Senate Health & Social Services, 4/23/26, 3:30pm

This hearing of the Senate Health and Social Services Committee will now come to order. Today is Thursday, April 23rd, and the time is 3:31. We are in Butrovich Room 205. Members present are Senator Myers, Senator Tobin, Vice Chair Giesel, myself, Senator Dunbar.

We expect Senator Clayman shortly. He's away on other business. Before I let the record reflect that we have a quorum to conduct business, before we begin, I would like to thank Mary Gwen Kawakami, the Senate Health and Social Services Recording Secretary, and Susan Quigley from the Juneau LIO for staffing the committee today. We have one item on our agenda. We will have our third hearing on SB 281, Health Care Compacts Rural Health Program, sponsored by the Senate Health and Social Services Committee.

Last time the bill was before us, we heard invited testimony from the Department of Health and the Division of Corporations, Business and Professional Licensing. Today we will look at adopting a committee substitute and hear a summary of changes from our committee aide, Ariel Harbison. So we'll start with that. Ms. Harbison, if you would please come forward. Also, for the committee's awareness, online we have, for questions, we have Janet Orwig from SIPACT, Donald Woodyard from the Executive Director of the Interstate Commission for EMS Personnel Practice, Carl Sims, Program Director for the National Center for Interstate Compacts.

Actually, you know what, I believe those folks actually might testify under public testimony. We also have online for testimony Lisa Parenton, Director of Statewide Services, Department of Public Safety, Glenn Saviors, Deputy Director of the CBPL, DCCED, and Brian Webb from the State EMS Training Coordinator, Department of Health. In the room we have Sylvan Robb, Director of Corporations of Business and Professional Licensing, and Courtney Enright, Special Assistant to the Commissioner, Department of Health. So we have a lot of folks here. To offer their thoughts, some for public testimony, most available for questions.

All right. So, Ms. Harbison, if you would please begin your recap. Thank you, Chair Dunbar and members of the Senate Health and Social Services Committee. For the record, Ariel Harbison, staff to Senator Dunbar. I want to start with a brief recap of SB 281, Health Care Compacts Rural Health Program.

Version N of SB 281 would enact for medical licensure compacts, physician, physician assistants, psychologists, and EMS personnel. It would also expand the scope of practice for physician assistants, allowing them to provide medical care to the fullest extent of their license. Finally, it would establish the Rural Health Transformation Program Advisory Council.

Very good. And we have a committee substitute. Actually, do we have a— Madam Vice Chair, do we have a motion? Mr. Chairman, I move the committee substitute for Senate Bill 281, version 34LS1488/g, as in Gollivan, before the committee as our working document. I will object for purposes of discussion.

Oh yes, uh, Senator Myers. Oh, sorry, Mr. Chair, I wasn't trying to.

The gun, but I just have a couple of questions when it's time for that. Oh yeah, very good. So we're going to go through a summary of changes and then we'll have questions before I remove my objection. Uh, Ms. Harbison, could you please go through the summary of changes? Absolutely.

Through the chair, Ariel Harbison. Um, for the committee's knowledge, the summary of changes is quite lengthy, and the way it most made sense to me was to kind of break it up into 4 sections. Happy to pause at the end of each one to see if there's questions on those specific sections. Part 1 in the summary of changes, we have deleted the language regarding the PA scope of practice. And so sections in the original legislation were— that have been deleted are sections 1, 3, 5 through 7, 9 through 12, 14 through 22, 29, 31, 33, 35 through 37.

So we'll pause here for questions. I'll say briefly that we know there's another PA scope of practice bill that is going through the body. And we spoke with the sponsor and felt that this maybe wasn't the best vehicle for this bill. So, that is the justification there. I think it's a good piece of legislation, just not in this legislation.

All right. Please continue, Ms. Harbison. So, part 2. Our office received a few requests regarding background checks and fingerprinting for licensure under these compacts. Without clarifying statutory language, the Department of Public Safety would be unable to process background checks required under these healthcare compacts.

