CSHB 265(HSS): "An Act relating to telehealth; relating to the practice of medicine and the practice of nursing; relating to medical assistance coverage for services provided by telehealth; and providing for an effective date."
00 CS FOR HOUSE BILL NO. 265(HSS) 01 "An Act relating to telehealth; relating to the practice of medicine and the practice of 02 nursing; relating to medical assistance coverage for services provided by telehealth; and 03 providing for an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 08.01 is amended by adding a new section to read: 06 Sec. 08.01.085. Telehealth. (a) A health care provider licensed in this state 07 may provide health care services within the health care provider's authorized scope of 08 practice to a patient in this state through telehealth without first conducting an in- 09 person visit. 10 (b) If a health care provider determines in the course of a telehealth encounter 11 with a patient under this section that some or all of the encounter will extend beyond 12 the health care provider's authorized scope of practice, the health care provider shall 13 advise the patient that the health care provider is not authorized to provide some or all 14 of the services to the patient, recommend that the patient contact an appropriate
01 provider for the services the health care provider is not authorized to provide, and limit 02 the encounter to only those services the health care provider is authorized to provide. 03 The health care provider may not charge for any portion of an encounter that extends 04 beyond the health care provider's authorized scope of practice. 05 (c) A fee for a service provided through telehealth under this section must be 06 reasonable and consistent with the ordinary fee typically charged for that service and 07 may not exceed the fee typically charged for that service. 08 (d) A physician, podiatrist, osteopath, or physician assistant licensed under 09 AS 08.64 may prescribe, dispense, or administer through telehealth under this section 10 a prescription for a controlled substance listed in AS 11.71.140 - 11.71.190 if the 11 physician, podiatrist, osteopath, or physician assistant complies with AS 08.64.364. 12 (e) An advanced practice registered nurse licensed under AS 08.68 may 13 prescribe, dispense, or administer through telehealth under this section a prescription 14 for a controlled substance listed in AS 11.71.140 - 11.71.190 if the advanced practice 15 registered nurse complies with AS 08.68.710. 16 (f) Except as authorized under (d) and (e) of this section, a person licensed 17 under this title or in another state may not prescribe, dispense, or administer through 18 telehealth under this section a controlled substance listed in AS 11.71.140 - 11.71.190. 19 (g) A health care provider may not be required to document a barrier to an in- 20 person visit to provide health care services through telehealth. The department or a 21 board may not limit the physical setting from which a health care provider may 22 provide health care services through telehealth. 23 (h) Nothing in this section requires the use of telehealth when a health care 24 provider determines that providing health care services through telehealth is not 25 appropriate or when a patient chooses not to receive health care services through 26 telehealth. 27 (i) In this section, 28 (1) "health care provider" means an audiologist or speech-language 29 pathologist licensed under AS 08.11; a behavior analyst licensed under AS 08.15; a 30 chiropractor licensed under AS 08.20; a professional counselor licensed under 31 AS 08.29; a dental hygienist licensed under AS 08.32; a dentist licensed under
01 AS 08.36; a dietitian or nutritionist licensed under AS 08.38; a naturopath licensed 02 under AS 08.45; a marital and family therapist licensed under AS 08.63; a physician 03 licensed under AS 08.64; a podiatrist, osteopath, or physician assistant licensed under 04 AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse licensed under 05 AS 08.68; a dispensing optician licensed under AS 08.71; an optometrist licensed 06 under AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or 07 occupational therapist licensed under AS 08.84; a psychologist or psychological 08 associate licensed under AS 08.86; or a social worker licensed under AS 08.95; 09 (2) "licensed" means holding a current license in good standing; 10 (3) "telehealth" has the meaning given in AS 47.05.270(e). 11 * Sec. 2. AS 08.64.364(b) is amended to read: 12 (b) The board may not impose disciplinary sanctions on a physician or 13 physician assistant for prescribing, dispensing, or administering a prescription drug 14 that is a controlled substance or botulinum toxin if the requirements under (a) of this 15 section and AS 08.64.363 are met [AND THE PHYSICIAN OR PHYSICIAN 16 ASSISTANT PRESCRIBES, DISPENSES, OR ADMINISTERS THE 17 CONTROLLED SUBSTANCE OR BOTULINUM TOXIN WHEN AN 18 APPROPRIATE LICENSED HEALTH CARE PROVIDER IS PRESENT WITH 19 THE PATIENT TO ASSIST THE PHYSICIAN OR PHYSICIAN ASSISTANT 20 WITH EXAMINATION, DIAGNOSIS, AND TREATMENT]. 