Legislature(2017 - 2018)CAPITOL 106

03/29/2018 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearings: State Medical Board TELECONFERENCED
-- Public Testimony --
+= SB 174 PROGRAMS FOR PERSONS WITH DISABILITIES TELECONFERENCED
Moved SB 174 Out of Committee
-- Testimony <Invited/Public> --
-- Public Testimony --
+= SB 108 MEDICAL CARE/LICENSING/MEDICAL BOARD TELECONFERENCED
Moved CSSSSB 108(FIN) Out of Committee
-- Testimony <Invited/Public> --
-- Public Testimony --
+= HB 358 INSURANCE COVERAGE FOR TELEHEALTH TELECONFERENCED
Moved HB 358 Out of Committee
-- Testimony <Invited/Public> --
-- Public Testimony --
*+ HJR 32 CONST. AM: PARENTAL CONSENT TO ABORTION TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 193 HEALTH CARE; BALANCE BILLING TELECONFERENCED
Moved CSHB 193(HSS) Out of Committee
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 29, 2018                                                                                         
                           3:06 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Tiffany Zulkosky, Vice Chair                                                                                     
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 193                                                                                                              
"An Act  relating to  insurance trade  practices and  frauds; and                                                               
relating to emergency services and balance billing."                                                                            
                                                                                                                                
     - MOVED CSHB 193(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
SENATE BILL NO. 174                                                                                                             
"An Act  relating to the duties  of the Department of  Health and                                                               
Social Services;  and relating to the  administration of programs                                                               
for persons with physical and mental disabilities."                                                                             
                                                                                                                                
     - MOVED SB 174 OUT OF COMMITTEE                                                                                            
                                                                                                                                
CS FOR SS FOR SENATE BILL NO. 108(FIN)                                                                                          
"An  Act relating  to the  State Medical  Board; relating  to the                                                               
licensing  of physicians,  osteopaths, and  podiatrists; relating                                                               
to  the  certification of  medical  assistants;  relating to  the                                                               
practice  of  medicine; relating  to  the  practice of  podiatry;                                                               
relating to the practice of  osteopathy; relating to assault of a                                                               
medical professional; and providing for an effective date."                                                                     
                                                                                                                                
     - MOVED CSSSSB 108(FIN) OUT OF COMMITTEE                                                                                   
                                                                                                                                
CONFIRMATION HEARING(S)                                                                                                         
                                                                                                                                
State Medical Board                                                                                                           
                                                                                                                                
     Dr. Liu Sai-Ling - Nome                                                                                                    
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
HOUSE BILL NO. 358                                                                                                              
"An Act relating to insurance coverage for benefits provided                                                                    
through telehealth; and providing for an effective date."                                                                       
                                                                                                                                
     - MOVED HB 358 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE JOINT RESOLUTION NO. 32                                                                                                   
Proposing an amendment to the Constitution of the State of                                                                      
Alaska relating to notice and consent before termination of a                                                                   
minor's pregnancy.                                                                                                              
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 193                                                                                                                  
SHORT TITLE: HEALTH CARE; BALANCE BILLING                                                                                       
SPONSOR(s): REPRESENTATIVE(s) GRENN                                                                                             
                                                                                                                                
03/24/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/24/17       (H)       HSS, L&C                                                                                               
03/08/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/08/18       (H)       Heard & Held                                                                                           
03/08/18       (H)       MINUTE(HSS)                                                                                            
03/27/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/27/18       (H)       -- MEETING CANCELED --                                                                                 
03/29/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: SB 174                                                                                                                  
SHORT TITLE: PROGRAMS FOR PERSONS WITH DISABILITIES                                                                             
SPONSOR(s): SENATOR(s) MICCICHE                                                                                                 
                                                                                                                                
02/02/18       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/02/18       (S)       HSS                                                                                                    
02/21/18       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/21/18       (S)       Moved SB 174 Out of Committee                                                                          
02/21/18       (S)       MINUTE(HSS)                                                                                            
02/22/18       (S)       HSS RPT  5DP                                                                                           
02/22/18       (S)       DP:    WILSON,   BEGICH,    VON   IMHOF,                                                               
                         MICCICHE, GIESSEL                                                                                      
03/01/18       (S)       TRANSMITTED TO (H)                                                                                     
03/01/18       (S)       VERSION: SB 174                                                                                        
03/05/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/05/18       (H)       CRA, HSS                                                                                               
03/13/18       (H)       CRA AT 8:00 AM BARNES 124                                                                              
03/13/18       (H)       Heard & Held                                                                                           
03/13/18       (H)       MINUTE(CRA)                                                                                            
03/15/18       (H)       CRA RPT 4DP                                                                                            
03/15/18       (H)       DP:   DRUMMOND,    RAUSCHER,   ZULKOSKY,                                                               
                         PARISH                                                                                                 
03/15/18       (H)       CRA AT 8:00 AM BARNES 124                                                                              
03/15/18       (H)       Moved SB 174 Out of Committee                                                                          
03/15/18       (H)       MINUTE(CRA)                                                                                            
03/20/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/20/18       (H)       -- MEETING CANCELED --                                                                                 
03/27/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/27/18       (H)       -- MEETING CANCELED --                                                                                 
03/29/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: SB 108                                                                                                                  
SHORT TITLE: MEDICAL CARE/LICENSING/MEDICAL BOARD                                                                               
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
04/07/17       (S)       READ THE FIRST TIME - REFERRALS                                                                        
04/07/17       (S)       L&C, FIN                                                                                               
01/18/18       (S)       SPONSOR SUBSTITUTE INTRODUCED-REFERRALS                                                                
01/18/18       (S)       L&C, FIN                                                                                               
02/13/18       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/13/18       (S)       Moved SSSB 108 Out of Committee                                                                        
02/13/18       (S)       MINUTE(L&C)                                                                                            
02/14/18       (S)       L&C RPT  5DP                                                                                           
02/14/18       (S)       DP: COSTELLO, STEVENS, MICCICHE, MEYER,                                                                
                         GARDNER                                                                                                
02/27/18       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
02/27/18       (S)       Heard & Held                                                                                           
02/27/18       (S)       MINUTE(FIN)                                                                                            
03/13/18       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
03/13/18       (S)       Moved CSSSSB 108 Out of Committee                                                                      
03/13/18       (S)       MINUTE(FIN)                                                                                            
03/14/18       (S)       FIN RPT CS  5DP 1NR   SAME TITLE                                                                       
03/14/18       (S)       DP: HOFFMAN, MACKINNON, BISHOP, VON                                                                    
                         IMHOF, STEVENS                                                                                         
03/14/18       (S)       NR: OLSON                                                                                              
03/21/18       (S)       TRANSMITTED TO (H)                                                                                     
03/21/18       (S)       VERSION: CSSSSB 108(FIN)                                                                               
03/22/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/22/18       (H)       HSS, L&C, FIN                                                                                          
03/27/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/27/18       (H)       -- MEETING CANCELED --                                                                                 
03/29/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 358                                                                                                                  
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH                                                                                  
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/19/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/18       (H)       HSS, L&C                                                                                               
03/08/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/08/18       (H)       Heard & Held                                                                                           
03/08/18       (H)       MINUTE(HSS)                                                                                            
03/22/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/22/18       (H)       -- MEETING CANCELED --                                                                                 
03/29/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HJR 32                                                                                                                  
SHORT TITLE: CONST. AM: PARENTAL CONSENT TO ABORTION                                                                            
SPONSOR(s): REPRESENTATIVE(s) LEDOUX                                                                                            
                                                                                                                                
