ALASKA STATE LEGISLATURE  SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE  March 26, 2007 1:34 p.m. MEMBERS PRESENT Senator Bettye Davis, Chair Senator Joe Thomas, Vice Chair Senator John Cowdery Senator Kim Elton Senator Fred Dyson MEMBERS ABSENT  All members present COMMITTEE CALENDAR  SENATE JOINT RESOLUTION NO. 3 Relating to the effect of Medicare rates on senior citizens' access to healthcare; and urging the United States Congress to increase Medicare rates for Alaska. MOVED SJR 3 OUT OF COMMITTEE SENATE BILL NO. 98 "An Act relating to dental hygienists." HEARD AND HELD PREVIOUS COMMITTEE ACTION  BILL: SJR 3 SHORT TITLE: MEDICARE RATES IN ALASKA SPONSOR(s): SENATOR(s) WIELECHOWSKI 03/07/07 (S) READ THE FIRST TIME - REFERRALS 03/07/07 (S) HES 03/26/07 (S) HES AT 1:30 PM BUTROVICH 205 BILL: SB 98 SHORT TITLE: DENTAL HYGIENISTS SPONSOR(s): SENATOR(s) DAVIS 02/28/07 (S) READ THE FIRST TIME - REFERRALS 02/28/07 (S) HES, L&C 03/26/07 (S) HES AT 1:30 PM BUTROVICH 205 WITNESS REGISTER    Senator Bill Wielechowski Alaska State Capitol Juneau, AK 99801-1182 POSITION STATEMENT: Sponsor of SJR 3   Karleen Jackson, Commissioner Department of Health and Social Services (DHSS) Juneau, AK POSITION STATEMENT: Available for questions on SJR 3 Tom Obermeyer, aide to Senator Davis Juneau, AK POSITION STATEMENT: Presented SB 98 for the sponsor Gail Walton, member Alaska State Dental Hygienist Association Wasilla, AK POSITION STATEMENT: In support of SB 98 Rena Bauer, Faculty Director Dental Hygiene Program University of Alaska Fairbanks Fairbanks, AK POSITION STATEMENT: In support of SB 98 Mike Booth, President Alaska Dental Society Anchorage, AK POSITION STATEMENT: In support of SB 98 Jim Tulle, Executive Director Alaska Dental Society Anchorage, AK POSITION STATEMENT: In support of SB 98 Royann Royer, representing herself Chugiak, AK POSITION STATEMENT: In support of SB 98 Glenn Martin, representing himself Anchorage, AK POSITION STATEMENT: In support of SB 98 Mary Cerney, representing herself Fairbanks, AK POSITION STATEMENT: In support of SB 98 David Logan, Legislative Chair Alaska Dental Society Juneau, AK POSITION STATEMENT: In support of SB 98 Nathan Lukes, representing himself Anchorage, AK POSITION STATEMENT: In support of SB 98 ACTION NARRATIVE CHAIR BETTYE DAVIS called the Senate Health, Education and Social Services Standing Committee meeting to order at 1:34:34 PM. Present at the call to order were Senators Dyson, Thomas, Elton, Cowdery, and Chair Davis. SJR 3-MEDICARE RATES IN ALASKA    CHAIR DAVIS announced SJR 3 to be under consideration. SENATOR WIELECHOWSKI, sponsor of SJR 3, explained that it regards Medicare reimbursement rates; 55,000 Alaskans rely on the federal program, which is the largest health-care program in the country. The resolution addresses the many Alaskans with inadequate coverage; Medicare is letting down many citizens in paying less than 50 percent of the costs of their medical treatment. Seniors must often call dozens of doctors before finding one that will treat them under Medicare. The problem is projected to only get worse; the number of Alaskans on Medicare will double in future years. If reimbursement rates drop any further, doctors will have to stop accepting Medicare patients. Military beneficiaries are being adversely affected as well. The Congressional Budget Office projects a loss of $240 million in Medicare funding Alaska between 2008 and 2015; the problem in Alaska is particularly bad because the state has higher costs of providing medical care and fewer doctors, and the funding formula doesn't take these factors into account. Alaska is the only state in which Medicare reimbursement rates are even lower than those of Medicaid. The joint resolution calls on Congress and the United States Department of Health and Human Services to address this crisis by rewriting the funding formulas for Alaska; he urged the committee to join him in supporting SJR 3. 1:38:59 PM SENATOR DYSON asked if the same funding situation applies to Medicaid. SENATOR WIELECHOWSKI said that there is a problem with Medicaid, but it isn't quite as extensive. Medicare is particularly troubled because the funding rate is 25 percent less than that of Medicaid; also the number of seniors is growing quickly. SENATOR DYSON asked why both issues couldn't be addressed in one resolution. SENATOR WIELECHOWSKI said that the committee could certainly decide to do so. SENATOR COWDERY said that the problem with Medicaid is mostly the cost of drugs, and the average wholesale prices are too high and need to be brought to a reasonable level. 