CSHB 265(FIN): "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(FIN) 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) A physician licensed in another state may provide health care services 11 through telehealth to a patient located in the state as provided in this subsection, 12 subject to the investigative and enforcement powers of the department under 13 AS 08.01.087, and subject to disciplinary action by the State Medical Board under 14 AS 08.64.333. The privilege to practice under this subsection extends only to ongoing
01 treatment or follow-up care related to health care services previously provided by the 02 physician to the patient and applies only if 03 (1) the physician and the patient have an established physician-patient 04 relationship; and 05 (2) the physician has previously conducted a physical examination of 06 the patient in person. 07 (c) If a health care provider determines in the course of a telehealth encounter 08 with a patient under this section that some or all of the encounter will extend beyond 09 the health care provider's authorized scope of practice, the health care provider shall 10 advise the patient that the health care provider is not authorized to provide some or all 11 of the services to the patient, recommend that the patient contact an appropriate 12 provider for the services the health care provider is not authorized to provide, and limit 13 the encounter to only those services the health care provider is authorized to provide. 14 The health care provider may not charge for any portion of an encounter that extends 15 beyond the health care provider's authorized scope of practice. 16 (d) A fee for a service provided through telehealth under this section must be 17 reasonable and consistent with the ordinary fee typically charged for that service and 18 may not exceed the fee typically charged for that service. 19 (e) A physician, podiatrist, osteopath, or physician assistant licensed under 20 AS 08.64 may prescribe, dispense, or administer through telehealth under this section 21 a prescription for a controlled substance listed in AS 11.71.140 - 11.71.190 if the 22 physician, podiatrist, osteopath, or physician assistant complies with AS 08.64.364 23 and any federal law governing the prescription, dispensing, or administering of a 24 controlled substance. 25 (f) An advanced practice registered nurse licensed under AS 08.68 may 26 prescribe, dispense, or administer through telehealth under this section a prescription 27 for a controlled substance listed in AS 11.71.140 - 11.71.190 if the advanced practice 28 registered nurse complies with AS 08.68.710 and any federal law governing the 29 prescription, dispensing, or administering of a controlled substance. 30 (g) Except as authorized under (e) and (f) of this section, a person licensed 31 under this title may not prescribe, dispense, or administer through telehealth under this
01 section a controlled substance listed in AS 11.71.140 - 11.71.190. 02 (h) A health care provider may not be required to document a barrier to an in- 03 person visit to provide health care services through telehealth. The department or a 04 board may not limit the physical setting from which a health care provider may 05 provide health care services through telehealth. 06 (i) Nothing in this section requires the use of telehealth when a health care 07 provider determines that providing health care services through telehealth is not 08 appropriate or when a patient chooses not to receive health care services through 09 telehealth. 10 (j) In this section, 11 (1) "health care provider" means 12 (A) an audiologist or speech-language pathologist licensed 13 under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor 14 licensed under AS 08.20; a professional counselor licensed under AS 08.29; a 15 dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a 16 dietitian or nutritionist licensed under AS 08.38; a naturopath licensed under 17 AS 08.45; a marital and family therapist licensed under AS 08.63; a physician 18 licensed under AS 08.64; a podiatrist, osteopath, or physician assistant licensed 19 under AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse 20 licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an 21 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a 22 physical therapist or occupational therapist licensed under AS 08.84; a 23 psychologist or psychological associate licensed under AS 08.86; or a social 24 worker licensed under AS 08.95; or 25 (B) a physician licensed in another state; 26 (2) "licensed" means holding a current license in good standing; 27 (3) "telehealth" has the meaning given in AS 47.05.270(e). 28 * Sec. 2. AS 08.64 is amended by adding a new section to read: 29 Sec. 08.64.333. Disciplinary sanctions: physician licensed in another state. 30 (a) The board may sanction a physician licensed in another state who provides health 31 care services through telehealth under AS 08.01.085(b) if the board finds after a