21 * Sec. 3. AS 08.68 is amended by adding a new section to article 6 to read: 22 Sec. 08.68.710. Prescription of drugs without physical examination. (a) The 23 board may not impose disciplinary sanctions on an advanced practice registered nurse 24 for rendering a diagnosis, providing treatment, or prescribing, dispensing, or 25 administering a prescription drug that is not a controlled substance to a person without 26 conducting a physical examination if 27 (1) the advanced practice registered nurse or another licensed health 28 care provider in the medical practice is available to provide follow-up care; and 29 (2) the advanced practice registered nurse requests that the person 30 consent to sending a copy of all records of the encounter to the person's primary care 31 provider if the prescribing advanced practice registered nurse is not the person's
01 primary care provider and, if the person consents, the advanced practice registered 02 nurse sends the records to the person's primary care provider. 03 (b) The board may not impose disciplinary sanctions on an advanced practice 04 registered nurse for prescribing, dispensing, or administering a prescription drug that 05 is a controlled substance if the requirements under (a) of this section and 06 AS 08.68.705 are met and the advanced practice registered nurse prescribes, 07 dispenses, or administers the controlled substance. 08 (c) Notwithstanding (a) and (b) of this section, an advanced practice registered 09 nurse may not prescribe, dispense, or administer a prescription drug in response to an 10 Internet questionnaire or electronic mail message to a person with whom the advanced 11 practice registered nurse does not have a prior provider-patient relationship. 12 (d) In this section, 13 (1) "controlled substance" has the meaning given in AS 11.71.900; 14 (2) "prescription drug" has the meaning given in AS 08.80.480; 15 (3) "primary care provider" has the meaning given in AS 21.07.250. 16 * Sec. 4. AS 18.08 is amended by adding a new section to read: 17 Sec. 18.08.100. Telehealth. (a) An individual certified or licensed under this 18 chapter may practice within the individual's authorized scope of practice under this 19 chapter through telehealth with a patient in this state if the individual's certification or 20 license is in good standing. 21 (b) If an individual certified or licensed under this chapter determines in the 22 course of a telehealth encounter with a patient that some or all of the encounter will 23 extend beyond the individual's authorized scope of practice, the individual shall advise 24 the patient that the individual is not authorized to provide some or all of the services to 25 the patient, recommend that the patient contact an appropriate provider for the services 26 the individual is not authorized to provide, and limit the encounter to only those 27 services the individual is authorized to provide. The individual certified or licensed 28 under this chapter may not charge for any portion of an encounter that extends beyond 29 the individual's authorized scope of practice. 30 (c) A fee for a service provided through telehealth under this section must be 31 reasonable and consistent with the ordinary fee typically charged for that service and
01 may not exceed the fee typically charged for that service. 02 (d) An individual certified or licensed under this chapter may not be required 03 to document a barrier to an in-person visit to provide health care services through 04 telehealth. The department or the council may not limit the physical setting from 05 which an individual certified or licensed under this chapter may provide health care 06 services through telehealth. 07 (e) Nothing in this section requires the use of telehealth when an individual 08 certified or licensed under this chapter determines that providing services through 09 telehealth is not appropriate or when a patient chooses not to receive services through 10 telehealth. 11 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 12 * Sec. 5. AS 47.07 is amended by adding a new section to read: 13 Sec. 47.07.069. Payment for telehealth. (a) The department shall pay for all 14 services covered by the medical assistance program provided through telehealth in the 15 same manner as if the services had been provided in person, including 16 (1) behavioral health services; 17 (2) services covered under home and community-based waivers; 18 (3) services covered under state plan options under 42 U.S.C. 1396 - 19 1396p (Title XIX, Social Security Act); 20 (4) services provided by a community health aide or a community 21 health practitioner certified by the Community Health Aide Program Certification 22 Board; 23 (5) services provided by a behavioral health aide or behavioral health 24 practitioner certified by the Community Health Aide Program Certification Board; 25 (6) services provided by a dental health aide therapist certified by the 26 Community Health Aide Program Certification Board; 27 (7) services provided by a chemical dependency counselor certified by 28 a certifying entity for behavioral health professionals in the state specified by the 29 department in regulation; 30 (8) services provided by a rural health clinic or a federally qualified 31 health center;
