Legislature(2017 - 2018)BARNES 124
04/02/2018 03:15 PM House LABOR & COMMERCE
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SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD 4:05:27 PM VICE CHAIR WOOL announced that the next order of business would be CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 108(FIN), "An Act relating to the State Medical Board; relating to the licensing of physicians, osteopaths, and podiatrists; relating to the certification of medical assistants; relating to the practice of medicine; relating to the practice of podiatry; relating to the practice of osteopathy; relating to assault of a medical professional; and providing for an effective date." 4:05:43 PM SENATOR CATHY GIESSEL, Alaska State Legislature, presented SB 108 as prime sponsor. She indicated her PowerPoint presentation would also serve a sectional analysis of the proposed bill. 4:06:58 PM SENATOR GIESSEL pointed to slide 2, "Purpose": 1. Streamline Physician Licensing 2. Need for office assistants a. Unlicensed b. Licensed 1. Streamline MD licensing Section 1, 2, 8, 9, 10 State Medical Board to write regulations to delegate to EXECUTIVE SECRETARY: 1. review applications and grant license if requirements are met 2. review applications and issue temporary license if requirements are met 3. grant certification if requirements are met 4. spells out prohibitions to this delegate authority SENATOR GIESSEL explained that the documentation is maintained until the state Medical Board meets, but the board only meets four times per year. She said this creates a backlog. She said that one the examiner looks at the documentation, it would be forwarded to the executive secretary who would review the applications and make appropriate action. 4:09:09 PM REPRESENTATIVE KNOPP asked why it is not the responsibility of the executive secretary to prepare the documentation for the board. SENATOR GIESSEL reviewed the application process. She stated the applications could be approved immediately or go to the board if there were issues with an application. SENATOR GIESSEL continued to slide 4, "Streamline MD Licensing": Section 10, 11 1. Allows another person, designated by the board, to help the Executive Secretary to issue temporary license. 2. Outlines when this could happen SENATOR GIESSEL shared that the process is used by the largest licensing board in the state. 4:14:29 PM SENATOR GIESSEL moved to slide 5-6, "2.a. Unlicensed Assistive Personnel": Unlicensed personnel trained in "routine medical tasks" Section 3 Regulations will o authorize delegation to unlicensed person o prohibit delegation of pain management or opioid related activities o define "routine medical tasks" Section 6 adds person, performing delegated "routine medical duties" to exception under "License to practice medicine, podiatry, or osteopathy" Section 12 Adds "medical assistant" to list to practice medicine Section 14 adds "medical assistants" to definition of "medical professional" under Title 12 Criminal Procedure SENATOR GIESSEL said the bill would correct a gap in the board's laws. 4:17:00 PM REPRESENTATIVE JOSEPHSON asked whether there would be a need to ensure that the unlicensed people have specific training. SENATOR GIESSEL answered that initially all that was required was a high school diploma but now there was some education available. She added there would be a higher level of education required. REPRESENTATIVE WOOL asked for confirmation that this first group of medical assistants won't need a license in the future, but the physician will be able to delegate to them. SENATOR GIESSEL answered in the affirmative. SENATOR GIESSEL progressed to slide 7-8, "2.b. medical Assistants - license/certification": Why? Prescription Drug Monitoring Program (PDMP) ~prohibits access by any unlicensed person ~envisioned clinician delegates "look up" before prescribing Problem ~No licensed people in MD clinic, other than the MD ~Frequent need to check PDMP (AS 17.30.200 requires license). Solution recognize training and certification Training programs accredited by o Commission on Accreditation of Allied Health Education Programs (CAAHEP) o Accrediting Bureau of Health Education Schools (ABHES) National exams for Certification Alaska's community colleges training programs Recognized in many other states/territories. WA, CA, TX, FL, PA, OH, IL, MT, MS, ND, SD, WY 4:21:17 PM SENATOR GIESSEL addressed slide 9, "2.b. Medical assistant with certification process": Section 4 Certifying process defined in regulation by Board Section 5 Limits use of term "certified" Section 13 Certification is equivalent to a license 4:22:41 PM VICE CHAIR WOOL suggested the licensure is simply to check the PDMP and maybe enters the new data. He suggested this would be creating another licensed person who would need training, licensure, and a background check. SENATOR GIESSEL corrected that the pharmacist enters the data into the PDMP. She said the other statement was correct. VICE CHAIR WOOL suggested a physician could remove themselves from vulnerability to revocation of their license by having another licensed person in the office. SENATOR GIESSEL answered that each licensed person is accountable for their actions under their license. 