02/07/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/07/18       (H)       HSS, STA, JUD                                                                                          
03/29/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
RYAN JOHNSTON, Staff                                                                                                            
Representative Jason Grenn                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 193 on behalf of the bill                                                                   
sponsor, Representative Grenn.                                                                                                  
                                                                                                                                
ANNE ZINK, MD                                                                                                                   
Alaska American College of Emergency Physicians'                                                                                
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of HB 193.                                                                   
                                                                                                                                
SAMI ALI, MD                                                                                                                    
Alaska Emergency Medicine Associates                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 193.                                                                          
                                                                                                                                
STEVEN COMPTON, MD                                                                                                              
President                                                                                                                       
Alaska Heart and Vascular Institute                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 193.                                                                   
                                                                                                                                
SENATOR PETER MICCICHE                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented SB 174 as the sponsor of the                                                                   
bill.                                                                                                                           
                                                                                                                                
KAITLEEN STANSBERRY, Intern                                                                                                     
Senator Peter Micciche                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented the sectional analysis on behalf                                                               
of the bill sponsor, Senator Micciche.                                                                                          
                                                                                                                                
MAGGIE WINSTON, Chair                                                                                                           
Governor's Council on Disabilities and Special Education                                                                        
Kenai, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of SB 174.                                                                          
                                                                                                                                
MICHELLE GIRAULT, Board Member                                                                                                  
Key Coalition                                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SB 174.                                                                          
                                                                                                                                
LIZETTE STIEHR, Executive Director                                                                                              
Alaska Association on Developmental Disabilities                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SB 174.                                                                          
                                                                                                                                
COREY GILMORE                                                                                                                   
Governor's Council on Disabilities and Special Education                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of SB 174.                                                                          
                                                                                                                                
SENATOR CATHY GIESSEL                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented SSSB 108 as the sponsor of the                                                                 
bill.                                                                                                                           
                                                                                                                                
FRED PARADY, Deputy Commissioner                                                                                                
Office of the Commissioner                                                                                                      
Department of Commerce, Community & Economic Development                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of SB 108.                                                                          
                                                                                                                                
DANNY ROBINETTE, MD                                                                                                             
Chief Medical Officer                                                                                                           
Foundation Health Partners                                                                                                      
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SB 108.                                                                          
                                                                                                                                
LIU SAI-LING, MD                                                                                                                
Appointee                                                                                                                       
State Medical Board                                                                                                             
Nome, Alaska                                                                                                                    
POSITION STATEMENT:  Answered questions during the confirmation                                                               
hearings for State Medical Board.                                                                                               
                                                                                                                                
BERNICE NISBETT, Staff                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 358 on behalf of the bill                                                                   
sponsor, Representative Spohnholz.                                                                                              
                                                                                                                                
AROM EVANS, MD                                                                                                                  
Medical Director                                                                                                                
Orion Behavioral Health Network                                                                                                 
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 358.                                                                          
                                                                                                                                
LYN FREEMAN, Ph.D.                                                                                                              
Mind Matters Research                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of the proposed bill.                                                               
                                                                                                                                
VICTORIA KNAPP, Chief Operating Officer                                                                                         
Mat-Su Health Services                                                                                                          
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of HB 358.                                                                          
                                                                                                                                
ANNA LATHAM, Deputy Director                                                                                                    
Division of Insurance                                                                                                           
Department of Commerce, Community & Economic Development                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
358.                                                                                                                            
                                                                                                                                
REPRESENTATIVE GABRIEL LEDOUX                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Presented HJR  32  as the  sponsor of  the                                                             
resolution.                                                                                                                     
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:06:37 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:06   p.m.                                                               
Representatives  Spohnholz,   Zulkosky,  Kito,  Sullivan-Leonard,                                                               
Johnston,  and  Eastman  were  present  at  the  call  to  order.                                                               
Representative Tarr arrived as the meeting was in progress.                                                                     
                                                                                                                                
3:07:30 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  Confirmation hearing would be                                                               
postponed until later in the meeting.                                                                                           
                                                                                                                                
              HB 193-HEALTH CARE; BALANCE BILLING                                                                           
                                                                                                                                
3:08:40 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be  HOUSE BILL  NO.  193,  "An Act  relating  to insurance  trade                                                               
practices  and frauds;  and relating  to  emergency services  and                                                               
balance  billing."   [In front  of the  committee was  Version T,                                                               
adopted as the working draft on March 8, 2018]                                                                                  
                                                                                                                                