01 (9) services provided by an individual or entity that is required by 02 statute or regulation to be licensed or certified by the department or that is eligible to 03 receive payments, in whole or in part, from the department; 04 (10) services provided through audio, visual, or data communications, 05 alone or in any combination, or through communications over the Internet or by 06 telephone, including a telephone that is not part of a dedicated audio conference 07 system, electronic mail, text message, or two-way radio; 08 (11) assessment, evaluation, consultation, planning, diagnosis, 09 treatment, case management, and the prescription, dispensing, and administration of 10 medications, including controlled substances; and 11 (12) services covered under federal waivers or demonstrations other 12 than home and community-based waivers. 13 (b) The department shall adopt regulations for services provided by telehealth, 14 including setting rates of payment. Regulations calculating the rate of payment for a 15 rural health clinic or federally qualified health center must treat services provided 16 through telehealth in the same manner as if the services had been provided in person, 17 including calculations based on the rural health clinic or federally qualified health 18 center's reasonable costs or on the number of visits for recipients provided services, 19 and must define "visit" to include a visit provided by telehealth. The department may 20 not decrease the rate of payment for a telehealth service based on the location of the 21 person providing the service, the location of the eligible recipient of the service, the 22 communication method used, or whether the service was provided asynchronously or 23 synchronously. The department may exclude or limit coverage or reimbursement for a 24 service provided by telehealth, or limit the telehealth modes that may be used for a 25 particular service, only if the department 26 (1) specifically excludes or limits the service from telehealth coverage 27 or reimbursement by regulations adopted under this subsection; 28 (2) determines, based on substantial medical evidence, that the service 29 cannot be safely provided using telehealth or using the specified mode; or 30 (3) determines that providing the service using the specified mode 31 would violate federal law or render the service ineligible for federal financial
01 participation under applicable federal law. 02 (c) All services delivered through telehealth under this section must comply 03 with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191). 04 (d) In this section, 05 (1) "federally qualified health center" has the meaning given in 42 06 U.S.C. 1396d(l)(2)(B); 07 (2) "rural health clinic" has the meaning given in 42 U.S.C. 08 1396d(l)(1); 09 (3) "state plan" means the state plan for medical assistance coverage 10 developed under AS 47.07.040; 11 (4) "telehealth" has the meaning given AS 47.05.270(e). 12 * Sec. 6. AS 47.30 is amended by adding a new section to read: 13 Sec. 47.30.585. Telehealth. (a) An entity designated by the department under 14 AS 47.30.520 - 47.30.620 may provide community mental health services authorized 15 under AS 47.30.520 - 47.30.620 through telehealth to a patient in this state. 16 (b) If an individual employed by an entity designated by the department under 17 AS 47.30.520 - 47.30.620, in the course of a telehealth encounter with a patient, 18 determines that some or all of the encounter will extend beyond the community mental 19 health services authorized under AS 47.30.520 - 47.30.620, the individual shall advise 20 the patient that the entity is not authorized to provide some or all of the services to the 21 patient, recommend that the patient contact an appropriate provider for the services the 22 entity is not authorized to provide, and limit the encounter to only those services the 23 entity is authorized to provide. The entity may not charge a patient for any portion of 24 an encounter that extends beyond the community mental health services authorized 25 under AS 47.30.520 - 47.30.620. 26 (c) A fee for a service provided through telehealth under this section must be 27 reasonable and consistent with the ordinary fee typically charged for that service and 28 may not exceed the fee typically charged for that service. 29 (d) An entity permitted to provide telehealth under this section may not be 30 required to document a barrier to an in-person visit to provide health care services 31 through telehealth. The department may not limit the physical setting from which an
