Legislature(2017 - 2018)BELTZ 105 (TSBldg)

02/13/2018 01:30 PM Senate LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SSSB 108 Out of Committee
-- Public Testimony --
Heard & Held
-- Public Testimony --
Moved HB 18 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
          SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD                                                                       
1:33:10 PM                                                                                                                    
CHAIR COSTELLO announced the consideration of SB 108.                                                                           
1:33:36 PM                                                                                                                    
SENATOR CATHY GIESSEL, Alaska State Legislature Juneau, Alaska,                                                                 
sponsor of SB 108, introduced the legislation speaking to the                                                                   
following sponsor statement:                                                                                                    
     Senate  Bill  108 is  a  streamlining  bill which  will                                                                    
     improve  the   licensing  process  for   physicians  in                                                                    
     Alaska.  Outdated and  overly  cumbersome statutes  and                                                                    
     regulations  are interfering  with the  ability of  our                                                                    
     medical  community  to  meet   the  needs  of  Alaskans                                                                    
     because of  delays of licensure that  negatively impact                                                                    
     both doctors and patients. A  fully qualified doctor in                                                                    
     good standing should not be  required to wait months to                                                                    
     obtain a license to serve our state.                                                                                       
     The  Alaska  State  Medical Board  has  requested  this                                                                    
     legislation so  they may expeditiously  and responsibly                                                                    
     issue licenses to physician applicants.                                                                                    
     SB  108  gives the  executive  secretary  of the  State                                                                    
     Medical Board  expanded authority  to review  and issue                                                                    
     licenses     to    applicants     with    uncomplicated                                                                    
     applications. With  a better system in  place DCCED and                                                                    
     the State  Medical Board will  be able to  respond more                                                                    
     efficiently  at a  time when  healthcare  access is  of                                                                    
     great concern in our state.                                                                                                
     SB 108  will authorize the board's  executive secretary                                                                    
     to  grant  licenses  to   qualified  applicants  for  a                                                                    
     permanent  medical license,  a temporary  permit, or  a                                                                    
     locum tenens  permit. It will also  authorize the board                                                                    
     to designate a board  member to grant temporary permits                                                                    
     to qualified applicants. [Sections  10 and 11] The bill                                                                    
     outlines  exceptions  to  that   authority  such  as  a                                                                    
     suspended   or  revoked   license   or  other   special                                                                    
     circumstances  that  would  necessitate  a  full  board                                                                    
     The bill  creates a new  category of  certified medical                                                                    
     assistants  who  will   perform  additional  duties  in                                                                    
     medical  settings.  The  Board will  set  criteria  for                                                                    
     educational  requirements,  certification, renewal  and                                                                    
     revocations for Certified Medical Assistants.                                                                              
     The   bill  provides   for   physician  delegation   of                                                                    
     specific,  routine activities  to unlicensed  personnel                                                                    
     working in physician offices. [Sections 3, 6, and 13]                                                                      
SENATOR  GIESSEL  advised  that  licenses  are  currently  issued                                                               
within two months  but just five percent of  the applications are                                                               
complete  when they're  submitted.  That has  contributed to  the                                                               
current backlog  of about 290  applications. Also, the  number of                                                               
applicants has  increased markedly,  largely due  to telemedicine                                                               
applicants. She reminded members  that any physician who provides                                                               
care through telemedicine must be licensed in the state.                                                                        
1:40:41 PM                                                                                                                    
SENATOR GIESSEL explained  that the request for  the new category                                                               
of  "certified  medical  assistant"  came  from  pain  management                                                               
doctors who need  an assistant in the office who  can look at the                                                               
prescription  drug  monitoring  program   (PDMP)  for  them.  She                                                               
reminded  members that  when the  legislature crafted  the opioid                                                               
bill it required  licensure to look at the  database. In practice                                                               
this  takes  a lot  of  time  in  a physician's  day.  Certifying                                                               
medical assistants  provides a solution.  The board  will outline                                                               