3:09:06 PM                                                                                                                    
                                                                                                                                
RYAN JOHNSTON,  Staff, Representative  Jason Grenn,  Alaska State                                                               
Legislature, offered a brief recap  of the proposed bill, HB 193,                                                               
stating that the  bill was effectively a ban  on balanced billing                                                               
for  medical providers,  while also  instituting a  hold harmless                                                               
clause  for insurance  providers.   He  explained  that the  bill                                                               
would  only  remove a  patient  from  this billing  situation  in                                                               
emergency situations.                                                                                                           
                                                                                                                                
3:09:38 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened invited testimony.                                                                                       
                                                                                                                                
3:09:57 PM                                                                                                                    
                                                                                                                                
ANNE ZINK, MD, Alaska American College of Emergency Physicians',                                                                
paraphrased from a letter of support, dated March 28, 2018,                                                                     
which read:  [Included in members' packets]                                                                                     
                                                                                                                                
     Representing more than 80%  of the emergency physicians                                                                    
     providing emergency  medical care to the  people of our                                                                    
     state, the  Alaska Chapter of  the American  College of                                                                    
     Emergency Physicians writes today to support HB193.                                                                        
                                                                                                                                
     HB 193  will protect  patients and families  across the                                                                    
     state from  the high costs  and sticker shock  that can                                                                    
     come from  "surprise medical  bills." Both  doctors and                                                                    
     patients  support this  important  measure, which  will                                                                    
     provide consumer  protections for  patients, strengthen                                                                    
     access to  care, and  put an  end once  and for  all to                                                                    
     surprise bills.                                                                                                            
                                                                                                                                
     As emergency  physicians in  Alaska, we  know firsthand                                                                    
     about the gaps in  patient healthcare coverage that can                                                                    
     cause  patients to  postpone or  avoid treatment  until                                                                    
     it's too late.  According to a national  survey, 44% of                                                                    
     people reported  that they  didn't seek  treatment when                                                                    
     they  were sick  or injured  because of  costs. At  the                                                                    
     same time,  35% of Americans would  have trouble paying                                                                    
     their  regular  bills  if  faced  with  a  $400  health                                                                    
     emergency. This  is alarming,  but not  surprising, and                                                                    
     we  must  work together  to  ensure  that patients  can                                                                    
     safely  access emergency  care  without worrying  about                                                                    
     going bankrupt.                                                                                                            
                                                                                                                                
     What good is insurance if  it fails us in an emergency?                                                                    
     Insurance companies  are shifting hundreds  of millions                                                                    
     of dollars in  costs to patients and  doctors each year                                                                    
     through higher  premiums, deductibles  and cost-sharing                                                                    
     requirements.  At  the   same  time,  Alaska  insurance                                                                    
     companies are  narrowing their  networks -  making them                                                                    
     smaller through  limiting access  to doctors  and care,                                                                    
     which means fewer options and  choices for patients and                                                                    
     creating  large  coverage   gaps  where  care  patients                                                                    
     thought would  be covered, turns  out not to  be. These                                                                    
     gaps are  leading to surprise  bills, adding  even more                                                                    
     costs for patients.                                                                                                        
                                                                                                                                
     Alaska  patients  and  families deserve  better.  Right                                                                    
     now, the state has a  regulation in place that requires                                                                    
     insurance companies  to cover  these unexpected  out of                                                                    
     network  costs  during  emergencies  through  fair  and                                                                    
     appropriate payments to  doctors. But, Alaska insurance                                                                    
     companies are  working to  undermine this  regulation -                                                                    
     and we need your help  to ensure patients are protected                                                                    
     in the long  run. We're working to support  a new bill,                                                                    
     HB 193,  that will end surprise  billing altogether and                                                                    
     provide the protection patients need.                                                                                      
                                                                                                                                
     HB  193  is  a  comprehensive  solution  that  protects                                                                    
     patients and ends surprise  bills by requiring insurers                                                                    
     to  cover unexpected,  emergency out  of network  care,                                                                    
     and limiting  patient financial  exposure. HB  193 will                                                                    
     protect patients from receiving  large bills that their                                                                    
     insurance   companies   have   refused   to   pay.   By                                                                    
     establishing  an  appropriate  and  fair  reimbursement                                                                    
     standard between  insurers and doctors, the  bill takes                                                                    
     patients  out  of the  middle  and  improves access  to                                                                    
     care.                                                                                                                      
                                                                                                                                
     HB  193   sets  a  fair  minimum   standard,  the  80th                                                                    
     percentile rule  that has been working  in Alaska since                                                                    
     2004, which insurers use as  a benchmark to pay out-of-                                                                    
     network   physicians,  providers   or  facilities   for                                                                    
     unexpected care.  HB 193 bans balance  billing, meaning                                                                    
     no  further  bills  would  go   to  patients  in  these                                                                    
     situations.  Because  doctors  will  be  payed  fairly,                                                                    
     there is no need for additional bills.                                                                                     
                                                                                                                                
     Despite  negative   attention  created   by  misleading                                                                    
     information  by insurance  companies, patients  support                                                                    
     the  80th percentile  rule,  and  want their  insurance                                                                    
     plans  to fairly  cover out-of-network  emergency care.                                                                    
     The 80th percentile rule  relies on transparent market-                                                                    
     based information that takes  into account local market                                                                    
     prices  for services.  They are  based in  market costs                                                                    
     and not  set by government or  manipulated by insurance                                                                    
     companies.                                                                                                                 
                                                                                                                                
     Although  critics  have  claimed  that  providers  with                                                                    
     extremely large  market share  can impact  prices under                                                                    
     this standard,  there's no evidence  or report  of foul                                                                    
     play.  ISER (UAA's  Institute  of  Social and  Economic                                                                    
     Research)  is  currently  looking  at  this  issue  for                                                                    
     Alaska. Research  in New  York State  has shown  that a                                                                    
     similar  standard  did  not  increase  cost  after  its                                                                    
     implementation there.                                                                                                      
                                                                                                                                
     Without  the 80th  percentile rule  in HB193,  patients                                                                    
     will be  left unprotected as insurance  companies shirk                                                                    
     their  responsibility   to  pay.  In   fact,  insurance                                                                    
     companies  would  be  allowed  to set  any  rates  they                                                                    
     wanted  -  with  no  regard  for  costs  or  impact  on                                                                    
     emergency room staffing or services.                                                                                       
                                                                                                                                
