CSSB 175(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 SENATE BILL NO. 175(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 other than a physician 07 licensed in another state may provide health care services within the health care 08 provider's authorized scope of practice to a patient in this state through telehealth 09 without first conducting an in-person visit. 10 (b) A physician licensed in another state may provide health care services 11 within the physician's authorized scope of practice through telehealth to a patient 12 located in the state if 13 (1) the physician and the patient have an established physician-patient 14 relationship;
01 (2) the physician has previously conducted a physical examination of 02 the patient in person; and 03 (3) the health care services provided through telehealth consist of 04 ongoing treatment or follow-up care related to health care services previously 05 provided by the physician to the patient. 06 (c) If a health care provider determines in the course of a telehealth encounter 07 with a patient under this section that some or all of the encounter will extend beyond 08 the health care provider's authorized scope of practice, the health care provider shall 09 advise the patient that the health care provider is not authorized to provide some or all 10 of the services to the patient, recommend that the patient contact an appropriate 11 provider for the services the health care provider is not authorized to provide, and limit 12 the encounter to only those services the health care provider is authorized to provide. 13 The health care provider may not charge for any portion of an encounter that extends 14 beyond the health care provider's authorized scope of practice. 15 (d) A fee for a service provided through telehealth under this section must be 16 reasonable and consistent with the ordinary fee typically charged for that service and 17 may not exceed the fee typically charged for that service. 18 (e) A physician, podiatrist, osteopath, or physician assistant licensed under 19 AS 08.64 may prescribe, dispense, or administer through telehealth under this section 20 a prescription for a controlled substance listed in AS 11.71.140 - 11.71.190 if the 21 physician, podiatrist, osteopath, or physician assistant complies with AS 08.64.364. 22 (f) An advanced practice registered nurse licensed under AS 08.68 may 23 prescribe, dispense, or administer through telehealth under this section a prescription 24 for a controlled substance listed in AS 11.71.140 - 11.71.190 if the advanced practice 25 registered nurse complies with AS 08.68.710. 26 (g) Except as authorized under (e) and (f) of this section, a person licensed 27 under this title or in another state may not prescribe, dispense, or administer through 28 telehealth under this section a controlled substance listed in AS 11.71.140 - 11.71.190. 29 (h) A health care provider may not be required to document a barrier to an in- 30 person visit to provide health care services through telehealth. The department or a 31 board may not limit the physical setting from which a health care provider may
01 provide health care services through telehealth. 02 (i) Nothing in this section requires the use of telehealth when a health care 03 provider determines that providing health care services through telehealth is not 04 appropriate or when a patient chooses not to receive health care services through 05 telehealth. 06 (j) In this section, 07 (1) "health care provider" means 08 (A) an audiologist or speech-language pathologist licensed 09 under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor 10 licensed under AS 08.20; a professional counselor licensed under AS 08.29; a 11 dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a 12 dietitian or nutritionist licensed under AS 08.38; a naturopath licensed under 13 AS 08.45; a marital and family therapist licensed under AS 08.63; a physician 14 licensed under AS 08.64; a podiatrist, osteopath, or physician assistant licensed 15 under AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse 16 licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an 17 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a 18 physical therapist or occupational therapist licensed under AS 08.84; a 19 psychologist or psychological associate licensed under AS 08.86; or a social 20 worker licensed under AS 08.95; or 21 (B) a physician licensed in another state; 22 (2) "licensed" means holding a current license in good standing; 23 (3) "telehealth" has the meaning given in AS 47.05.270(e). 24 * Sec. 2. AS 08.64.364(b) is amended to read: 25 (b) The board may not impose disciplinary sanctions on a physician or 26 physician assistant for prescribing, dispensing, or administering a prescription drug 27 that is a controlled substance or botulinum toxin if the requirements under (a) of this 28 section and AS 08.64.363 are met [AND THE PHYSICIAN OR PHYSICIAN 29 ASSISTANT PRESCRIBES, DISPENSES, OR ADMINISTERS THE 30 CONTROLLED SUBSTANCE OR BOTULINUM TOXIN WHEN AN 31 APPROPRIATE LICENSED HEALTH CARE PROVIDER IS PRESENT WITH
