S.B. 150 Healthcare Providers Scope of Practice Amendments: transcript

There we go. Thank you. Thank you, Mr. Vice Chair. Appreciate the Opportunity to present for your committee. Senate one 50. We had some dis a number of discussions during the interim, uh, as we talked in, in business and labor, and there was a, also a working group put together, um, by Department of Commerce in discussing some things. The concept is, uh, from time to time, we've, we've seen this happen up here in the legislature where, especially in the medical, uh, professional fields where we have something come forward that could potentially change the scope of practice or change, how, how we provide care, uh, how care is administered, different things. And some, oftentimes it leads to legislation. And sometimes that legislation is contentious. The thought was, how do we, how do we get good information to the legislature, good professional information to the legislature so they can make good, good decisions? And so this is the product of that thought process spec, specifically with healthcare. Uh, and how do we do that? And so we're, we're recommending that if, if something comes forward, you know, if, uh, someone within the field of practice, uh, some type of, there's some type of an innovation, whether it's technical technology or other things, that it comes forward an idea of how to, how to better provide healthcare and specifically, you know, could potentially lower cost, could provide better healthcare to the, to the patient, uh, be a, be a better service. How do we do that? And so, if, if, if an entity within that kind of concept, it could be a legislator, it could be someone within the medical field, it could be, you know, an organization that comes to and say, Hey, we think that we ought look at this and let's explore this and see if there's an opportunity, the, to play this out. Let's say there, there is someone that comes forward, they approach, you know, ler, which is within the Department of Commerce, office of Professional Licensure Review. The, that office would then, uh, reach back out to the Business and Labor Interim committee and, uh, the, specifically the chairs and say, Hey, we, there's a concept here. Do you think it's worthy of taking a bigger, bigger look at it? And if there was an agreement, yeah, then, then they would go back and start putting together a team. There would not be a, an in place team. It would be something that would be, because to be determined at the time, depending on what profession was involved, there would be recommendations from the board involved. So let's say it's the Board of Medicine, they would make a recommendation of a person to be there. And, and, and there was, there was some con discussion about how do we connect the process with the board involved. And that was the termination. That an agreement that the board could specifically choose someone that could be on, on that discussion group. And then that person would be the liaison back to the board. You know, they, we'd want people from the industry, people from, you know, the profession. And also some people with that, uh, specific expertise that could come back, whether that be research or technical expertise relevant to the scope of practice, come back. They would, they would have that discussion and look at, you know, the, the proposal and then make recommendations. And then they would report back to the, the labor, the business and labor interim committee. There's no shells in this. It doesn't say that they, that the committee has to do anything with. It simply was a, a process to try getting, try and get out in front of some of these potential conflicts and provide good information to the legislature. That's me personally. This, my whole goal with the bill is to try to get good information to the legislature so we can make good decisions instead of just, you know, like one person with one constituent going somewhere. Uh, and that's still available, by the way. Anybody can, any one of us can do that. But this helps, you know, just provide good information back to the legislature so we can do our job and make, and have that at hand and make, make good decisions. Like I say, the, once the process is, is completed, then it'd be up to the, the committee or the individual legislators, whether they move forward with anything on that particular topic. So with that, I'm open for any questions, Burton.

So this light Isn't How you doing? Thanks For bringing this bill forward. I've read a lot of it. Um, I think it's good practice. And, uh, uh, the question I do have though is, is has your sub been advanced on that bill? Say That again? Has your sub been adopted on the bill yet?

Yes. Alright. Yeah, we did, uh, we're working on the first sub right now, and it, it was actually amended as well. Alright. There was a slight amendment that, that was the connection portion that I was talking about connecting the board. And that originally we, we didn't have that true connection between the specific board and a number of the boards that could be involved in this. Felt like there really ought to be a direct connection back to them, uh, without specifically saying they had to go back. We felt like that if we had allowed them to pick a, a person to be on that discussion group, that that would be the person that would be responsible to li lay liaison back to the board. So that was, that was where the amendment came in. Okay.