     Alaska patients and families  need this full protection                                                                    
     from  surprise bills.  This  bill  with strengthen  the                                                                    
     healthcare  system,   offering  protection   first  and                                                                    
     foremost  to patients,  and  ensuring  the doctors  and                                                                    
     emergency  rooms can  keep their  doors  open and  keep                                                                    
     staffed with  needed specialists and providers  to best                                                                    
     treat patients in emergencies.                                                                                             
                                                                                                                                
     We hope we can count on your support for HB 193.                                                                           
                                                                                                                                
3:12:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON,  noting  that   there  were  two  major                                                               
insurance  providers  in  Alaska,   asked  if  her  business  was                                                               
currently in-network for either of those providers.                                                                             
                                                                                                                                
DR. ZINK expressed agreement that her group was in-network.                                                                     
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked if  her group contracted  with out                                                               
of network physicians.                                                                                                          
                                                                                                                                
DR. ZINK replied that her  group covered the emergency department                                                               
at the Mat-Su  Regional Medical Center, and, as they  billed as a                                                               
unified  group,   they  were  in-network   with  all   the  major                                                               
providers.   She explained that  most providers wanted to  be in-                                                               
network and did  not want to shift that burden  to patients.  She                                                               
stated that they did not  have any contract negotiations, and, as                                                               
they were busy with patients,  they "just take what the insurance                                                               
companies give  us."   She declared "that's  the reason  why this                                                               
legislation is really important."                                                                                               
                                                                                                                                
DR. ZINK  expressed her  agreement with  Representative Johnston,                                                               
that the  bulk of their  emergency room visits, if  insured, were                                                               
in-network.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  about the  operations  in  other                                                               
emergency room facilities in Alaska.                                                                                            
                                                                                                                                
DR. ZINK  replied that there  was a similar model  throughout the                                                               
state for emergency providers, that  most were independent groups                                                               
contracted with  a hospital.   She pointed out that  the networks                                                               
were shrinking  in the  Lower 48,  resulting in  larger insurance                                                               
gaps.   She  expressed her  hope that  this proposed  legislation                                                               
would get in front of that.   She declared that her group did not                                                               
send many  balance bills, although this  was a huge issue  in the                                                               
Lower 48.                                                                                                                       
                                                                                                                                
3:15:04 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
3:15:33 PM                                                                                                                    
                                                                                                                                
SAMI  ALI, MD,  Alaska Emergency  Medicine Associates,  explained                                                               
that her  group of physicians  staffed the emergency room  at the                                                               
Providence  Alaska  Medical  Center  and  provided  care  to  all                                                               
patients who  came through the  emergency room.  She  pointed out                                                               
that the  facility did  not use mid-level  providers.   She asked                                                               
that  the  80th  percentile  rule be  preserved  to  prevent  any                                                               
reduction in  quality care or  to accessibility for  medical care                                                               
for patients  in Alaska.   She declared  support for  proposed HB                                                               
193 as it would enable physician  groups in Alaska to recruit and                                                               
retain  high quality  physicians,  as this  was  a difficulty  in                                                               
Alaska.                                                                                                                         
                                                                                                                                
3:18:38 PM                                                                                                                    
                                                                                                                                
STEVEN  COMPTON,   MD,  President,  Alaska  Heart   and  Vascular                                                               
Institute, stated  that practicing cardiology in  Anchorage was a                                                               
challenge, as it  was difficult to recruit physicians  to come to                                                               
Alaska.    He   reported  that  to  attain  the   same  ratio  of                                                               
cardiologists  to  population  as  the  Lower  48,  it  would  be                                                               
necessary to more than double  the number of cardiologists in the                                                               
state.    He noted  that,  as  the  Baby Boomer  demographic  was                                                               
entering the  age for  needing more  cardiology care,  the demand                                                               
for  services had  "accelerated tremendously  in the  last decade                                                               
and  will continue  to do  so," and  that the  state was  already                                                               
underserved.  He  stated that it was a  fundamental commitment of                                                               
his organization  to provide  care to  anyone who  walked through                                                               
the door.   He reported that  his group served 30  percent of the                                                               
state Medicare  population, and noted  that all  Medicare clinics                                                               
lost  money and  were heavily  subsidized by  the hospitals.   He                                                               
said that  the "way we keep  the lights on is  by cost shifting."                                                               
He explained that the Medicare  charges were paid with funds from                                                               
private payers,  allowing them  to maintain access  to care.   He                                                               
declared support for the proposed bill.                                                                                         
                                                                                                                                
3:23:10 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
3:23:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY moved  to report  CSHB 193,  Version 30-                                                               
LS0466\T,   Wallace,  3/6/18,   out  committee   with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  193(HSS) was moved from the  House Health and                                                               
Social Services Standing Committee.                                                                                             
3:23:55 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
         SB 174-PROGRAMS FOR PERSONS WITH DISABILITIES                                                                      
                                                                                                                                
3:26:18 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be SENATE  BILL NO. 174,  "An Act relating  to the duties  of the                                                               
Department of  Health and  Social Services;  and relating  to the                                                               
administration of  programs for persons with  physical and mental                                                               
disabilities."                                                                                                                  
                                                                                                                                
3:26:44 PM                                                                                                                    
                                                                                                                                
SENATOR  PETER MICCICHE,  Alaska  State Legislature,  paraphrased                                                               
from the Sponsor Statement [Included  in members' packets], which                                                               
read:                                                                                                                           
                                                                                                                                
     When  Alaskans with  physical  and mental  disabilities                                                                    
     are  able  to actively  participate  in  the system  of                                                                    
     their care,  a higher  quality of  life is  achieved as                                                                    
     well as a sense of  independence. SB 174 will provide a                                                                    
     clear  pathway  to  achieve both  of  these  things  by                                                                    
     allowing the  Department of Health and  Social Services                                                                    
     to  take  a  more flexible  approach  to  administering                                                                    
     programs. A  positive, person-centered  approach should                                                                    
     be embedded  within all decisions made  at both systems                                                                    
     design and service delivery levels.                                                                                        
                                                                                                                                
