Legislature(2015 - 2016)HOUSE FINANCE 519

04/07/2016 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 1:45 p.m. Today --
<Bill Hearing Canceled>
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 230(FIN) Out of Committee
Heard & Held
HOUSE BILL NO. 237                                                                                                            
     "An Act  relating to an  interstate compact  on medical                                                                    
     licensure;  amending the  duties of  the State  Medical                                                                    
     Board;  and  relating  to   the  Department  of  Public                                                                    
     Safety's   authority  to   conduct  national   criminal                                                                    
     history record checks of physicians."                                                                                      
1:53:31 PM                                                                                                                    
REPRESENTATIVE   PAUL  SEATON,   SPONSOR,  appreciated   the                                                                    
opportunity to  present the bill.  He relayed that  the bill                                                                    
would  make  Alaska  a  party   to  the  Interstate  Medical                                                                    
Licensure Compact,  which would expedite licensing  to bring                                                                    
qualified  physicians  to  Alaska.  He shared  that  it  was                                                                    
currently a  14 to 18-week  licensure process. He  had heard                                                                    
from new doctors who were  from Alaska and licensed in other                                                                    
states  who wanted  to  return to  practice  in Alaska.  The                                                                    
individuals had been  waiting over six months  and still had                                                                    
not  received their  Alaskan  license  and were  considering                                                                    
jobs outside of  Alaska due to the delay. He  noted that the                                                                    
department [Department  of Commerce, Community  and Economic                                                                    
Development (DCCED)] was attempting to  speed up some of the                                                                    
processes.  He spoke  to the  importance of  getting doctors                                                                    
into Alaska on  a quicker basis due to the  state's need for                                                                    
physicians.  He cited  turnover  as an  issue. He  explained                                                                    
that licensure under  the compact had a  higher criteria and                                                                    
required  fingerprinting, background  checks,  and other.  A                                                                    
state seeking to be a member  of the compact had to agree to                                                                    
the   qualifications;  the   state  could   have  additional                                                                    
qualifications  and  under  the compact  a  physician  would                                                                    
receive  a  provisional  license until  they  fulfilled  the                                                                    
state's additional  requirements. When  a person  received a                                                                    
license under the  compact they would then  have the ability                                                                    
to apply  for work in  any other states within  the compact.                                                                    
Individuals had to pay the full  fees to the state and would                                                                    
receive a  license to  practice very quickly  in any  of the                                                                    
states under the compact.                                                                                                       
1:57:00 PM                                                                                                                    
Representative Kawasaki could see  the need and benefits for                                                                    
the state.  He asked for  verification that becoming  one of                                                                    
the  13 states  with the  licensure compact  should make  it                                                                    
easier  for  Alaska  state examiners  to  qualify  a  person                                                                    
registered in another state.                                                                                                    
Representative  Seaton   replied  in  the   affirmative.  He                                                                    
detailed  that  a  person  who  had  satisfied  the  compact                                                                    
criteria for  licensure could get  a license to  practice in                                                                    
any of the other compact  states. He furthered that Alaska's                                                                    
physicians who  met the criteria could  also obtain licenses                                                                    
more quickly in other states as well.                                                                                           
Representative  Kawasaki pointed  to  the  fiscal note  that                                                                    
appeared to  be "hefty."  He observed  that the  fund source                                                                    
was receipt  supported services.  He believed that  once the                                                                    
compact was  in place  it would actually  cost less  for the                                                                    
agency to administer.                                                                                                           
Representative Seaton deferred the question to his staff.                                                                       
TANEEKA HANSEN,  STAFF, REPRESENTATIVE PAUL  SEATON, replied                                                                    
that the largest  portion of the fiscal note was  due to the                                                                    
background checks, which were  a requirement of the compact.                                                                    
She   relayed   that   currently   background   checks   and                                                                    
fingerprinting  were not  required  for Alaskan  physicians.                                                                    
The  bill  had  a   specific  authorization  for  physicians                                                                    
applying  for an  expedited license  through the  compact to                                                                    
undergo the background  checks; the bulk of  the fiscal note                                                                    
included  the fingerprinting  fee. Additional  funds in  the                                                                    
note were related  to travel and designating a  person to be                                                                    