the criteria for certification in  regulation. [Sections 4 and 5]                                                               
Section  12 provides  a penalty  for anyone  practicing as  a CMA                                                               
without a license.                                                                                                              
SENATOR  GIESSEL  said  the  State   Medical  Board  and  DCCED's                                                               
Division  of Corporations,  Business  and Professional  Licensing                                                               
support the bill.                                                                                                               
1:43:27 PM                                                                                                                    
CHAIR  COSTELLO   recognized  that   Senator  Meyer   joined  the                                                               
committee some time ago.                                                                                                        
SENATOR MICCICHE asked if it's  typical that Section 3 leaves the                                                               
definition for "routine  medical duties" to the  board instead of                                                               
putting it in the bill.                                                                                                         
SENATOR GIESSEL said it's logical;  similar authority is given to                                                               
the Board of  Nursing that also delegates  to unlicensed assisted                                                               
personnel. The  board knows exactly which  routine medical duties                                                               
would be appropriate for an unlicensed person to do.                                                                            
SENATOR MICCICHE  asked if  the statutes  allow an  applicant who                                                               
meets the qualifications to receive a temporary permit.                                                                         
SENATOR  GIESSEL   said  yes.  The  bill   allows  the  executive                                                               
administrator  or  a  board  designee   to  issue  the  temporary                                                               
1:45:34 PM                                                                                                                    
SENATOR  STEVENS  said  he assumes  the  executive  administrator                                                               
would be carefully  chosen, but it sounds a little  loose to then                                                               
extend authority to another person.                                                                                             
SENATOR GIESSEL said the Board  of Medicine in collaboration with                                                               
the   Division  of   Corporations,   Business  and   Professional                                                               
Licensing hires  the executive administrator.  It is  generally a                                                               
rigorous  process  and  there are  qualifying  criteria  for  the                                                               
individual that's  hired. She  added that it  was the  board that                                                               
wanted  the  additional  board  member   who  could  act  if  the                                                               
executive administrator were absent.                                                                                            
SENATOR STEVENS  said he  was reading  on page  4 where  it says,                                                               
"allow another person designated by  the board." He asked if that                                                               
was in the bill because it doesn't say another board member.                                                                    
1:47:13 PM                                                                                                                    
At ease                                                                                                                         
1:47:47 PM                                                                                                                    
CHAIR COSTELLO reconvened the meeting.                                                                                          
SENATOR GIESSEL  explained that the board  requested the language                                                               
and may  have been  thinking of delegating  the authority  to the                                                               
licensing examiner  who also scrutinizes applications.  She added                                                               
that  the  Board  of  Medicine is  extremely  careful  about  who                                                               
receives licensure. She said this  pertains to a temporary permit                                                               
and she is confident in the board's judgement.                                                                                  
SENATOR STEVENS  summarized it is  not a  willy-nilly appointment                                                               
of someone off  the street. It's someone  with qualifications and                                                               
1:49:19 PM                                                                                                                    
CHAIR COSTELLO opened public testimony for SB 108.                                                                              
1:49:34 PM                                                                                                                    
DR. DANNY  ROBINETTE, Chief  Medical Officer,  Fairbanks Memorial                                                               
Hospital  and Tanana  Valley Clinic,  Fairbanks, Alaska,  advised                                                               
that  the hospital  has experienced  periodic  delays in  getting                                                               
physicians licensed.  On three  occasions in  the past  two years                                                               
this  has resulted  in physician  candidates accepting  positions                                                               
out of state because they  needed a paycheck. A surgeon currently                                                               
on staff had  to wait eight months for his  license. He said each                                                               
candidate  should be  rigorously screened  and those  with issues                                                               
should receive closer  scrutiny and take more  time. However, the                                                               
process  should   be  streamlined  so  that   clean,  unblemished                                                               
candidates  are not  unduly held  up causing  good physicians  to                                                               
accept positions in other states.                                                                                               