1:42:38 PM KARLEEN JACKSON, Commissioner for the Department of Health and Social Services (DHSS), thanked Senator Wielechowski and said that the only way to fix this problem is to work with the congressional delegation and the federal government. She gave an example to show the importance of improving the Medicare program. 1:44:00 PM SENATOR THOMAS said that he hopes to see insurance and pharmaceutical companies participate in finding a solution. SENATOR COWDERY moved to report SJR 3 from committee with individual recommendations and attached fiscal note(s). There being no objection, the motion carried. SB 98-DENTAL HYGIENISTS    CHAIR DAVIS announced SB 98 to be under consideration. 1:46:21 PM TOM OBERMEYER, aide to Senator Davis, sponsor of SB 98, said that the bill will improve the oral health care, overall health, well-being, and individual appearance and comfort of Alaskans. It allows better access to professionally trained dental hygienists and expanded services, and will help stem the epidemic of oral diseases affecting certain segments of the population; similar bills have passed in other states. He then explained the process for becoming a licensed dental hygienist, and how the bill will allow additional services to be performed by hygienists with prior board approval and a minimum of experience. The committee substitute (CS) for the bill makes a few small changes. 1:50:02 PM CHAIR DAVIS said that the CS reflects the differences in the companion house bill. SENATOR COWDERY moved to adopt the proposed committee substitute to SB 98, labeled 25-LS0670\C, Version C, as the working document of the committee. There being no objection, the motion carried. MR. OBERMEYER explained that the CS takes into account the differences in the house bill, regarding licensing, observation, and the approval of collaborative agreements. 1:52:30 PM SENATOR ELTON asked why a dental hygienist wouldn't need to be licensed in Alaska like a dentist would. MR. OBERMEYER said that the board has the final word on the matter, and it generally oversees assistants and examinations in the state. There are substantial training and examinations involved in working in Alaska. SENATOR ELTON said that the language of the bill mentions a national examining board, and it seems that the bill will allow someone licensed anywhere in the country to practice in Alaska. MR. OBERMEYER replied that the preface provides for a required endorsement by the Alaskan board for someone wishing to practice in the state. CHAIR DAVIS said that other testifiers should be able to comment on the issue. SENATOR COWDERY asked how many other states have adopted similar bills. MR. OBERMEYER replied that at least four others have done so, and cited statistics on each. SENATOR COWDERY asked how many dental hygienists graduate every year from University of Alaska (UA) schools. MR. OBERMEYER said that the he knows the UA program is competitive and effectual, but he will have to research its graduation numbers. 1:58:57 PM GAIL WALTON, member of the Alaska State Dental Hygienist Association (ASDHA), said that UA Anchorage has 12 graduates each year, and there's a UA Fairbanks program under development for 6 additional students. The program is two years long. SENATOR COWDERY asked if the program is sufficiently rigorous. MS. WALTON said that the number of hygienists is sufficient but could be reviewed; regardless, currently Alaskan needs are not being met. Hygienists aren't allowed to work in nontraditional settings and aren't being used to their full potential. The ASDHA supports SB 98, as well as the state Oral Health Coalition. She clarified that hygienists would have to be licensed in Alaska if moving from another state. 2:02:29 PM SENATOR ELTON asked if there are reciprocal agreements between Alaska and other states in terms of dental hygienist licensing. MS. WALTON replied that a license for each state must be obtained, but the board for another state would automatically give a hygienist a license if they were already licensed in Alaska. There are some states that don't allow credentials from different licensing boards; a license would be issued based on completion of an accredited program, passing of the regional boards, or licensing in another state. The board would still be able to refuse a license. She explained that the restorative function of the bill would create an efficient oral health care delivery system in a limited amount of time. Local anesthesia has been in Alaska statue since 1981, with history of required disciplinary action. A dentist is still required to diagnose the patient's needs; whether or not the hygienists will be able to administer anesthesia remains at the discretion of the dentist. This bill will be allow for great improvement in dental health services in nursing homes, hospitals, and rural areas; it will reach many individuals needing dental care. Similar programs in other states have been proven safe and effective. 