To the, to the first sub. Alright. Thank you. Understood.

Good morning, Mr. Chair and members of the committee. Margaret Willie Bussey, executive director of the Utah Department of Commerce. Really happy to be here with you and this early hour-ish. Um, just wanted to say how much we appreciate Senator Vickers and his leadership on this issue and how much we appreciate the work of Jeff Shumway and his team at our Office of Professional Licensure Review. We see this as a really, uh, incredible opportunity, uh, to enable technology to get to the practitioner level that is appropriate for them as new technology comes online, which we see as an amazing opportunity to lower costs in healthcare. If lower trained and lower cost practitioners are able to use these technologies to perform the same service, that is a huge win for patients. And so increasing access and lowering cost is, is really what we see the end result of this bill. And so, really appreciate your support.

All right. Um, I'm trying to push my button because I do Wanna ask. Oh, okay. And the lights aren't working. There you go. Okay, good. Um, this question is for, uh, Margaret, if you come back up, please. Just, just, uh, one thing with regard to medical care that, that always concerns me, and I just want to ask you the question, uh, based on, uh, using lower level folks to provide service, do you, do you, are you concerned about, uh, the, the dumbing down or the lessening of medical care by doing that? Is that, is that, did that enter the equation or the discussion?

So I think it's a great question, and I think that in a way is actually the whole point of this bill, which is for a, a team of experts that LER would convene at the request of a legislator or a request of, you know, maybe it's a hospital or Intermountain or, or any party, they can request that, hey, this new technology, this new tool to do laser, this new AI tool to, to, to, um, look at images, right? Uh, they can request to see if that tool is good enough that would enable a lower level practitioner to do it with the same e efficacy as a higher level practitioner. Does that make sense? And then they would pass on that recommendation to you all so you all can decide, essentially. And so that's really the, the idea behind it, that it just provides, uh, the opportunity to study an issue, get the evidence to you all so you can make a decision so it doesn't kind of get caught up into sort of turf wars and, and, you know, the stuff that you see kind of all the time between different, um, practitioner levels. Thanks. Yeah.

I'd like to move that we pass out Senate Bill one 50.

I would thank you for the work on this. This has been a long time coming, like in years, and this particular project represents, uh, an amount of work by our office that, um, I don't think any of us understood that you'd have to deal with, uh, prior to it. So thank you for that. Um, but, uh, Senator Vickers, I think, um, we're gonna, we're gonna head the right direction there. There's been a lot of pushback internally, I think, in the medical field about, um, what we're trying to accomplish. But I think as we all look at the outcomes and taking care of patients and expanding access, I think that's, that's, we're headed the right direction. So thank you.

Trying. Okay. Yeah, I, um, oh, she disappeared. All right. Yeah. I, I, I feel the same way that some of you have also said that, that when it comes to innovation, that our code often makes us too slow to respond. That there are opportunities for people to do things that they can be easily trained to do. And we've talked about, you know, modular credentials and all these other sorts of things. Uh, so, um, yeah, I, I'm definitely encouraged that, that we could have a way to move forward and to allow people to, to get into new technologies, new training, and figure it out as we move forward without being sort of locked in or provincial in, in the way that we do things. So, I, I'm encouraged that we should move forward.

I appreciate the, you know, the dialogue about this. This has, uh, been an interesting concept. We've seen some of the value of having good discussions about things, especially in the medical field. And I think this gives us an opportunity to, to get expertise coming back to us and giving us good information always. I think we're always better. We make better decisions when we have better data, better, better information about what we're talking about. So I appreciate that,