01 hearing that the physician 02 (1) committed an act that constitutes grounds to sanction a physician 03 licensed in this state under AS 08.64.326(a)(1) - (13); 04 (2) exceeded the scope of the physician's privilege to practice in this 05 state under AS 08.01.085; or 06 (3) prescribed, dispensed, or administered through telehealth to a 07 patient located in the state a controlled substance listed in AS 11.71.140 - 11.71.190. 08 (b) If the board finds grounds to sanction a physician under (a) of this section, 09 the board may 10 (1) permanently prohibit the physician from practicing in the state; 11 (2) prohibit the physician from practicing in the state for a determinate 12 period; 13 (3) censure the physician; 14 (4) issue a letter of reprimand to the physician; 15 (5) place the physician on probationary status under (d) of this section; 16 (6) limit or impose conditions on the physician's privilege to practice 17 in the state; 18 (7) impose a civil fine of not more than $25,000; 19 (8) issue a cease and desist order prohibiting the physician from 20 providing health care services through telehealth under AS 08.01.085(b); an order 21 issued under this paragraph remains in effect until the physician submits evidence 22 acceptable to the board showing that the violation has been corrected; 23 (9) promptly notify the licensing authority in each state in which the 24 physician is licensed of a sanction imposed under this subsection. 25 (c) In a case involving a physician alleged to have committed an act under 26 AS 08.64.326(a)(13), the final findings of fact, conclusions of law, and order of the 27 authority that suspended or revoked a license or certificate constitute a prima facie 28 case that the license or certificate was suspended or revoked and the grounds under 29 which the suspension or revocation was granted. 30 (d) The board may place a physician on probation under this section until the 31 board finds that the deficiencies that required the imposition of a sanction have been
01 remedied. The board may require a physician on probation to 02 (A) report regularly to the board on matters involving the 03 reason for which the physician was placed on probation; 04 (B) limit the physician's practice in the state to those areas 05 prescribed by the board; 06 (C) participate in professional education until the board 07 determines that a satisfactory degree of skill has been attained in areas 08 identified by the board as needing improvement. 09 (e) The board may summarily prohibit a physician from practicing in the state 10 under AS 08.01.085(b) if the board finds that the physician, by continuing to practice, 11 poses a clear and immediate danger to public health and safety. A physician prohibited 12 from practicing under this subsection is entitled to a hearing conducted by the office of 13 administrative hearings (AS 44.64.010) not later than seven days after the effective 14 date of the order prohibiting the physician from practicing. The board may lift an order 15 prohibiting a physician from practicing if the board finds after a hearing that the 16 physician is able to practice with reasonable skill and safety. The physician may 17 appeal a decision of the board under this subsection to the superior court. 18 (f) The board may recover from a physician the cost of proceedings resulting 19 in a sanction under (b) of this section, including the costs of investigation by the board 20 and department, and hearing costs. 21 (g) The board may prohibit a physician from practicing in the state upon 22 receipt of a certified copy of evidence that a license to practice medicine in another 23 state or territory of the United States or province or territory of Canada has been 24 suspended or revoked. The prohibition remains in effect until a hearing can be held by 25 the board. 26 (h) The board shall be consistent in the application of disciplinary sanctions. A 27 significant departure from earlier decisions of the board involving similar situations 28 must be explained in findings of fact or orders made by the board. 29 * Sec. 3. AS 08.64.364(b) is amended to read: 30 (b) The board may not impose disciplinary sanctions on a physician or 31 physician assistant for prescribing, dispensing, or administering a prescription drug
01 that is a controlled substance or botulinum toxin if the requirements under (a) of this 02 section and AS 08.64.363 are met [AND THE PHYSICIAN OR PHYSICIAN 03 ASSISTANT PRESCRIBES, DISPENSES, OR ADMINISTERS THE 04 CONTROLLED SUBSTANCE OR BOTULINUM TOXIN WHEN AN 05 APPROPRIATE LICENSED HEALTH CARE PROVIDER IS PRESENT WITH 06 THE PATIENT TO ASSIST THE PHYSICIAN OR PHYSICIAN ASSISTANT 07 WITH EXAMINATION, DIAGNOSIS, AND TREATMENT]. 