4:25:09 PM REPRESENTATIVE JOSEPHSON suggested that the physician would still be held responsible [from a legal standpoint]. 4:25:43 PM REPRESENTATIVE BIRCH asked how many applications are rejected a year. SENATOR GIESSEL deferred to the department and to the executive secretary of the state medical board. REPRESENTATIVE BIRCH said there are a lot of confidentiality issues in a medical office. He asked whether the proposal was to certify everyone in a medical office. SENATOR GIESSEL answered that the provision would not include the bookkeepers. 4:28:12 PM SENATOR GIESSEL briefly addressed "Urgent need for SB 108" on slide 10-11. Efficient, expeditious and effective licensing of MDs Legal clarity for delegation of "routine medical duties" to unlicensed personnel (medical assistants) More legally stringent delegated activities to licensed entity, a medical assistant who has achieved certification These changes needed this session SUPPORT: State Medical Board (requested) Dept of Commerce Alaska State Hospital and Nursing Home Association Alaska State Medical Association Foundation Health Partners (Fairbanks) No opposition 4:30:35 PM FRED PARADY, Deputy Commissioner, Department of Commerce, Community & Economic Development (DCCED), answered questions in the hearing on SB 108. He said his department had seen an increase in requests for licensure. He said the department had an initiative to streamline the application process. He indicated the issues that slowed the process had been identified. He added that only around ten percent of the applications were complete when they were sent it. He described changes to the online process that would be implemented. 4:34:41 PM REPRESENTATIVE SULLIVAN-LEONARD shared her understanding that the aim was to streamline the process. She asked whether licensure could be invoked when the coursework is completed. MR. PARADY said he had not heard that suggestion before but that it seemed interesting. REPRESENTATIVE SULLIVAN-LEONARD shared that her hesitation to fully support the proposal was due to the apparent "double duty" in the process. MR. PARADY answered that he thought the school would be quite a logical location for the online process. 4:36:26 PM VICE CHAIR WOOL asked whether the licensure was a statutory responsibility of the state licensing board. MR. PARADY deferred to the sponsor. He said he thinks it recognizes the limited board meeting schedule and ability to address problem-free applications. 4:37:33 PM DEBORA STOVERN, Executive Secretary, State Medical Board, Division of Corporations, Businesses, and Profession Licensing (DCBPL), answered questions in the hearing on SB 108. She said it is important to note that the board is allowed to grant that limited authority to the executive secretary under specific conditions. She added the any application with adverse information would still require the board to review for approval of temporary or permanent licenses. She said it would continue to require specific delegation by the board on an annual basis. REPRESENTATIVE BIRCH asked how many applicants are rejected. MS. STOVERN answered that the board actually denies only a couple of applications per year as an outright denial. She said other applications that have adverse information or information of concern would be asked to come into an in-person interview. REPRESENTATIVE BIRCH said it seemed like a low-risk proposal. 4:42:43 PM REPRESENTATIVE JOSEPHSON asked what is being licensed. He asked if someone has done an internship and a residency, what is being granted with licensure. MS. STOVERN answered the board issues licenses to practice medicine in the state. 4:43:45 PM JEANNIE MONK, Alaska State Hospital and Nursing Home Association (ASHNA), testified in support of SB 108. She said ASHNA is in support of fixing the statutory deficiency to allow physicians to delegate the tasks. VICE CHAIR WOOL asked about the Certified Medical Assistant license. MS. MONK answered there are some concerns about creating new certified personnel, but it was not enough to avoid supporting the proposed bill. VICE CHAIR WOOL asked whether the medical assistant would have to acquire a new range of skills. MS. MONK answered that would be left to the board. She added that she thinks other states do have certified medical assistants. 4:46:38 PM VICE CHAIR WOOL opened public testimony on SB 108. 4:46:52 PM VICE CHAIR WOOL asked whether Certified Medical Assistant is a one-off certification. SENATOR GIESSEL answered that the position requirement may expand. She suggested that if a person is going to pay for the licensing exam and fees, they may cost more to hire. VICE CHAIR WOOL held over SB 108.