     So  why  establish  an avenue  for  participation?  All                                                                    
     persons deserve  the right to  be treated  with respect                                                                    
     and  dignity. Higher  quality of  life  is achieved  by                                                                    
     encouraging  individuals   with  physical   and  mental                                                                    
     disabilities  to participate  fully in  the social  and                                                                    
     economic environment  of their homes,  communities, and                                                                    
     the State.                                                                                                                 
                                                                                                                                
     Improved   stewardship   of  public   monies   requires                                                                    
     stakeholder  input   from  a  broad   cross-section  of                                                                    
     Alaskan   urban  and   rural   communities  to   ensure                                                                    
     effectiveness   of  program   redesign  efforts.   Five                                                                    
     project teams  comprised of over 70  people are already                                                                    
     working to make this a  reality by focusing on areas of                                                                    
     person-directed culture  change, workforce enhancement,                                                                    
     community   awareness,   legislative  engagement,   and                                                                    
     measuring success.                                                                                                         
                                                                                                                                
     SB 174  does not create  the right to  self-direct care                                                                    
     or supersede  laws related to eligibility  programs. It                                                                    
     will not have  a financial impact on the  State. SB 174                                                                    
     does provide  a long overdue unifying  vision to assure                                                                    
     that the  available resources, whether great  or small,                                                                    
     are allocated  and applied in  a manner  that maximizes                                                                    
     the   contributions   to    community   that   Alaskans                                                                    
     experiencing   disabilities    can   make,    and   the                                                                    
     flexibility of systems to  utilize those resources with                                                                    
     responsible stewardship now and in perpetuity.                                                                             
                                                                                                                                
3:28:34 PM                                                                                                                    
                                                                                                                                
SENATOR   MICCICHE   emphasized    that   Alaskans   experiencing                                                               
disabilities were  not cattle, they  were not a number,  but that                                                               
they were individual,  amazing Alaskans who had  hopes and dreams                                                               
and  wanted to  accomplish  the  very most  they  could in  their                                                               
lives.   He  noted that  when  past services  had been  delegated                                                               
without their  participation, they  had sometimes felt  more like                                                               
numbers than amazing individuals.   He offered his belief that we                                                               
would all want the same input.                                                                                                  
                                                                                                                                
3:29:47 PM                                                                                                                    
                                                                                                                                
KAITLEEN  STANSBERRY,  Intern,  Senator  Peter  Micciche,  Alaska                                                               
State  Legislature,  paraphrased   from  the  Sectional  Analysis                                                               
[Included in members' packets], which read:                                                                                     
                                                                                                                                
     Section 1                                                                                                                
                                                                                                                                
     AS  47.80.095. Legislative  Findings Related  to Person                                                                    
     with   Disabilities.   Adds   a  new   section   titled                                                                    
     Legislative   Findings   Related    to   Persons   with                                                                    
     Disabilities.  It presents  how Alaskans  with physical                                                                    
     and  mental disabilities  quality of  life is  enhanced                                                                    
     when allowed  to actively participate in  their support                                                                    
     services.                                                                                                                  
                                                                                                                                
     Section 2                                                                                                                
                                                                                                                                
     Adds  new language  allowing the  Department of  Health                                                                    
     and  Social Services  to take  a  flexible approach  in                                                                    
     allowing active  participation for those  with physical                                                                    
     and mental disabilities.                                                                                                   
                                                                                                                                
3:30:47 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened invited testimony.                                                                                       
                                                                                                                                
3:31:09 PM                                                                                                                    
                                                                                                                                
MAGGIE  WINSTON, Chair,  Governor's Council  on Disabilities  and                                                               
Special  Education, shared  her background  as an  individual who                                                               
had experienced a  disability at 21 years of age  which took away                                                               
functional  use of  her arms  and her  legs.   She said  that the                                                               
services she received allowed her to  live in her own home, to be                                                               
a mom, to go  to her job at a center  for independent living, and                                                               
to  be  an  advocate  for   other  individuals  that  experienced                                                               
disabilities.  She asked for support  for the proposed bill as it                                                               
would make  individuals feel supported with  this flexible shared                                                               
vision  for  services  and  it solidified  the  spirit  of  self-                                                               
determination,  as  things can  often  seem  chaotic and  out  of                                                               
control.   She declared  that this offered  her support  toward a                                                               
meaningful life, something that we all wanted.                                                                                  
                                                                                                                                
3:33:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  how  the  proposed  bill                                                               
would assist her in the Medicaid process.                                                                                       
                                                                                                                                
MS. WINSTON offered her belief  that the bill language solidified                                                               
something more  sustainable for service provision  in the future,                                                               
so  that individuals  looking for  services in  the future  would                                                               
have  a  language  to  empower   and  enable  them  to  be  self-                                                               
determining.                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD mused that  it would allow better                                                               
communication with  a health care  professional or  other support                                                               
services for inclusion in the decision-making process.                                                                          
                                                                                                                                
MS. WINSTON  said that it  would establish a foundation  of self-                                                               
directedness, so that  she did not need to  accept something that                                                               
would not work for her.   The proposed bill would declare support                                                               
for her in her individuality and her needs.                                                                                     
                                                                                                                                
3:35:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY asked  whether the  proposed bill  would                                                               
allow statutory  support for individuals  to opt out  of services                                                               
they might  not need, and  have self-directed  conversations with                                                               
the department for the services they desired.                                                                                   
                                                                                                                                
MS. WINSTON expressed her agreement.                                                                                            
                                                                                                                                
3:36:20 PM                                                                                                                    
                                                                                                                                
MICHELLE GIRAULT,  Board Member,  Key Coalition, stated  that the                                                               
Key Coalition  was very  supportive of the  proposed bill  to put                                                               
into statute  a foundational language  that was value  driven and                                                               
upheld and  supported those  primary stakeholders  across Alaska.                                                               
She declared that  the proposed bill would  enable departments to                                                               
work together to provide more synchronous delivery systems.                                                                     
                                                                                                                                