The compact language alone is insufficient to authorize DPS to conduct national criminal history record checks. Specifically, the EMS compact would require amending either now or approximately 5 years when fingerprint-based background checks would be implemented. In the current statutory language, it does not meet the requirements under federal law. DPS also requested adding statutory language to explicitly limit the use and dissemination of criminal justice information collected in these background checks. To what is authorized under federal law.

The Division of Corporations, Business, and Professional Licensing has requested the committee consider expanding requirements for background checks for all license types under the State Medical Board— that would be physicians, osteopathic physicians, podiatrists, and PAs— rather than those just looking for licensure under these compacts, which is how the bill is currently written. This is essential for the health and safety of Alaskans, most of whom assume background checks are already a licensure requirement. I will now review those changes in the CS before the committee, SB 281 version G. So in version G, section 2, AS 0864190 is amended to expand the scope of background checks. It clarifies information obtained can only be used for the purposes in determining qualifications and fitness for licensure or compact privilege under this chapter. Section 3, AS 0864-200, is amended by adding a new subsection 6, which requires submitting applicant fingerprints and fees to the Department of Public Safety for criminal justice information and national criminal history record check.

In section 4, 5, and 6, it includes osteopaths, podiatrists, and foreign medical graduates in subsection 6 of AS 0864-200.

Section 15 amends AS 1264-200 to authorize the Division of Public Safety to conduct national criminal history record checks for occupations listed in subsections 26 through 28: physicians, osteopaths, podiatrists, physician assistants, psychologists, emergency medical technicians, mobile intensive care paramedic, and advanced emergency medical technician. Section 16, AS 1808082, requires submitting applicant fingerprints and fees to the Department of Public Safety for criminal justice information and national criminal history record check for occupations that are listed in the EMS Compact. Unreferenced sections have been renumbered accordingly. So I'll say online we have Lisa Pierrentin, Director of Statewide Services, Department of Public Safety, if folks have questions for them or questions for our Ms. Harbison. Senator Tobin and then Senator Myers, you want to talk about this section or different section?

My questions are at the, I believe, the very section at the very end of the bill. So I'm good till then. Very good. Senator Tobin. Thank you, Mr. Chairman.

And this might be a question better suited for somebody online, and I apologize, I don't know who to direct it to. I'm just curious about this new section related to criminal background checks and fingerprinting and how that might— how our military reciprocity with licensure might be affected or delayed or slowed by this requirement. Particularly, I'm also thinking about how many travelers we do have that come to the state— traveling nurses, traveling physicians— and will this impede that ability to have those providers come into our state quickly? And also, I'm thinking about the tribal health components, and is this a requirement for all practicing medical providers, or, or is tribal health somehow separate from this as well? And just trying to have a better understanding and grasp of this section.

Very good. Um, I think I want to direct that to Ms. Purinton. Department of Public Safety. Ms. Purinton, do you have, um, did you hear Senator Tobin's question?

Uh, thank you, Chair Dunbar. For the record, Lisa Purinton, Director for the Division of Statewide Services with the Department of Public Safety. Um, thank you. Through the chair to Senator Tobin, if I understand the question was whether the background checks are required for all licensees under this compact language. And if that's the question, that would not be a decision for the Department of Public Safety.

That would be more for the licensing body. If the compact language required the background check, then that licensing body would send the, the information to the Department of Public Safety to get that information and release it back to the licensing body. The limitations that we've asked for not disclosing it outside of the purposes of licensure was to make sure that that information was kept within a government entity as required under Public Law 92-544, which governs the access of non-criminal justice information— I'm sorry, criminal justice information for non-criminal justice purposes. Hmm.

Interesting. Okay. Let's see here. I—. Yeah, go ahead, Senator Myers.

Do you have a question? Just a suggestion. I believe we have Sylvan Robb in the audience. She might be able to help out a little bit on that one. Director Robb, do you want to come forward?

If you would please put yourself on the record.

Thank you, Mr. Chair. Good afternoon. For the record, Sylvan Robb, Director of the Division of Corporations, Business and Professional Licensing. If I may, Mr. Chair— Senator Tovin, do you mind running through your questions again?

