Legislature(2021 - 2022)BUTROVICH 205

04/20/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 67 NURSING: LICENSURE; MULTISTATE COMPACT TELECONFERENCED
Failed to Move Out of Committee
+= SB 78 HEALTH CARE SERVICES BY TELEHEALTH TELECONFERENCED
Moved CSSB 78(HSS) Out of Committee
+= SB 80 PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION TELECONFERENCED
Moved CSSB 80(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
           SB  78-HEALTH CARE SERVICES BY TELEHEALTH                                                                        
                                                                                                                                
1:50:28 PM                                                                                                                    
CHAIR WILSON  announced the consideration  of SENATE BILL  NO. 78                                                               
"An Act relating to telehealth."                                                                                                
                                                                                                                                
SENATOR  COSTELLO   stated  that  Governor   Dunleavy  introduced                                                               
legislation extending the  disaster declaration retroactively and                                                               
into the future. She opined that  Alaskans are ready to move into                                                               
a recovery  phase so  it would  be better to  make laws  that are                                                               
COVID aware. The Labor and  Commerce Committee introduced a suite                                                               
of bills  to determine whether  practices, which  began following                                                               
the disaster declaration, would be  allowed to continue. SB 78 is                                                               
one of those bills.                                                                                                             
                                                                                                                                
1:52:38 PM                                                                                                                    
KATIE  MCCALL,   Staff,  Senator   Mia  Costello,   Alaska  State                                                               
Legislature, Juneau, Alaska, stated SB  78 was taken from Section                                                               
6  of  the  Governor's  disaster   declaration  bill.  It  allows                                                               
licensed  healthcare providers  and  nurses  to provide  services                                                               
through telehealth in their licensed field.                                                                                     
                                                                                                                                
1:53:56 PM                                                                                                                    
CHAIR WILSON moved Amendment 1.                                                                                                 
                                                                                                                                
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
                                               32-LS0532\A.1                                                                    
                                                      Fisher                                                                    
                                                     4/14/21                                                                    
                                                                                                                                
    OFFERED IN THE SENATE                 BY SENATOR WILSON                                                                     
        TO: SB 78                                                                                                               
                                                                                                                                