3:38:29 PM                                                                                                                    
                                                                                                                                
LIZETTE  STIEHR,   Executive  Director,  Alaska   Association  on                                                               
Developmental  Disabilities,  paraphrased  from a  letter,  dated                                                               
March 13, 2018, which read:  [Included in members' packets]                                                                     
                                                                                                                                
     AADD,   the   Alaska   Association   on   Developmental                                                                    
     Disabilities,    is   the    professional   association                                                                    
     representing  the voice  of forty-six  organizations in                                                                    
     Alaska that  provide home and  community-based services                                                                    
     to   individuals   who  experience   intellectual   and                                                                    
     developmental  disabilities. The  Association has  been                                                                    
     an active  and strong  supporter of the  development of                                                                    
     the Shared  Vision. The Vision brings  a renewed energy                                                                    
     and excitement to the work  the provider community. The                                                                    
     Shared Vision reminds each of  us why we have dedicated                                                                    
     our professional life  to this field and  where we want                                                                    
     the focus  of services to  be, on the  individual being                                                                    
     supported.                                                                                                                 
                                                                                                                                
     We  are so  appreciative  of  Senator Micciche's  SB174                                                                    
     that  embeds the  Shared Vision  in  statue. In  statue                                                                    
     this  Shared  Vision  will  provide  a  consistent  and                                                                    
     strong  platform  for  individuals to  lead  their  own                                                                    
     services, rather than a  bureaucracy. It enriches their                                                                    
     lives and  the fabric  of the  community in  which they                                                                    
     participate. Services  matching the Shared  Vision will                                                                    
     provide  for  a  more  independence  life  and  greater                                                                    
     personal  confidence for  individuals.  This will  help                                                                    
     stretch    limited   funds    farther   with    greater                                                                    
     participation   in  the   community  involving   unpaid                                                                    
     natural supports.                                                                                                          
                                                                                                                                
     Having the  Shared Vision in  stature will  assure that                                                                    
     the  underlying  philosophy  of  dignity,  respect  and                                                                    
     choice  doesn't  change  with   shifts  in  funding  or                                                                    
     political  leaders.  Thank  you again  for  your  time,                                                                    
     attention and efforts on behalf  of so many individuals                                                                    
     in  Alaska both  providing and  receiving services  and                                                                    
     supports.                                                                                                                  
                                                                                                                                
3:41:03 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
3:41:26 PM                                                                                                                    
                                                                                                                                
COREY  GILMORE, Governor's  Council on  Disabilities and  Special                                                               
Education,  shared that  he  was  a recipient  of  services.   He                                                               
explained  that services  were provided  based on  a document  of                                                               
care for what  other people think they may need.   These plans of                                                               
care were decided in a  large conference while "people talk about                                                               
you."   Right at the end  of the meeting, these  people would ask                                                               
him what  he would  like to  work on.   He  declared that  it was                                                               
necessary "to  turn that on its  head," make these plans  of care                                                               
about what  the individual wants  to do, and that  the individual                                                               
needed to  be control of  that.   He pointed to  the difficulties                                                               
for his  staff as they tried  to follow the plan,  even though he                                                               
stated that  he had not  agreed to that goal.   If he  refused to                                                               
work on  a goal, he  would receive  less service.   He emphasized                                                               
that the plan  of care should be the individual's  plan, and that                                                               
"we can all stand  to work on" these goals.   He pointed out that                                                               
he hated to work on goals that were not his own.                                                                                
                                                                                                                                
3:45:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR said  that  she  did not  know  that by  not                                                               
working on  the goals in  the plan  of care, an  individual could                                                               
lose  those services.    She  asked if  this  was  based on  non-                                                               
participation for those services.                                                                                               
                                                                                                                                
MR.  GILMORE declared  that he  was all  for participation,  that                                                               
life required  audience participation.  He  stated that currently                                                               
the  goals  were  not  participatory,   they  were  meant  to  be                                                               
habilitative,  which was  often  difficult for  individuals.   He                                                               
noted that,  as he was 42  years old and had  cerebral palsy, his                                                               
philosophy  was that  if he  could  be habilitated,  none of  his                                                               
staff would  need to  be here.   He  expressed support  for goals                                                               
that he could  live with, pointing out that currently  he did not                                                               
have the  ability to say  "no, I didn't agree  to that goal.   We                                                               
have to do it  because it's in our plan of care.   If we don't do                                                               
it, we can lose services."   He explained that habilitation was a                                                               
means to justify the cost.                                                                                                      
                                                                                                                                
3:48:19 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
3:48:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN   offered  Conceptual  Amendment   1,  as                                                               
follows:                                                                                                                        
                                                                                                                                
     Delete "can achieve a meaningful life"                                                                                     
                                                                                                                                
     Replace with "can be more active"                                                                                          
                                                                                                                                
REPRESENTATIVE EASTMAN  said that  would remove the  question for                                                               
the philosophical components for the meaning of life.                                                                           
                                                                                                                                
3:49:53 PM                                                                                                                    
                                                                                                                                
SENATOR MICCICHE offered an example  for activity and opined that                                                               
he was unsure that this activity  would lead to a more active, or                                                               
meaningful, life.  He declared  that this was not about activity,                                                               
but was about self-determination for  personal treatment, and the                                                               
"most value out of life how you  see fit."  He declared that this                                                               
was not  about physical activity,  but was  about accomplishment,                                                               
opportunity, and fulfillment.                                                                                                   
                                                                                                                                
CHAIR SPOHNHOLZ expressed her agreement.                                                                                        
                                                                                                                                
REPRESENTATIVE EASTMAN moved to adopt Conceptual Amendment 1.                                                                   
                                                                                                                                
CHAIR SPOHNHOLZ  objected for discussion.   She pointed  out that                                                               
the  proposed bill  had been  drafted in  collaboration with  the                                                               
Governor's Council on Disabilities and Special Education.                                                                       
                                                                                                                                
3:51:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  directed attention to  the top of page  2 of                                                               
the  proposed  bill.   She  offered  her  belief that  "having  a                                                               
meaningful life" was  language often used per  the reasons stated                                                               
by Senator  Micciche.  She  declared that recognition,  no matter                                                               
the physical  or intellectual challenges or  limitations, for the                                                               
opportunity  to  have  a  full  and  meaningful  life  should  be                                                               
supported.                                                                                                                      
                                                                                                                                