Thank you, Mr. Chair. I do have a substitute online and a potential amendment to that substitute. Uh, so I'll address the sub. Primarily the differences in the sub were to do some clarifications and pri and coordination with Senate Bill 31. So we didn't have any conflict between those two bills. Um, we've been dealing for a number of years with different types of, um, changes in scope of practice in the healthcare arena. And so oler or Office of Professional licensure often reviews those and we take, take a look at it. Typically what happens is someone will bring a, a piece of legislation forward, uh, to change a licensure or scope of practice. It's oftentimes it's, uh, dependent upon new technology. Um, if you remember the, the, the battle we did over optometrist and ophthalmologists with, uh, lasers for different types of laser surgery. And, and from time to time these come forward, as we've talked about how to try to best get valuable information to the legislature to make good decisions and to try to get out in front of some of these things. We've tried to, we, we discussed numerous different ways throughout the interim about how best to go about that. How best can we utilize the resources of, uh, ler but also, you know, provide information and to the appropriate committees or committee that typically hears those types of things to try to, to move forward. So in the bill it's recommended this, that. Um, and the other thing that we've run up against, um, and I've found this, I, years ago I ran a bill that said that if a legislator was going to run a piece of legislation that concerned a medical professional board, that they had to go to the board. Well, I found out pretty quickly that legislators don't, like, shall, you know, they like me and they don't like shall, and they, they don't like to be directed. And so we've taken that into consideration. In fact, you've seen some builds go through four this year that actually removed some of that language on Opular. You know, we had, when Opular was, was, um, kind of the new version of was created, I think I'm pretty sure Senator Bramble did that a piece of legislation in that it said that if a legislator was bringing forward a bill that was changing, you know, changing a licensure, wishing a new license for an occupation, they had to go to opular. And, um, you know, we found out once again that legislators don't like shall. And so that there has been a bill going through the legislature, it may even have already passed the house that removed that component. So keeping all those things in mind, we were trying to figure out, okay, how's the best way to balance this? So you think about it, who could, who would most likely be coming forward to make a request to this type? Well, you could have a legislator. It could be a legislator coming forward saying, Hey, we've got this new technology. We think we ought to, uh, it fits into this scope of practice in this particular profession. You know, would, you know, let's, let's take a look at it. It could be, um, someone from a prof, that professional organization, you know, particular professional organization or others. It could be a, you know, a large, uh, health employer, those types of things. So with, with that, in that spirit in mind, we're saying, okay, if that happens, if there's, if we're thinking about, uh, something that's coming forward that probably ought to be looked at, they would, you know, any one of those could come forward and make a request to LER and say, Hey, um, we think you ought to look at this. Now, at that point, um, we would direct the bill would direct LER to review that, determine whether there was a need to, to take a look at that. And there may or may not be. If there is, then they would move forward and put together a, a group of professionals to look at that. And that, if you look at that on lines 31, 39, it says, in consultation with the applicable board appointed. So let's say for example, it had to do, uh, with nursing, uh, they would go to the board and, and comp and, uh, consultation with the that board. Uh, pick a couple of individuals from that, that occupation and pick, and then it, it says May on line 1 42, uh, select one or more of the following individuals, you know, to put together, basically put together a group of experts to look at it and, and review it, study it, and then make a recommendation. What would they do with that recommendation? That was the next step. Okay, the next step, you know, we thought, well, they, they really need to, before they go forward, they need to talk to the chairs of Business and Labor and say, Hey, we've got this request and we're, you know, do you, do you concur that we should move forward? Then we go forward. So I kind of got in front of myself, they put the group together, and then they come back and they re re prepare a report. They give it to the Business and Labor Interim committee. You know, they, they can describe what they recommend, um, describe how the incorporating innovation could change, you know, the profession. And, and then, then the board, the business, the committee could do what they, they chose to do with it. Um, in this sub, you'll say, see on line 1 61, it says May, it says, upon receiving the preliminary report under subsection five, the business Labor Interim Committee may recommend draft legislation to address the preliminary report. Uh, recommend, you know, continue on. Basically they could do what they, they could choose to do or take action, and they may take action on that. Um, the amendment will be a kind of a policy discussion. Um, do we want, do we, should we direct the, the committee to take an action? Well, even if it's take some kind of action, even it's no action. Or do we just to continue to say may, kind of going back to that spirit that legislators don't like to be told what to do. You know, I, you know, we put May in the May in the bill in the sub, and we do have an amendment prepared if you choose to do shall, uh, and I'll leave that up to, up to the committee. And I, I'd really, you know, be honest with you, I don't really care one way or the other. In talking to some various groups about this, I know that we've worked with the, the Salt Lake Chamber with large health employers. They're very much in supportive of this kind of concept. In talking to representatives and from some of the professional boards, they feel like that there should be more, uh, a kind of a, a tie back with the board. So for example, in 1 39, you know, the LER is going to go going to, in consultation with the applicable board, choose members to look at the whatever that question is, and you'll see that there's no specific tie back to that board. But here, during our, during our process, it's very transparent because the, that report would become public. It would go to the Business and Labor Committee, interim committee at that time, the, that applicable board, our thought is that that applicable board, they could also address it and they could take action independent of the, of the business labor committee. And then, then, then it moves forward. And then the committee may or may not and may take action on that. They may open a bill file, it may not, uh, a legislator may choose to use that and open a bill file. So the, so our thought is that I don't know that we need to do, to go, to have any kind of a requirement to go specifically back to that board because through the the transparent legislative process, they would have that opportunity. Um, I have spoken to the medical association, they, they would like to see some additional, uh, kind of tightening up in lines 1 39 to 1 45, maybe spec being a little more specific on, on some of those. And I'm happy to address that and continue to work on that. Um, and with that, Mr. Chair, uh, I believe that concludes my presentation.