Yes, I'm happy to. I think I'm confused about the scope of these additional sections and just hoping that you can help provide just a little bit more clarity. So the way I heard and the way that I'm looking at this, and I might be getting the sections because we're adding new sections and we're changing section numbers, so I'm curious about how this section, particularly pertaining to fingerprinting, might impact when we have a military reciprocity licensure, the speed of it. If we, if we do already have fingerprinting for those particular expedited licenses, does this add an additional requirement, or is there reciprocity component? I'm thinking also about travelers.

We have a significant traveler providers community in the state already. I know in my hometown of Nome, most of the providers there are travelers, but they're part of IHS. And so I'm curious if this— how this impacts IHS. Uh, thank you very much for that recap. Um, through the chair to Senator Tobin, so, um, with regard to military licensure and the impact on speed, so, um, licensure for military members as well as military spouses is covered by the Service Member Civil Relief Act.

SCRA, um, which is a federal law, um, that has specific requirements that allow someone to obtain a permanent, um, license if they meet those requirements. However, the SCRA law does specifically say that in the event that, um, the person is coming from a compact state to another state that's a member of a compact, um, for that profession, that the compact governs, um, and so the rules of the compact cover it. So if we join these compacts and people are coming from a compact state, then the compact takes precedent over SCRA. Otherwise, that Service Members Civil Relief Act is what governs, and it provides for quick licensure for military members and their spouses. Follow-up?

Yep. Thank you, Mr. Chairman. And so if you have a current law that will be superseded by this new law, do we anticipate that there will be Any delay in issuing those licenses? Do we anticipate there might be some confusion from folks? Can you just help alleviate my concern that this might stop some of the folks in my district from being able to get licensed?

Through the chair to Senator Tobin, I think you're now kind of moved on to the traveler portion of your question. We take great pains to try to ensure that we have robust information on our website to help people navigate the licensure process, as well as having numerous opportunities for people to reach out to the division to have questions answered. When it comes to travelers, the For any profession in which we're not a member of a compact, which right now is everything except physical therapy, in audiology and speech-language pathology, which has not gone live in Alaska yet, for all the other professions, you know, a traveler needs to meet the same requirements as somebody who is coming, who's an Alaskan. And so the speed is the same whether you're an out-of-state applicant or a Alaskan applicant. Um, oh, I'm sorry, did you want to follow up on that specific one or move on to your IHS question?

IHS. Um, through the chair to Senator Tobin, um, so individuals who are providing services at federal facilities like IHS facilities, tribal facilities, VA facilities, um, are required to be licensed. They do not need to be licensed, um, in Alaska because they are operating at those federal facilities. Um, and so, um, should If people choose to be— get licensed in Alaska, they could do that through the compact, but it's not a requirement if they are operating there. So if you're coming from another state and have a license in good standing in that state, you can use that to operate at those federal facilities or tribal facilities.

Yep. Senator Giesel. Thank you, Senator Tobin. Thank you, Mr. Chairman. This is actually, I think, for DPS.

One of the biggest slowdown pieces of licensure is the fingerprint process, which we are doing as a caveman process on a piece of paper that the person who has these, uh, fingerprints done now takes that piece of paper, uh, to wherever it is they're going to submit them for licensure to DPS, whatever. It is ponderously slow. I think we may be the only state that does it this way. The rest do it electronically. Mr. Chairman, I will be looking— first, well, first of all, let me ask DPS, when is this going to change to electronic fingerprints that are submitted electronically?

Thank you, Senator Giesel. Again, for the record, Lisa Carrington with the Department of Public Safety. I appreciate the question. Through the Chair to Senator Giesel, we certainly appreciate your concerns on the manual process for processing fingerprints. We do receive electronic fingerprints.

We receive— I'd probably say 95% of all criminal fingerprints are submitted to us and processed electronically. Those are mostly coming from the Department of Corrections facilities. The non-criminal justice applicant fingerprints that are coming through us, we do have an electronic process set up with the Department of Health through their background check unit, so those do—.

Ms. Spearington, I think you might have gotten cut off. Oh, could you repeat what you just said, Ms. Spearington? Oh, thank you. I'm sorry, I should have—. Last 15 seconds.

