Alaska is a large, sparsely populated state. The land mass of the state encompasses 570,641 square miles, averaging a population density of just 1.3 persons per square mile. This is the lowest population density of any state. The 2020 Alaska resident population was estimated at 728,903 by the Alaska Department of Labor and Workforce Development. This represented a decrease of 3,831 people compared to 2019. This was the fourth year of annual population decrease in Alaska since the oil crisis in the mid-1980s and the largest recent annual rate of decline. The decrease was primarily driven by negative migration, however the state also had 263 fewer resident births compared to 2019. There were 9,634 resident births in 2020. Alaska had 153,125 children less than 15 years of age (21.0% of the total population) and 144,484 women of childbearing age (15-44 years) in 2020 (19.8% of the total population).

Alaska has a trend of migration from rural to urban areas that has remained relatively stable over the past 20+ years. In 2020, approximately 17% of Alaskans lived in cities or places with populations of fewer than 2,500 people (down from 20% in 2019). Four areas with more than 20,000 people were home to 51% of Alaska’s population: the Municipality of Anchorage (population 288,970), the City and Borough of Juneau (31,773), the City of Fairbanks (31,410), and Knik-Fairview Census Designated Place (CDP) in the Matanuska-Susitna Borough (20,039). The Mat-Su Borough continued multiple years of increased population grown and had the largest growth rate among all economic regions over the past 10 years; 2020 was the first year when a Mat-Su CDP fell into the category of more than 20,000 residents.

The industries with the greatest number of employees in Alaska include government, health care, retail trade, leisure, and hospitality. According to the Department of Defense, as of March 31, 2021, 20,594 active-duty military personnel were stationed in Alaska. Additionally, Alaska was home to 4,717 service members in the national guard/reserves and 5,208 permanently assigned civilian military personnel. Anchorage, Fairbanks, and Kodiak Island all have large active-duty military and dependent populations. Compared with other states, Alaska has the highest per capita number of veterans, with 73,226 veterans as of 2018, including 22,631 veterans under age 45, 19% of whom were women. In 2019, active-duty military represented nearly 3% of the state’s overall population while veterans were around 10%.

According to the Department of Labor statewide projections, Alaska’s statewide population is projected to increase from 731,007 in 2019 to 813,822 in 2045. As Alaska’s population ages in the coming years, annual growth is expected to slow. Alaska’s population aged 65+ is expected to grow at the fastest rate over the projection period, followed by the population aged 20-64. Recent declines in birth rates are projected to slow growth among the population aged 0-19.

In 2019, 66% of Alaska’s population was reported to be White, 19% Alaska Native/American Indian, 8% Asian, 5% African American, and 2% Native Hawaiian or Other Pacific Islander (all percentages are for the race alone or in combination). Alaskans of Hispanic origin made up 7%. Cultural diversity among the non-Native population is increasing. The 2019 American Community Survey (ACS) indicates 8% of Alaskans were foreign-born. Pacific Islanders are the fastest-growing racial group in Alaska, largely due to immigration, and the largest immigrant group in Alaska are Filipinos (documented and undocumented) (Anchorage Daily News, 2019).

More than half of the students in the Anchorage School District identified as non-White, speaking over 100 different languages. In the 2020-21 school year, the racial group with the next highest percentage of students after White was Asian or Pacific Islander (40% and 18% of all students, respectively). In the 2018-2019 school year, 16 of the top 30 highest diversity public schools in the United States were in Anchorage. The Asian and Pacific Islander population has been increasing, growing from 6% of births in 2000 to 11% in 2020. About a third (36%) of API births are to Filipino persons and 23% are to Samoan persons.

Strengths and challenges that impact health status

Health disparities and health equity have large implications for the health status of Alaska’s MCH population. The most well documented and commonly studied differences in health status are between the Alaska Native and non-Native populations and between rural/frontier and urban populations. Alaska Native people experience disproportionate health outcomes in several domains. The causes of these disparities are multifactorial and include a long history of colonization, discrimination, and the loss of traditional lifestyles. As the Alaska Native population becomes increasingly urban or adopts western lifestyles and diet, whether by choice or not, chronic diseases such as diabetes and heart disease are of increasing concern. Living in remote communities with high unemployment rates, low income and significantly higher costs for food, fuel, and supplies, as well as barriers to accessing health care services are also contributing factors.

