Legislature(2019 - 2020)CAPITOL 106
03/26/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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Audio | Topic |
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Start | |
HB22 | |
HB29 | |
HB97 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
*+ | HB 22 | TELECONFERENCED | |
*+ | HB 29 | TELECONFERENCED | |
*+ | HB 86 | TELECONFERENCED | |
*+ | HB 97 | TELECONFERENCED | |
+ | TELECONFERENCED |
HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS 4:34:07 PM CO-CHAIR ZULKOSKY announced that the final order of business would be HOUSE BILL NO. 97, "An Act relating to the prescription of drugs by a physician assistant without physical examination." 4:34:29 PM CO-CHAIR SPOHNHOLZ moved to adopt the proposed committee substitute (CS) for HB 97, labeled 31-LS0695\M, Marx, 3/21/19 as the working draft. CO-CHAIR ZULKOSKY objected for discussion. 4:34:53 PM REID HARRIS, Staff, Representative Jonathan Kreiss-Tomkins, stated that HB 97 was "about increasing patient access to care, particularly for rural and medically underserved areas." He directed attention to maps [Included in members' packets] which portrayed that the entire state, except for the Railbelt, was considered to be a medically underserved area. He stated that it could be problematic for many rural communities to find fair and cheap access to health care. He paraphrased from the Sponsor Statement [Included in members' packets] which read: The 2016 Medicaid Reform bill (SB 74) provided for the use of telehealth by revising Alaska statutes to require the Alaska Board of Medicine to adopt regulations and guidelines for physicians rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.64.364. Unintentionally, SB 74 only addressed physicians, and the Board issued guidelines that made different requirements for physician assistants (PAs) and physicians, citing a lack of legislative intent that the provisions of SB 74 should apply to PAs. The omission of PAs from the Medicaid Reform bill led to them being subject to limitations on the use of telemedicine. Specifically, the Medical Board released guidelines stating that physician assistants could not treat a patient via telemedicine without first conducting an in-person examination, or with a collaborating physician or other practitioner in the same group practice. House Bill 97 aligns the law with the intent of the Medicaid Reform bill, clarifying that PAs can provide telemedicine in the same manner as physicians. Under HB97, the PA would be subject to the same statutory oversight as physicians regarding the practice of telemedicine, as well as the same disciplinary sanctions when appropriate. Alaska, with its vast geographical challenges and limited access to vital healthcare, stands to benefit from this legislation. HB 97 will increase patient access to care, extending the reach of medicine to medically underserved areas. MR. HARRIS pointed out that, although it was legislative intent to allow physician assistants (PAs) to practice telemedicine, the "Medical Board didn't see it that way hence we have these two fix-it bills before both bodies." MR. HARRIS directed attention to the PA Scope of Practice document [Included in members' packets] and paraphrased from the document, which read: A broad, generalist medical education prepares PAs to take medical histories, perform physical examinations, order and interpret laboratory tests, diagnose illness, develop and manage treatment plans for their patients, prescribe medications and assist in surgery. MR. HARRIS stated that PAs could prescribe Schedule II - V medications, and he paraphrased from the "Drug Schedule" [Included in members' packets], which read: Schedule I Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4- methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote Schedule II Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin Schedule III Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone Schedule IV Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol Schedule V Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin MR. HARRIS explained that a Physician Assistant must have an active and collaborative plan that was maintained with a supervisor and, under the guidance of their collaborating physician, would be authorized to prescribe Schedule II - V drugs. He added that the PA must have an authorization and license from the Drug Enforcement Administration. He summarized and stated that the proposed bill would allow approximately 700 licensed PAs in Alaska to provide telemedicine in the same manner as physicians and extend the reach of medicine to patients in underserved areas. He pointed to the supporting letters from physician assistants practicing in rural areas [Included in members' packets]. He reported that the State Medical Board assumed a neutral position on the proposed bill, and that the fiscal note for $5300 was for the first year only, to pay for legal fees and to update the regulations. 4:41:29 PM REPRESENTATIVE JACKSON asked if this proposed bill could be part of the telehealth bill as it allowed for physician assistants to prescribe drugs. 4:42:06 PM CO-CHAIR SPOHNHOLZ replied that the proposed bill was in a different section of law, even though it intersected to allow physician assistants to participate in telehealth. 