[FOREIGN LANGUAGE] Can you hear me? Yes, we can hear you now. Okay, I apologize. Again, for the record, Lisa Carrington with the Department of Public Safety. I will start over.

Through the Chair to Senator Gaisel, the Department of Public Safety currently accepts probably 95% of all of the criminal arrest fingerprint cards to the department is received electronically. The non-criminal justice applicant cards that we receive for employment and licensing purposes primarily are 90% manual processes. We do have one electronic process that we've had in place for years with the Department of Health. Largely, this limitation was due to the technology at the time. We had a 40-year-old mainframe system that we've been running on, and it just did not have the functionality to be able to allow for this electronic submission from non-criminal justice entities.

So we have, in late January, we converted all of our systems into a modern platform that we're still working through to get fully transitioned. And now that we have that technology, that is certainly something we will be looking at exploring with all of our clients to automate a lot of this process that would replace the manual submitting the fingerprint cards, we convert it to a digital process, and then we would mail the process— those results back to the requesting agency. So, we're very much looking forward to it. It would require some technical changes, not only on our side, but possible changes with our clients on how they could get that information to us in electronic format as well. And we will certainly be exploring that capacity and that functionality as soon as we get the current system fully stabilized and operational.

Thank you, Mr. Chairman. Thank you. So I want us to go back just a little bit. So we included this in the CS, and I should note for the record we've been joined by Senator Clayman now at 3:50. That we added this at the behest of the administration, but I'm not sure if that person— Ms. Pierrenton, was it you and your office that requested these series of changes?

And— or can you speak to it as to why the administration asked for these changes?

Thank you. Again, for the record, Lisa Parenton. To the Chair, Senator Dunbar, the changes that were requested regarding the background check language, we— the information that we release, as I mentioned earlier, is Public Law 92-544. We are required to comply with the requirements of that in order to request national criminal history records that are maintained primarily by the Federal Bureau of Investigation, the FBI. We can certainly release state records based on state laws.

That's not going to be an issue. But in order to get those national checks, we have to comply with that. And that Public Law 92-544 is the governing body that authorizes whether the language in the state statute complies with the requirements of that federal law that allows for the sharing of criminal justice information, which is going to be your criminal history records, to share that information for non-criminal justice purpose. And that's to make sure that all the states and entities are protecting that information from unauthorized use to— because obviously it's going to be very confidential and could be detrimental to an individual's employment licensing character in a variety of issues with that confidential information. So with that, we reviewed the requirements of Public Law 92-544 that is very specific on when the information can be requested, who can be, who the information can be requested for, the categories of licensees or employees have to be very specifically specified in statute.

The information can only be shared with another government entity, not a private entity. And so, we requested those changes very cognizant of the template language for a lot of these compact bills, and did not want to intervene with any of that language, but we needed to shore up some of the language that was in the compact language to make sure that we were going to be able to comply with Public Law 92-544. So, that's why we asked for those very specific changes to amend that statute outside of the compact language that we are hoping that will comply with that Public Law 92-544. I hope that answered the question.

Yes, I think it did. Okay, well, let's move on. We've got— I'm sorry, Senator Giesel. So, Mr. Chairman, this is actually a significant issue. The sharing of the data can only be with another government agency.

So here's a registered nurse, comes, gets a license, right? And maybe we have modernized ourselves and we're doing it electronically, but regardless, when that individual goes to a facility to provide care for Medicaid patients, that fingerprint process has to be started all over again, has to be done again, because it can't be shared with Providence Hospital. I'll just use an example, right? So we have licensees that are having to get numerous fingerprints for different entities. It's kind of a barrier.

Thank you, Madam Chair. It sounds like this won't resolve that barrier, but rather help us to comply with the federal law. Is that accurate, Ms. Pierrentin?

Through the Chair, Lisa Pierrentin, Department of Public Safety. Um, Chair Dunbar, yes, um, to address Senator Diesel's concern, she's absolutely correct where the employer and the licensing body are two different purposes, two authorizing, two different authorizing statutes to get that information. That's the current process that exists for all of the non-criminal justice applicants. Processes. This will not change that.

