Commission.
- MOVED CSHCR 13(HES) OUT OF COMMITTEE
HOUSE BILL NO. 319
"An Act relating to the practice of dentistry and to dental
assistants."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HCR 13
SHORT TITLE: EDUCATION FUNDING/COST FACTOR COMMISSION
SPONSOR(s): REPRESENTATIVE(s) HAWKER BY REQUEST OF JT LEG
EDUCATION FUNDING TASK FORCE
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) HES
02/07/08 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 319
SHORT TITLE: DENTISTS & DENTAL ASSISTANTS
SPONSOR(s): REPRESENTATIVE(s) RAMRAS
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) HES, L&C
02/07/08 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE MIKE HAWKER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HCR 13, as the prime sponsor.
DAVE JONES, Assistant Superintendant
Kenai Peninsula Borough School District
Soldotna, Alaska
POSITION STATEMENT: Testified in support of HCR 13.
PATTY KRUEGER, Staff
to Representative Jay Ramras
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 319 on behalf of
Representative Ramras, sponsor.
JANE PIERSON, Staff
to Representative Jay Ramras
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered a question during the hearing on
HB 319.
DAVID L. EICHLER, D.D.S.; President
Alaska Board of Dental Examiners
North Pole, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
319.
DAVID LOGAN, D.D.S.; Legislative Liaison
Alaska Dental Society
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
319.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:04:01 PM.
Representatives Wilson, Roses, Seaton, and Gardner were present
at the call to order. Representatives Cissna, Fairclough, and
Keller arrived as the meeting was in progress.
HCR 13-EDUCATION FUNDING/COST FACTOR COMMISSION
3:05:27 PM
CHAIR WILSON announced that the first order of business would be
HOUSE CONCURRENT RESOLUTION NO. 13, Establishing and relating to
the Education Funding District Cost Factor Commission.
3:05:34 PM
REPRESENTATIVE MIKE HAWKER, Alaska State Legislature, introduced
HCR 13 as the prime sponsor. Representative Hawker informed the
committee that HCR 13 was one of the recommendations made by the
Joint Legislative Education Funding Task Force [(JLEFTF)] and
addresses the issue of the cost differential factor in the
student funding formula for education. This factor is the
multiplier that is used to determine education funding,
recognizing that education costs more in rural areas than in
Anchorage. The amount of this factor has been studied by the
American Institute of Research (AIR) and the University of
Alaska's Institute of Social and Economic Research (ISER);
still, it remains an issue of controversy. The JLEFTF
recommended that the legislature be set on the task of
developing a methodology and calculation of the cost deferential
factor that satisfies a sufficient number of legislators. House
Concurrent Resolution 13 creates the Education Funding District
Cost Factor Commission, comprised mostly of legislators, to be
charged with the task of examining school district cost
differentials and determining a formula to adequately and
equitably fund education throughout Alaska, and reporting to the
full legislative body prior to September 30, 2009.
Representative Hawker explained that there is an alternate
proposal that creates a gubernatorial task force comprised of
members of the community; however, he opined that the
legislature is responsible for funding the educational system
for the state, thus the commission should consist of
legislators.
3:12:18 PM
CHAIR WILSON stated that the JLEFTF made many compromises during
the process of its deliberations. She asked Representative
Hawker to discuss those compromises.
3:13:15 PM
REPRESENTATIVE HAWKER related that the work on the district cost
factors, by the commission created by HCR 13, would have a
scientific and economic focus, as opposed to the policy issues
that were a priority of the JLEFTF. The joint, bi-partisan,
legislative approach is intentionally meant to provide an
academic process to the cost factor. He pointed out that
latitude and freedom are built into the legislation to allow for
a process that is scientifically and economically valid.
3:15:29 PM
REPRESENTATIVE FAIRCLOUGH inquired whether the joint committee,
when looking at policy such as millage rates and matching
contributions, considered the declining enrollments of some
Alaska schools. She asked whether the sponsor regards the
identification of "policy points" to be an important addition to
this bill.
REPRESENTATIVE HAWKER acknowledged that policy matters are
relevant to the discussion; however, this legislation was
specifically targeted to the one task of quantifying differences
in cost, in the different geographic locations, of conducting
similar activities. The discussion of the proper way to fund
schools is another question, perhaps to be included in the
proposal to create a House Standing Committee on Education.