08 * Sec. 4. AS 08.68.100(a) is amended to read: 09 (a) The board shall 10 (1) adopt regulations necessary to implement this chapter, including 11 regulations 12 (A) pertaining to practice as an advanced practice registered 13 nurse, including requirements for an advanced practice registered nurse to 14 practice as a certified registered nurse anesthetist, certified clinical nurse 15 specialist, certified nurse practitioner, or certified nurse midwife; regulations 16 for an advanced practice registered nurse who holds a valid federal Drug 17 Enforcement Administration registration number must address training in pain 18 management and opioid use and addiction; 19 (B) necessary to implement AS 08.68.331 - 08.68.336 relating 20 to certified nurse aides in order to protect the health, safety, and welfare of 21 clients served by nurse aides; 22 (C) pertaining to retired nurse status; [AND] 23 (D) establishing criteria for approval of practical nurse 24 education programs that are not accredited by a national nursing accrediting 25 body; and 26 (E) establishing guidelines for rendering a diagnosis, 27 providing treatment, or prescribing, dispensing, or administering a 28 prescription drug to a person without conducting a physical examination 29 under AS 08.68.710; the guidelines must include a nationally recognized 30 model policy for standards of care of a patient who is at a different 31 location than the advanced practice registered nurse;
01 (2) approve curricula and adopt standards for basic education programs 02 that prepare persons for licensing under AS 08.68.190; 03 (3) provide for surveys of the basic nursing education programs in the 04 state at the times it considers necessary; 05 (4) approve education programs that meet the requirements of this 06 chapter and of the board, and deny, revoke, or suspend approval of education 07 programs for failure to meet the requirements; 08 (5) examine, license, and renew the licenses of qualified applicants; 09 (6) prescribe requirements for competence before a former registered, 10 advanced practice registered, or licensed practical nurse may resume the practice of 11 nursing under this chapter; 12 (7) define by regulation the qualifications and duties of the executive 13 administrator and delegate authority to the executive administrator that is necessary to 14 conduct board business; 15 (8) develop reasonable and uniform standards for nursing practice; 16 (9) publish advisory opinions regarding whether nursing practice 17 procedures or policies comply with acceptable standards of nursing practice as defined 18 under this chapter; 19 (10) require applicants under this chapter to submit fingerprints and the 20 fees required by the Department of Public Safety under AS 12.62.160 for criminal 21 justice information and a national criminal history record check; the department shall 22 submit the fingerprints and fees to the Department of Public Safety for a report of 23 criminal justice information under AS 12.62 and a national criminal history record 24 check under AS 12.62.400; 25 (11) require that a licensed advanced practice registered nurse who has 26 a federal Drug Enforcement Administration registration number register with the 27 controlled substance prescription database under AS 17.30.200(n). 28 * Sec. 5. AS 08.68 is amended by adding a new section to article 6 to read: 29 Sec. 08.68.710. Prescription of drugs without physical examination. (a) The 30 board may not impose disciplinary sanctions on an advanced practice registered nurse 31 for rendering a diagnosis, providing treatment, or prescribing, dispensing, or
01 administering a prescription drug that is not a controlled substance to a person without 02 conducting a physical examination if 03 (1) the advanced practice registered nurse or another licensed health 04 care provider in the medical practice is available to provide follow-up care; and 05 (2) the advanced practice registered nurse requests that the person 06 consent to sending a copy of all records of the encounter to the person's primary care 07 provider if the prescribing advanced practice registered nurse is not the person's 08 primary care provider and, if the person consents, the advanced practice registered 09 nurse sends the records to the person's primary care provider. 10 (b) The board may not impose disciplinary sanctions on an advanced practice 11 registered nurse for prescribing, dispensing, or administering a prescription drug that 12 is a controlled substance if the requirements under (a) of this section and 13 AS 08.68.705 are met and the advanced practice registered nurse prescribes, 14 dispenses, or administers the controlled substance. 15 (c) Notwithstanding (a) and (b) of this section, an advanced practice registered 16 nurse may not prescribe, dispense, or administer a prescription drug in response to an 17 Internet questionnaire or electronic mail message to a person with whom the advanced 18 practice registered nurse does not have a prior provider-patient relationship. 19 (d) In this section, 20 (1) "controlled substance" has the meaning given in AS 11.71.900; 21 (2) "prescription drug" has the meaning given in AS 08.80.480; 22 (3) "primary care provider" has the meaning given in AS 21.07.250. 23 * Sec. 6. AS 18.08 is amended by adding a new section to read: 24 Sec. 18.08.100. Telehealth. (a) An individual certified or licensed under this 25 chapter may practice within the individual's authorized scope of practice under this 26 chapter through telehealth with a patient in this state if the individual's certification or 27 license is in good standing. 28 (b) If an individual certified or licensed under this chapter determines in the 29 course of a telehealth encounter with a patient that some or all of the encounter will 30 extend beyond the individual's authorized scope of practice, the individual shall advise 31 the patient that the individual is not authorized to provide some or all of the services to