Significant improvements in the health of Alaska Native people have been made since the 1970s. Large investments in infrastructure including housing, safe water and sanitation facilities, community health aide-staffed tribal village clinics, and regional hospitals contributed to significant improvements in life expectancy, infant mortality and infectious disease. However, continuing and significant disparities remain, including in key MCH outcomes such as post-neonatal mortality; child, adolescent, teen (especially teen suicide), and maternal mortality; and oral health.

Uninsured populations are less likely to access routine, preventive care and more likely to seek care when health problems are severe and require treatment. In 2019, 58% of Alaskan adults aged 19-64 years were covered by employer or other private health insurance and 16% were covered by Medicaid (Kaiser Foundation). Among children with special health care needs, 48% were covered by Medicaid. According to the 2020 Scorecard on State Health System Performance by the Commonwealth Fund, Alaska ranks 42nd in the nation for both uninsured adults and uninsured children, with 16% of adults and 8% of children uninsured. A limitation of many data sources on health insurance is that they do not count tribal coverage or Indian Health Service as insurance, which may inflate Alaska’s percentage who are uninsured.

Poverty affects health both through decreased access to material resources, like health care and nutritious food, and through increased exposure to negative social and environmental factors, like violence, lead, and air pollution. It is associated with poor maternal health and birth outcomes such as infant mortality, low birth weight, and child maltreatment. According to the Spring 2021 Kids Count Alaska Economic Well-Being report, there are significant disparities in poverty indicators by race/ethnicity in Alaska. In 2018, the proportion of American Indian/Alaska Native children living in extreme poverty was more than double that of other racial/ethnic groups and more than four times the proportion of non-Hispanic White children. Rates of childhood poverty are highest in the Northern and Southwest regions of the state.

Survivors of violent crimes are at risk for posttraumatic stress disorder, major depressive episodes, and drug abuse/dependence. Youth exposed to community violence have increased rates of anxiety, aggression, and future violent behavior. In 2019, Alaska’s homicide rate per 100,000 individuals was 10.8, tying with Missouri for the 6th highest rate among all states.  The 2015 Alaska Victimization Survey results show a decline in intimate partner violence and sexual assault since 2010, although data support that fully 50% of adult women in the state have experienced violence in their lifetime, compared to 37.3% nationwide. In 2018-2019, 59% of Alaskan children lived in a safe neighborhood (based on parental opinion, NSCH). Adverse Childhood Experiences (ACEs) are major risk factors for leading causes of illness and death as well as poor quality of life. The higher the number of ACEs a person has, the more likely they are to experience poor health. The 2013-2015 Alaska BRFSS found that 65.7% of Alaskans had one or more ACEs, while 19.5% reported four or more.

Health care delivery in Alaska consists of four distinct systems; tribal, military, public and private. The Alaska Native Tribal Health Consortium (ANTHC) is a consortium of tribal entities that provides several levels of medical care: primary care at village clinics, primary and secondary care at regional hospitals, and tertiary care at the Alaska Native Medical Center hospital in Anchorage. ANMC receives some funding from the Indian Health Service but is supported to a greater extent by the various regional corporations. Publicly-funded health care agencies serve the largest portion of low income, uninsured individuals and families in Alaska. To date, there are a total of 27 organizations (including tribal corporations) that provide primary care and preventive health services at over 150 community health centers (CHCs) statewide. In addition to CHCs, the state government operates 16 Public Health Centers that provide population-based health services, disease screening and referral, and extensive collaboration with other community providers to assure coordinated care and access to services for vulnerable populations. On the private side, there are private non-profit and for-profit secondary and tertiary care hospitals, as well as self-employed and private practice health care providers. The military system is expansive, with clinics and hospitals in some of the larger population areas of the state, as well as a relationship with the Veteran's Administration supporting the active duty and retired armed forces.

Geographic isolation means significant challenges in assuring all MCH populations have access to routine preventive care, and acute medical and specialty care. Approximately 75% of Alaskan communities, including the capital city of Juneau, are not connected to a road system. Accessing "nearby health services" or specialized health care means travel by commercial jet, small plane, the marine ferry system, all-terrain vehicles, small boats or snow machines. Some residents may travel distances equivalent to Washington, D.C. to New Orleans for even routine medical care. Severe weather can render travel impossible, creating especially critical situations in medical emergencies.