3:17:43 PM
REPRESENTATIVE KELLER pointed out that the resolution calls for
the president of the Senate and the speaker of the House to
appoint the chair and vice chair of the commission. He asked
about the wisdom of that approach.
REPRESENTATIVE HAWKER responded that this language was cloned
from the legislation that created the JLEFTF, and that he was
comfortable, but not adamant, with this procedure.
3:19:10 PM
REPRESENTATIVE KELLER then asked whether experts on this issue
would be part of the task force.
REPRESENTATIVE HAWKER explained that this is a legislative
process in order to fulfill the constitutional mandate to
provide the system of schools for the state. If needed, an
additional fiscal note could be attached to provide funding for
professional resources.
3:20:57 PM
REPRESENTATIVE SEATON agreed that the eleven members of the
commission should set up the parameters. He noted that the
resolution lacks the authority to write a Request for Proposal
(RFP) to fund the development of the cost factor model.
REPRESENTATIVE HAWKER supported Representative Seaton's
suggestion. Additionally, the committee may want to consider
eliminating the termination date of the commission, he remarked.
3:22:16 PM
CHAIR WILSON pointed out that the fiscal note attached is for
$30,000.
3:22:28 PM
REPRESENTATIVE GARDNER asked for the purpose of an ongoing
commission once a functional model was developed.
REPRESENTATIVE HAWKER said that he simply offered the change for
the committee's consideration.
3:23:04 PM
CHAIR WILSON stated that the Department of Education and Early
Development (EED) is mandated to check the cost factor every two
years. She noted that this bill will be going to the finance
committee with the attachment of the fiscal note.
3:23:45 PM
REPRESENTATIVE HAWKER opined that the fiscal note will force the
bill through the Finance Committee.
3:24:00 PM
REPRESENTATIVE CISSNA encouraged the sponsor to specify the
inclusion of no less than two minority members of each body to
the commission.
3:25:06 PM
CHAIR WILSON asked whether there were minority members on the
JLEFTF.
REPRESENTATIVE HAWKER said yes. He recalled that a very
important member of the minority was appointed to the JLEFTF and
expressed his trust in the fairness of the presiding officers to
make the appointments. He stated the importance of maintaining
the public perception of bipartisanship.
3:26:18 PM
REPRESENTATIVE KELLER noticed that on page 1, line 16, HCR 13
directs that the commission is established for the purpose of
examining school district cost differentials. He opined that
this long standing problem would need to be studied at the
community level and the commission should not be limited to
looking at the formula.
REPRESENTATIVE HAWKER responded that the intent of the
resolution is specifically limited to examining the existing
formulas and cost differentials. This specific problem has
caused the legislature to be in gridlock for many years.
3:28:46 PM
REPRESENTATIVE ROSES recalled that this resolve was the sole
unanimous point agreed upon by members of the JLEFTF, on which
he served. He stated that the establishment of a committee to
develop a process to arrive at valid differentials for this
purpose is a priority.
REPRESENTATIVE HAWKER agreed that the importance of this task
was a universal consideration.
3:30:51 PM
REPRESENTATIVE FAIRCLOUGH voiced her confidence that
bipartisanship would occur in the appointments to the
commission.
3:31:44 PM
REPRESENTATIVE SEATON surmised that this issue is comprehensive
enough that a diverse group will be appointed, or its
recommendations would fail.
3:32:28 PM
REPRESENTATIVE CISSNA agreed that the current political
atmosphere is of a reasonable nature. However, her experience
has been that inequities can occur. She offered Amendment 1,
such that each [body] would provide no less than two members of
the minority caucus.
3:34:11 PM
REPRESENTATIVE SEATON objected. He explained that, if there is
a small majority, the amendment would mandate a disproportionate
number of minority members.
3:35:34 PM
REPRESENTATIVE FAIRCLOUGH stated her opposition to the amendment
and pointed out the geographic imbalance that could occur.
3:36:38 PM
REPRESENTATIVE CISSNA withdrew Amendment 1, and offered
Amendment 2 such that no less than one minority member is
appointed by the president of the Senate and the speaker of the
House.
3:38:00 PM
REPRESENTATIVE SEATON objected.
REPRESENTATIVE SEATON asked whether Amendment 2 was a conceptual
amendment.