I couldn't, yeah, I couldn't get it to turn off. For some reason I couldn't either.

Thank you, Mr. Chair. At the risk of PTSD, I'm gonna give an example here in the cosmetology industry, last year we worked on, um, for example, master estheticians. Yeah. That technology is changing rapidly. New machinery is coming on a lot. And, and up to date, the representatives from the company that manufactures the machine are basically the training entity. So is this something you envision in that space? New machine, new technology comes on board? If a requester comes forward, that it would go through this process to see how, if and where additional regulation or licensure would be required? No, it would simply be a recommendation. And so if, you know, let's, let's take that situation and I think that esthetician would fall under this, under healthcare, but I'm not, we might have to phone a friend to find out for sure on that. But if let's say it does, then yeah, the request would come forward. LER would, in that case, I don't know what board they would go to. You know, that, that's the challenge I've got. And you know, because in, in this, you know, they would go to, if it was say, affected nursing, they'd go to nursing. If it was pharmacy, pharmacy or medical, you know, medical, and then put together a group of, of experts and people that would, you know, could fully understand the situation, they would review it. Then OPA would put a report together, making recommendations, and they would give that to the, you know, the committee and then, then the committee could choose to move forward or a legislator could move, choose to move forward with it. So, Mr. Chair, so you would, you would probably have to still decide whether like cosmetology would be included in, in this group or if they're outside Of this group. Yeah. And we have representing some commerce here. Maybe I can have, uh, Jeff come forward and he can clarify that. Because, because I, I just, you know, if there is a line where is that delineation? Yeah. That, that this is what we're gonna do in this space. Recognizing your PTSD. Yeah. Thank you.

Good to be with you again, Senator. Thank you. Um, Jeff Shumway, director of the Office of Professional Licensure review. So two, two clarifying elements in the bill. Number one, there's a definition of healthcare practitioner on line 85, which says it has to be an individual licensed in a regulated healthcare occupation. Right.

Okay. Redefine that for me in like language I might understand.

So for instance, um, if you think of the Cosmetic Medical Procedures Act, if it requires a nurse practitioner or a physician to do the act, then, then they would be implicated in

The book. Okay. There's the line. Thank you. I understand that now. Okay.

Alan Dayton, Intermountain Health, You got 'em coming to the front. It's a pleasure to be here. This is a great bill. We're very pleased with Senator Vickers bringing it and the department for working on this. We have about 4,800 physicians and apps that work for Intermountain Health. Probably 18,000 nurses. And the one thing I've noticed in my career up here is whenever you start messing with licensing, you get a lot of political friction and it's a mess. This process I think takes a lot of the political friction outta the equation that will make it a lot more efficient and streamlined. I think the second point that this bill succeeds at is, um, modernization with AI and all the technology coming into hospital services and clinic services. We can't have old licenses always just hold the same form. They're going to change. So this bill allows adaptation and I think the third and and final piece, it allows for transparency. It allows us to look in through the window and see how this is done. So we can review it, we can talk about it and we can debate it. Wonderful. Bill, we fully support it. Thank you.