01 THE PATIENT TO ASSIST THE PHYSICIAN OR PHYSICIAN ASSISTANT 02 WITH EXAMINATION, DIAGNOSIS, AND TREATMENT]. 03 * Sec. 3. AS 08.68 is amended by adding a new section to article 6 to read: 04 Sec. 08.68.710. Prescription of drugs without physical examination. (a) The 05 board may not impose disciplinary sanctions on an advanced practice registered nurse 06 for rendering a diagnosis, providing treatment, or prescribing, dispensing, or 07 administering a prescription drug that is not a controlled substance to a person without 08 conducting a physical examination if 09 (1) the advanced practice registered nurse or another licensed health 10 care provider in the medical practice is available to provide follow-up care; and 11 (2) the advanced practice registered nurse requests that the person 12 consent to sending a copy of all records of the encounter to the person's primary care 13 provider if the prescribing advanced practice registered nurse is not the person's 14 primary care provider and, if the person consents, the advanced practice registered 15 nurse sends the records to the person's primary care provider. 16 (b) The board may not impose disciplinary sanctions on an advanced practice 17 registered nurse for prescribing, dispensing, or administering a prescription drug that 18 is a controlled substance if the requirements under (a) of this section and 19 AS 08.68.705 are met and the advanced practice registered nurse prescribes, 20 dispenses, or administers the controlled substance. 21 (c) Notwithstanding (a) and (b) of this section, an advanced practice registered 22 nurse may not prescribe, dispense, or administer a prescription drug in response to an 23 Internet questionnaire or electronic mail message to a person with whom the advanced 24 practice registered nurse does not have a prior provider-patient relationship. 25 (d) In this section, 26 (1) "controlled substance" has the meaning given in AS 11.71.900; 27 (2) "prescription drug" has the meaning given in AS 08.80.480; 28 (3) "primary care provider" has the meaning given in AS 21.07.250. 29 * Sec. 4. AS 18.08 is amended by adding a new section to read: 30 Sec. 18.08.100. Telehealth. (a) An individual certified or licensed under this 31 chapter may practice within the individual's authorized scope of practice under this
01 chapter through telehealth with a patient in this state if the individual's certification or 02 license is in good standing. 03 (b) If an individual certified or licensed under this chapter determines in the 04 course of a telehealth encounter with a patient that some or all of the encounter will 05 extend beyond the individual's authorized scope of practice, the individual shall advise 06 the patient that the individual is not authorized to provide some or all of the services to 07 the patient, recommend that the patient contact an appropriate provider for the services 08 the individual is not authorized to provide, and limit the encounter to only those 09 services the individual is authorized to provide. The individual certified or licensed 10 under this chapter may not charge for any portion of an encounter that extends beyond 11 the individual's authorized scope of practice. 12 (c) A fee for a service provided through telehealth under this section must be 13 reasonable and consistent with the ordinary fee typically charged for that service and 14 may not exceed the fee typically charged for that service. 15 (d) An individual certified or licensed under this chapter may not be required 16 to document a barrier to an in-person visit to provide health care services through 17 telehealth. The department or the council may not limit the physical setting from 18 which an individual certified or licensed under this chapter may provide health care 19 services through telehealth. 20 (e) Nothing in this section requires the use of telehealth when an individual 21 certified or licensed under this chapter determines that providing services through 22 telehealth is not appropriate or when a patient chooses not to receive services through 23 telehealth. 24 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 25 * Sec. 5. AS 47.07 is amended by adding a new section to read: 26 Sec. 47.07.069. Payment for telehealth. (a) The department shall pay for 27 services covered by the medical assistance program provided through telehealth in the 28 same manner as if the services had been provided in person, including 29 (1) behavioral health services; 30 (2) services covered under home and community-based waivers; 31 (3) services covered under state plan options under 42 U.S.C. 1396 -
