SB 175: "An Act relating to telehealth; relating to the practice of medicine; relating to medical assistance coverage for services provided by telehealth; and providing for an effective date."
00 SENATE BILL NO. 175 01 "An Act relating to telehealth; relating to the practice of medicine; relating to medical 02 assistance coverage for services provided by telehealth; and providing for an effective 03 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 may provide health care 07 services within the health care provider's authorized scope of practice to a patient in 08 this state through telehealth without first conducting an in-person examination if the 09 health care provider holds a license in good standing. If a health care provider is 10 licensed in another state, the health care provider may provide services under this 11 section only to a patient who is referred by a health care provider licensed under this 12 title or a federal or tribal health care program. 13 (b) If a health care provider determines in the course of a telehealth encounter 14 with a patient under this section that some or all of the encounter will extend beyond
01 the health care provider's authorized scope of practice, the health care provider shall 02 advise the patient that the health care provider is not authorized to provide some or all 03 of the services to the patient, recommend that the patient contact an appropriate 04 provider for the services the health care provider is not authorized to provide, and limit 05 the encounter to only those services the health care provider is authorized to provide. 06 The health care provider may not charge for any portion of an encounter that extends 07 beyond the health care provider's authorized scope of practice. 08 (c) A fee for a service provided through telehealth under this section must be 09 reasonable and consistent with the ordinary fee typically charged for that service and 10 may not exceed the fee typically charged for that service. 11 (d) A physician, osteopath, physician assistant, or advanced practice registered 12 nurse may examine, diagnose, and provide treatment through telehealth under this 13 section for opioid use disorder. No other person licensed under this title or licensed in 14 another state may examine, diagnose, or provide treatment through telehealth under 15 this section for opioid use disorder. 16 (e) A physician, podiatrist, osteopath, or physician assistant may prescribe, 17 dispense, or administer through telehealth under this section a prescription for a 18 controlled substance listed in AS 11.71.140 - 11.71.190 or a botulinum toxin if the 19 physician, podiatrist, osteopath, or physician assistant complies with AS 08.64.364. 20 An advanced practice registered nurse may prescribe, dispense, or administer through 21 telehealth under this section a prescription for a controlled substance listed in 22 AS 11.71.140 - 11.71.190 other than buprenorphine to a patient if the advanced 23 practice registered nurse first conducts an in-person examination of the patient. No 24 other person licensed under this title or in another state may prescribe, dispense, or 25 administer through telehealth under this section a prescription for a controlled 26 substance listed in AS 11.71.140 - 11.71.190 or a botulinum toxin. 27 (f) Nothing in this section requires the use of telehealth when a health care 28 provider determines that providing health care services through telehealth is not 29 appropriate or when a patient chooses not to receive health care services through 30 telehealth. 31 (g) In this section,
01 (1) "health care provider" means an audiologist or speech-language 02 pathologist licensed under AS 08.11 or in another state; a behavior analyst licensed 03 under AS 08.15 or in another state; a chiropractor licensed under AS 08.20 or in 04 another state; a professional counselor licensed under AS 08.29 or in another state; a 05 dental hygienist licensed under AS 08.32 or in another state; a dentist licensed under 06 AS 08.36 or in another state; a dietitian or nutritionist licensed under AS 08.38 or in 07 another state; a naturopath licensed under AS 08.45 or in another state; a marital and 08 family therapist licensed under AS 08.63 or in another state; a physician, podiatrist, 09 osteopath, or physician assistant licensed under AS 08.64 or in another state; a direct- 10 entry midwife certified under AS 08.65 or in another state; a nurse licensed under 11 AS 08.68 or in another state; a dispensing optician licensed under AS 08.71 or in 12 another state; an optometrist licensed under AS 08.72 or in another state; a pharmacist 13 licensed under AS 08.80 or in another state; a physical therapist or occupational 14 therapist licensed under AS 08.84 or in another state; a psychologist or psychological 15 associate licensed under AS 08.86 or in another state; or a social worker licensed 16 under AS 08.95 or in another state; 17 (2) "telehealth" has the meaning given in AS 47.05.270(e). 18 * Sec. 2. AS 08.64.364(b) is amended to read: 19 (b) The board may not impose disciplinary sanctions on a physician or 20 physician assistant for prescribing, dispensing, or administering a prescription drug 21 that is a controlled substance or botulinum toxin if the requirements under (a) of this 22 section and AS 08.64.363 are met [AND THE PHYSICIAN OR PHYSICIAN 23 ASSISTANT PRESCRIBES, DISPENSES, OR ADMINISTERS THE 24 CONTROLLED SUBSTANCE OR BOTULINUM TOXIN WHEN AN 25 APPROPRIATE LICENSED HEALTH CARE PROVIDER IS PRESENT WITH 26 THE PATIENT TO ASSIST THE PHYSICIAN OR PHYSICIAN ASSISTANT 27 WITH EXAMINATION, DIAGNOSIS, AND TREATMENT]. 28 * Sec. 3. AS 18.08 is amended by adding a new section to read: 29 Sec. 18.08.100. Telehealth. (a) An individual certified or licensed under this 30 chapter may practice within the individual's authorized scope of practice under this 31 chapter through telehealth with a patient in this state if the individual's certification or