SENATOR STEVENS  asked if  there could  be any  justification for                                                               
holding up an application for eight months.                                                                                     
DR  ROBINETTE  said  it  could certainly  be  justified  in  some                                                               
instances, but not the case he mentioned.                                                                                       
SENATOR STEVENS  asked if  his belief was  that this  would speed                                                               
the process while  giving the board time  to investigate concerns                                                               
and red flags.                                                                                                                  
DR.  ROBINETTE  said yes;  the  statute  and regulations  clearly                                                               
define  the things  that constitute  a  clean application.  There                                                               
shouldn't be  a timeline  that rushes  an application  that isn't                                                               
1:53:59 PM                                                                                                                    
SENATOR  MICCICHE read  questions  and  answers about  processing                                                               
times  from  the  legislative  research  document  titled  "State                                                               
Medical  Licensing  Timeframes.   He   said  it  looks  like  the                                                               
requirements  for  a  temporary  permit   are  the  same  as  the                                                               
requirements for a regular license,  which makes him wonder about                                                               
the timesaving.                                                                                                                 
DR.  ROBINETTE deferred  a full  answer to  the board.  He didn't                                                               
know  all  the  details  for  issuing  a  temporary  permit,  but                                                               
Fairbanks   Memorial   Hospital    typically   issues   temporary                                                               
privileges to  someone with a  clean application and  for exigent                                                               
patient care reasons.                                                                                                           
SENATOR MICCICHE asked if someone from the board was available.                                                                 
CHAIR COSTELLO said  she didn't see anyone from  the board online                                                               
but would try to get an answer before the end of the meeting.                                                                   
1:56:16 PM                                                                                                                    
KIRA  BOYD, Chief  Operating  Officer,  ALGONE, Wasilla,  Alaska,                                                               
testified in  support of  SB 108. She  explained that  the clinic                                                               
offers regenerist  medicine, interventional pain  management, and                                                               
dependency  therapy with  a focus  on opioid  use disorders.  The                                                               
clinic   regularly  treats   a  high-needs,   high-touch  patient                                                               
population and  is faced with  high overhead  costs, particularly                                                               
because specialty providers  often require lucrative compensation                                                               
packages to lure them to the state.                                                                                             
She said  ALGONE has  a team  of over  40 medical  assistants who                                                               
team up with the providers to  take care of the high-needs, high-                                                               
touch  patients. However,  existing  statute  relating to  opioid                                                               
oversight  and implementation  of the  PDMP has  made these  care                                                               
teams dramatically  less efficient.  ALGON sought  immediately to                                                               
find  the solution  and eventually  looked at  other states  that                                                               
license  medical  assistants.  They   were  able  to  send  model                                                               
legislation to the  sponsor's staff. ALGON fully  supports SB 108                                                               
and wants the committee to know that the process works.                                                                         
MS  BOYD said  the State  Medical Board  expressed concern  about                                                               
cost and  resources to get medical  assistants licensed. However,                                                               
the choice is to either  create an efficient system for licensing                                                               
or require clinics  to hire more nurses and pass  that cost on to                                                               
the already overburdened  health care consumers. She  said SB 108                                                               
is the solution that Alaska needs now.                                                                                          
SENATOR STEVENS  asked how  many of  the 40  currently unlicensed                                                               
medical assistants would become certified should SB 108 pass.                                                                   
MS. BOYD said not all  ALGON's medical assistants are unlicensed,                                                               
but in a perfect world  all their medical assistants would become                                                               
SENATOR  STEVENS   said  he   thought  that   certifying  medical                                                               
assistants was new.                                                                                                             
MS.  BOYD  clarified   that  some  but  not   all  ALGON  medical                                                               
assistants are  certified. The  ones that  are not  certified are                                                               
not currently  able to  assist providers by  looking at  the PDMP                                                               
2:00:31 PM                                                                                                                    
At ease                                                                                                                         
2:01:13 PM                                                                                                                    
CHAIR COSTELLO  reconvened the meeting and  continued with public                                                               