REPRESENTATIVE CISSNA indicated that it was.
REPRESENTATIVE SEATON removed his objection.
3:38:13 PM
REPRESENTATIVE GARDNER objected. She acknowledged
Representative Cissna's concern, but cautioned that the
amendment introduces an element of partisanship into the
resolution.
REPRESENTATIVE CISSNA affirmed that the amendment is a
reasonable protection against partisanship.
3:41:06 PM
A roll call vote was taken. Representatives Keller, Seaton, and
Cissna voted in favor of Amendment 2. Representatives Gardner,
Fairclough, Roses, and Wilson voted against it. Therefore,
Amendment 2 failed by a vote of 3 to 4.
3:41:31 PM
DAVE JONES, Assistant Superintendant, Kenai Peninsula Borough
School District, said that he supports the formation of a body
to look at the cost differentials. Mr. Jones agreed that, even
with changes to the foundation formula, legitimate geographic
cost differentials are needed to apply to that formula for
equitable funding across the state. He cited that the success
of the JLEFTF supports the creation of the commission in a
similar format, and the commission may achieve the solution that
has been searched for for ten years. He opined that
Representative Hawker should be appointed to the commission.
3:44:09 PM
CHAIR WILSON closed public testimony.
3:44:19 PM
REPRESENTATIVE FAIRCLOUGH stated her support for the concept of
the failed Amendment 2; however, she expressed her belief that
this is a nonpartisan resolution.
3:44:57 PM
CHAIR WILSON expressed her concern that the amendment could be
misinterpreted.
3:45:16 PM
REPRESENTATIVE KELLER offered Amendment 3, such that on page 2,
line 7, following the number "(3)", the language "one" is
replaced with "five", and the following language is added: "to
include a certified public accountant, a data analyst, and a
member of the state school board".
3:46:22 PM
REPRESENTATIVE FAIRCLOUGH objected.
3:46:31 PM
CHAIR WILSON asked how many were on the JLEFTF this summer.
3:46:42 PM
REPRESENTATIVE HAWKER answered eleven members with one appointed
by the governor.
CHAIR WILSON concluded that this amendment would make 15
members.
REPRESENTATIVE HAWKER added that the amendment would also need
to change the total number of members.
3:47:02 PM
REPRESENTATIVE FAIRCLOUGH withdrew her objection.
3:47:10 PM
REPRESENTATIVE GARDNER objected and asked whether the additions
were to comport with SB 219.
REPRESENTATIVE KELLER responded that he added the state school
board member.
3:47:38 PM
REPRESENTATIVE FAIRCLOUGH expressed her concern that adding four
additional people could bring in lobbying for personal
interests. She reminded the committee that the fiscal note
provides for the necessary expert advice, and cautioned against
adding the perception of undue influence.
3:49:09 PM
REPRESENTATIVE SEATON supported the concept that the problem has
been getting the legislature to address the issue, and the
committee should be a legislative task force with questions
answered by experts. He indicated his opposition to the
amendment.
3:50:15 PM
REPRESENTATIVE ROSES stated his opposition to the amendment
because it misrepresents what this committee is to do. The
legislators are to gather and discuss the parameters and
guidelines for an RFP or a request for data analysis.
3:51:13 PM
CHAIR WILSON commented that the fiscal note is presently
dedicated for travel.
3:51:32 PM
REPRESENTATIVE FAIRCLOUGH pointed out that there was a
duplication of the fiscal note.
3:52:21 PM
REPRESENTATIVE KELLER withdrew Amendment 3, and offered
Amendment 4, as follows:
Page 1, line 16,
Delete "school district"
Insert "community."
REPRESENTATIVE KELLER stated that this small change will broaden
the product of the commission. He stressed the value of
breaking down the cost studies, not by school district, but by
areas within a school district.
3:53:32 PM
REPRESENTATIVE SEATON objected.
3:53:39 PM
REPRESENTATIVE HAWKER acknowledged that this valid point was
discussed by the JLEFTF with the best example being the Kenai
Peninsula Borough School District. This school district is
composed of urban schools and small, very remote, rural schools
with very high cost considerations. He opined that "school
district cost differentials" is a term out of statute and
presumed the committee will address the idea of the parsing of
schools within a district. In fact, there is a large
discrepancy even within the Anchorage School District.