in  communication with  the commission.  She explained  that                                                                    
under the compact, two commissioners  would come from Alaska                                                                    
to participate  on the Interstate Commission;  they would be                                                                    
current members  or staff  of the  medical board.  She added                                                                    
that  there   would  be  additional  travel   and  needs  to                                                                    
coordinate with the commission.                                                                                                 
Representative Kawasaki  asked if the State  of Alaska would                                                                    
be  made  aware if  a  physician  in  the compact  had  been                                                                    
sanctioned  in  another  state. He  wondered  how  it  would                                                                    
impact licensure.                                                                                                               
Ms.  Hansen  replied  that  there  were  compact  provisions                                                                    
listed in  the bill that outlined  disciplinary actions. She                                                                    
detailed  that if  there was  a disciplinary  sanction taken                                                                    
against any  expedited license in  another state,  the other                                                                    
states were  automatically notified  by the  state's medical                                                                    
board and the individual's  state license would be suspended                                                                    
until  a review  was  conducted.  Alaska's current  statutes                                                                    
included  a   provision  for   suspending  a   license  upon                                                                    
notification  or  proof of  another  state  action upon  the                                                                    
license until a hearing could be held.                                                                                          
2:01:09 PM                                                                                                                    
Representative  Guttenberg shared  a story  about a  dentist                                                                    
from New Zealand  who could not obtain a  license in Alaska.                                                                    
He thought  it appeared  that an individual  had to  live in                                                                    
another  state or  have a  percentage of  their practice  in                                                                    
another  state before  they could  transfer the  license. He                                                                    
furthered  that   the  individual  could  not   have  merely                                                                    
obtained  a  license  in   California  and  transferred  the                                                                    
license  to  Alaska;  the requirements  for  residency  were                                                                    
still  in   place.  He  asked   how  the  bill   related  to                                                                    
international compacts.  He wondered if the  residency issue                                                                    
still played a role.                                                                                                            
Ms. Hansen answered that there  was a section that addressed                                                                    
the definition  of the designation  of a state  of principal                                                                    
licensure,  which was  a  baseline  requirement for  compact                                                                    
eligibility. She  detailed that  an individual  was required                                                                    
to designate  a compact  state as  their state  of principal                                                                    
licensure.  Requirements  included  that the  state  be  the                                                                    
individual's primary  residency, a minimum of  25 percent of                                                                    
the practice of  medicine occurred, and the  location of the                                                                    
individual's  employer.  She  elaborated that  if  no  state                                                                    
qualified  under  the  requirements,  the state  had  to  be                                                                    
designated  as  a state  of  residence  for the  purpose  of                                                                    
federal  income  tax. Individuals  would  have  to meet  the                                                                    
qualifications in  one of the  12 compact states  (13 states                                                                    
if Alaska joined the compact).                                                                                                  
Representative  Guttenberg   asked  for   verification  that                                                                    
international  doctors  could  not  come in  and  receive  a                                                                    
license. He surmised that the  individuals would be required                                                                    
to have residency in another  state. He asked about the time                                                                    
Ms.  Hansen answered  that  the compact  did  not outline  a                                                                    
requirement for the length of  residency. She noted that the                                                                    
information may  be outlined in  the commission  bylaws. She                                                                    
did not know the current  standards for an individual Alaska                                                                    
license  for  an  international physician  coming  into  the                                                                    
state. She  explained that  currently physicians  not living                                                                    
in Alaska could  apply for a license in Alaska;  they had to                                                                    
apply for a license in each state they wanted to practice.                                                                      
Representative Seaton noted that  the primary reason for the                                                                    
bill  was to  save  individuals who  wanted  to practice  in                                                                    
multiple states  from applying for  a license  separately in                                                                    
each of the locations.  He furthered that expedited licenses                                                                    
were  electronically  issued.  He explained  that  currently                                                                    
getting a license in Alaska was  only done on paper - it was                                                                    
not  as  efficient  as  it  could  be.  He  added  that  the                                                                    