testimony on SB 108.                                                                                                            
2:01:22 PM                                                                                                                    
BRYAN   FARTHING,   President,   Alaska  Academy   of   Physician                                                               
Assistants (PA), Anchorage, Alaska,  said he appreciates the work                                                               
that's been  done on SB  108, but  the PA community  is concerned                                                               
that when  physicians and other medical  professionals are listed                                                               
in the bill physician assistants aren't always included.                                                                        
2:03:10 PM                                                                                                                    
FRED  PARADY,   Deputy  Commissioner,  Department   of  Commerce,                                                               
Community and Economic Development  (DCCED), said the workload of                                                               
the  State Medical  Board has  increased dramatically,  primarily                                                               
due  to   telemedicine  legislation.  In  2015   the  application                                                               
processing   backlog   reached   an  average   of   six   months.                                                               
Telemedicine companies were  coming in to license  100 doctors at                                                               
a time. Complaints came in  from applicants and medical companies                                                               
and the responding to those complaints was time consuming.                                                                      
MR. PARADY  said the division  processed 22 percent  more medical                                                               
licenses and 31 percent more  nursing licenses last year than the                                                               
year before  and they've already  received more this  fiscal year                                                               
to  date  than  the  entire previous  year.  Through  the  budget                                                               
process and previous  legislation, the division has  been able to                                                               
devote  more staff  to these  programs. They  have added  two new                                                               
PCNs that  are paid  by licensing  fees and  they went  through a                                                               
triage  process to  reduce  the backlog.  They  also initiated  a                                                               
strategic planning process to  streamline the application process                                                               
for health care  professions. That was identified  as the highest                                                               
priority. He shared the results of that hard-working team.                                                                      
The   strategic  planning   process   included  a   comprehensive                                                               
examination of  the application process  to identify  barriers or                                                               
obstacles  ("rubs"). Twenty-seven  were  identified. He  directed                                                               
attention  to  a  handout  and   explained  that  the  department                                                               
requires applicants  to send certified  and true copies  of their                                                               
diploma and  all certificates.  The question  the team  asked was                                                               
whether   certified  and   true   copies   were  necessary   when                                                               
verification   was  already   required.   He  said   rub  17   is                                                               
specifically  germane to  the bill;  it is  the requirement  that                                                               
every  application   needs  to  be  approved   by  the  executive                                                               
administrator.  Considering   the  number  of   applications  the                                                               
department  moves  forward,  waiting  for approval  can  be  time                                                               
consuming both at the executive  director and at the board level.                                                               
The board  might meet  just once  every three  months. Rub  22 is                                                               
that the board  needs to review every file, even  those that have                                                               
no  discrepancies.  What SB  108  proposes  is to  delegate  that                                                               
authority.  In   answer  to   Senator  Steven's   question  about                                                               
delegation,  he  clarified  that   is  an  active  delegation  of                                                               
authority  to another  board  member or  the  director or  deputy                                                               
director of the division.                                                                                                       
CHAIR COSTELLO asked Mr. Parady to  send a copy of the handout to                                                               
the committee aide.                                                                                                             
MR. PARADY  agreed. He  continued to  explain that  the strategic                                                               
planning process  continued as  the team  evaluated the  cause of                                                               
each problem, determined whether it  served a public safety need,                                                               
and whether  the process needed  to be updated or  simplified. In                                                               
response  to those  27  rubs the  department  initiated a  three-                                                               
pronged  approach to  implement solutions  that would  streamline                                                               
the licensure process. The first  prong was to make small changes                                                               
through board regulations. Specific to  SB 108, the State Medical                                                               
Board proactively  scrubbed its regulations. He  cited an example                                                               
of a regulation that served no public safety need.                                                                              
The second prong  of the streamlining strategy  adds two features                                                               
to  the   technology  platform.   The  first  makes   the  online                                                               