Specialty care, even in urban areas of the state, is limited. Many communities have no facilities equipped for childbirth, so pregnant women must leave their homes four weeks before their due date and travel to a larger community with a hospital that performs births. Even well-child check-ups, prenatal exams and regular dental exams are difficult to provide. Recruiting and retaining physicians and primary health care providers for non-urban practices is an ongoing barrier to providing health care services.

Innovative systems have been created to overcome barriers to health care delivery related to high transportation costs and lack of skilled resources in the small communities. The Community Health Aide Program is a network of about 550 Community Health Aides/Practitioners (CHAPs) who work in over 170 rural Alaska villages to provide basic health care services and referrals. The CHAP program is a vital link in the Alaska Tribal Health System. The Alaska Dental Health Aide Therapist Initiative, another ANTHC program, is conducted in collaboration with the University of Alaska-Barrow and various established sites in Bethel and Anchorage to train Alaska Native dental health aides for community-level dental disease prevention in underserved Alaska Native populations. The Behavioral Health Aide Project aims to develop village-based behavioral health service capacity, focusing on prevention, early intervention, and case management.

Title V in the Context of the State Health Agency

The Alaska Department of Health and Social Services (DHSS) was originally established in 1919 as the Alaska Territorial Health Department. With the proclamation of statehood on January 3, 1959, the department’s responsibilities were expanded to include the protection and promotion of public health and welfare. These core duties are reflected in the mission of the department – to promote and protect the health and well-being of Alaskans – and are outlined in Article 7, Sections 4 and 5 of the Constitution of the State of Alaska.

Programs for the MCH and CYSCHN populations in Alaska are primarily managed within Sections of the Division of Public Health (DPH) located in DHSS. The Section of Women's, Children's and Family Health (WCFH) is the designated Title V and CYSCHN agency. WCFH programs are described in the WCFH Program Descriptions (attached as a supporting document, in addition to the WCFH organizational chart). The Section of Chronic Disease Prevention and Health Promotion (CDPHP) manages the following programs that serve the MCH population: Physical Activity and Nutrition; Youth Risk Behavior Survey (YRBS); Tobacco Prevention and Control; and Injury Prevention. As of July 1, 2021, this Section will also now contain programs related to FASD and other substance misuse, addiction, and prevention activities. Additionally, in FY22, WCFH will be partnering with CDPHP and the Department of Education & Early Development to create the Office of School Health & Safety. It is anticipated the Office will become another Unit within WCFH. The Section of Epidemiology (SOE) manages the Alaska Immunization Program.

Other MCH programs are managed in other Divisions of DHSS: EPSDT Outreach – Division of Health Care Services (Medicaid agency); Early Intervention/Infant Learning Program – Division of Senior and Disability Services; Strengthening Families – Office of Children’s Services (OCS); WIC/Nutrition Programs – Division of Public Assistance.

Over the past several years, DHSS has faced significant budget cuts in its share of state general fund dollars and has eliminated or reduced programs while trying to live within a budget that depends entirely on the price of oil and federal funding. DPH is frequently the target of across-the-board cuts. Cuts to administrative services largely funded by state funds, such as information technology, human resources, and financial/procurement, have also had a significant impact on public health program operations. The past year has seen an influx in COVID-related funding for public health through the American Rescue Plan Act and other legislation, as well as funding specifically to address health equity. Due to COVID-19, there were no cuts to the Division of Public Health in FY22.

Three local governments, the Municipality of Anchorage, North Slope Borough, and Maniilaq Association, operate local health departments as grantees of the State Public Health Nursing section. As noted above, Alaska DHSS offers a wide range of health assessment and disease prevention services through Public Health Centers (PHC) and itinerant nursing services that reach approximately 280 communities statewide. However, since 2015, many public health nursing positions have been cut in addition to the closure of six community PHC’s across the state. Specific services that are no longer provided due to budget cuts include well child exams for children over 7 years of age, and immunizations, reproductive health services, and sexually transmitted infection screening and treatment for adults 30 and over. The impact of these ongoing cuts to Public Health Nursing has been clear as the Department responded to the 2020 COVID-19 pandemic, and some nursing positions were reinstated using federal funding specific to COVID.  Public Health Nursing also brought on many new long-term, non-permanent positions to support COVID-19 contact tracing and vaccination efforts statewide. In the FY22 budget, some funds were reinstated to help mitigate some of the prior cuts, but the Section remains underfunded.