01 1396p (Title XIX, Social Security Act); 02 (4) services provided by a community health aide or a community 03 health practitioner certified by the Community Health Aide Program Certification 04 Board; 05 (5) services provided by a behavioral health aide or behavioral health 06 practitioner certified by the Community Health Aide Program Certification Board; 07 (6) services provided by a dental health aide therapist certified by the 08 Community Health Aide Program Certification Board; 09 (7) services provided by a chemical dependency counselor certified by 10 a certifying entity for behavioral health professionals in the state specified by the 11 department in regulation; 12 (8) services provided by a rural health clinic or a federally qualified 13 health center; 14 (9) services provided by an individual or entity that is required by 15 statute or regulation to be licensed or certified by the department or that is eligible to 16 receive payments, in whole or in part, from the department; 17 (10) services provided through audio, visual, or data communications, 18 alone or in any combination, or through communications over the Internet or by 19 telephone, including a telephone that is not part of a dedicated audio conference 20 system, electronic mail, text message, or two-way radio; 21 (11) assessment, evaluation, consultation, planning, diagnosis, 22 treatment, case management, and the prescription, dispensing, and administration of 23 medications, including controlled substances; and 24 (12) services covered under federal waivers or demonstrations other 25 than home and community-based waivers. 26 (b) The department shall adopt regulations for services provided by telehealth, 27 including setting rates of payment. Regulations calculating the rate of payment for a 28 rural health clinic or federally qualified health center must treat services provided 29 through telehealth in the same manner as if the services had been provided in person, 30 including calculations based on the rural health clinic or federally qualified health 31 center's reasonable costs or on the number of visits for recipients provided services,
01 and must define "visit" to include a visit provided by telehealth. The department may 02 not decrease the rate of payment for a telehealth service based on the location of the 03 person providing the service, the location of the eligible recipient of the service, the 04 communication method used, or whether the service was provided asynchronously or 05 synchronously. The department may exclude or limit coverage or reimbursement for a 06 service provided by telehealth, or limit the telehealth modes that may be used for a 07 particular service, only if the department 08 (1) specifically excludes or limits the service from telehealth coverage 09 or reimbursement by regulations adopted under this subsection; 10 (2) determines, based on substantial medical evidence, that the service 11 cannot be safely provided using telehealth or using the specified mode; or 12 (3) determines that providing the service using the specified mode 13 would violate federal law or render the service ineligible for federal financial 14 participation under applicable federal law. 15 (c) All services delivered through telehealth under this section must comply 16 with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191). 17 (d) In this section, 18 (1) "federally qualified health center" has the meaning given in 42 19 U.S.C. 1396d(l)(2)(B); 20 (2) "rural health clinic" has the meaning given in 42 U.S.C. 21 1396d(l)(1); 22 (3) "state plan" means the state plan for medical assistance coverage 23 developed under AS 47.07.040; 24 (4) "telehealth" has the meaning given AS 47.05.270(e). 25 * Sec. 6. AS 47.07.069(a), enacted by sec. 5 of this Act, is amended to read: 26 (a) The department shall pay for services covered by the medical assistance 27 program provided through telehealth if the department pays for those services when 28 [IN THE SAME MANNER AS IF THE SERVICES HAD BEEN] provided in person, 29 including 30 (1) behavioral health services; 31 (2) services covered under home and community-based waivers;
01 (3) services covered under state plan options under 42 U.S.C. 1396 - 02 1396p (Title XIX, Social Security Act); 03 (4) services provided by a community health aide or a community 04 health practitioner certified by the Community Health Aide Program Certification 05 Board; 06 (5) services provided by a behavioral health aide or behavioral health 07 practitioner certified by the Community Health Aide Program Certification Board; 08 (6) services provided by a dental health aide therapist certified by the 09 Community Health Aide Program Certification Board; 10 (7) services provided by a chemical dependency counselor certified by 11 a certifying entity for behavioral health professionals in the state specified by the 12 department in regulation; 13 (8) services provided by a rural health clinic or a federally qualified 14 health center; 15 (9) services provided by an individual or entity that is required by 16 statute or regulation to be licensed or certified by the department or that is eligible to 17 receive payments, in whole or in part, from the department; 18 (10) services provided through audio, visual, or data communications, 19 alone or in any combination, or through communications over the Internet or by 20 telephone, including a telephone that is not part of a dedicated audio conference 21 system, electronic mail, text message, or two-way radio; 22 (11) assessment, evaluation, consultation, planning, diagnosis, 23 treatment, case management, and the prescription, dispensing, and administration of 24 medications, including controlled substances; and 25 (12) services covered under federal waivers or demonstrations other 26 than home and community-based waivers. 