     Page 1, following line 2:                                                                                                  
          Insert new bill sections to read:                                                                                     
        "* Section  1. AS 08.15 is  amended by adding  a new                                                                
     section to read:                                                                                                           
          Sec. 08.15.045. Telehealth. (a) A person licensed                                                                   
     under  this  chapter  may  practice  behavior  analysis                                                                    
     through  telehealth as  defined  in AS 47.05.270(e).  A                                                                    
     person  licensed  to   practice  behavior  analysis  in                                                                    
     another  jurisdiction  may practice  behavior  analysis                                                                    
     through telehealth with a patient  in this state if the                                                                    
     person's   license  is   in  good   standing  in   that                                                                    
     jurisdiction.                                                                                                              
          (b)  If a person licensed to practice behavior                                                                        
     analysis  determines  in  the course  of  a  telehealth                                                                    
     encounter  with  a  patient  that  the  encounter  will                                                                    
     extend  beyond  the   licensee's  authorized  scope  of                                                                    
     practice, the  licensee shall  advise the  patient that                                                                    
     the licensee is not  authorized to provide the services                                                                    
     to the  patient, recommend that the  patient contact an                                                                    
     appropriate provider, and  terminate the encounter. The                                                                    
     licensee may  not charge  for services  provided during                                                                    
     an encounter described in this subsection.                                                                                 
          (c)  A fee for a service provided through                                                                             
     telehealth under  this section  must be  reasonable and                                                                    
     consistent with the ordinary  fee typically charged for                                                                    
     that  service and  may not  be more  than five  percent                                                                    
     above  the  ordinary  fee typically  charged  for  that                                                                    
     service.                                                                                                                   
        *  Sec.  2. AS 08.29  is  amended  by adding  a  new                                                                  
     section to article 3 to read:                                                                                              
          Sec. 08.29.240. Telehealth. (a) A person licensed                                                                   
     under   this   chapter    may   practice   professional                                                                    
     counseling   through    telehealth   as    defined   in                                                                    
     AS 47.05.270(e).   A   person  licensed   to   practice                                                                    
     professional  counseling  in another  jurisdiction  may                                                                    
     practice  professional  counseling  through  telehealth                                                                    
     with a client in this  state if the person's license is                                                                    
     in good standing in that jurisdiction.                                                                                     
          (b)  If a person licensed to practice                                                                                 
     professional counseling  determines in the course  of a                                                                    
     telehealth encounter  with a client that  the encounter                                                                    
     will extend  beyond the scope  of practice or  scope of                                                                    
     services  permitted  under  (a) of  this  section,  the                                                                    
     licensee shall  advise the client that  the licensee is                                                                    
     not authorized  to provide the services  to the client,                                                                    
     recommend  that  the   client  contact  an  appropriate                                                                    
     provider,  and terminate  the  encounter. The  licensee                                                                    
     may  not   charge  for  services  provided   during  an                                                                    
     encounter described in this subsection.                                                                                    
          (c)  A fee for a service provided through                                                                             
     telehealth under  this section  must be  reasonable and                                                                    
     consistent with the ordinary  fee typically charged for                                                                    
     that  service and  may not  be more  than five  percent                                                                    
     above  the  ordinary  fee typically  charged  for  that                                                                    
     service.                                                                                                                   
        *  Sec.  3. AS 08.63  is  amended  by adding  a  new                                                                  
     section to read:                                                                                                           
          Sec. 08.63.250. Telehealth. (a) A person licensed                                                                   
     under  this chapter  may  practice  marital and  family                                                                    
     therapy    through    telehealth    as    defined    in                                                                    
     AS 47.05.270(e). A person  licensed to practice marital                                                                    
     and   family  therapy   in  another   jurisdiction  may                                                                    
     practice marital and  family therapy through telehealth                                                                    
     with a client in this  state if the person's license is                                                                    
     in good standing in that jurisdiction.                                                                                     
          (b)  If a person licensed to practice marital and                                                                     
     family   therapy  determines   in  the   course  of   a                                                                    
     telehealth encounter  with a client that  the encounter                                                                    
     will extend  beyond the scope  of practice or  scope of                                                                    
     services  permitted  under  (a) of  this  section,  the                                                                    
     licensee shall  advise the client that  the licensee is                                                                    
     not authorized  to provide the services  to the client,                                                                    
     recommend  that  the   client  contact  an  appropriate                                                                    
     provider,  and terminate  the  encounter. The  licensee                                                                    
     may  not   charge  for  services  provided   during  an                                                                    
     encounter described in this subsection.                                                                                    
          (c)  A fee for a service provided through                                                                             
     telehealth under  this section  must be  reasonable and                                                                    
     consistent with the ordinary  fee typically charged for                                                                    
     that  service and  may not  be more  than five  percent                                                                    
     above  the  ordinary  fee typically  charged  for  that                                                                    
     service."                                                                                                                  
                                                                                                                                
     Page 1, line 3:                                                                                                            
          Delete "Section 1"                                                                                                  
          Insert "Sec. 4"                                                                                                     
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                              
     Page 3, following line 31:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "*  Sec. 8.  AS 08.86  is amended  by  adding a  new                                                                
     section to article 6 to read:                                                                                              
          Sec. 08.86.225. Telehealth. (a) A psychologist or                                                                   
     psychological  associate  licensed under  this  chapter                                                                    
     may  practice   psychology  or   provide  psychological                                                                    
     services, as applicable,  through telehealth as defined                                                                    
     in  AS 47.05.270(e).  A  person  licensed  to  practice                                                                    
     psychology   or  provide   psychological  services   in                                                                    
     another   jurisdiction  may   practice  psychology   or                                                                    
     provide psychological services  through telehealth with                                                                    
     a client  in this state  if the person's license  is in                                                                    
     good standing in that jurisdiction.                                                                                        
          (b)  If a person licensed to practice psychology                                                                      
     or  provide psychological  services  determines in  the                                                                    
     course  of a  telehealth encounter  with a  client that                                                                    
     the encounter will extend beyond  the scope of practice                                                                    
     or  scope  of  services  permitted under  (a)  of  this                                                                    
     section, the licensee shall advise  the client that the                                                                    
     licensee is  not authorized to provide  the services to                                                                    
     the  client,  recommend  that  the  client  contact  an                                                                    
     appropriate provider, and  terminate the encounter. The                                                                    
     licensee may  not charge  for services  provided during                                                                    
     an encounter described in this subsection.                                                                                 
          (c)  A fee for a service provided through                                                                             
     telehealth under  this section  must be  reasonable and                                                                    
     consistent with the ordinary  fee typically charged for                                                                    
     that  service and  may not  be more  than five  percent                                                                    
     above  the  ordinary  fee typically  charged  for  that                                                                    
     service."                                                                                                                  
                                                                                                                                
SENATOR HUGHES objected for purposes of discussion.                                                                             
                                                                                                                                