And 100% consent of NMBAR, these changes are just to make sure we're complying to get the.

For the new requirements that are outlined in the compact language. Understood. Okay, thank you, Ms. Pierrentin. So at this point, we're going to move forward. Uh, Ms. Harbinson, can you continue?

We're now on page 2 of the summary of changes.

For the record, Ariel Harbinson, staff to Senator Dunbar. Uh, part 3, uh, is for the licensure compacts. I would like to note that Interstate Medical Licensure Compact, the PA Licensure Compact, and the Psychologist and Psychological Associates Compact all remain the same. There was a request to edit some language in the EMS section. So, this is Section 17, AS 18.08, and it is Section 14 of the EMS Compact.

It changes the word "association" to "associated" in the title. The remainder of the compact stays the same. It was simply a typo which was corrected to match the language in the EMS Compact. [Speaker:COMMISSIONER ARKOOSH] Very good. [Speaker:MS. KELLY] Next, I'll move on to Part 4, which is in regards to the Rural Health Transformation Program.

This is the last section I will cover. The changes made in this section came at the request of the Department of Health to better align the language with the current membership of the Advisory Council. The changes made in the next 3 parts of the Rural Health Transformation Program that are the department duties and reports were also requested by the Department of Health. New Section 18, AS 22.29, is amended to read: And we are looking at Section 4429.410, the Rural Health Transformation Program Advisory Council. Subsection 1 adds, or Tribal Health Consortium.

Subsection B removes the requirement for the member to be of a medical facility. Subsection 2 removes the requirement for a member to be a health provider that works with a Federally Qualified Health Care Organization, adds that the member may represent a Federally Qualified Health Center. Subsection 3 removes the requirement for the member to be a board member, executive officer, administrator for a hospital. It adds that that member can represent a hospital or professional organization for hospitals. Subsection 4 removes the requirement for a member to work in a school or a local government, adds that the member represents local government.

Subsection 5 removes the member who works in behavioral health, adds that a member represents the Alaska Mental Health Trust Authority. Subsection 8 adds a member who is the Department of Health Deputy Commissioner or designee who is a non-voting member and serves as chair. Subsection F allows the council to adopt bylaws for operations. Let me pause you there for a moment, Matt. Ms. Harbison, I just want to explain this.

So I think folks are aware that there already exists an advisory council. It appears to be doing a very good job. Our goal from the beginning was to put some— put the advisory council into statute so that some of these legislative controls on the RHTP program were more formalized. However, we didn't want to undo or prevent any of the good work that the Department of Health was already doing. And so, we have, working with the Department of Health, changed our proposed advisory council to more closely mirror the existing advisory council, again, to set up and statute and hope that it goes forward.

So I will— if there are any questions— Senator Tobin. Thank you, Mr. Chairman. And this might be a question for the department, as I know this is already an existing entity, and I want to ensure, after a previous committee hearing I was in where I saw that we have designated seats for population sizes, we've ensured that we have geographic representation on some of these large advisory groups that as we are codifying existing practice, we're also guaranteeing and ensuring that we'll have that regional representation, that we will ensure that there's large organizations, small organizations, that there are organizations that work within tribal communities, there are organizations that work with other underrepresented communities that will be protected because I know we're about to head through a very important electoral process, and there is a lot of opportunity for whoever comes in next to reimagine this in any sort of way and undo this good work. Thank you, Sandra Tobin. I'm actually looking— do we have— we don't have page numbers on this.

I'm trying to— 102. Thank you, Vice Chair Giesel. Ms. Enright, do you want to speak to any of this? Are you able to speak to any of this?

Through the chair, Senator Tobin, I mean, I think any board or commission is inherently flawed. We can't have every entity or every group there and still also be functional. Oh, yes. I'm sorry, Ms. Enright, could you identify yourself for the record? Sorry.

Courtney Enright, legislative liaison, Department of Health. Through the chair, Senator Tobin. But the entities that we've chosen to work with do represent a wide range in the state of Alaska. And so, you know, that was really our goal. And part of the reason we made some recommendations there was that we wanted to make sure we could bring in groups that represented, you know, broad variety in communities.