27 * Sec. 7. AS 47.07.069(b), enacted by sec. 5 of this Act, is amended to read: 28 (b) The department shall adopt regulations for services provided by telehealth, 29 including setting rates of payment. The department may set a rate of payment for a 30 service provided through telehealth that is different from the rate of payment for 31 the same service provided in person. [REGULATIONS CALCULATING THE
01 RATE OF PAYMENT FOR A RURAL HEALTH CLINIC OR FEDERALLY 02 QUALIFIED HEALTH CENTER MUST TREAT SERVICES PROVIDED 03 THROUGH TELEHEALTH IN THE SAME MANNER AS IF THE SERVICES 04 HAD BEEN PROVIDED IN PERSON, INCLUDING CALCULATIONS BASED 05 ON THE RURAL HEALTH CLINIC OR FEDERALLY QUALIFIED HEALTH 06 CENTER'S REASONABLE COSTS OR ON THE NUMBER OF VISITS FOR 07 RECIPIENTS PROVIDED SERVICES, AND MUST DEFINE "VISIT" TO 08 INCLUDE A VISIT PROVIDED BY TELEHEALTH. THE DEPARTMENT MAY 09 NOT DECREASE THE RATE OF PAYMENT FOR A TELEHEALTH SERVICE 10 BASED ON THE LOCATION OF THE PERSON PROVIDING THE SERVICE, 11 THE LOCATION OF THE ELIGIBLE RECIPIENT OF THE SERVICE, THE 12 COMMUNICATION METHOD USED, OR WHETHER THE SERVICE WAS 13 PROVIDED ASYNCHRONOUSLY OR SYNCHRONOUSLY.] The department may 14 exclude or limit coverage or reimbursement for a service provided by telehealth, or 15 limit the telehealth modes that may be used for a particular service, only if the 16 department 17 (1) specifically excludes or limits the service from telehealth coverage 18 or reimbursement by regulations adopted under this subsection; 19 (2) determines, based on substantial medical evidence, that the service 20 cannot be safely provided using telehealth or using the specified mode; or 21 (3) determines that providing the service using the specified mode 22 would violate federal law or render the service ineligible for federal financial 23 participation under applicable federal law. 24 * Sec. 8. AS 47.30 is amended by adding a new section to read: 25 Sec. 47.30.585. Telehealth. (a) An entity designated by the department under 26 AS 47.30.520 - 47.30.620 may provide community mental health services authorized 27 under AS 47.30.520 - 47.30.620 through telehealth to a patient in this state. 28 (b) If an individual employed by an entity designated by the department under 29 AS 47.30.520 - 47.30.620, in the course of a telehealth encounter with a patient, 30 determines that some or all of the encounter will extend beyond the community mental 31 health services authorized under AS 47.30.520 - 47.30.620, the individual shall advise
01 the patient that the entity is not authorized to provide some or all of the services to the 02 patient, recommend that the patient contact an appropriate provider for the services the 03 entity is not authorized to provide, and limit the encounter to only those services the 04 entity is authorized to provide. The entity may not charge a patient for any portion of 05 an encounter that extends beyond the community mental health services authorized 06 under AS 47.30.520 - 47.30.620. 07 (c) A fee for a service provided through telehealth under this section must be 08 reasonable and consistent with the ordinary fee typically charged for that service and 09 may not exceed the fee typically charged for that service. 10 (d) An entity permitted to provide telehealth under this section may not be 11 required to document a barrier to an in-person visit to provide health care services 12 through telehealth. The department may not limit the physical setting from which an 13 entity may provide health care services through telehealth. 14 (e) Nothing in this section requires the use of telehealth when an individual 15 employed by an entity designated by the department under AS 47.30.520 - 47.30.620 16 determines that providing services through telehealth is not appropriate or when a 17 patient chooses not to receive services through telehealth. 18 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 19 * Sec. 9. AS 47.37 is amended by adding a new section to read: 20 Sec. 47.37.145. Telehealth. (a) A public or private treatment facility approved 21 under AS 47.37.140 may provide health care services authorized under AS 47.37.030 - 22 47.37.270 through telehealth to a patient in this state. 23 (b) If an individual employed by a public or private treatment facility 24 approved under AS 47.37.140, in the course of a telehealth encounter with a patient, 25 determines that some or all of the encounter will extend beyond the health care 26 services authorized under AS 47.37.030 - 47.37.270, the individual shall advise the 27 patient that the facility 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 facility is not authorized to provide, and limit the encounter to only those services the 30 facility is authorized to provide. The facility may not charge a patient for any portion 31 of an encounter that extends beyond the authorized health care services under