State Priorities

The mission of the Alaska DHSS is to promote and protect the health and well-being of Alaskans. The Department's priorities – Health and wellness across the life span; Health care access, delivery and value; and Safe and responsible individuals, families and communities – span the breadth of the department and encompass the unique service-areas represented within.

In 2019, DHSS, in partnership with ANTHC, conducted the Healthy Alaskans 2030 State Health Assessment and developed new leading health indicators for Healthy Alaskans 2030 (HA2030). The 30 health priorities identified for HA2030 include reducing the rates of cancer, suicide and poor mental health, child maltreatment and interpersonal violence and sexual assault. Alaskans also wanted to see alcohol, tobacco and drug use curtailed, and an increase in disease prevention through vaccines, improved community access to in-home water and sewer services and optimally fluoridated water, and increasing the percent of children at a healthy weight. As well, there are goals for improved healthcare access, protective factors for adolescents and social determinants of health. WCFH staff members participate in several ongoing HA2030 workgroups.

The Alaska DPH mission is to protect and promote the health of Alaskans; with a vision of healthy Alaskans today and tomorrow. In 2019, DPH conducted a strategic planning process to update the Division’s Strategic Plan, and the summary 2020-2023 Strategic Plan was released in June 2020. During the past year, the COVID-19 pandemic response delayed further development of the Strategic Plan. In 2021, the Division has begun to re-visit the Plan and reconvene workgroups. The Strategic Plan was expanded to cover the next 5 years to better align with Healthy Alaskans and recognize the impact COVID-19 had on public health efforts. The division is working to get back into non-COVID related to priorities while also still mitigating things like vaccine hesitancy.

In 2017, the WCFH established a one-page strategic plan overview (attached as a supporting document) reflective of the priorities outlined in the MCH Title V needs assessment as well as state priorities. The Section plans to update this plan during the second half of 2021, now that the DPH Strategic Plan goals have been finalized, the Title V 2020-2024 Five Year Needs Assessment is completed, and response to the COVID-19 pandemic has become less intense.

DPH is actively pursuing accreditation status with the national Public Health Accreditation Board (PHAB), with plans to submit a letter of intent, application, and fees to PHAB by the end of September 2021. The process of obtaining initial accreditation status is giving DPH the opportunity to assess its performance against a set of nationally recognized standards and measures based on the 10 Essential Public Health Services.  WCFH staff are represented on the core team leading this effort as well as domain-specific teams such as workforce development.

Components of Alaska’s System of care for meeting the needs of underserved and vulnerable populations

Alaska ranked 32nd among all states and the District of Columbia on the Commonwealth Fund’s 2020 Scorecard on State Health System Performance, which was based on 49 measures of health care access, quality, service use and costs of care, health outcomes and income-based health care disparities. Alaska was below the national average in three of the main categories (access and affordability, prevention and treatment, and healthy lives) and above average on avoidable hospital use and cost and income disparities.

The only children’s hospital in Alaska is the Children’s Hospital at Providence (TCHAP), located in Anchorage. The state’s only Level III NICU is at TCHAP, while Alaska Native Medical Center and Alaska Regional Hospital in Anchorage and Fairbanks Memorial Hospital have Level II NICUs. Increasing NICU services has been discussed at some hospitals. WCFH is monitoring this in terms of any effects to regionalization of care. To reduce costs, in May 2018, the military hospital at Joint Base Elmendorf-Richardson (JBER) began transferring infants born between 32-36 weeks and/or patients in labor to ANMC instead of Providence, as was previously done. Since both JBER and ANMC are federal entities, this agreement allows JBER to save funds in comparison to transferring the patients to a private facility. It also serves to increase the census at ANMC.

There is a chronic shortage of pediatric subspecialists in the state. While TCHAP and ANTHC have been successful in recruiting subspecialists to the state, many are represented by only one clinician in that specialty.  We have had success is recruiting three pediatric neurodevelopmental specialists, with another potential specialist anticipated to arrive in 2022, the past couple of years has seen a decline of pediatric providers from other areas such as endocrinology, hematology, and rheumatology, among others. Specialty providers in Alaska turnover due to burnout from taking so much call, not having a strong in-state professional network, and the lack of ties to an in-state university or medical school. In November of 2019, the All Alaska Pediatric Partnership (AAPP) convened a community meeting to begin work on addressing this issue as a state. The Title V Director helped in the planning and facilitation of this event. This has become a priority for AAPP in their multi-year strategic plan. Work group focuses include telehealth, provider training and workforce development, coordination of services, partnerships with additional universities and provider recruitment. The Title V MCH, CYSHCN Director and CYSHCN Program Manager are active participants in this process. WCFH is very encouraged by the active participation of both TCHAP and ANTHC in working together to identify solutions to this important issue.