Representative Hawker emphasized that this is another reason to
go beyond conventional wisdom in this process.
3:56:09 PM
CHAIR WILSON agreed and cited other communities that are
affected.
3:56:54 PM
REPRESENTATIVE SEATON stressed that the funding formula works
through school districts and the problem of transportation costs
arises within schools districts, not necessarily between
communities. A funding formula must be based on a school
district basis and then adjusted, through the model, by the
diversity of the school district. He emphasized that the basis
of the funding formula and the cost differential must match.
3:59:03 PM
REPRESENTATIVE ROSES supported the community cost idea because
cost differentials can be utilized in other areas, for example,
in health and social services. In fact, area cost differentials
must be researched by scrutinizing each individual community
within school districts.
4:00:13 PM
REPRESENTATIVE FAIRCLOUGH concurred. She explained that the
amendment would create a policy change that may cause more
problems than it solves. Policy issues should be set aside for
the purpose of the mission of this resolution.
4:01:19 PM
A roll call vote was taken. Representative Keller voted in
favor of Amendment 4. Representatives Seaton, Cissna,
Fairclough, Roses, and Wilson voted against it. Therefore,
Amendment 4 failed by a vote of 1-5.
4:02:02 PM
REPRESENTATIVE SEATON offered Amendment 5, as follows:
Page 2, line 18;
Delete "December 31, 2010"
Insert "April 1, 2011"
4:02:17 PM
REPRESENTATIVE FAIRCLOUGH objected.
4:02:20 PM
REPRESENTATIVE SEATON explained that 2010 is an election year
and he stated the possible necessity to re-appoint the entire
commission.
4:03:18 PM
REPRESENTATIVE FAIRCLOUGH withdrew her objection.
4:03:28 PM
REPRESENTATIVE KELLER objected. He urged the committee to
discuss the inclusion of public comment to the report of
findings. He then removed his objection.
4:04:07 PM
CHAIR WILSON objected for discussion. She suggested the
addition of a sunset clause and then removed her objection.
4:04:33 PM
There being no further objection, Amendment 5 was adopted.
4:04:47 PM
REPRESENTATIVE SEATON offered conceptual Amendment 6, such that
on page 2, line 3, the following language would be added:
"FURTHER RESOLVED that the commission may solicit a RFP through
Legislative Budget and Audit to conduct a study based on the
model".
4:05:07 PM
REPRESENTATIVE FAIRCLOUGH objected.
4:05:15 PM
REPRESENTATIVE SEATON explained that the purpose of the
amendment was to provide a method to conduct the study and
implement the model.
4:06:15 PM
REPRESENTATIVE HAWKER clarified that the work product is that
the commission submits a report of its findings and proposed
legislative changes to the legislature. He cautioned that this
is not be assigned to Legislative Budget and Audit.
Representative Hawker questioned whether this is the type of
activity for the funding sources for external resources. He
committed to addressing this issue, perhaps through the
expansion of the fiscal note, during hearings before the House
Finance Standing Committee.
4:08:01 PM
REPRESENTATIVE SEATON agreed that the issue can be addressed
later and that Representative Hawker can explore the most
efficient mechanism to get the study conducted based on the
model. He further suggested that the study could be conducted
after the report is presented and the parameters have been
approved by the legislature.
4:09:58 PM
REPRESENTATIVE HAWKER indicated that this point illustrates why
the resolution gives the commission latitude to carry the
process forward. He opined that if the commission needs
additional resources to complete its task, the funding would
come from the legislature's budget that is already appropriated,
and additional authority would not be needed.
4:11:20 PM
CHAIR WILSON asked whether the commission would be charged with
creating a model that can be updated efficiently each year.
REPRESENTATIVE HAWKER confirmed that the charge is to create a
valid and durable model that can be accurately updated. He
cited the Medicaid cost projection model format as an example
program that is used annually to update cost projections.
4:13:22 PM
REPRESENTATIVE SEATON asked whether the report that is presented
to the legislature would be of a model with subsequent
authorization for a study, or, would the commission also conduct
the study and present the calculated cost differentials.
REPRESENTATIVE HAWKER answered that the clear deliverable is the
report of its findings. The committee ought to report a
durable model; however, it may not be possible. He stressed
that the resolution is deficient in that it does not
specifically provide that the committee would engage
professional resources to support its efforts.