01 AS 47.37.030 - 47.37.270. 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) A facility permitted to practice 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 a 08 facility may provide health care services through telehealth. 09 (e) Nothing in this section requires the use of telehealth when an individual 10 employed by a facility approved under AS 47.37.140 determines that providing 11 services through telehealth is not appropriate or when a patient chooses not to receive 12 services through telehealth. 13 (f) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 14 * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to 15 read: 16 MEDICAID STATE PLAN FEDERAL APPROVAL. (a) To the extent necessary to 17 implement this Act, the Department of Health and Social Services shall amend and submit for 18 federal approval the state plan for medical assistance coverage consistent with AS 47.07.069, 19 enacted by sec. 5 of this Act. 20 (b) To the extent necessary to implement this Act, the Department of Health shall 21 amend and submit for federal approval the state plan for medical assistance coverage 22 consistent with AS 47.07.069(a), as amended by sec. 6 of this Act, and AS 47.07.069(b), as 23 amended by sec. 7 of this Act. 24 * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to 25 read: 26 REGULATIONS. (a) Each applicable board responsible for licensing a profession 27 authorized to provide telehealth services under sec. 1 of this Act shall adopt regulations 28 necessary to implement sec. 1 of this Act. The licensing boards shall adopt the regulations not 29 later than June 30, 2023. 30 (b) The State Medical Board shall adopt regulations necessary to implement sec. 2 of 31 this Act. The State Medical Board shall adopt the regulations not later than June 30, 2023.
01 (c) The Department of Health shall adopt regulations necessary to implement secs. 4, 02 5, 8, and 9 of this Act. The Department of Health shall adopt the regulations not later than 03 June 30, 2023. 04 * Sec. 12. The uncodified law of the State of Alaska is amended by adding a new section to 05 read: 06 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 5 of this Act takes effect 07 only if, on or before June 30, 2023, the United States Department of Health and Human 08 Services 09 (1) approves amendments to the state plan for medical assistance coverage 10 under AS 47.07.069, enacted by sec. 5 of this Act; or 11 (2) determines that its approval of the amendments to the state plan for 12 medical assistance coverage under AS 47.07.069, enacted by sec. 5 of this Act, is not 13 necessary. 14 (b) The commissioner of health shall notify the revisor of statutes in writing within 30 15 days after the United States Department of Health and Human Services approves amendments 16 to the state plan or determines that approval is not necessary under (a)(1) or (2) of this section. 17 (c) Sections 6 and 7 of this Act take effect only if sec. 5 of this Act takes effect as 18 provided in (a) of this section and if, after June 30, 2023, and on or before June 30, 2030, the 19 United States Department of Health and Human Services 20 (1) approves amendments to the state plan for medical assistance coverage 21 under AS 47.07.069(a), as amended by sec. 6 of this Act, and AS 47.07.069(b), as amended 22 by sec. 7 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(a), as amended by sec. 6 of this Act, and 25 AS 47.07.069(b), as amended by sec. 7 of this Act, is not necessary. 26 (d) The commissioner of health shall notify the revisor of statutes in writing within 30 27 days after the United States Department of Health and Human Services approves amendments 28 to the state plan or determines that approval is not necessary under (c)(1) or (2) of this section. 29 * Sec. 13. Sections 10(a) and 11(a) and (b) of this Act take effect immediately under 30 AS 01.10.070(c). 31 * Sec. 14. Section 11(c) of this Act takes effect July 1, 2022.
01 * Sec. 15. If sec. 5 of this Act takes effect under sec. 12(a) of this Act, it takes effect 02 June 30, 2023. 03 * Sec. 16. If secs. 6 and 7 of this Act take effect under sec. 12(c) of this Act, they take effect 04 June 30, 2030. 05 * Sec. 17. Except as provided in secs. 13 - 16 of this Act, this Act takes effect June 30, 06 2023.