Since July 2019, there has not been a Genetics Clinic in the state of Alaska. The contractors providing these services previously (Oregon Health & Science University) no longer had the staffing capacity to travel to Alaska. TCHAP decided to discontinue their Genetics Clinic and not look for an alternative contractor. This required all Alaska families to travel out of state for diagnostic services. Genetics clinics in Seattle and Portland continue to experience long waiting times for an appointment. ANTHC entered into an agreement with the University of Utah to provide diagnostic genetics services to tribal health beneficiaries that started in January 2021. This was supposed to start in 2020 but was delayed due to COVID-19 travel restrictions and the transition to telehealth. While this does provide services to the Alaska Native population, there remains a gap for children who are not beneficiaries. One of the main concerns regarding sponsorship of genetics in Alaska is the cost. There are ongoing concerns regarding Medicaid reimbursement for genetic testing due to denials. The Title V Director, ANTHC MCH Director, and Medicaid Medical Director have been part of a working group to change the reimbursement policy for genetic testing. While it has not received final approval, we anticipate there will be a positive change in this area.

While there are many negatives associated with the COVID-19 pandemic, one bright spot has been the rise in the opportunity to offer healthcare services to patients via telehealth, both within tribal health and the private sector. Many of the existing resources for specialty care are concentrated in the large population centers. The majority of the state’s pediatricians and neonatal and maternal specialists are primarily based in Anchorage, Fairbanks, and Juneau. Access to these resources from other areas often entails high transportation costs, many times borne by the Medicaid program. Under emergency orders resulting from pandemic mitigation efforts, the Alaska Medicaid program provided reimbursement for a broader definition of health care visits, including telehealth. This has had a tremendous impact for many patients and families in need of neurodevelopmental assessments. Not having to travel to a clinic with a child with behavioral needs and allowing a provider to assess a child in their home environment has improved the experience and outcome of autism diagnosis for many children receiving services through the Neurodevelopmental Outreach Clinic. As a result, the plan moving forward is to offer this clinic as a hybrid, where the practitioner can determine whether the child should be seen in-person or via telehealth. This change will increase access and equity to services, while being more appropriately sensitive to the child’s individual behavioral needs.

The pandemic also led to a substantial increase in provision of health care services using telehealth modalities for the adult population. Anecdotal reports from mental and behavioral health care providers around the state showed that broader use of telehealth platforms allowed people in rural areas of the state in particular, greater access to timely counseling services than was the case pre-pandemic. Some women’s health partners were able to modify their service delivery models to offer other preventive health services via telehealth or other options, including contraceptive quick starts for low-risk clients, at-home test kits for Chlamydia and other STIs, and screening and management of some health conditions. As a result of these experiences, many providers are advocating to permanently adopt these service delivery modifications and more flexible reimbursement structures.

Medicaid and Denali KidCare (CHIP) serve a large share of Alaska’s at-risk and vulnerable child population, however the state has the third highest rate of uninsured children in the country (9.4%) (Georgetown University Health Policy Institute). In 2018, 82.5% of all uninsured eligible children participated in Medicaid/CHIP. Medicaid coverage for pregnant women and children was broadened in the 1980s with an expansion of eligibility based on higher income standards and the addition of EPSDT, which broadened specific services that the state was required to provide children. Alaska implemented Medicaid expansion under the Affordable Care Act in September 2015, extending coverage to childless adults up to 138% FPL.

Alaska is one of two remaining states whose Medicaid payments are based on fee for service. Because of this, CYSHCN and their families are only able to access care coordination at two points within our system of care. The first is if they are eligible for Part C Early Intervention services, where the child must be under 36 months of age and have a documented 50% developmental delay. The second is if they are eligible for either a Children with Complex Medical Needs or Intellectual or Developmental Disability waiver. To contain costs, Senior and Disability Services is only selecting 50 new waivers a year limiting families’ access to care coordination.