department was trying  to expedite things by the  end of the                                                                    
year  - some  renewals were  done electronically.  The state                                                                    
was  behind   the  curve  on  electronic   verification  and                                                                    
submission of background information.                                                                                           
2:05:09 PM                                                                                                                    
Vice-Chair  Saddler  asked  about   the  current  process  a                                                                    
physician  licensed  in another  state  undertook  to get  a                                                                    
license in Alaska. He asked how long the process took.                                                                          
Representative  Seaton replied  that  the current  licensing                                                                    
process for first-time licenses in  Alaska was done on paper                                                                    
and required  all of the background  information. The normal                                                                    
timeframe was 14  to 16 weeks; however, with  staff cuts the                                                                    
length of time had been somewhat extended in recent years.                                                                      
Vice-Chair Saddler asked  how much it cost to  apply for and                                                                    
receive a state license.                                                                                                        
Representative Seaton  answered that the charge  for a state                                                                    
license through the compact was  whatever the state charged.                                                                    
He  explained that  an individual  did not  receive a  price                                                                    
break by applying electronically  for the expedited license.                                                                    
The process  provided an expedited  way to obtain  a license                                                                    
and saved  applicants from going through  paperwork for each                                                                    
state they wanted to practice in.                                                                                               
Vice-Chair Saddler asked if it  was common for physicians to                                                                    
want to be licensed in multiple states.                                                                                         
Representative Seaton  did not have numerical  data on hand;                                                                    
however, he  provided an example  of eye  surgeons traveling                                                                    
from the  Pacific Northwest to  do surgeries once a  week in                                                                    
Ms. Hansen  elaborated that the  licensure compact  had been                                                                    
adopted  by  many  rural states  where  physicians  traveled                                                                    
between  small  communities  or those  taking  advantage  of                                                                    
telemedicine, which  required the  physician to  be licensed                                                                    
in the state they were practicing.                                                                                              
Representative Wilson thanked the  sponsor for the bill. She                                                                    
relayed that she had helped  three or four physicians in the                                                                    
past  year with  the process  that had  taken three  or four                                                                    
months.  She   added  that  a  physician   could  have  been                                                                    
practicing  for 30  years and  they were  still required  to                                                                    
have their original transcripts and  residency - some of the                                                                    
items did  not exist  any longer because  a person  had been                                                                    
practicing  for so  long. She  discussed that  the Fairbanks                                                                    
hospital cancer  center only had  one specialist  in several                                                                    
different  areas, which  meant if  someone went  on vacation                                                                    
the hospital  had to  bring a  physician up  to fill  in for                                                                    
that two-week period.  She believed the bill  would make the                                                                    
process   go  much   quicker  for   individuals  in   states                                                                    
participating in the compact.                                                                                                   
Ms. Hansen  replied that theoretically  the answer  was yes.                                                                    
She detailed  that the bylaws  were currently  being written                                                                    
by the  Interstate Commission.  How long  it would  take for                                                                    
states to  be notified  had not yet  been seen  in practice.                                                                    
She furthered that  if a physician had  an expedited license                                                                    
in  one  state  all  they   needed  to  do  was  notify  the                                                                    
commission that  they would like  to be licensed  in another                                                                    
state. A  state was directed to  issue a license as  soon as                                                                    
it received  the fees and  notification. She  concluded that                                                                    
the process should be much faster.                                                                                              
Representative  Wilson  did  not   believe  there  would  be                                                                    
thousands  more doctors  applying for  a license  because it                                                                    
was easier. She remarked that  the fiscal note specified the                                                                    
need  for   an  additional  employee  [within   DCCED].  She                                                                    
believed that in reality after  the bill was implemented the                                                                    
process would be much easier.  She reasoned that there would                                                                    
be less paperwork.                                                                                                              
Representative Seaton deferred the question to DCCED.                                                                           
Representative  Wilson wondered  if the  bill would  require                                                                    
all physicians in  Alaska - Alaskan residents  included - to                                                                    