3:52:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  said that he  supported the idea  of more                                                               
and  increase  and  other words;  however,  the  current  wording                                                               
indicated that, without  this program, a person  cannot achieve a                                                               
meaningful life.   He  offered his belief  that, as  the proposed                                                               
bill was not  intended to give a meaningful life  when the person                                                               
did  not otherwise  have a  meaningful life,  philosophically, it                                                               
was  more  than  could  be  achieved through  the  program.    He                                                               
acknowledged  that, although  there  were many  good things  that                                                               
could "come of this program,  but giving someone meaningful life,                                                               
even if we were just talking  about more meaningful life, I think                                                               
that would be  an entirely different concept."  He  said that the                                                               
proposed bill was  currently written in such a way  that a person                                                               
could not  achieve a  meaningful life  without this  program, and                                                               
that he did not agree with that.                                                                                                
                                                                                                                                
3:53:20 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ maintained her objection.                                                                                       
                                                                                                                                
3:53:31 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Eastman  voted in                                                               
favor  of Conceptual  Amendment  1.   Representatives  Spohnholz,                                                               
Kito,  Tarr, Sullivan-Leonard,  and  Zulkosky  voted against  it.                                                               
Therefore, Conceptual Amendment  1 failed by a vote of  1 yea - 5                                                               
nays.                                                                                                                           
                                                                                                                                
3:54:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR expressed  her pleasure  that this  proposed                                                               
bill and  another bill regarding supportive  decision making were                                                               
both moving forward, as they seemed long overdue.                                                                               
                                                                                                                                
CHAIR SPOHNHOLZ  declared that the concept  of self-determination                                                               
was  one  of  the  most  important  concepts  that  we  have,  as                                                               
individuals,  to allow  control of  our  own bodies  and our  own                                                               
destinies.   She stated  that most  of us don't  like to  be told                                                               
what to do,  and that we should  be able to make  the choices for                                                               
our own lives that  best fit with our values.   She added that we                                                               
should be  able to build our  skills in ways that  are meaningful                                                               
to us, and not necessarily to other people.                                                                                     
                                                                                                                                
3:55:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY  moved to  report  SB  174, Version  30-                                                               
LS1258\D, out  of committee  with individual  recommendations and                                                               
the accompanying  zero fiscal notes.   There being  no objection,                                                               
SB  174 was  moved  from  the House  Health  and Social  Services                                                               
Standing Committee.                                                                                                             
3:56:11 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:56 p.m. to 3:58 p.m.                                                                       
                                                                                                                                
          SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD                                                                       
                                                                                                                                
3:58:22 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be CS  FOR SPONSOR SUBSTITUTE  FOR SENATE BILL NO.  108(FIN), "An                                                               
Act  relating  to  the  State  Medical  Board;  relating  to  the                                                               
licensing  of physicians,  osteopaths, and  podiatrists; relating                                                               
to  the  certification of  medical  assistants;  relating to  the                                                               
practice  of  medicine; relating  to  the  practice of  podiatry;                                                               
relating to the practice of  osteopathy; relating to assault of a                                                               
medical professional; and providing for an effective date."                                                                     
                                                                                                                                
3:58:30 PM                                                                                                                    
                                                                                                                                
SENATOR CATHY  GIESSEL, Alaska State Legislature,  explained that                                                               
the proposed  bill included requests  by the State  Medical Board                                                               
for  changes  to their  statutes.    She presented  a  PowerPoint                                                               
titled "SB  108, State  Medical Board,"  and introduced  slide 2,                                                               
"Purpose,"  which  listed  the  two  purposes  of  the  bill:  to                                                               
streamline physician licensing  and to address the  need for both                                                               
licensed and unlicensed office assistants.                                                                                      
                                                                                                                                
3:59:58 PM                                                                                                                    
                                                                                                                                
SENATOR  GIESSEL addressed  slide 3,  "Streamline MD  licensing,"                                                               
which was  addressed by the  proposed bill  in Sections 1,  2, 8,                                                               
and 9 [and  10] for changes to the process  for license approval.                                                               
She declared  that the reason to  the delay for approval  was the                                                               
need for the  license application to first be  reviewed, and then                                                               
forwarded to  the State Medical  Board for evaluation  during its                                                               
quarterly meeting.   She explained  that the proposed  bill would                                                               
authorize  the executive  administrator  to look  at the  license                                                               
applications,  and if  it was  complete, and  there were  not any                                                               
concerns, the  administrator would  be authorized to  approve the                                                               
license  and   issue  temporary   licenses,  as  well   as  grant                                                               
certifications.  The proposed bill  also spelled out prohibitions                                                               
for the  board to limit  the executive  administrator's authority                                                               
in this realm.   She added that this process  had already been in                                                               
use  by   the  Department  of  Commerce,   Community  &  Economic                                                               
Development  for 20  years.   She declared  that it  was a  safe,                                                               
efficient, and proven system.                                                                                                   
                                                                                                                                
4:01:49 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL moved  on to slide 4,  "Streamline MD licensing,"                                                               
and reported that  Sections 10 and 11 of the  proposed bill added                                                               
an additional  second person to  issue temporary  licenses should                                                               
the executive administrator not be  available.  She declared that                                                               
that  this would  help streamline  the license  approvals between                                                               
those quarterly  board meetings.   She  reported that  there were                                                               
approximately  290 licenses  in backlog,  although some  of these                                                               
may not be complete.  She noted  that only about 5 percent of the                                                               
applications were complete when submitted.                                                                                      
                                                                                                                                
SENATOR  GIESSEL  directed  attention  to  slide  5,  "Unlicensed                                                               
Assistive Personnel,"  which was  addressed in  Section 3  of the                                                               
proposed bill.   She reported  that, in the  mid-1990s, physician                                                               
offices began  to hire unlicensed  personnel for  routine medical                                                               
duties in order to reduce overhead  costs.  She pointed out that,                                                               
as  the  state medical  laws  prohibited  the delegation  of  any                                                               
medical duties to  an unlicensed person, the  proposed bill would                                                               
correct that  gap in the  laws and it would  authorize delegation                                                               
of routine medical tasks, as  defined by the State Medical Board,                                                               
to an unlicensed person.                                                                                                        
                                                                                                                                