01 the patient, recommend that the patient contact an appropriate provider for the services 02 the individual is not authorized to provide, and limit the encounter to only those 03 services the individual is authorized to provide. The individual certified or licensed 04 under this chapter may not charge for any portion of an encounter that extends beyond 05 the individual's authorized scope of practice. 06 (c) A fee for a service provided through telehealth under this section must be 07 reasonable and consistent with the ordinary fee typically charged for that service and 08 may not exceed the fee typically charged for that service. 09 (d) An individual certified or licensed under this chapter may not be required 10 to document a barrier to an in-person visit to provide health care services through 11 telehealth. The department or the council may not limit the physical setting from 12 which an individual certified or licensed under this chapter may provide health care 13 services through telehealth. 14 (e) Nothing in this section requires the use of telehealth when an individual 15 certified or licensed under this chapter determines that providing services through 16 telehealth is not appropriate or when a patient chooses not to receive services through 17 telehealth. 18 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 19 * Sec. 7. AS 47.07 is amended by adding a new section to read: 20 Sec. 47.07.069. Payment for telehealth. (a) The department shall pay for all 21 services covered by the medical assistance program provided through telehealth in the 22 same manner as if the services had been provided in person, including 23 (1) behavioral health services; 24 (2) services covered under home and community-based waivers; 25 (3) services covered under state plan options under 42 U.S.C. 1396 - 26 1396p (Title XIX, Social Security Act); 27 (4) services provided by a community health aide or a community 28 health practitioner certified by the Community Health Aide Program Certification 29 Board; 30 (5) services provided by a behavioral health aide or behavioral health 31 practitioner certified by the Community Health Aide Program Certification Board;
01 (6) services provided by a dental health aide therapist certified by the 02 Community Health Aide Program Certification Board; 03 (7) services provided by a chemical dependency counselor certified by 04 a certifying entity for behavioral health professionals in the state specified by the 05 department in regulation; 06 (8) services provided by a rural health clinic or a federally qualified 07 health center; 08 (9) services provided by an individual or entity that is required by 09 statute or regulation to be licensed or certified by the department or that is eligible to 10 receive payments, in whole or in part, from the department; 11 (10) services provided through audio, visual, or data communications, 12 alone or in any combination, or through communications over the Internet or by 13 telephone, including a telephone that is not part of a dedicated audio conference 14 system, electronic mail, text message, or two-way radio; 15 (11) assessment, evaluation, consultation, planning, diagnosis, 16 treatment, case management, and the prescription, dispensing, and administration of 17 medications, including controlled substances; and 18 (12) services covered under federal waivers or demonstrations other 19 than home and community-based waivers. 20 (b) The department shall adopt regulations for services provided by telehealth, 21 including setting rates of payment. Regulations calculating the rate of payment for a 22 rural health clinic or federally qualified health center must treat services provided 23 through telehealth in the same manner as if the services had been provided in person, 24 including calculations based on the rural health clinic or federally qualified health 25 center's reasonable costs or on the number of visits for recipients provided services, 26 and must define "visit" to include a visit provided by telehealth. The department may 27 not decrease the rate of payment for a telehealth service based on the location of the 28 person providing the service, the location of the eligible recipient of the service, the 29 communication method used, or whether the service was provided asynchronously or 30 synchronously. The department may exclude or limit coverage or reimbursement for a 31 service provided by telehealth, or limit the telehealth modes that may be used for a