adhere to the fingerprinting requirement.                                                                                       
Representative Seaton answered  in the negative. Individuals                                                                    
would  not  be  subject to  the  fingerprinting  requirement                                                                    
unless  they  wanted  to obtain  an  expedited  license  for                                                                    
another state.  The bill did not  change Alaska requirements                                                                    
for  its  licenses. He  furthered  that  if a  physician  in                                                                    
Alaska  wanted to  obtain an  expedited license  for another                                                                    
state they  would have to  satisfy the background  check and                                                                    
fingerprint requirements for the compact.                                                                                       
Representative Wilson shared that  a doctor had participated                                                                    
in the Iditarod,  but had almost been  unable to participate                                                                    
because it  took so long  to get his  replacement physicians                                                                    
licensed.  She believed  the bill  would  make more  doctors                                                                    
want to come to Alaska.                                                                                                         
2:11:32 PM                                                                                                                    
Representative  Munoz believed  the  bill went  hand-in-hand                                                                    
with  the   Medicaid  reform   bill  currently   before  the                                                                    
legislature - especially as it  related to telemedicine. She                                                                    
thanked the sponsor for bringing the bill forward.                                                                              
Vice-Chair  Saddler  asked if  the  primary  purpose of  the                                                                    
compact was  to expedite licenses  and increase the  ease of                                                                    
cross-state licensure.                                                                                                          
Ms.  Hansen answered  that it  was primary  purpose, but  it                                                                    
also allowed states  in the compact to  maintain a database.                                                                    
She  detailed   that  the  exchange  of   information  about                                                                    
disciplinary  actions  would  be   up  to  date  and  easily                                                                    
accessed  by all  states. The  Federation  of State  Medical                                                                    
Boards  kept track  of  licenses  for participating  states;                                                                    
therefore, Alaska  was able  to obtain  some of  the primary                                                                    
documents  through  the  coordinated database.  The  compact                                                                    
database  provided  additional  detail  with  all  licensure                                                                    
information, which would enable easier confirmations.                                                                           
Vice-Chair  Saddler remarked  that there  was a  federalized                                                                    
system and  each state  had the power  to set  its standards                                                                    
for any profession.  He believed the bill  presumed that any                                                                    
state's  medical license  was  as appropriately  set as  any                                                                    
other. He  surmised that any  physician licensed in  any one                                                                    
of  the states  should be  quickly able  to practice  in any                                                                    
other state within  the compact. He asked if  there were any                                                                    
states that had extraordinarily  high standards for extended                                                                    
residencies, education, or training.                                                                                            
Representative Seaton responded that  the assumption was not                                                                    
that every state had the  criteria, just like Alaska did not                                                                    
require  a  fingerprint  or background  check.  The  compact                                                                    
allowed the  doctors within Alaska  to also qualify  for the                                                                    
compact  if   they  applied  and  provided   the  additional                                                                    
required criteria;  at that point  they could  easily obtain                                                                    
licenses  in  other  states.   People  understood  that  the                                                                    
compact had a  uniform group of criteria,  which were higher                                                                    
than  required  in  a  number of  states,  and  that  anyone                                                                    
satisfying the  universally high  criteria would be  able to                                                                    
get  a  license and  practice  medicine  in Alaska  with  an                                                                    
expedited license.                                                                                                              
Vice-Chair  Saddler asked  for  verification  that the  bill                                                                    
only  applied   to  medical   physicians  and   not  nurses,                                                                    
optometrists, ophthalmologists, or other.                                                                                       
Representative Seaton replied in the affirmative.                                                                               
Representative Gara relayed that he  had not heard about any                                                                    
opposition  or controversy  related  to the  bill. He  noted                                                                    
that the state  medical board and Alaska  State Hospital and                                                                    
Nursing Home  Association (ASHNHA)  had supported  the bill.                                                                    
He was happy to move the bill forward.                                                                                          
Representative  Wilson  asked  why the  bill  would  require                                                                    
another  staff because  she believed  it  would make  things                                                                    
much easier.                                                                                                                    