I mean, like, for example, the Hospital Association represents, I believe, all hospitals in the state of Alaska, which includes some tribal hospitals, some that are community owned. And that's just one example. And you know, so that's kind of been our goal is to work with broad overarching groups. Follow-up? Yes, Senator Tobin.

Thank you, Mr. Chairman. And as I said before, I don't want to undo the good work that you've done now. I want to ensure that going forward there will not be large disruptions. And my concern, and I'm just going to use an example here on page 102 on line 26, or excuse me, line 28, it says one member who represents a local government appointed by the governor. And depending on who is governor, the person who is currently there could be replaced, and that might be the rural voice, and that person could be replaced with an urban voice.

And so that is my concern, is I want to just ensure that as we move forward, that the voices who are in the room now, uh, and the work that you have done is not undone, uh, by particular whims or interests of whoever comes next.

Do you have any response to that, Ms. Enright? Through the chair, Senator Tobin, I can't control who the next governor is or who they might choose to appoint. So I don't have any ability to answer your question or concern. Thank you. Senator Kiesel?

Well, Mr. Chairman, just— I understand what Senator Tobin is concerned about, but I do look at line 18 where it identifies a member who represents a tribal health organization or consortium. "And that includes an organization recognized by the Indian Health Service." That's a pretty exclusive group of people. ANTHC is probably the only organization that could represent— be— fulfill this recommendation or this identification, and so I think that's a pretty secure one. The other thing is "represents a hospital or professional organization." That's on line 26. That Alaska Hospital and Health Care Association or whatever AHHA is also has some behavioral health organizations part of that as well.

So I think these really narrow down who could be appointed. So I think that's some assurance even though there is the appointed by the governor and it doesn't appear there's a confirmation process related to this. There is no confirmation process. Um, Ms. Enright, uh, well, I'll just suggest, Senator Tobin, you know, we, we are probably going to set— I'm probably going to set the amendment deadline for next week. And if you wanted to have a rural seat of some kind, depending on how that's structured, um, I don't think it would disrupt— I guess this is what question I want to ask Ms. Enright.

If we were to leave all of these intact and the existing members intact and maybe add someone, if Senator Tobin decided to bring that kind of amendment, how disruptive to the functioning of this council would that be? [Speaker:DR. LISA PETERS] I mean, through the Chair, I don't know that adding— Courtney Enright legislatively is on Department of Health. I don't know that adding a member is a big concern. I think only one of the things we would flag is just it would be helpful to keep it at an odd number of voting members in case there's anything that's too contentious, but other than that, That would be our only thought. And Mr. Chairman?

Yes, Senator Tobin. And to just put it for consideration to the department, we do have boards and commissions where the authorizing language at the beginning says with a focus on ensuring geographic diversity and ensuring population sizes of certain sizes are represented with existing membership, and that doesn't— That doesn't change any of the existing members. It just codifies that the hope is for that broad geographic diversity and those communities to have a voice at the table. And so I'll work with the chairman and folks.

To see if— and with your department to see if there's some language that codifies what you do but yet provides for that stipulation around ensuring that all Alaskans have a voice. Thank you, Senator Tobin. Um, I don't see other— oh, I'm sorry, uh, Senator Myers. And then we do have a little bit more of her presentation to go through. Go ahead, Sarah Myers.

Yeah, um, so about the, the RHTP Council, um, I noticed in the original version of the bill that we had a repealer in there. It says once final reports have been delivered. I'm curious why we removed the repealer.

That's an interesting question. I'm not sure. Senator Myers, do you have any insight into that? Ms. Enright or Ms. Harbison? Courtney Enright, legislative liaison, Department of Health.

I think it was inadvertent if we recommended the elimination of it when we were going through. We don't have a problem with the sunset. Yeah, I agree. So if that was an oversight, we can put that back in. Cool.

Okay. Ms. Harbison, if you would continue.