4:15:46 PM
REPRESENTATIVE SEATON re-stated his question. He then remarked:
I want to figure out what our expectation is or if we
are actually having them construct the model, and, and
then that's going to be the report and then the
legislature's going to fund the conducting the study
to, to fill out that model. ... Right now, I'm a
little confused because maybe we don't have the
specificity. I was adding in the portion in this
amendment, and I'm speaking to the amendment that,
yes, you have the authority to go do the study, or
conduct the study, or get the RFP, ... and then I
backed up and I'm not sure that that ... is what the
report was really requesting or was ... the report was
requesting looking at the parameters and developing a
model. ... I'm at a loss.
4:17:14 PM
REPRESENTATIVE ROSES expressed his understanding that the charge
would be for the commission to provide an end product that would
be an area cost differential, without an intermediate step. He
cautioned that legislative approval of the parameters for the
study will slow the process by years.
4:18:28 PM
REPRESENTATIVE HAWKER offered a hypothetical example of how the
committee would operate. First, there must be a decision of how
to solve the problem. This may include advice from consultants,
or other procedures. The desired outcome would be the creation
of a working model that would provide the numbers for
presentation to the legislature. Finally, the legislature would
have the larger discussion regarding the annual or bi-annual
review of the numbers.
4:21:14 PM
CHAIR WILSON asked whether the JLEFTF decided that it wanted a
model, or new numbers.
REPRESENTATIVE HAWKER opined that it wanted an analysis
mechanism that legislators could agree would produce new and
accurate numbers.
4:21:54 PM
REPRESENTATIVE ROSES clarified that the task force was looking
for not necessarily new, but accurate, numbers.
4:22:20 PM
CHAIR WILSON recalled that, during her tenure in the
legislature, there have been three studies, and each time the
validity of the results was questioned.
4:23:24 PM
REPRESENTATIVE HAWKER stated that the effort is to develop a
mechanism, in an open process, that results in a fair and
appropriate calculation.
4:23:48 PM
REPRESENTATIVE SEATON withdrew Amendment 6, and said that he
would leave the issue to the sponsor to address.
4:24:59 PM
REPRESENTATIVE FAIRCLOUGH asked for confirmation from the
sponsor that the $30,000 provided in the fiscal note is enough
funding for an economist to be made available to the commission.
REPRESENTATIVE HAWKER stated his intent to raise the issue with
Legislative Legal and with the Finance Committee staff
immediately.
4:26:15 PM
REPRESENTATIVE ROSES moved to report HCR 13, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHCR 13(HES) was
reported out of the House Health, Education and Social Services
Standing Committee.
HB 319-DENTISTS & DENTAL ASSISTANTS
4:27:14 PM
CHAIR WILSON announced that the final order of business would be
HOUSE BILL NO. 319, "An Act relating to the practice of
dentistry and to dental assistants."
4:27:09 PM
PATTY KRUEGER, Staff to Representative Jay Ramras, Alaska State
Legislature, introduced HB 319 on behalf of Representative
Ramras, sponsor. She read from the following prepared
statement:
Oral health plays a key role in overall health
unfortunately not all Alaskan's enjoy good dental
health due to geographical barriers, cost of dental
care and limitations on dental personnel. House Bill
319 follows the provisions already in place in 36
other states allowing for expanded duties of dental
assistants thereby improving access to dental care and
reducing costs for dental care. With expanded duties,
dental assistants can help community health centers
and traveling dental teams provide greater access to
care and more cost effective care. This bill
specifically will allow certified dental assistants to
place "fillings" into a cavity prepared by a licensed
dentist and allows a certified dental assistant to do
coronal polishing of the teeth. House Bill 319 is
beneficial to the citizens of Alaska by improving
access to care while still maintaining the oversight
to ensure safety and quality of care. This bill is
supported by the Alaska Dental Society, Alaska Board
of Dental Examiners, Alaska Dental Outreach Consortium
and the Alaska Native Tribal Health Consortium. House
Bill 319 meets the goals of the preliminary report for
the Governor's Health Care Strategies Planning
Council.
4:29:44 PM
REPRESENTATIVE FAIRCLOUGH asked for the source of the
definitions that are found on page 5, line 5 to 15, of the bill.
JANE PIERSON, Staff to Representative Jay Ramras, Alaska State
Legislature, informed the committee that the definitions in the
bill were provided by the Alaska Dental Society, Inc.
