03/30/1994 01:41 PM Senate HES

 CHAIRMAN RIEGER introduced  SB 231  (PAY PHYSICIAN ASSTS UNDER                
 MEDICAID) as the last order of business before the committee.                 
                                                                               
 CAROL CARROL, Staff to Senator Kerttula, explained that SB 231                
 would add physician assistants to the optional services reimbursed            
 under Medicaid.  She discussed the current problems regarding                 
 billing and physician assistants.  Medicaid requires that the                 
 physician must see each patient billed under their number at least            
 once.  SB 231 would allow physician assistants to bill Medicaid for           
 services they provided to patients in their local areas.  She noted           
 the presence of a fiscal note from DHSS.                                      
                                                                               
 CHAIRMAN RIEGER said that he intended to have SB 231 at the same              
 time as a bill regarding Medicaid in Senate Finance where the                 
 fiscal note could be addressed.  He said that he would hear                   
 testimony on the fiscal note if anyone wished to testify.                     
                                                                               
 SENATOR SALO stated that the fiscal note seemed inflated and would            
 be best handled in Senate Finance.                                            
                                                                               
 SENATOR SHARP inquired as to the numbering of the list on page 2 of           
 SB 231.  CAROL CARROL explained that as funds run short, numbers 1-           
 4 would be removed.  From numbers 5 and up, the groups become a               
 higher priority when removing money from Medicaid.  CHAIRMAN RIEGER           
 agreed with Senator Sharp that there seemed to be a drafting error            
 in the numbering.                                                             
                                                                               
 Number 140                                                                    
                                                                               
 SENATOR LEMAN stated that the situation which brought this problem            
 to Senator Kerttula's attention had been resolved due to                      
 designating the entity as a rural health clinic.  He asked if                 
 adoption of SB 231 would create disparities in billing for Medicaid           
 services and other billings by physician assistants who have to use           
 the collaborating doctor's number for all other billings.                     
 CAROL CARROL clarified that a physician assistant in a physician's            
 office on location bills under the physician's number.  SB 231                
 addresses a physician assistant collaborating with a physician at             
 a remote location where the physician does not see every Medicaid             
 patient.  The physician assistant cannot bill Medicaid for those              
 services because the collaborating physician does not see the                 
 patient at a remote site.  She concluded that SB 231 deals with               
 physician assistants at remote sites, but it would allow a                    
 physician assistant to set up their own site with a collaborating             
 physician and see patients.  She said that most physician                     
 assistants currently, are located in a physician's office in their            
 location.                                                                     
                                                                               
 JOHN RILEY, Alaska Academy of Physician Assistants, reiterated that           
 the primary purpose of SB 231 was to allow reimbursement of                   
 physician assistants working in remote sites.  He noted that                  
 previously, physician assistants billed through their collaborating           
 physician's Medicaid number or through a clinic's Medicaid number,            
 in certain designated rural health clinics.  He acknowledged that             
 there are some physician assistants in remote areas who do bill               
 under their physician's number although the physician is not on               
 site, which DHSS says is not allowable.  In communities where a               
 physician assistant is the only health care provider, this issue              
 would be a clear barrier to care for Medicaid recipients.  He                 
 informed the committee of an October 1993 study that found that               
 about half of the physician assistants are located in rural areas             
 outside of Anchorage, Fairbanks, and Juneau.                                  
                                                                               
 Mr. Riley stated that the fiscal note seems higher than it should             
 be.  The fiscal note would be more accurate if it represented a               
 parallel number to the fees generated for Medicaid by currently               
 practicing nurses practitioners.  This is a $200,000 cost to the              
 state.  He assumed that the reimbursement rate for physician                  
 assistants would be similar to that of nurse practitioners, 80                
 percent.  That would result in a decreased billing rate to Medicaid           
 which would lead to cost shifting.                                            
                                                                               
 Number 249                                                                    
                                                                               
 WENDY HLADICK, Physician Assistant and Registered Nurse in Galena,            
 said that she was speaking for the rural areas of Galena,                     
 Telkeetna, Healey, McGrath, Pelican, Skagway, and Seward.  She                
 informed the committee that non-physician providers, physician                
 assistants and nurse practitioners, are able to diagnosis and treat           
 80 percent of their patient's problems.  She stated that non-                 
 physician providers are less expensive to train than physicians and           
 have a proven track record comparable to physicians.  SB 231 would            
 remove some of the inequalities in practice between nurse                     
 practitioners and physician assistants.  She did not believe that             
 current regulations adequately or fairly reimburse physician                  
 assistants.  SB 231 would help educate insurance companies of                 
 physician assistants.  Physician assistants offer affordable,                 
 quality health care.  She said that passage of SB 231 would                   
 recognize physician assistants as health care providers worthy of             
 reimbursement just as nurse practitioners, and recognize the need             
 for uniform percentile reimbursement by all insurance carriers for            
 physician assistants.                                                         
                                                                               
 SENATOR ELLIS moved to adopt Senator Kerttula's amendment which               
 adds physician assistants to the list of non-discriminatory groups.           
                                                                               
  AMENDMENT                                                                  
                                                                               
 Page 1, line 1, after " Act ":                                                
  Insert " relating to physician assistants "                                  
                                                                               
 Page 1, line 4, after " Section 1. ":                                         
  Insert new material to read:                                                 
  "AS 21,36.090(d) is amended to read:                                         
   (d) Except to the extent necessary to comply with AS                        
  21.42.365 and AS 21.56, a person may not practice or permit                  
  unfair discrimination against a person who provides a service                
  covered under a group disability policy that extends coverage                
  on an expense incurred basis, or under a group service or                    
  indemnity type contract issued by a nonprofit corporation, if                
  the service is within the scope of the provider's occupational               
  license.  In this subsection, "provider" means a state                       
  licensed physician,  physician assistant,  dentist, osteopath,             
  optometrist, chiropractor, nurse midwife, advanced nurse                     
  practitioner, naturopath, physical therapist, occupational                   
  therapist, psychologist, psychological associate, [OR]                       
 licensed  clinical social worker, or certified direct-entry                   
 midwife.                                                                      
  *Sec. 2.  AS 23,30.265(24) is amended to read:                               
    (24) "physician" includes doctors of medicine,                             
  surgeons,  physician assistants,  chiropractors, osteopaths,               
  dentists, and optometrists;                                                  
  *Sec.   3. "                                                                 
                                                                               
                                                                               
 CHAIRMAN RIEGER objected.  He explained that there was a similar              
 bill, Family & Marital Therapist, in the Labor & Commerce committee           
 which had not moved.  He preferred that this amendment be offered             
 in Finance in order to have Senator Kerttula, the prime sponsor, as           
 well as Senator Kelly, the chairman of Labor & Commerce, would be             
 present to discuss their views.  Chairman Rieger stated that he               
 tended to support the amendment.                                              
                                                                               
 SENATOR SALO believed that the amendment did not move out of Labor            
 & Commerce because another amendment was offered adding                       
 acupuncturists.  That seemed to complicate the issue.                         
                                                                               
 CHAIRMAN RIEGER removed his objection.                                        
                                                                               
 CAROL CARROL stated that this allows physician assistants to be               
 covered under workman's compensation for any services they fund or            
 under third party payers insurance companies.                                 
                                                                               
 Hearing no objection, the amendment was adopted.                              
                                                                               
 SENATOR ELLIS moved SB 231 out of committee with individual                   
 recommendations.  Hearing no objections, it was so ordered.