Thank you. For the record, Ariel Harbison, staff to Senator Dunbar. We are now going to move on to Section 4429.240, which is council duties. Removes the council's duties relating to administering surveys and obtaining feedback from stakeholders about implementation of the rural health transformation Rural Health Transformation Program adds the council's role as aiding the department in the state's participation of the Rural Health Transformation Program. Section 4429.430, Department Duties and Procurement, under subsection A, subsection C and D, changes updates to occur annually instead of quarterly for grant application scoring, awardees, uses of grants, and state-funded projects from the Rural Health Transformation Program.

Subsection C removes the permission for the Department of Health to adopt regulations. Subsection B, Sections 1 and 2, removes the requirement that the Department of Health award grants equally to applicants of each judicial district, equally across organizations based on employee size, and requiring priority to historically underserved populations. Section 44.29.440, under reports, subsection A, removes the requirement that the advisory council provide a report and deliver it to the Senate Secretary and Chief Clerk of the House by the first day of each regular session of the legislature. Adds that the Department of Health shares interim and federal reports annually with the legislature. Subsections B and C have been removed.

Sections 39 through 41 have been removed. Thank you. Senator Tobin. Thank you, Mr. Chairman, and I feel bad that we had Courtney go sit down and may invite her back up. Ms. Enright, can you just speak to— as I'm assuming that this was worked collaboratively with the department and the subsection B, the removal of the requirement for the Department of Health to remove— to distribute grants by judicial district, equally the ability to give resources to organizations of different sizes, and then of course the prioritization of historically underserved populations, as we know that there are significant needs for those populations in Alaska and why we wouldn't be prioritizing these resources to those underserved communities.

Courtney Enright, legislative liaison, Department of Health. Through the chair, Senator Tobin, because it conflicts with the Centers for Medicaid and Medicare Services for where we have to spend the money. We're required to spend the money in a way that best aligns with the goals and initiatives that are outlined in our application. And so these additional requirements may conflict with that. They may absolutely line up depending on, you know, where applications are from, but it was additional layers of requirements on a federal grant that requires us to spend money a specific way.

Follow-up? Yes, go ahead. Thank you, Mr. Chairman. While I understand that the department wrote the application in a very short period of time and didn't have an opportunity to maybe have more input and insight from stakeholders just because of that truncated period, I'm curious about just the department's focus on how to distribute these resources in a way that they don't all fall in Anchorage. While be it I represent Anchorage and I'm very passionate about making sure that the underserved people in the community I reside in receive resources.

I also recognize the need that we deploy resources across the state and that we ensure that the communities that, again, who have historically been underserved get these dollars. So, kóorng yin right, legislative liaison, Department of Health, through the chair, Senator Tobin. So technically Anchorage is the only part of the state not classed as rural, and so any money we deploy in Anchorage has to be specifically to serve rural populations that come into that hub. That inherently should help alone, but from besides that, we are looking at geographic distribution in the process of, you know, when we're doing evaluation, but we still have to primarily line up with the goals and initiatives we specified to CMS when we distribute these funds. We have to meet those requirements.

Thank you, Senator Tobin. Actually, I was wondering, Senator Giesel, we're in sort of a unique situation here where you have been our representative to the advisory council. And I guess I would wonder if you could relay to us sort of on the record, have there been any conversations at that advisory council about the concerns that Senator Tobin has brought forward? I mean, do you feel like as the Department of Health is going forward and looking to sift through these 1,800 proposals, that there will be adequate consideration for underserved communities and rural communities and geographic diversity? Thank you, Mr. Chairman.

I would— adamant yes, huge concern. That's why they're setting up regional meetings around the state. There was also the opinion expressed that these outside entities that want to come in and sell products not take over these community meetings. There's a real emphasis that these should be for communities to hear their concerns, hear their needs. I would also add that the seated member on the advisory council from the Tribal Health Organization is quite participating and outspoken about the needs of rural Alaska and underserved areas.

So the subject comes up often and is well covered. Thank you, Sandra Keyes-Saw. I know for the record, while that might have sounded like a scripted back and forth, it was not. She's just that good. Senator Myers.