4:30:44 PM
REPRESENTATIVE FAIRCLOUGH further asked for confirmation that
the definitions are consistent with standard dental procedures.
4:31:56 PM
DAVID L. EICHLER, D.D.S.; President, Alaska Board of Dental
Examiners, affirmed that the definitions are standard in the
dental industry.
4:32:07 PM
DAVID LOGAN, D.D.S.; Legislative Liaison, Alaska Dental Society,
agreed with Dr. Eichler. He added that the definitions for
supervision are defined elsewhere in the statute; in fact, the
bill creates a new class of supervised entity with the dental
assistant. Previously, dental assistants have been a non
regulated entity.
4:33:27 PM
REPRESENTATIVE FAIRCLOUGH then asked whether these definitions
are accepted nationally, or just in Alaska.
DR. EICHLER explained that the two definitions related to
supervision would be specific with the state of Alaska statute
and regulation. The definitions of "calculus" and "coronal
polishing" meet the standards of clinical dental practice, and
the scope of practice of the "dental assistant" is defined by
statute in individual states.
4:34:24 PM
REPRESENTATIVE SEATON assumed that the bill creates a more
limited scope for a dental assistant when compared to the
responsibilities of a physician's assistant. For example, the
only time that the dental assistant can perform these procedures
is when the dentist is present in the facility.
DR. LOGAN said that is correct. A dental assistant can only work
in the presence of the dentist, under direct or indirect
supervision.
4:35:24 PM
REPRESENTATIVE ROSES asked whether a local dental assistant
would be allowed to correct the polishing after a traveling
dentist has left the community.
DR. LOGAN explained that coronal polishing has to do with
cleaning the teeth, not the adjustment of fillings. He stressed
that a dental assistant cannot make any adjustments to a tooth
with a dentist present.
4:36:46 PM
REPRESENTATIVE FAIRCLOUGH asked about the repeal of AS
08.32.110(d) that allows dental assistants to apply topical
preventive agents and sealants.
DR. LOGAN explained that the provision cited by Representative
Fairclough was defined under the hygiene statutes and this
authority is now found in the bill on page 4, line 21.
4:37:56 PM
CHAIR WILSON asked whether there is a national board or agency
that certifies dental assistants.
DR. EICHLER said yes. He added that national standards are not
a part of the regulatory requirements in Alaska. In answer to a
question, he further explained that it is difficult to obtain
dental office personnel in Alaska, and many are trained on the
job by the dentist.
4:39:12 PM
CHAIR WILSON asked whether there would be an objection to
requiring certification for dental assistants who will be
performing the expanded duties.
DR LOGAN responded that there is not a national certification
process for dental health care providers; however, each state is
allowed to credential to their own statute. He said he was not
aware of any state that required certification from a national
board for all assistants.
DR. EICHLER concurred.
4:40:55 PM
REPRESENTATIVE ROSES asked whether dental assistants are
required to be licensed.
DR. EICHLER indicated no.
4:41:07 PM
REPRESENTATIVE FAIRCLOUGH referred to page 4, line 23, and asked
for further clarification of "other dental operations and
services except as provided in AS 08.32.110(c) and this
chapter."
DR. EICHLER stated that AS 08.32.110(c) is an exception to the
delegation powers that could be delegated to a hygienist. These
same exceptions would apply to a dental assistant, also.
Paragraph (3) of the bill allows the delegation of services,
except for those previously cited.
4:43:07 PM
REPRESENTATIVE FAIRCLOUGH pointed out that one of the other
services delegated to a hygienist is the administration of a
local anesthetic, and the bill would also apply this exception
to dental assistants.
DR. EICHLER disagreed.
4:43:47 PM
REPRESENTATIVE FAIRCLOUGH further asked whether this procedure
is allowed under paragraph (c).
DR. EICHLER clarified that a dental hygienist is allowed to
administer a local anesthetic with a separate certification. He
stated that there is no provision in this bill to allow that
certification for dental assistants.
4:45:04 PM
CHAIR WILSON observed that there is time to clear this up before
the bill is moved from committee.
REPRESENTATIVE SEATON referred to page 4, line [25], [sub]
section (b), and asked for clarification of "direct supervision"
as compared to "indirect supervision."