1:54:09 PM                                                                                                                    
CHAIR WILSON  explained that SB  78 attempts  to fix a  parity in                                                               
Alaska's  healthcare services  by allowing  behavioral healthcare                                                               
providers to participate in telehealth  services. There is a need                                                               
to  change the  behavioral healthcare  section of  the Governor's                                                               
disaster declaration bill  to codified law. He stated  there is a                                                               
follow  up amendment  regarding  behavioral healthcare  providers                                                               
that removes the pay parity section.                                                                                            
                                                                                                                                
1:55:11 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:56:21 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
SENATOR REINBOLD  stated she  supports telehealth.  She continues                                                               
to be  a strong  proponent of  the established  patient in-person                                                               
meeting  requirement.  She commented  that  if  any members  have                                                               
conflicts of interest,  they need to be forthright and  put it on                                                               
the record.                                                                                                                     
                                                                                                                                
1:57:21 PM                                                                                                                    
SENATOR HUGHES withdrew her objection.                                                                                          
                                                                                                                                
1:57:28 PM                                                                                                                    
CHAIR WILSON found no further objection and Amendment 1 passed.                                                                 
                                                                                                                                
1:57:38 PM                                                                                                                    
SENATOR HUGHES moved Amendment 2.                                                                                               
                                                                                                                                
                                                                                                                                
                          AMENDMENT 2                                                                                       
                                                                                                                                
                                               32-LS0532\A.2                                                                    
                                                      Fisher                                                                    
                                                     4/12/21                                                                    
                                                                                                                                
     OFFERED IN THE SENATE                 BY SENATOR HUGHES                                                                    
        TO: SB 78                                                                                                               
                                                                                                                                
     Page 2, lines 22 - 24:                                                                                                     
          Delete "consistent with the ordinary fees                                                                             
     typically charged for that service  and may not be more                                                                    
     than  five percent  above the  ordinary fees  typically                                                                    
     charged for that service"                                                                                                  
          Insert "may not exceed the ordinary fees                                                                              
     typically charged for that service"                                                                                        
                                                                                                                                
     Page 3, lines 25 - 27:                                                                                                     
          Delete "consistent with the ordinary fees                                                                             
     typically charged for that service  and may not be more                                                                    
     than  five percent  above the  ordinary fees  typically                                                                    
     charged for that service"                                                                                                  
          Insert "may not exceed the ordinary fees                                                                              
     typically charged for that service"                                                                                        
                                                                                                                                
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
1:57:52 PM                                                                                                                    
SENATOR HUGHES  read Amendment  2 and stated  there is  no reason                                                               
for  a telehealth  provider's fee  to be  more than  an in-office                                                               
visit. Telehealth  is a  savings to  the provider,  requires less                                                               
staff and appointments are typically  shorter. The purpose of the                                                               
amendment is to remove the  additional five percent fee allowance                                                               
because there is no justification for it.                                                                                       
                                                                                                                                
SENATOR COSTELLO  stated she supports  Amendment 2. She  asked if                                                               
Amendment  2  was  written  with  contemplation  of  Amendment  1                                                               
passing  so that  language  regarding the  five  percent fee  was                                                               
consistent.                                                                                                                     
                                                                                                                                
CHAIR WILSON replied that for  the record Amendment 2 would cover                                                               
both  the bill  and Amendment  1. Drafters  at Legislative  Legal                                                               
Services will make the conforming changes.                                                                                      
                                                                                                                                
2:00:00 PM                                                                                                                    
CHAIR  WILSON  withdrew his  objection  and  asked if  there  was                                                               
further objection; finding none, Amendment 2 passed.                                                                            
                                                                                                                                
SENATOR REINBOLD  stated she  understands the  need for  the bill                                                               
but struggled with  page 3 line 16-18 and line  12, which removes                                                               
the established  provider requirement to meet  in-person at least                                                               
once. She is unsure  how she will vote on the  floor but will not                                                               
hold up the bill.                                                                                                               
                                                                                                                                
SENATOR HUGHES asked if the  Alaska Medical Association commented                                                               
on  the removal  of  the established  patient  requirement of  at                                                               
least one in-person  visit. An in-person exam  is foundational to                                                               
most medical care.  She asked if there are  restrictions in place                                                               
prohibiting  telehealth providers  from  diagnosing and  treating                                                               
conditions that should be done in-person.                                                                                       
                                                                                                                                
2:02:20 PM                                                                                                                    
SENATOR  COSTELLO  responded  that  in  context  of  last  year's                                                               
disaster  declaration,  the  state  was allowed  to  waive  every                                                               
regulation and  law, which is  why the environment of  a disaster                                                               
should be  seriously considered.  She stated  she spoke  with the                                                               
Alaska Medical Association. SB 78  was drafted to address changes                                                               
brought about by the disaster declaration.                                                                                      
                                                                                                                                