Yeah, I'm just curious the way it's written regarding the tribal portion. We mentioned ANT-C as something that fits there. I'm wondering if Tanana Chiefs Conference is also an organization that might qualify for that. I am not sure. Do you have any insight into that, Ms. Enright?

Courtney Enright, legislative liaison, Department of Health. I believe the language says consortium or tribal health organization, and my understanding, I believe Tanna Chiefs Conference is a tribal health organization. Okay, so it is a possibility. Yes, and also TCC, I believe, participates in the consortium as a member in certain ways too. Gotcha.

Okay, thank you. Very good. Okay, I believe that is at the end of the summary changes, Ms. Harbison. Through the chair, Ariel Harbison, yes. Very good.

Are there any other questions before I remove my objection? I— so that I remove my objection. Are there further objections to adopting the CS? Seeing none, the CS is adopted.

Very good. Are there any further questions for Miss Harbison before we go to public testimony? Not seeing any. Thank you, Miss Harbison. So last meeting we opened public testimony on 281.

I'm going to continue that public testimony today. We'll open it. For now. Is there anyone in the room who would like to testify on this bill? Seeing none, um, I've been informed that I think everyone who is online is for questions.

Oh no, we have one here. Uh, Mr. Garcia, Sam Garcia, are you here for public testimony?

Yes, I'm here. Very good. Uh, good to hear from you, Sam. Uh, would you please put yourself on the record and begin your testimony? You'll have 2 minutes.

Thank you. I'm grateful for the opportunity to speak on the Alaska Mental Health Board for support of SB 281. I live and work in Alaska. I'm Alaska-born and raised. I know firsthand how the distance, the weather, workforce shortages can impact care and accessing it from whether you're up north or over in the White Cay region, can be a challenge.

And even in Anchorage. So I do a lot of outreach.

This was last winter, I tried to help somebody that was struggling with homelessness. They were in very real need of substance use treatment and they were ready and wanting it. After helping them get on the schedule for an assessment, they were told it was a.

A 6-month wait to get that assessment. That's a pretty extreme example, but that happens all the time, right? And for somebody that finally finds that motivation to take that step in the recovery, being told that you're just to get that assessment, which gives you the level of care you need for treatment, That's not even a treatment bed. That leaves people feeling crushed, unheard, and quite often will slip into further crisis.

SB 281 is something that can help change that by making access to a PA, to a clinician, more accessible. By being able to join interstate licensure compacts and creating more pathways, we can recruit and retain more clinicians more rapidly, including for telehealth services that are— it's a vital, a vital need for our rural areas. Making these changes and these reforms can help with patient safety through the board oversight and removing some of the outdated barriers that keep the— our capable providers from treating Alaskans that are in need. Um, for somebody living on the street, waiting months for care is often the difference between recovery and continued harm. SB 281 makes that timely care possible.

Please support SB 281 so we can stop losing people to long wait lists and strengthen our behavioral health system. Thank you again, and have a great day. Thank you, Mr. Garcia. I don't see any questions.

Thank you for your testimony. I don't see anyone else online. Everybody else is just here for questions, I believe. Is there any way to confirm that? [FOREIGN LANGUAGE] Okay.

They are free for questions. Okay. Well, I don't believe there is anyone else online for testimony. If you do have public testimony, of course, you can always email the committee. At this time, I'm going to close public testimony on SB 281.

So for announcements today, I'm setting an amendment deadline for two items. First, SB 261, Senator Greg Jackson's bill on unhoused young adults, IDs and birth certificates. If you're considering an amendment for this bill, please have them to my office by 5 PM Monday, April April 27th. Also, this bill, SB 281, Healthcare Compact— if you're considering an amendment for this bill, please have them to my office by Wednesday, 5 PM Wednesday, April 29th, before our Thursday meeting next week. Um, so, uh, the next meeting of the Senate Health and Social Services Committee will be held Tuesday, April 28th.

At that time, we will take up SB 261 for public testimony, look to the committee, then we'll have a presentation from Michael Baylet from Baylet Health here to discuss state strategy Strategies for Addressing the Affordable— Affordability Crisis in the Commercial Market. Thank you, everyone, for productive hearing. This meeting is adjourned. It is 4:18 PM.