Good afternoon. Uh, John Pullman. I'm the Director of Innovation of the one Utah Health Collaborative. The one Utah Health Collaborative is an independent nonprofit public private entity. It was formed by Governor Cox and funded by the state legislature. Our charge is to make healthcare sustainable chart a path. Over the next 15 years, uh, we convene leaders and are, we are not, we do not advocate on scope of practice changes. Our charge is to really, how do we improve a healthcare system in Utah, particularly making it affordable. I think the context that people need to have when looking at any practice changes is the challenges we have in healthcare right now. Um, it is on a unsustainable financial trajectory. We have employers that are facing the largest premium increases in the last 20 years. We have people who are uninsured, who are facing large premium increases. PHP is spending more money this last year than they have in a long time. Um, costs are going up and there is also an access problem. Anyone who's tried to schedule a primary care visit or colonoscopy will find that it is booked out. If you, uh, if you look at Utah's future with growing population trends, with an aging population, there's going to be a greater demand and retiring physicians a greater demand. So the solution the collaborative has always advocated for is innovation. We need innovation to identify ways to improve the healthcare efficiency that will reduce costs and increase access for Utahans. Um, this shows up in technology and we appreciate, we need to identify ways in which we can responsibly incorporate those. That also comes up in the necessity of modernizing the way in which we evaluate scope of practice laws. And that's really what this, what this does. So, um, we have worked closely with Opular over the last years. We like their methodology. They find a very fair way to look at patient safety and health system efficiency, both of which need to be kept in mind as you look forward. So fully support of this legislation.

Thank you, Mr. Chair and members of the committee. I'm Mary Catherine Perry. I'm the Executive Vice President of Public Policy and Government Affairs for the Utah Chamber. Um, the Utah Chamber was part of this study with ler, and I just have to say, we regularly and annually survey our members, our business members. We have all kinds of members across the state, large, small, medium, um, public, private nonprofits. And one of their top concerns every year is the rising costs of healthcare. Um, this bill creates a mechanism that will allow Utah to respond quickly to changes in technology, um, in healthcare and key practitioners working at the top of their license. We hope this will make Utah hub for healthcare tech innovation, um, while also maintaining safety, improving access, and containing costs for the public and for the workforce as well. We believe this bill is a constructive step forward toward modernizing healthcare regulation in a way that benefits patients, providers, and Utah businesses. And we encourage continued coordination with experts in each scope of practice. We encourage you to support this bill. Thank you.

Hello, members of the committee, Mr. Chair. Great to be here. Margaret Woolley Buss, the Executive Director of the Utah Department of Commerce. Uh, we're thrilled that, that we were able to put forth this, this idea and have Senator Vickers sponsor this bill. Um, we see a lot of activity from medical providers when it comes to, uh, tech technological tools. We're seeing a lot of that in our AI sandbox that you all created with our Office of AI policy. That's where we see a lot of activity, where, um, providers are coming forward or, or even, uh, technological innovators are coming forward and saying, we have this amazing new tool. And what it does is actually enables lower level, lower cost practitioners to be able to use it, um, because the tool itself is so good. And so this is the kind of thing that we can expect to see, um, happen in a studied way, in a neutrally studied way for you all to be able to evaluate and do it in a way that is, um, hopefully quicker so that we can get changes made, uh, into our healthcare system and really lead out in the country. We've had conversations with people at the national, the federal level, um, and they are, they love that what we are doing here and, uh, want to be able to emulate it. So, just wanted to make that comment. We're really excited about this. This is one of our flagship bills from ler and appreciate your support. Thank you.