4:42:28 PM REPRESENTATIVE CLAMAN asked why the bill did not include nurse practitioners as they were also allowed to prescribe medications. MR. HARRIS explained that registered nurse practitioners were not overseen by the State Medical Board. CO-CHAIR SPOHNHOLZ interjected that nurse practitioners were already allowed to practice telehealth, adding that nurses were overseen by the Board of Nursing. She stated that physician assistants were the only group of providers that had been inadvertently omitted in earlier legislation, Senate Bill 74. REPRESENTATIVE CLAMAN asked if nurse practitioners had been allowed to practice telehealth in Senate Bill 74. CO-CHAIR SPOHNHOLZ replied, "yes." 4:43:37 PM MR. HARRIS, in response to Representative Jackson, directed attention to the AAPA guidelines [Included in members' packets] and paraphrased from the Education and Experience, which read: The intensive PA program curriculum is modeled on the medical school curriculum. The typical PA program extends over 27 continuous months and begins with classroom instruction in basic medical sciences. This is followed by rotations in medical and surgical disciplines including family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine and psychiatry. PA students complete at least 2,000 hours of supervised clinical practice in various settings and locations by graduation. Almost all PA programs now award master's degrees, and by 2020 all programs must do so. 4:45:01 PM REPRESENTATIVE PRUITT asked if PAs would be required to use the drug database. MR. HARRIS said that was correct. REPRESENTATIVE PRUITT asked why the PAs had been omitted from previous legislation. MR. HARRIS offered his understanding that the legislative intent was for physicians to engage in telemedicine with an assumption, incorrect as it was, that PAs working under the physician would also be allowed. After passage of Senate Bill 74, the State Medical Board stated that the new language would not include PAs because they were not directly named. 4:46:54 PM DEBORAH STOVERN, Executive Administrator, State Medical Board, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community & Economic Development, said that the State Medical Board did not feel that "they could make the call that the legislative intent was to include physician assistants because the language of the statute said physicians only." She offered her understanding the proposed bill was an attempt to correct that. REPRESENTATIVE PRUITT asked for clarification that, although the intent may have been there, she could not "jump to that conclusion because the statute wasn't clear enough." He asked if this was "clean-up" and if she did support this opportunity. MS. STOVERN said that was her understanding of the position by the State Medical Board on this legislation. She pointed out that the State Medical Board had reviewed Senate Bill 44, which was identical legislation, and had issued a letter of support. 4:49:24 PM REPRESENTATIVE PRUITT asked for clarification to the changes in the proposed committee substitute. MR. HARRIS replied that the proposed committee substitute added a section with an effective bill date of March 1, 2020, which had been requested by the division. 4:50:25 PM The committee took a brief at-ease. 4:50:46 PM CO-CHAIR ZULKOSKY removed her objection. There being no further objection, the proposed committee substitute (CS) for HB 97, labeled 31-LS0695\M, Marx, 3/21/19 was adopted as the working draft. 4:51:05 PM REPRESENTATIVE TARR asked if the State Medical Board had concerns with the prescription of drugs by physician assistants or with other interactions with the patient. 4:51:56 PM MS. STOVERN said that the State Medical Board had issues with both subject to the collaborative plan between the supervising physician and the physician assistant. REPRESENTATIVE TARR asked if the collaborative practice was necessary for both issues. MS. STOVERN replied, yes it was correct that the physician assistant would only have authority for whatever the supervising physician allowed. 4:53:35 PM CHRISTOPHER DIETRICH, Orion Behavioral Health Network, stated that currently the PA could not establish care without a face to face examination and that the proposed bill would now allow this. 4:55:09 PM REPRESENTATIVE TARR questioned whether the requirement for the first face to face meeting was the snafu. MR. DIETRICH expressed his agreement that the proposed bill would clarify this and expedite the necessary care. 4:56:09 PM AROM EVANS, MD, Orion Behavioral Health, stated his support for proposed HB 97 and that his practice had the collaborative plan in place. [HB 97 was held over.]
Document Name | Date/Time | Subjects |
---|---|---|
HB022 Supporting Document-Letter of Support from American Foundation for Suicide Prevention - Alaska Chapter 03.07.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
HB022 Supporting Document-Letter of Support from Suicide Prevention Council 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
HB022 Fiscal Note DHSS-SPC-3.22.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
HB022 Supporting Document-Letter of Support from NAMI Alaska 3.6.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
HB022 Sponsor Statement 03.15.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
HB022 Supporting Document Legislative Audit of Suicide Prevention Council 3.6.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
HB029 Sectional Analysis ver A 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM |
HB 29 |
HB029 Sponsor Statement 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
HB029 Supporting Document-Letter of Support 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
HB029 Fiscal Note DCCED-DOI 3.22.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
HB029 Letter of Support Moda Health 03.25.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
HB029 Presentation 03.25.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM |
HB 29 |
HB0097 Supporting Document AK State Medical Bd Roster.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document AAPA general overview.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document AK State Medical Bd PA scope of practice.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document DEA Drug Schedules.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document Medically Underserved Areas HRSA.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document PA guidelines AK State Medical Bd.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB0097 Supporting Document PA Prescriptive Authority (AAC).pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
HB097 Draft Proposed Blank CS ver M 3.21.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
HB097 Fiscal Note DCCED-CBPL-3.22.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
HB097 Supporting Document Letters of Support for companion legislation SB44.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM SFIN 4/9/2019 9:00:00 AM |
HB 97 SB 44 |
HB0097 Sectional.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
HB0097 Sponsor Statement.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |