Legislature(2015 - 2016)BARNES 124

01/25/2016 03:15 PM LABOR & COMMERCE

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Audio Topic
03:17:53 PM Start
03:18:24 PM SB53
03:50:46 PM Overview: Department of Commerce, Community and Economic Development, Division of Banking and Securities
04:16:53 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 53 ADVANCED PRACTICE REGISTERED NURSES TELECONFERENCED
Moved HCS SB 53(L&C) Out of Committee
+ Overview: TELECONFERENCED
Division of Banking & Securities by Dept. of
Commerce, Community & Economic Development
           SB 53-ADVANCED PRACTICE REGISTERED NURSES                                                                        
                                                                                                                                
3:18:24 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON announced  that the first order of  business would be                                                               
SENATE  BILL  NO.  53,  "An Act  relating  to  advanced  practice                                                               
registered   nursing;   relating    to   certified   direct-entry                                                               
midwifery; and providing for an effective date."                                                                                
                                                                                                                                
3:18:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HUGHES   moved  to   adopt  the   proposed  House                                                               
committee  substitute  (HCS)  for  SB  53,  labeled  29-LS0043\P,                                                               
Bruce, 1/20/16.   There being no objection, Version  P was before                                                               
the committee.                                                                                                                  
                                                                                                                                
3:18:52 PM                                                                                                                    
                                                                                                                                
SENATOR CATHY GIESSEL, Alaska State  Legislature, speaking as the                                                               
sponsor of  SB 53, directed attention  to the chart found  in the                                                               
committee packet entitled, "APRN  ALLIANCE" which illustrated the                                                               
current related  Alaska statute and the  statute changes proposed                                                               
in SB 53.   Senator Giessel said the bill  would change the title                                                               
of Advanced  Nurse Practitioner (ANP) and  Nurse Anesthetist (NA)                                                               
to  that  of Advanced  Practice  Registered  Nurse (APRN).    She                                                               
explained the change  would bring the state  into compliance with                                                               
the  national  title  conformity   that  is  recommended  by  the                                                               
National  Council  of  State  Boards   of  Nursing  in  order  to                                                               
eliminate  the confusion  of  consumers  and insurance  entities.                                                               
Nationally,  interested parties  agreed  that APRN  would be  the                                                               
"umbrella title."   The aforementioned  chart showed  the current                                                               
state  situation which  has  Nurse  Practitioner (NP),  Certified                                                               
Nurse  Midwife (CNM),  and  Certified  Clinical Nurse  Specialist                                                               
(CNS) included under  the title of ANP, and a  separate title for                                                               
NAs.  The  bill creates a uniform title of  APRN, under which all                                                               
four of the clinical specialties  would function, thus clarifying                                                               
the  specialties for  consumers  and insurers.   Senator  Giessel                                                               
assured the committee that the bill  does not change the scope of                                                               
practice for any of the specialties;  in fact, the bill is simply                                                               
a   title  change,   although  it   is   lengthy  because   nurse                                                               
practitioners serve in  multiple aspects of health  care, and the                                                               
title  corrections must  be cited  in many  sections of  statute.                                                               
She offered to provide further  testimony by staff and supporters                                                               
of the bill.                                                                                                                    
                                                                                                                                
CHAIR  OLSON  invited  Senator   Giessel's  staff  to  provide  a                                                               
sectional analysis of the bill.                                                                                                 
                                                                                                                                
3:22:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COLVER  noted that  SB 53 is  simply an  update of                                                               
the descriptions  of nursing practices  and asked, "Would  you be                                                               
fighting  off any  attempts to  hijack your  bill to  like insert                                                               
different agendas ... we can  be assured that you're committed to                                                               
this clean bill."                                                                                                               
                                                                                                                                
SENATOR GIESSEL responded yes.                                                                                                  
                                                                                                                                
REPRESENTATIVE HUGHES  asked whether  a nurse  practitioner would                                                               
be referred to as a nurse  practitioner, or an APRN.  She opined,                                                               
the  title "practitioner"  depicts  a higher  level  of scope  of                                                               
practice among members of the public.                                                                                           
                                                                                                                                