Good. Almost evening. Uh, Chris ine the Utah Medical Association. Um, we appreciate all the efforts that Senator Vickers has put into this bill. Uh, we've got a little bit of heartburn with two or three things, but we've spoken to him and we're very happy that he's willing to work with us and others to Iron out anything that, uh, may be of concern. Um, I do want to express the sentiment of our doctors in Utah as we represent DOS and MDs across the state. Um, we like greater access to healthcare. We like cheaper healthcare, but you can get cheaper healthcare a lot of places and not great quality. So we wanna make sure that patient safety and healthcare quality is tantamount and not necessarily streamlining or making things easier for lower level, uh, providers to get into areas that they're not great at. To use the sandbox analogy, sandboxes are great until you find out a cat has pooped in it. So we wanna make sure that whatever we're doing, it's patient safety first. We have providers who actually are qualified, trained and have everything they need to give the patient everything they need. That doesn't necessarily mean AI or a newfangled piece of equipment or the company selling that equipment, uh, rises to the level of qualified. Thank you.

Alright. Thank you. Yeah. My name is Seth Stewart. Um, I like to take a look at bills like these from the perspective of someone who might be trying to help ameliorate some of the underlying problems we've been talking about healthcare costs, we've been talking about, uh, the scope of licensing and so on. This bill does change who controls the innovation, and it does centralize authority. And it's, uh, it's, it's concerning in that regard because even if you wanted to take a relatively small scale approach to it, say you want to provide a skincare diagnostic app or something like that, this would fall under the scope of that as I understand it. And I would really subject you to a lot of these, uh, administrative hurdles and so on. And I don't, I frankly don't believe that the costs are contained. They certainly haven't been ever since the state adopted the doctrine that it was responsible to administer public health or license the delivery of healthcare. And so I would ask under what enumerated power is it, uh, permissible for the state to license, uh, these things or expand the licensure requirements, uh, the healthcare costs of, it's not a secret. They've gone through the roof under this theory, despite technological and scientific advances of extraordinary kinds and variety. So, um, and, and I can tell you where that doctrine came from. I, there there's not a provision in the state constitution that actually grants the state authority over matters of healthcare. Uh, the typical doctrine that's cited is, is the so-called general police powers of the state. And that comes from a Supreme Court decision in 1905, uh, that involved this invention of this idea of general police powers, uh, essentially out of thin air. Uh, they were quoting Federalist Number 45, but butchering the wording of it, saying that the powers of the states are numerous and indefinite. Indefinite does not mean unlimited. It simply means that the federal constitution doesn't specify what the powers of the state shall be. And so we still have to hold ourselves to the doctrine of enumerated powers. And if, if we're going to fantasize that this is going to somehow bring down healthcare costs through increased, uh, regulatory creep, uh, that's not going happen. It never has happened. And, and so let's bring it back to earth, uh, turn this back into a more of a free market. And so I, I urge you to oppose this bill. Thank you. You

Thank you, Mr. Chair. The moment probably passed, but I was, I was gonna say with a sandbox analogy, the cat is probably the best case scenario. Good point. You don't wanna sleep there. Okay.

I'll make a motion that we do entitled Embody Senate Bill one 50 and replace it with first substitute Senate bill one 50.

I'll waive Waives. I place the motion.

Question for the committee. If you look at the amendment to the first substitute Senate bill one 50, what the, the policy question is, is after, after the preliminary report is given, and it, and it's given to the Business and Labor interim committee, do you want to direct specifically that the committee take action or just leave it as a may? And I don't care if we, if we choose to leave it just a may as it is in the sub. I do need someone to make, and I can do it if you want, but I need to make a verbal amendment, which is a technical correction on line 1 66, which is just adding the word take. Why don't You go ahead and if anyone wants to change it when you get it, the floor, we can do that.

I would make a verbal amendment. Uh,

And so right after c add the word take so it would re it read, take any other action.

I would make, uh, a motion that we favorably recommend first substitute Senate bill one 50 as amended.

