Legislature(2019 - 2020)BARNES 124
04/29/2019 03:15 PM LABOR & COMMERCE
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HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS 3:21:28 PM CO-CHAIR LEDOUX announced that the first order of business would be HOUSE BILL NO. 97, "An Act relating to the prescription of drugs by a physician assistant without physical examination." 3:21:46 PM CO-CHAIR WOOL moved to adopt the proposed committee substitute (CS) for HB 97, labeled 31-LS0695\S, Fisher, 4/23/19, as the working draft. There being no further objection, Version S was before the committee. 3:22:57 PM REID HARRIS, Staff, Representative Jonathan Kreiss-Tomkins, Alaska State Legislature, presented HB 97 on behalf of Representative Kreiss-Tomkins, prime sponsor. He paraphrased parts of the sponsor statement [included in the committee packet], which read in its entirety as follows [original punctuation provided]: The 2016 Medicaid Reform Bill (SB 74) provided for the use of telehealth, revising Alaska statutes to require the Alaska State Medical Board to adopt regulations and guidelines for physicians rendering a diagnosis; providing treatment; or prescribing, dispensing, or administering a prescription drug to a person without first conducting a physical examination under AS 08.64.364. However, SB 74 only addressed physicians and the Board's interpretation was that the bill's provisions should not apply to physician assistants (PAs). This effectively barred PAs from practicing telemedicine, requiring them to first conduct in-person examinations. House Bill 97 aligns statute with the intent of the Medicaid Reform Bill, clarifying that PAs can provide telemedicine in collaboration with and under the oversight of physicians. Under HB97, PAs are 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 3:25:00 PM MR. HARRIS directed attention to the document labelled, "AAPA," from the American Academy of Physician Assistants [included in the committee packet] and highlighted what physician assistants (PAs) do, as well as briefly described their education and experience. He said that PAs are not operating independently from a physician and must have an active, collaborative plan of regular contact. Under that plan, physicians authorize their functions and the medications they can prescribe. He pointed out that in Alaska, if a physician assistant (PA) has a Drug Enforcement Administration (DEA) authorization number they can prescribe schedule 2-5 substances. MR. HARRIS turned attention to two maps from the Health Resources & Services Administration (HRSA) [included in the committee packet] that display health professional shortage areas (HPSA) and medically underserved populations in the United States, both of which are present in Alaska. He further noted that the passage of HB 97 and its companion bill, SB 44, would allow over 700 PAs to engage in telehealth services within the state of Alaska. 3:30:19 PM CO-CHAIR WOOL sought clarification on whether the 700 PAs would be physically present in Alaska or if they would be out of state and accessed via telehealth. MR. HARRIS offered his understanding that they would be in Alaska. He recounted that when the first telemedicine statutes were passed several years ago there was concern about medical jobs being outsourced out of state. However, currently, he said that isn't happening. CO-CHAIR WOOL, in reference to Teladoc, contended that outsourcing is happening. MR. HARRIS acknowledged that the company Teladoc is in Tennessee; however, the doctors still reside in the state of Alaska. CO-CHAIR WOOL offered his understanding that the doctors working for Teladoc are on-call 24/7 and located out of state. 3:32:16 PM DEBORAH STOVERN, Department of Commerce, Community & Economic Development, in response to Representative Wool, stated that there are approximately 700 licensed PAs in Alaska. She noted that in order to enter a collaborative agreement between a physician and a PA, they must both be licensed in the state of Alaska; however, there is no requirement that either reside in the state. 3:34:17 PM REPRESENTATIVE HANNAN asked why the Alaska State Medical Board hasn't taken a position on this bill. MS. STOVERN explained that the Board reviewed HB 97 in February and took a position in support of the legislation. She noted that they issued a letter referencing their position, which could be provided to the committee upon request. REPRESENTATIVE HANNAN questioned whether leaving PAs out of the original statute [AS 08.64.364 Prescription of drugs without physical examination] that gives doctors authorization to practice telemedicine was intentional. MR. HARRIS offered his understanding that the original intent of was to allow both physicians and PAs to practice telemedicine. He added that it's not irrational that the Board interpreted it differently, as the original bill only addressed physicians. MR. HARRIS noted that HB 97 has an effective date of March 1, 2020, per request of the Alaska State Medical Board. 3:36:49 PM CO-CHAIR LEDOUX opened public testimony. 3:37:00 PM CHRISTOPHER DIETRICH, Assistant Medical Director, Orion Behavioral Health Network, informed the committee that he is a PA practicing adolescent and child psychiatry in Alaska from Kotzebue to Ketchikan. He noted that he also serves an underserved demographic by offering is services to the Department of Corrections (DOC). He stated that PAs are medical providers who diagnose illnesses, develop and manage treatment plans, prescribe medications, and often service as a patient's principal healthcare provider. With thousands of hours of medical training, he said, PAs are versatile and collaborative. He expressed his support for HB 97 as to decrease barriers to his patients in rural access areas and to make it easier for all patients to have adequate treatment. 3:38:55 PM CO-CHAIR LEDOUX closed public testimony. She announced that HB 97 was held over.