2:15:46 PM                                                                                                                    
Representative   Seaton  deferred   the   question  to   the                                                                    
JANEY   HOVENDEN,   DIRECTOR,  DIVISION   OF   CORPORATIONS,                                                                    
BUSINESS   AND   PROFESSIONAL   LICENSING,   DEPARTMENT   OF                                                                    
COMMERCE, COMMUNITY  AND ECONOMIC DEVELOPMENT,  replied that                                                                    
the  bill represented  an additional  pathway to  licensure.                                                                    
She continued that the bill  only applied to individuals who                                                                    
met the higher  criteria [required by the  compact]. The old                                                                    
pathway would still have to  remain in place because not all                                                                    
physicians  would qualify  for the  higher criteria  (e.g. a                                                                    
person could  have no disciplinary records).  The new system                                                                    
would be  housed with the executive  administrator who would                                                                    
track the licenses and handle  the fingerprinting cards that                                                                    
the other pathway did not  have. The position [listed in the                                                                    
fiscal  note] was  an  Office Assistant  I  (range 10)  that                                                                    
would   assist   the   executive  administrator   with   the                                                                    
specialized    program.    The   position    would    handle                                                                    
communication with the  commission, travel arrangements, and                                                                    
Representative Gara believed the  costs would be funded with                                                                    
a  fee  charged to  doctors  for  use  of the  service.  Ms.                                                                    
Hovenden  answered  in the  affirmative.  The  fee would  be                                                                    
charged  to  physicians who  selected  to  use the  specific                                                                    
pathway to licensure.                                                                                                           
Representative  Guttenberg noted  that  he  had often  heard                                                                    
that due to  the competitive nature of the  field in Alaska,                                                                    
other doctors  were keeping  doctors out.  He asked  how the                                                                    
bill would  deal with that  process. He provided  an example                                                                    
of a highly  skilled and qualified doctor  in another state.                                                                    
He wondered if  the medical board had an  approval or denial                                                                    
basis.  Alternatively,  he  wondered  if  the  person  would                                                                    
receive  a  license  because   they  qualified  through  the                                                                    
Ms.  Hovenden answered  that if  a person  qualified through                                                                    
the  compact and  had no  discipline on  their record  there                                                                    
were no additional requirements.                                                                                                
Vice-Chair  Saddler asked  for  verification  that the  bill                                                                    
enacted  the  entirety  of  the   charter  for  the  compact                                                                    
(beginning in Section 6 of the legislation).                                                                                    
Representative    Seaton   replied    that   it    was   his                                                                    
understanding.  He  noted  that the  bylaws  were  currently                                                                    
being worked out by the  commission and would not be enacted                                                                    
by the bill.                                                                                                                    
Vice-Chair Saddler understood that  the fees for the license                                                                    
application  and  fingerprinting  would   be  borne  by  the                                                                    
applicants.   He  remarked   that  any   interstate  compact                                                                    
required some  staff support.  He asked  if the  fiscal note                                                                    
reflected any  portion of  the compact's  shared maintenance                                                                    
and management costs.                                                                                                           
Ms.  Hansen replied  that the  issue would  be decided  more                                                                    
clearly  in  the  bylaws.  The   compact  did  authorize  an                                                                    
assessment on  the member  states; however,  in conversation                                                                    
with current  commissioners in  the compact,  the indication                                                                    
was that they planned to  raise the needed revenue through a                                                                    
licensure fee. She  detailed that it would  essentially be a                                                                    
registration fee  for doctors using the  compact system. She                                                                    
added that  until the  bylaws were  written it  was possible                                                                    
that the cost  would be an assessment on  member states. She                                                                    
relayed  that the  commission was  comprised of  two members                                                                    
from each medical board.                                                                                                        
2:20:52 PM                                                                                                                    
Vice-Chair  Saddler asked  if the  department had  detail on                                                                    
how  many physicians  licensed in  Alaska  also had  medical                                                                    
licenses  in other  states. Ms.  Hovenden  replied that  the                                                                    
department did not track that information.                                                                                      
HB  237  was  HEARD  and   HELD  in  committee  for  further                                                                    

Document Name Date/Time Subjects
HB 237 Dr. Hornberger letter.pdf HFIN 4/7/2016 1:30:00 PM
HB 237