Um, just one, one point, you know, I'd refer you to, if you're thinking what could rise to the level of this look at lines 89, 88, or 90 and 91, um, it's going to provide a patient better access to healthcare, better health outcomes, or lower healthcare costs. So keep that in, that barometer in mind. And also, it would come forward only if it's something that had to be regulated. So it would, if it didn't rise to that, then it wouldn't come to this. So, thanks.

File motion. Motion To adjourn. Motion to adjourn. Non debatable.

Uh, you know, we've created the Office of Professional License Review ler, and it's been very viable in reviewing different situations, especially in healthcare arenas working, wondering about, you know, give us some recommendations on scope of practice and other types of things. Uh, we trying to, and kind of scheming, trying to figure out what's the best way to use that and try to also to try to preempt some things that come along so you can try to prevent maybe some turf battles and those types of things. But, but really just pro helping as innovation comes along. And, and healthcare is an amazing thing and we're constantly finding innovations of different types, whether it be technology or different ways to treat patients and better treat patients and, and even innovative ways to treat patients. So the S Bill one 50, uh, what we're we're doing here is, is setting up a process whereby if there is an innovation that comes along that may potentially change some type of a practice, whether it be how some, a particular practice, practice is done or extending the scope of practice, there can be requests go out to, uh, op LER and they can look at it and determine whether there is worth, it's what's worthy moving doing, moving forward with reviewing it and making recommendations. If that was the case, you know, a legislator can do that. Someone in the industry can do that, and it would have to be something substantial. It's not just trivial. But if they reviewed that and determined that there was value in moving forward on that particular innovation, then they would put together a preliminary report, submit it to Business and Labor Interim Committee and give, give instructions about how they would go about it. And then, then if that was the case, then if, if the interim committee approved it, then they would move forward with the, with the review. They would set up a, a committee. There would not be a permanent committee re appointed because it could vary from time to time depending on what, what the innovation is. They would pull people from the industry, they would pull people from, uh, the affected boards, meaning healthcare boards and recommending boards. And they would review that, that, uh, innovation. Then at that, when they're completed, they would put together a final report and then submit that also to the Business and Labor Interim committee with recommendations. It may lead to a recommendation, it may lead to nothing and just say, no, you know, we're fine where we're at. Uh, at that point then the Business and Labor Committee would have the information. There's no requirement that they move forward and, you know, take any action. Most likely they would, but there's no requirement there. Uh, with that explanation, I do have an amendment online amendment number three, which is attempting to close the loop between the, the board that might be affected. So let's say it's something in nursing and if the, the nursing board in this amendment, little bit of a change in how the makeup of this ad hoc committee would be put together. They would have, they would put a person on that, that, that ad hoc committee and that way there'd be a connection back to that board. And then also, uh, LER would request that they have the ability to pull somebody from, you know, with research, uh, credibility and those types of things so that they can make sure that they have a good sound, you know, a broad scope, but also very good professionals that could look at that particular innovation. So with that, Mr. President, I would make him a motion to, um, approve amendment number three in my name.

Thank you Mr. President. I, you know, that describes the bill. I'm, I'm open for any questions.

Thank you. I would wait summation and move the first substitute Senate bill one 50 as amended and be read a third time.

Senator Vickers. Thank you Mr. President Pro Tem, uh, Senate Bill one 50 sets up a process where we can, uh, try to get out in front of some new, new innovations and technology pieces and others as they come into the healthcare world. Um, if they're, if that rises to that level, then our Office of Professional Licensure review or ler uh, working in conjunction with the affected board. Uh, for example, one of the medical professional boards, whether it be medicine, pharmacy, nursing or others, would put together a group to review that process and work with the Business and Labor Interim Committee and the chairs of that committee to determine whether a study needs to go forward. And then if there is, uh, findings, recommendations they would report that would be reported back to the interim committee at that point, the interim committee could take action on that and, and recommend legislation or, or not. So bottom line is we're just trying to get out in front of some of these things and try to prevent some of the, the turf battles that we've had in the past and, uh, get good bottom line. We always want to get good information to the legislature so we can make good choices That I'm open for Questions. Thank you.