2:06:40 PM RENA BAUER, Faculty Director of the Dental Hygiene Program at the UA Fairbanks campus, said that all hygienists are licensed by the state; each hygienist has to meet a state's particular criteria. She strongly supports the bill which will enhance the UA's ability to attract students. The class of January 2008 will be the first dental hygienist class at the UA Fairbanks. The general supervision of anesthesia will enhance the ability to serve the rural population in the state. She added that the amount of graduates from the UA system is based on the American Dental Association's requirement for a one-to-six student/instructor ratio. 2:10:48 PM SENATOR COWDERY asked how many dentists and hygienists are in rural Alaska, and how more can be attracted. MS. BAUER replied that most hygienists in rural Alaska would be employed by the Alaska Native Medical Center; there are some Anchorage dentists who fly out to rural communities on a regular basis. She added that several states currently allow the restorative hygiene measures proposed by the bill. 2:12:17 PM MR. OBERMEYER referenced an informational packet to show the number of dental hygienists by region in Alaska, which reflects difficulties in the rural areas in terms of population. 2:14:30 PM MIKE BOOTH, president of the Alaska Dental Society (ADS), said that educating rural Alaskans about proper hygiene is one of the greatest challenges facing the state, and dental auxiliary use should be broadened. SB 98 and HB 136 will broaden the scope of duties, but the fast pace of the hearings has hampered necessary discussion. He then suggested several improvements to the bill which will lead to the full support of the ADS, including the categorization of local anesthesia. He added that the UA Anchorage dental hygiene program has the facilities to accommodate many more students, and should receive the funding to do so. 2:18:05 PM JIM TULLE, Executive Director of the ADS, said he was available for questions. ROYANN ROYER, representing herself, explained her work background and said that the expanded functions covered under the bill will increase the number of dental patients served daily. A typical village trip takes about a week, so sending a hygienist ahead of time would allow much more work to be done in a shorter period of time; hygienists possess the education and qualifications for expanded functions, and students could be mentored in these positions. SB 98 could be put into practice immediately. 2:22:57 PM GLENN MARTIN, representing himself, related his dental work experience and said that he strongly supports the bill; collaborative agreement would greatly increase efficiency by identifying need in advance. The dental profession needs to start utilizing its mid-level practitioners. 2:25:54 PM MARY CERNEY, representing herself, related her work history as a dental hygienist, explained the steps and education necessary to practice dental hygiene in the United States, and said that hygienists would have to have an Alaskan license acquired either through examination or endorsement. She added that the bill addresses a health care need in the general population, and would have a profound effect not only on rural but urban towns. SB 98 will improve overall health care in the state, and she encouraged the committee to pass the bill out of committee. 2:31:56 PM DAVID LOGAN, Legislative Chair for the Alaska Dental Society, said that a couple of changes may eventually be needed in the bill but that it should be passed out of the committee. CHAIR DAVIS said that she was unaware of any proposed amendments to the bill. MR. LOGAN explained the changes he wished to see in the bill, including the provision for general anesthetic. 2:34:44 PM NATHAN LUKES, representing himself, expressed his support for the bill and related a personal story about dental hygienists. CHAIR DAVIS said that there appeared to be some confusion regarding changes to the bill, and her intention was to keep it in committee. There being no further business to come before the committee, she adjourned the meeting at 2:36:53 PM.