01 particular service, only if the department 02 (1) specifically excludes or limits the service from telehealth coverage 03 or reimbursement by regulations adopted under this subsection; 04 (2) determines, based on substantial medical evidence, that the service 05 cannot be safely provided using telehealth or using the specified mode; or 06 (3) determines that providing the service using the specified mode 07 would violate federal law or render the service ineligible for federal financial 08 participation under applicable federal law. 09 (c) All services delivered through telehealth under this section must comply 10 with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191). 11 (d) In this section, 12 (1) "federally qualified health center" has the meaning given in 42 13 U.S.C. 1396d(l)(2)(B); 14 (2) "rural health clinic" has the meaning given in 42 U.S.C. 15 1396d(l)(1); 16 (3) "state plan" means the state plan for medical assistance coverage 17 developed under AS 47.07.040; 18 (4) "telehealth" has the meaning given AS 47.05.270(e). 19 * Sec. 8. AS 47.30 is amended by adding a new section to read: 20 Sec. 47.30.585. Telehealth. (a) An entity designated by the department under 21 AS 47.30.520 - 47.30.620 may provide community mental health services authorized 22 under AS 47.30.520 - 47.30.620 through telehealth to a patient in this state. 23 (b) If an individual employed by an entity designated by the department under 24 AS 47.30.520 - 47.30.620, in the course of a telehealth encounter with a patient, 25 determines that some or all of the encounter will extend beyond the community mental 26 health services authorized under AS 47.30.520 - 47.30.620, the individual shall advise 27 the patient that the entity is not authorized to provide some or all of the services to the 28 patient, recommend that the patient contact an appropriate provider for the services the 29 entity is not authorized to provide, and limit the encounter to only those services the 30 entity is authorized to provide. The entity may not charge a patient for any portion of 31 an encounter that extends beyond the community mental health services authorized
01 under AS 47.30.520 - 47.30.620. 02 (c) A fee for a service provided through telehealth under this section must be 03 reasonable and consistent with the ordinary fee typically charged for that service and 04 may not exceed the fee typically charged for that service. 05 (d) An entity permitted to provide telehealth under this section may not be 06 required to document a barrier to an in-person visit to provide health care services 07 through telehealth. The department may not limit the physical setting from which an 08 entity may provide health care services through telehealth. 09 (e) Nothing in this section requires the use of telehealth when an individual 10 employed by an entity designated by the department under AS 47.30.520 - 47.30.620 11 determines that providing services through telehealth is not appropriate or when a 12 patient chooses not to receive services through telehealth. 13 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 14 * Sec. 9. AS 47.37 is amended by adding a new section to read: 15 Sec. 47.37.145. Telehealth. (a) A public or private treatment facility approved 16 under AS 47.37.140 may provide health care services authorized under AS 47.37.030 - 17 47.37.270 through telehealth to a patient in this state. 18 (b) If an individual employed by a public or private treatment facility 19 approved under AS 47.37.140, in the course of a telehealth encounter with a patient, 20 determines that some or all of the encounter will extend beyond the health care 21 services authorized under AS 47.37.030 - 47.37.270, the individual shall advise the 22 patient that the facility is not authorized to provide some or all of the services to the 23 patient, recommend that the patient contact an appropriate provider for the services the 24 facility is not authorized to provide, and limit the encounter to only those services the 25 facility is authorized to provide. The facility may not charge a patient for any portion 26 of an encounter that extends beyond the authorized health care services under 27 AS 47.37.030 - 47.37.270. 28 (c) A fee for a service provided through telehealth under this section must be 29 reasonable and consistent with the ordinary fee typically charged for that service and 30 may not exceed the fee typically charged for that service. 31 (d) A facility permitted to practice telehealth under this section may not be
01 required to document a barrier to an in-person visit to provide health care services 02 through telehealth. The department may not limit the physical setting from which a 03 facility may provide health care services through telehealth. 04 (e) Nothing in this section requires the use of telehealth when an individual 05 employed by a facility approved under AS 47.37.140 determines that providing 06 services through telehealth is not appropriate or when a patient chooses not to receive 07 services through telehealth. 08 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 09 * Sec. 10. This Act takes effect immediately under AS 01.10.070(c).