3:24:48 PM                                                                                                                    
                                                                                                                                
SENATOR   GIESSEL   agreed   that  nurse   practitioners,   nurse                                                               
anesthetists, clinical nurse midwives,  and nurse specialists are                                                               
titles known to  the public and will still be  used; however, for                                                               
credentialing purposes  such as  signing a prescription,  the new                                                               
titles will apply.                                                                                                              
                                                                                                                                
CHAIR  OLSON expressed  his belief  that  "hijacking bills"  this                                                               
early in the session is unacceptable.                                                                                           
                                                                                                                                
3:25:57 PM                                                                                                                    
                                                                                                                                
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature, provided a sectional analysis  of SB 53 on behalf of                                                               
Senator Giessel.  She informed  the committee that 26 sections of                                                               
the bill are conforming amendments  that only change the previous                                                               
titles to that  of APRN.  The sectional analysis  was as follows:                                                               
section  1 allows  APRNs  to  use their  titles  and initials  on                                                               
documents, signs,  and advertising;  sections 2-4  are conforming                                                               
amendments; section 5  requires APRN regulations to  apply to one                                                               
who  is  a   CRNA,  CNS,  CNP,  or  CNM,   and  makes  conforming                                                               
amendments; section  6 adds  APRN to a  list of  licenses issued,                                                               
and  changes  the  term  "professional  nursing"  to  "registered                                                               
nursing";   section 7  adds a  new subsection  that sets  out the                                                               
qualifications  for  an  APRN  license;  section  8  repeals  and                                                               
reenacts   AS  08.68.190   concerning  license   examinations  to                                                               
establish separate examinations  for registered practitioners and                                                               
APRNs; section 9  is a conforming amendment;  section 10 requires                                                               
the of  Department of Commerce, Community  & Economic Development                                                               
(DCCED) to set  fees, and deletes the  term "vocational nursing";                                                               
section  11  removes  licensed professional  nurse  from  titles;                                                               
section 12 is a new subsection  authorizing the use of CRNA, CNS,                                                               
CNP,  and CNM,  under that  section; section  13 adds  APRN as  a                                                               
person who  can supervise a  practical nurse; sections 14  and 16                                                               
are related to the impersonation  of an APRN; section 15 requires                                                               
institutions  that  are  applying for  accreditation  to  provide                                                               
certain  information; sections  17-19 are  related to  unlicensed                                                               
practice;  section 20  adds APRN  to licensees  who may  delegate                                                               
certain duties; section 21 is  a conforming amendment; section 22                                                               
defines the practice of APRN  nursing; sections 23 through 25 are                                                               
conforming amendments; section  26 adds APRNs to  persons who are                                                               
considered  justified   in  conduct   that  would   otherwise  be                                                               
considered  the use  of force  when delivering  emergency medical                                                               
care; sections  27 and 28  are conforming amendments;  section 29                                                               
adds  APRNs  to  licensees  immune  from  civil  liability  while                                                               
escorting an injured  or sick person; section 30  is a conforming                                                               
amendment; section  31 adds APRNs to  practitioners authorized to                                                               
draw  blood  for tests  of  persons  charged with  sex  offenses;                                                               
sections  32  and  33  are   conforming  amendments;  section  34                                                               
clarifies  that  nurse-midwives  and direct  entry  midwives  are                                                               
certified;  sections 35  through  38  are conforming  amendments;                                                               
section 39 changes the term  "registered professional nursing" to                                                               
"registered nursing";  section 40  clarifies  that nurse-midwives                                                               
must be certified to be a  provider in a hospital under AS 21.87;                                                               
section 41 is a conforming  amendment; sections 42 and 43 clarify                                                               
that  nurse-midwives  are  certified  and  make  other  technical                                                               
amendments;  sections 44  through 46  are conforming  amendments;                                                               
section 47 adds  APRNs to the definition of  health care provider                                                               
in  statutory  provisions  regarding  prisons; section  48  is  a                                                               
conforming  amendment; section  49 adds  APRNs to  licensees with                                                               
specific  training who  may  assess  a child  with  respect to  a                                                               
waiver  related  to  children  and  disabled  persons  under  the                                                               
Medicaid waiver;  section 50 is  a conforming  amendment; section                                                               
51 adds APRNs  to practitioners who are not  liable for providing                                                               
information  to  the Department  of  Health  and Social  Services                                                               
(DHSS)  for  hearing screenings;  sections  52  through 54  allow                                                               
APRNs concerning  mental health commitment determine  if a person                                                               
may  be  administered  psychotropic medication  without  consent;                                                               
section 55  adds APRNs to  practitioners who may review  a health                                                               
care  plan for  an  assisted living  home  resident; sections  56                                                               
through 59 are conforming amendments;  section 60 repeals certain                                                               
redundant statutes; and section 61 sets a new effective date.                                                                   
                                                                                                                                