Specific state statutes and other regulations that have relevance to title v

Alaska state law directs DHSS to promulgate regulations for the control of conditions or diseases of public health importance. Alaska statutes authorize the Department to (among other activities) collect, analyze, and maintain databases of confidential information related to conditions of public health importance and any data needed to provide essential public health services and functions. Alaska regulations mandate reporting of certain conditions of public health importance to the Division of Public Health, including birth defects, which are reported to WCFH.  Additionally, the Department may identify, assess, prevent, and ameliorate conditions of public health importance through:

1. Surveillance—WCFH surveillance programs include the Pregnancy Risk Assessment Monitoring System (PRAMS), Childhood Understanding Behaviors Survey (CUBS), Alaska Birth Defects Registry (ABDR), and Maternal Child Death Review (MCDR);
2. Epidemiological tracking, program evaluation, and monitoring—in WCFH this includes the Title V Maternal-Child Health Indicators Program;
3. Testing and screening programs—in WCFH these programs include Breast and Cervical Cancer Screening; Pediatric subspecialty clinics; and newborn bloodspot, hearing and critical congenital heart defects screening;
4. Treatment;
5. Administrative inspections; or other techniques.

During 2018, regulations that affect the newborn bloodspot screening and Alaska Birth Defects Registry programs were revised. On July 1, 2018, Alaska became a one-screen state for bloodspot screening and also now funds and coordinates a courier system for transport. The updated birth defects registry regulations expand the list of organizations required to report and includes private or public health insurance organizations and diagnostic laboratories operating in Alaska, and requires infant/child and maternal identifiers to be reported.

The following is a full list of Alaska state statutes (AS) and Alaska administrative code (AAC) regulations of relevance to Title V. Items that are bolded have direct relevance to programs in WCFH.

AS 08.65 Direct-Entry Midwives

AS 08.68 Board of Nursing

AS 11.41.434-440 Sexual Abuse of a Minor

AS 14.07.020 Duties of the Department of Education and Early Development

AS 14.12.115 Indemnity to School Staff

AS 14.20.680  Required Alcohol and Drug Related Disabilities Training

AS 14.30.045 Tuberculosis screening

AS 14.30.065-127 Physical Examinations and Screening Examinations

AS 14.30.141 Self-administered Medication in School

AS 14.30.231 Assure appropriate programs & services for children with disabilities

AS 14.30.355-356 Sexual Abuse and Sexual Assault Awareness and Prevention

AS 14.30.362 Suicide Awareness and Prevention Training

AS 14.33.100  School Crisis Response Plan

AS 14.33.200 Harassment, Intimidation, or Bullying Prohibition Policy

AS 18.05 Administration of Public Health and Related Laws

AS 18.15.010-900 Disease Control & Threats to Public Health

AS 18.15.200 Screening for Metabolic Disorders

AS 18.16.010 Regulation of Abortions

AS 18.50.010-040 Vital Statistics Act

AS 18.66.310 Continuing Education for Public Employees

AS 25.20.010 Age of majority

AS 25.20.025 Examination and Treatment of Minors

AS 40.25.125 Public Record Disclosures

AS 44.29.020 Duties of the Department of Health & Social Services

AS 47.07.030 Medical Services to be Provided for Pregnant Women

AS 47.07.067 Payment for adult dental services

AS 47.17.010-290 Child Protection

AS 47.20 Services for Developmentally Delayed or Disabled Children

AS 47.20.300-390 Newborn and Infant Hearing Screening, Tracking and Intervention Program

04 AAC 06.055 Immunizations required for school entry

04 AAC 52.250  Special Education Aides

07 AAC 12.401-.449 Free Standing Birth Centers

07 AAC 23.010-.900 Programs for Children with Disabilities

07 AAC 27.007 Reporting by laboratories

07 AAC 27.012 Birth Defects Registry

07 AAC 27.110-.111 Prophylactic treatment of newborn's eyes

07 AAC 27.510-590 Screening of newborn children for metabolic disorders

07 AAC 27.600-650 Newborn Hearing Screening

07 AAC 27.890-.900 Confidentiality, authorized users, and security standards; definitions

07 AAC 78 Grant Programs

07 AAC 80 Fees for Department Services

12 AAC 02.280-282 Board of Nursing - licensing fees

12 AAC 44 Board of Nursing, including Advanced Nurse Practitioner

14 AAC 12-14 Renewal & Continuing Competency Requirements for Certified Direct-Entry Midwives

CH. 56 SLA 13 Critical Congenital Cardiac Screening