01 license is in good standing. 02 (b) If an individual certified or licensed under this chapter determines in the 03 course of a telehealth encounter with a patient that some or all of the encounter will 04 extend beyond the individual's authorized scope of practice, the individual shall advise 05 the patient that the individual is not authorized to provide some or all of the services to 06 the patient, recommend that the patient contact an appropriate provider for the services 07 the individual is not authorized to provide, and limit the encounter to only those 08 services the individual is authorized to provide. The individual certified or licensed 09 under this chapter may not charge for any portion of an encounter that extends beyond 10 the individual's authorized scope of practice. 11 (c) A fee for a service provided through telehealth under this section must be 12 reasonable and consistent with the ordinary fee typically charged for that service and 13 may not exceed the fee typically charged for that service. 14 (d) 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 (e) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 19 * Sec. 4. 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 21 services provided through telehealth in the same manner as if the services had been 22 provided in person. Except as provided in (b) of this section, the department shall pay 23 for all services covered by the medical assistance program, including 24 (1) behavioral health services; 25 (2) services covered under federal waivers or demonstrations; 26 (3) services provided by a community health aide or a community 27 health practitioner certified by the Community Health Aide Program Certification 28 Board; 29 (4) services provided by a behavioral health aide or behavioral health 30 practitioner certified by the Community Health Aide Program Certification Board; 31 (5) services provided by a dental health aide therapist certified by the
01 Community Health Aide Program Certification Board; 02 (6) services provided by a chemical dependency counselor certified by 03 the Alaska Commission for Behavioral Health Certification; 04 (7) services provided by a rural health clinic or a federally qualified 05 health center; 06 (8) services provided by an individual or entity that is required by 07 statute or regulation to be licensed or certified by the department or that is eligible to 08 receive payments, in whole or in part, from the department; 09 (9) services provided through audio, visual, or data communications, 10 alone or in any combination, or through communications over the Internet or by 11 facsimile, telephone, including a telephone that is not part of a dedicated audio 12 conference system, electronic mail, text message, or two-way radio; and 13 (10) assessment, evaluation, consultation, planning, diagnosis, 14 treatment, case management, and the prescription, dispensing, and administration of 15 medications, including controlled substances. 16 (b) The department shall adopt regulations for services provided by telehealth, 17 including setting rates of payment. Regulations calculating the rate of payment for a 18 rural health clinic or federally qualified health center must treat services provided 19 through telehealth in the same manner as if the services had been provided in person, 20 including calculations based on the rural health clinic or federally qualified health 21 center's reasonable costs or on the number of visits for recipients provided services. 22 The department may not decrease the rate of payment for a telehealth service based on 23 the location of the person providing the service, the location of the eligible recipient of 24 the service, the communication method used, or whether the service was provided 25 asynchronously or synchronously. The department may exclude or limit coverage or 26 reimbursement for a service provided by telehealth, or limit the telehealth modes that 27 may be used for a particular service, only if the department 28 (1) specifically excludes or limits the service from telehealth coverage 29 or reimbursement by regulations adopted under this subsection; 30 (2) determines, based on substantial medical evidence, that the service 31 cannot be safely provided using telehealth or using the specified mode; or
01 (3) determines that providing the service using the specified mode 02 would violate federal law or render the service ineligible for federal financial 03 participation under applicable federal law. 04 (c) 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) "telehealth" has the meaning given AS 47.05.270(e). 10 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 11 read: 12 MEDICAID STATE PLAN FEDERAL APPROVAL. To the extent necessary to 13 implement this Act, the Department of Health and Social Services shall amend and submit for 14 federal approval the state plan for medical assistance coverage consistent with AS 47.07.069, 15 enacted by sec. 4 of this Act. 16 * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 17 read: 18 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 4 of this Act takes effect 19 only if, on or before January 1, 2023, the United States Department of Health and Human 20 Services 21 (1) approves amendments to the state plan for medical assistance coverage 22 under AS 47.07.069, enacted by sec. 4 of this Act; or 23 (2) determines that its approval of the amendments to the state plan for 24 medical assistance coverage under AS 47.07.069, enacted by sec. 4 of this Act, is not 25 necessary. 26 (b) The commissioner of health and social services shall notify the revisor of statutes 27 in writing within 30 days after the United States Department of Health and Human Services 28 approves amendments to the state plan or determines that approval is not necessary under 29 (a)(1) or (2) of this section. 30 * Sec. 7. If sec. 4 of this Act takes effect, it takes effect on the day after the date the revisor 31 of statutes receives notice from the commissioner of health and social services under sec. 6(b)
01 of this Act. 02 * Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect immediately under 03 AS 01.10.070(c).