01 entity may provide health care services through telehealth. 02 (e) Nothing in this section requires the use of telehealth when an individual 03 employed by an entity designated by the department under AS 47.30.520 - 47.30.620 04 determines that providing services through telehealth is not appropriate or when a 05 patient chooses not to receive services through telehealth. 06 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 07 * Sec. 7. AS 47.37 is amended by adding a new section to read: 08 Sec. 47.37.145. Telehealth. (a) A public or private treatment facility approved 09 under AS 47.37.140 may provide health care services authorized under AS 47.37.030 - 10 47.37.270 through telehealth to a patient in this state. 11 (b) If an individual employed by a public or private treatment facility 12 approved under AS 47.37.140, in the course of a telehealth encounter with a patient, 13 determines that some or all of the encounter will extend beyond the health care 14 services authorized under AS 47.37.030 - 47.37.270, the individual shall advise the 15 patient that the facility is not authorized to provide some or all of the services to the 16 patient, recommend that the patient contact an appropriate provider for the services the 17 facility is not authorized to provide, and limit the encounter to only those services the 18 facility is authorized to provide. The facility may not charge a patient for any portion 19 of an encounter that extends beyond the authorized health care services under 20 AS 47.37.030 - 47.37.270. 21 (c) A fee for a service provided through telehealth under this section must be 22 reasonable and consistent with the ordinary fee typically charged for that service and 23 may not exceed the fee typically charged for that service. 24 (d) A facility permitted to practice telehealth under this section may not be 25 required to document a barrier to an in-person visit to provide health care services 26 through telehealth. The department may not limit the physical setting from which a 27 facility may provide health care services through telehealth. 28 (e) Nothing in this section requires the use of telehealth when an individual 29 employed by a facility approved under AS 47.37.140 determines that providing 30 services through telehealth is not appropriate or when a patient chooses not to receive 31 services through telehealth.
01 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 02 * Sec. 8. The uncodified law of the State of Alaska is amended by adding a new section to 03 read: 04 MEDICAID STATE PLAN FEDERAL APPROVAL. To the extent necessary to 05 implement this Act, the Department of Health and Social Services shall amend and submit for 06 federal approval the state plan for medical assistance coverage consistent with AS 47.07.069, 07 enacted by sec. 5 of this Act. 08 * Sec. 9. The uncodified law of the State of Alaska is amended by adding a new section to 09 read: 10 REGULATIONS. (a) Each applicable board responsible for licensing a profession 11 authorized to provide telehealth services under sec. 1 of this Act shall adopt regulations 12 necessary to implement sec. 1 of this Act. The licensing boards shall adopt the regulations not 13 later than June 30, 2023. 14 (b) The State Medical Board shall adopt regulations necessary to implement sec. 2 of 15 this Act. The State Medical Board shall adopt the regulations not later than June 30, 2023. 16 (c) The Department of Health and Social Services shall adopt regulations necessary to 17 implement secs. 4 - 7 of this Act. The Department of Health and Social Services shall adopt 18 the regulations not later than June 30, 2023. 19 * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to 20 read: 21 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 5 of this Act takes effect 22 only if, on or before January 1, 2023, the United States Department of Health and Human 23 Services 24 (1) approves amendments to the state plan for medical assistance coverage 25 under AS 47.07.069, enacted by sec. 5 of this Act; or 26 (2) determines that its approval of the amendments to the state plan for 27 medical assistance coverage under AS 47.07.069, enacted by sec. 5 of this Act, is not 28 necessary. 29 (b) The commissioner of health and social services shall notify the revisor of statutes 30 in writing within 30 days after the United States Department of Health and Human Services 31 approves amendments to the state plan or determines that approval is not necessary under
01 (a)(1) or (2) of this section. 02 * Sec. 11. If sec. 5 of this Act takes effect, it takes effect on the day after the date the revisor 03 of statutes receives notice from the commissioner of health and social services under sec. 04 10(b) of this Act. 05 * Sec. 12. Section 9 of this Act takes effect immediately under AS 01.10.070(c). 06 * Sec. 13. Except as provided in secs. 11 and 12 of this Act, this Act takes effect June 30, 07 2023.