I would wa summation and move the first substitute Senate bill one 50 pass.

Senator Vickers Baldy Lewin Aye. Rammer plus Fillmore Aye. Escamilla Aye. Fillmore Bald Aye. Grover Aye. Harper Aye. Kins Aye. Sson Aye. Johnson Juab McKay johnson. Mikel Aye. Milner Musselman Owens pitcher Plum Rebe Sandal Stevenson Stratton Vickers Aye. Er aye. Wilson Aye. Winterson Aye. President Adams

Thank you Mr. President pro tem.

First substitute Senate Bill one 50 Healthcare Providers Scope of Practice amendments by Senator Vickers. This bill was heard in Education business, business Labor with a vote of 9 0 7. The House sponsors Representative Dunnigan

Uh, MREL. Peram. Motion to circle.

Thank you Mr. Speaker Pro Tem. So the purpose of Senate Bill one 50 is to let the market tell us the state what may be possible in the healthcare market instead of the state dictating to the market. So in that sense, what comes through this, the process is intended to provide better outcomes to those receiving healthcare. So we have a, an office, uh, ler and every 10 years they're charged with reviewing on a rolling scale professions. What this bill applies to is healthcare professions professionals. And it can allow, if somebody comes up with an idea and says, oh, we have some new technology or an innovation, how can we incorporate this into our practice? Then there are certain entities that can make a re a request and have that, that study. Those are, uh, teaching education that teaches healthcare profession and healthcare profession know organization or, uh, a legislator. And they can say to ler, would you please study this and see if this new technology will help us? And, and what there's testing on is to see if it'll provide better access to healthcare, better health outcomes or lower healthcare costs. It does not include an upgrade in technology that there's no patient interaction with a healthcare practitioner. So they're still required to be an interaction with a healthcare practitioner. Then what happens is somebody submits that request, LER takes that request to the business Labor Committee presents the idea, gets input, and business labor decides if LER should go forward. If so, then LER gets professionals out of those, uh, professions and with their own, uh, professional staff. Then they come back, evaluate the technology and report back to business labor and say, Hmm, maybe there's some ideas here that can lead us to better outcomes. So we're putting a framework. So if since some new technology comes, it still involves a healthcare professional that might receive better outcomes. And I'm just gonna share a couple of ideas that might come. Now, this is not in place, so these are not ideas under consideration, but just to give you an idea, what if you had some additional at home or wearable sensors that allowed faster better care and reporting to your medical practitioner? And we have some of those, but there are new ones coming on all the time. What if we have AI enhanced radiology and imaging to move directly to treatment and simple low risk diagnoses, or what if we had medication therapy manage it that would, that would allow, uh, uh, quicker pre-authorization for prescriptions and a pharm tech to, to accomplish more with a pharmacist? So these are just some possibilities. So what it does, it's very legislative driven. It goes through the business Labor committee, but rather than waiting 10 years, somebody could go to LER and make a request and say, will you study this technology and see if it's gonna lead to better outcomes? And with that, I'm open to questions.

Thank you Mr. Speaker. Pro Tem. Um, I just wanna rise in support of the bill. It was a little, the bill was a little puzzling to me at first about what it accomplished, but I finally got my head around that. I think we, LAR has done a good job. It's a relatively recent office here in the state, but they've done quite a bit for us already in helping provide more information. When we are deciding what different license classes can do what, but right now there's, there's really two ways that LER takes action. One is they review all of our license classes on a 10 year interval. If 10 years rolls around, they'll, they'll review it again. Should it be bigger? Should it be smaller? What, what, what should happen with it? A second way is if we go to them and ask them to review a license class. And this really just adds a third way that industry itself, if it thinks that a new technology has made something about their license class need to be different, they may request it still goes through a per ler together with our input deciding. But industry may come request that review. And I think that's a good change.

Uh, I think this has a real potential. It it provides a process for us for medical professionals and educational school that teaches medical professionals to come and say there's some new technology. Maybe we should evaluate the scope of practice or how this can lead to lower cost and better outcomes. So I encourage your support.