3:34:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HUGHES  directed attention  to section 7,  page 5,                                                               
beginning line 15, which read:                                                                                                  
                                                                                                                                
        Sec. 7. AS 08.68.170 is amended by adding a new                                                                         
     subsection to read:                                                                                                        
      (c) An  applicant for a  license to  practice advanced                                                                    
     practice registered nursing shall  submit to the board,                                                                    
     on forms  and in  the manner  prescribed by  the board,                                                                    
     written evidence, verified by  oath, that the applicant                                                                    
      (1) is licensed as a registered nurse in the state;                                                                       
     and                                                                                                                        
      (2) has successfully completed an advanced practice                                                                       
       registered nurse education program that meets the                                                                        
     criteria established by the board under AS 08.68.100.                                                                      
                                                                                                                                
REPRESENTATIVE   HUGHES  asked   why  the   new  subsection   was                                                               
necessary.                                                                                                                      
                                                                                                                                
MS. CONWAY responded that this is  the criteria to qualify for an                                                               
APRN license.                                                                                                                   
                                                                                                                                
REPRESENTATIVE HUGHES restated her question.                                                                                    
                                                                                                                                
3:36:12 PM                                                                                                                    
                                                                                                                                
LAURA SARCONE, Certified  Nurse-Midwife; Co-Chair, APRN Alliance,                                                               
explained that the current section  relates to the qualifications                                                               
of registered or  practical nurse applicants; new  section 7 adds                                                               
a  subsection that  "pulls out  the advanced  practice registered                                                               
nurse  as  a  separate  category   from  registered  nursing  and                                                               
vocational nurses."                                                                                                             
                                                                                                                                
3:37:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON remarked:                                                                                              
                                                                                                                                
     There is in  the packet, there's a reference  to - sort                                                                    
     of a rebuttal  - to Dr. Joshua Stream and  I didn't see                                                                    
     his letter.  Can you give  me a sense of what criticism                                                                    
     he had?                                                                                                                    
                                                                                                                                
[Neither of the aforementioned documents were provided.]                                                                        
                                                                                                                                
MS.  CONWAY  informed  the committee  that  Dr.  Stream  provided                                                               
written  testimony which  questioned  whether nurse  anesthetists                                                               
were qualified to practice without  doctor supervision.  However,                                                               
since 2003,  nurse anesthetists in Alaska  have practiced without                                                               
doctor  supervision, as  this  is  decided by  each  state.   She                                                               
advised that Dr. Stream's comments were not germane to the bill.                                                                
                                                                                                                                
[CHAIR OLSON  and his  staff recalled  that Dr.  Stream's written                                                               
testimony was not received by any committee member.]                                                                            
                                                                                                                                
REPRESENTATIVE   JOSEPHSON   asked   about   the   role   of   an                                                               
anesthesiologist when a nurse anesthetist is present.                                                                           
                                                                                                                                
3:39:52 PM                                                                                                                    
                                                                                                                                
JEFF  WORRELL, Certified  Registered Nurse  Anesthetist, informed                                                               
the committee he  is past president of the  Alaska Association of                                                               
Nurse Anesthetists, and currently  works independently at a large                                                               
Anchorage hospital.                                                                                                             
                                                                                                                                