4:46:24 PM
DR. LOGAN explained that the current definition, under hygiene
statute, for "direct supervision" is that the dentist is in the
office, but not necessarily in the room, and the dentist is
required to see the patient before and after the work is done.
4:47:17 PM
CHAIR WILSON asked for further clarification.
DR. LOGAN responded that for "indirect supervision" the dentist
sees the patient beforehand, and is in the office, but not
necessarily in the room, and does not see the patient for
evaluation after the work is done. For example, taking a x-ray
only requires "indirect supervision."
4:48:10 PM
CHAIR WILSON asked for a description of procedures that
assistants are allowed to do with both "direct" and "indirect"
supervision.
DR. LOGAN stated that anything dental assistants do now, they
would still be able to do under "indirect supervision." House
Bill 319 will allow, with "direct supervision," the packing and
carving of filling materials and coronal polishing.
4:49:10 PM
CHAIR WILSON expressed a concern about the lack of certification
of the assistants who are performing these expanded duties. A
certification procedure, independent of the dentists, would
assuage this concern.
DR. LOGAN emphasized that the function of the dental board is to
license dentists and hygienists. He opined that the dental
board is in the best qualified position to authorize individuals
to perform procedures.
4:50:22 PM
CHAIR WILSON asked how the dental board makes this conclusion.
DR. EICHLER pointed out that the clause on page 3, line 24,
requires that the board will issue a certificate to dental
assistants upon completion of a training program. The
University of Alaska is willing to develop a training course to
ensure competency for the new duties.
4:51:22 PM
CHAIR WILSON surmised that dental assistants would attend, and
pass, competency classes prior to applying for certification.
4:51:41 PM
REPRESENTATIVE SEATON noted that on page 3, line 2, the bill
establishes the dentist's responsibility to ensure that an
assistant under his or her supervision meets the minimum
professional standards.
DR. EICHLER concurred.
4:52:43 PM
REPRESENTATIVE ROSES stated that the bill requires an assistant
to be competent, but does not require licensing.
DR. EICHLER agreed that the bill requires a certification course
only.
4:53:19 PM
REPRESENTATIVE ROSES asked whether a dental assistant would be
able to perform these functions without a certificate.
DR. EICHLER said no.
4:53:32 PM
REPRESENTATIVE ROSES recalled that Dr. Eichler had trained some
assistants in his office. He asked whether they had
certificates.
DR. EICHLER said they did not have certificates for these
functions. He added that the functions that a dental assistant
currently performs have no certification.
4:53:57 PM
REPRESENTATIVE ROSES confirmed that certifications will be
required for the expanded functions.
DR. EICHLER concurred.
4:54:09 PM
CHAIR WILSON asked for the consequences to the dentist of
allowing procedures by a noncertified assistant.
DR. LOGAN recalled that there was a case about 10 years ago and
the dentist was fined $5,000. He noted that the maximum fine is
now $25,000.
4:54:57 PM
REPRESENTATIVE FAIRCLOUGH opined that this bill would create
additional income for dentists.
4:55:21 PM
CHAIR WILSON asked whether the bill would allow dentists to
collect more money.
DR. LOGAN said no. He explained that dental billing is by
procedure regardless of how many providers are involved. He
added that the bill would allow a more cost effective means to
provide treatment for children who qualify for Medicaid.
4:56:41 PM
DR. LOGAN, in answer to a question, estimated that there are a
very, very low number of dentists who provide cleaning services
for Medicaid patients.
4:56:57 PM
CHAIR WILSON asked whether the bill would allow dental
assistants to perform the cleanings that dentists and hygienists
now perform, but at a lower cost.
DR. LOGAN said yes.
4:57:16 PM
REPRESENTATIVE SEATON observed that, in Homer, there are no
dentists that provide Medicaid patients with service.
4:58:08 PM
CHAIR WILSON shared that Ketchikan kids fly to Juneau for dental
care.
4:58:28 PM
REPRESENTATIVE FAIRCLOUGH opined that the owner of a dental
office will have the opportunity to provide additional access to
care.
4:58:59 PM
CHAIR WILSON asked whether the bill would be an incentive for
dentists to accept more Medicaid patients.
DR. LOGAN expressed his hope that the bill would lower one of
the barriers to Medicaid patients.
[Although not formally stated, HB 319 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:59 p.m.