application  process like  the one  used for  the permanent  fund                                                               
dividend.  The   user  cannot  advance  until   the  question  is                                                               
answered. The  second implements a  tracker so the  applicant can                                                               
see the  progress of  their application and  what a  holdup might                                                               
be.  Rollout of  this  technology enhancement  is anticipated  in                                                               
The third prong  of the streamlining strategy is a  change in the                                                               
statutes  that  would  improve  license  processing  times  while                                                               
continuing to ensure  public safety. The minor changes  in SB 108                                                               
will allow the State Medical  Board to grant additional authority                                                               
to the  executive administrator to  issue licenses that  meet the                                                               
strictest guidelines and allow  further delegation to supervisors                                                               
to expedite  and issue temporary  licenses. The bill  also closes                                                               
the loop with the prescription  drug monitoring program (PDMP) by                                                               
certifying  medical assistants  so  they are  eligible to  access                                                               
that database for the doctor.                                                                                                   
MR.   PARADY  concluded   his  comments   emphasizing  that   the                                                               
department is focused and attentive  to these issues. "We've been                                                               
hard at work on those granular  details where we can better serve                                                               
the public  and, ultimately,  better serving  these professionals                                                               
better serves Alaska citizens."                                                                                                 
2:13:00 PM                                                                                                                    
SENATOR MICCICHE asked 1) why there  is a temporary permit and 2)                                                               
if the temporary  permit satisfies the requirements  of the other                                                               
permits why it is still considered temporary.                                                                                   
2:13:20 PM                                                                                                                    
JANEY    MCCULLOUGH,   Director,    Corporations,   Business    &                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic Development  (DCCED), Juneau,  Alaska, said  a temporary                                                               
permit  is a  way of  getting  an applicant  to work  as fast  as                                                               
possible.  Currently the  executive administrator  can approve  a                                                               
temporary license  and the  formal full  license is  issued after                                                               
the board meets and approves every license.                                                                                     
SENATOR MICCICHE  said his point  is that other than  the board                                                                 
action, the  requirements are  no less  rigorous for  a temporary                                                               
MS. MCCULLOUGH confirmed that other  than the board approval, the                                                               
criteria  for a  temporary  license is  the same  as  for a  full                                                               
CHAIR COSTELLO  asked Mr.  Parady if he  shared the  creative new                                                               
application tracking process with other departments.                                                                            
MR. PARADY  said he'd  be happy  to share but  he wanted  to make                                                               
certain it operates correctly first.  If it's successful, it will                                                               
next be rolled out across the department's 43 license groups.                                                                   
2:15:51 PM                                                                                                                    
CHAIR COSTELLO closed public testimony on SB 108.                                                                               
2:16:09 PM                                                                                                                    
SENATOR MEYER moved  to report SB 108, version  U, from committee                                                               
with individual recommendations and attached fiscal note(s).                                                                    
CHAIR  COSTELLO announced  that without  objection, SB  108 moves                                                               
from the Senate Labor and Commerce Standing Committee.                                                                          

Document Name Date/Time Subjects
SB 108 ver U.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SSSB 108 Sponsor Statment 1-22-18.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SSSB108 Sectional Analysis 1-18-18.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SB108SS-DCCED-CBPL-02-08-2018.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SB108 Power Point Presentation 2-12-18.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SB108 Letter of Support ASMB 2-9-18.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SB108 Letter of Support - Foundation Health Partners 2-7-18.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SSSB108 Supporting Document State Med. Licensure Timeframes leg research 10-16-2015.pdf SL&C 2/13/2018 1:30:00 PM
SB 108
SB160.A.PDF SL&C 2/13/2018 1:30:00 PM
SB 160
SB160 Sponsor Statement.pdf SL&C 2/13/2018 1:30:00 PM
SB 160
SB160 Sectional Analysis.pdf SL&C 2/13/2018 1:30:00 PM
SB 160
SB160-DCCED-RCA-02-09-18.pdf SL&C 2/13/2018 1:30:00 PM
SB 160
SB160-LAW-CIV-02-10-2018.pdf SL&C 2/13/2018 1:30:00 PM
SB 160
SB 160 - AT&T Opposition.pdf SL&C 2/13/2018 1:30:00 PM
SB 160
HB 18 ver D.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Sponsor Statement.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Sectional Analysis.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Summary of Changes.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18-DOR-TAX-2-9-2018-HB 18.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Letter of Support - Goucher.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Supporting Document - Ketchikan Chamber Flyer.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Letter of Support - Seward Chamber of Commerce.pdf SL&C 2/13/2018 1:30:00 PM
HB 18
HB18 Ketchikan Chamber Letter of Support.pdf SL&C 2/13/2018 1:30:00 PM
HB 18