REPRESENTATIVE  JOSEPHSON restated  his question  as to  the need                                                               
for an anesthesiologist and a nurse anesthetist.                                                                                
                                                                                                                                
MR. WORRELL  explained that in current  practice both specialties                                                               
are  qualified to  provide anesthesia  services in  a variety  of                                                               
settings; however, the training differs:  a CRNA is trained first                                                               
as a nurse, followed by three  years of specialty training, and a                                                               
physician  anesthesiologist is  initially  trained as  physician,                                                               
followed by anesthesia training.   He advised that the titles are                                                               
different but the work is the same.                                                                                             
                                                                                                                                
REPRESENTATIVE HUGHES  directed attention to the  fiscal note and                                                               
asked whether the fees for  individual licenses would change; the                                                               
sponsor indicated they would not.                                                                                               
                                                                                                                                
3:43:22 PM                                                                                                                    
                                                                                                                                
JANEY  HOVENDEN, Director,  Division  of Corporations,  Business,                                                               
and Professional Licensing, DCCED,  answered that the fiscal note                                                               
identifies three programs in her  division that would be affected                                                               
by the  changes proposed  in SB  53.  The  average cost  would be                                                               
$2,500  per  regulation  project,  thus the  fiscal  note  totals                                                               
$7,500.    Her  division  would  attempt  to  garner  savings  by                                                               
combining this work with other ongoing regulation projects.                                                                     
                                                                                                                                
REPRESENTATIVE HUGHES asked whether  there would be an adjustment                                                               
of the fees charges to licensees.                                                                                               
                                                                                                                                
MS.  HOVENDEN said  the licensing  fees for  the nursing  program                                                               
would not be affected.                                                                                                          
                                                                                                                                
3:45:04 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON opened public testimony on SB 53.                                                                                   
                                                                                                                                
3:45:17 PM                                                                                                                    
                                                                                                                                
JULIE  GILLETTE, Chair,  Alaska  Board of  Nursing, informed  the                                                               
committee she is the chair of  the Alaska Board of Nursing, which                                                               
is fully in support of the bill.                                                                                                
                                                                                                                                
MR.  WORRELL  said  adopting  the   APRN  title  allows  for  the                                                               
portability of  licensure across state lines,  and for conformity                                                               
to billing standards with other states.                                                                                         
                                                                                                                                
3:47:03 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON,  after ascertaining no  one else wished  to testify,                                                               
closed public testimony.                                                                                                        
                                                                                                                                
3:47:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HUGHES moved to report  the HCS for SB 53, labeled                                                               
29-LS0043\P,  Bruce, 1/20/16,  out of  committee with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, HCS SB 53(L&C) was  reported out of the House Labor                                                               
and Commerce Standing Committee.                                                                                                

Document Name Date/Time Subjects
SB53 ver N.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Sponsor Statement ver N.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Sectional Analysis ver N.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Fiscal Note DCCED-CBPL 4-7-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Draft Proposed CS ver P.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- AK Pharmacists 3-6-2015.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- AKANA 2-22-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- ANPA 2-24-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- APRN Alliance 2-22-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- ASHNHA 3-5-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- Bd of Nursing 3-9-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- Dooley 3-6-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- FASDx Services 2-26-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- Hartz 2-26-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- Hiles 3-16-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- Myers 2-24-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter- Rader 2-22-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter-AaNA 3-9-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter-AARP 3-3-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter-AK Affiliate ACNM 2-23-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-States Adopting APRN Consensus Model.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Title Change Chart.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Benefits of APRN model.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Email-Logan 4-14-15.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Fiscal Note DCCED-CBPL-01-22-16.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Documents-Letter Rebuttal to MD Email.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
SB53 Supporting Document Dr. Robin Ninefeldt Jan. 21, 2016.pdf HL&C 1/25/2016 3:15:00 PM
SB 53
DCCED-Division of Banking Overview 1-25-15.pdf HL&C 1/25/2016 3:15:00 PM
Div. of Banking Overview