Changes  to Alaska  hire was  one of  those concerns.  She opined                                                               
that  she  did not  necessarily  want  people  to get  care  from                                                               
doctors  who  are   not  licensed  in  Alaska.   In  her  initial                                                               
discussion  with  the state  administration,  she  was told  some                                                               
Alaskans were established  patients of out of  state doctors. Due                                                               
to  the COVID  environment, they  could  not fly  outside of  the                                                               
state  to  receive  care. Instead,  they  received  care  through                                                               
telemedicine.  In-person visits  are also  valued. She  does want                                                               
Alaskans to  see Alaska licensed  doctors. SB  78 will go  to the                                                               
Labor and  Commerce Committee next. It  is her intent to  place a                                                               
sunset date  on the bill. She  stated she will work  with Senator                                                               
Begich's office on language related to Alaska hire.                                                                             
                                                                                                                                
She commented that the telehealth  measures that were passed were                                                               
of value  during the COVID  time period because they  allowed the                                                               
elderly  and fragile  to continue  receiving care.  Many Alaskans                                                               
like  receiving mental  health treatments  online. Telehealth  is                                                               
something to  appreciate. SB 78 tries  to bridge the gap  of what                                                               
was done under  the pandemic environment and how  we move forward                                                               
without a disaster declaration. She  stated she will consider the                                                               
points made and  intents to make improvements to  the bill before                                                               
it goes to the floor.                                                                                                           
                                                                                                                                
2:05:42 PM                                                                                                                    
SENATOR REINBOLD  shared that  she is  not in  favor of  the bill                                                               
because the Alaska  State Medical Association is  not. She opined                                                               
that the  disaster declaration  by the  Governor should  not have                                                               
lasted more than  30 days and might have been  an abuse of power.                                                               
Waiving  statutes  and regulations  should  be  done through  the                                                               
administrative  regulation  review   committee  with  legislature                                                               
approval.                                                                                                                       
                                                                                                                                
SENATOR BEGICH asked  for the word jurisdiction to  be defined in                                                               
Section 2  line 11 and Section  4 line 13    14. He will  vote to                                                               
move SB 78.                                                                                                                     
                                                                                                                                
2:08:21 PM                                                                                                                    
SENATOR HUGHES  stated she will  support SB 78. She  stated there                                                               
is a wide range of services  providers can offer; not all of them                                                               
are appropriate  without an  in-person physical  examination. She                                                               
respects the Alaska  Medical Association and opined  that this is                                                               
a  concern  for  them.  She  asked that  a  providers   scope  of                                                               
practice  be limited  to  only  services that  do  not require  a                                                               
physical exam.                                                                                                                  
                                                                                                                                
CHAIR WILSON noted that Labor  and Commerce is the next committee                                                               
of  referral,  and  the  intent  is to  move  the  bill  so  that                                                               
committees can continue refining it.                                                                                            
                                                                                                                                
2:10:29 PM                                                                                                                    
CHAIR WILSON solicited a motion to move the bill from committee.                                                                
                                                                                                                                
2:10:41 PM                                                                                                                    
SENATOR HUGHES  moved SB 78,  work order 32-LS0532\A  as amended,                                                               
from  committee  with  individual  recommendations  and  attached                                                               
fiscal notes (s).                                                                                                               
                                                                                                                                
2:10:48 PM                                                                                                                    
SENATOR REINBOLD objected.                                                                                                      
                                                                                                                                
2:10:52 PM                                                                                                                    
CHAIR WILSON called for a roll call vote.                                                                                       
                                                                                                                                
A roll  call vote was  taken. Senators Begich,  Hughes, Costello,                                                               
and Wilson  voted in  favor of  reporting SB  78 as  amended from                                                               
committee and  Senator Reinbold voted against  it. Therefore, the                                                               
motion passed by a 4:1 vote.                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that with 4 yeas and 1  nay, CSSB 78(HSS)                                                               
moved  from  the  Senate  Health  and  Social  Services  Standing                                                               
Committee.                                                                                                                      

Document Name Date/Time Subjects
SB 78 NORD Ltr of Support.pdf SHSS 4/20/2021 1:30:00 PM
SB 78
SB 80 Public Input 4.20.21 Redacted.pdf SHSS 4/20/2021 1:30:00 PM
SB 80
SB 78 Adopted Amendments 4.20.21.pdf SHSS 4/20/2021 1:30:00 PM
SB 78
SB 80 Amendment B.4 Wilson.pdf SHSS 4/20/2021 1:30:00 PM
SB 80