4:05:15 PM                                                                                                                    
                                                                                                                                
SENATOR  GIESSEL addressed  slide 6,  "2.a. Unlicensed  Personnel                                                               
Medical assistants," and noted that  Sections 6, 12, and 14 added                                                               
additional clean  up language, and  put "routine  medical duties"                                                               
under the  exception to the  license to practice medicine  as the                                                               
law currently  prohibited any of  these medical  activities being                                                               
delegated to  unlicensed people.   She  reported that  Section 12                                                               
added medical assistant to the  practice of medicine, and Section                                                               
14  added  medical  assistants   to  the  definition  of  medical                                                               
professional under the Title 12 Criminal Procedure.                                                                             
                                                                                                                                
SENATOR  GIESSEL  directed  attention  to a  second  category  of                                                               
medical assistant created  in the proposed bill  to again correct                                                               
a  problem identified  by practicing  physicians, slides  7 -  8,                                                               
"2.b. Medical  assistants - license/certification."   She relayed                                                               
that earlier  legislation had  prohibited unlicensed  people from                                                               
looking  into the  prescription  drug database,  as it  contained                                                               
sensitive  information.   She  stated that  this  had now  caused                                                               
problems  in the  offices of  pain  or cancer  doctors, as  these                                                               
doctors did  not have staff licensed  to perform this task.   She                                                               
relayed  that the  proposed  bill created  an  entity of  medical                                                               
assistants  who were  certified through  recognized training  and                                                               
certification  programs.    She  added  that  Alaska's  community                                                               
colleges had training programs  for certified medical assistants,                                                               
which were recognized  in many other states.   She explained that                                                               
Section 4 of the proposed  bill defined the certifying process in                                                               
regulation  by  the  board,  slide  9,  "Medical  assistant  with                                                               
certification  Process  defined."    She stated  that  Section  5                                                               
listed specific limitations for use  of the term "certified," and                                                               
that Section  13 included  certification in  the definition  of a                                                               
license.  She  pointed out that these  certified assistants would                                                               
be qualified  to look into  the prescription drug database  for a                                                               
physician, as well as being  assigned more complex medical duties                                                               
as determined by the medical board.                                                                                             
                                                                                                                                
4:10:04 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL  emphasized that the proposed  bill would provide                                                               
a  more  efficient,  expeditious,   and  effective  licensing  of                                                               
physicians, it would provide legal  clarity for the delegation of                                                               
routine medical  duties to unlicensed personnel,  and create more                                                               
stringent licensing  for a  person certified  or licensed  by the                                                               
board, slides  10 - 11, "Urgent  need for SB 108."   She declared                                                             
that the state  medical board "really needs this"  and that there                                                               
had not been any opposition to the proposed bill.                                                                               
                                                                                                                                
4:11:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  acknowledged that  other medical                                                               
professionals had  indicated the time  element to manage  all the                                                               
tasks.  She relayed that  certified medical assistants (CMA) were                                                               
very beneficial and asked if  the CMAs could apply a prescription                                                               
or write a prescription.                                                                                                        
                                                                                                                                
SENATOR GIESSEL offered  her belief that the  board intended that                                                               
CMAs  not be  allowed  to  do any  prescribing  or management  of                                                               
opioids other than  accessing the data base.   She cautioned that                                                               
the term CMA was a registered  trademark by one of the certifying                                                               
bodies, and that  neither the term or the words  were used in the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
4:13:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  mused that  the proposed bill  was providing                                                               
for  licensing,  registration,  or  certification  of  a  medical                                                               
assistant,  as   well  as   allowing  medical   professionals  to                                                               
designate  routine tasks  to  unlicensed  medical assistants.  He                                                               
asked  if  this  created  two   classes  of  medical  assistants,                                                               
licensed and unlicensed.                                                                                                        
                                                                                                                                
SENATOR GIESSEL  acknowledged that  there were two  categories of                                                               
medical assistants.  One was  a regular medical assistant whereas                                                               
the other had  sought on-going education, had  taken the national                                                               
certifying examination, and was  qualified to pursue licensing by                                                               
the State Medical Board.                                                                                                        
                                                                                                                                
REPRESENTATIVE KITO expressed concern  for the ability to oversee                                                               
a doctor's  office which  could have  both categories  of medical                                                               
assistant.                                                                                                                      
                                                                                                                                
SENATOR GIESSEL  stated that the  medical board would  define the                                                               
limitations on  both entities,  and that  it would  be up  to the                                                               
facility to  monitor that the  clinicians were  practicing within                                                               
the  scope of  their  license.   She  said  that  these were  all                                                               
logistics that the medical profession would work out.                                                                           
                                                                                                                                
4:15:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO asked about  the applicability of the medical                                                               
board asking to authorize a  new category of medical professional                                                               
when  they were  not  in  support of  a  similar  request by  the                                                               
naturopath  board.    He  expressed   concern  for  leaving  this                                                               
entirely   to   the  medical   board   while   not  knowing   the                                                               
requirements.                                                                                                                   
                                                                                                                                
SENATOR  GIESSEL  acknowledged  that  he had  identified  a  turf                                                               
situation which  occurred in  medicine.   She shared  an anecdote                                                               
for the nursing profession putting  in statute and regulation the                                                               
authority  to delegate  to unlicensed  assistive personnel.   She                                                               
said that  it was "pretty  routine" to trust  professional boards                                                               
with this.                                                                                                                      
                                                                                                                                
REPRESENTATIVE KITO  said that, although he  appreciated areas of                                                               
turf, it  was necessary  to carefully  understand what  was being                                                               
added.   He expressed  his concern for  the new  certification of                                                               
medical assistants  without fully  understanding their task.   He                                                               
asked  for a  commitment from  the medical  profession that  this                                                               
would  result  in  decreases  in   cost,  as  there  would  be  a                                                               
delegation of  tasks from a  licensed professional  to unlicensed                                                               
individuals.  He  expressed concern that the public  would not be                                                               
receiving the benefit.                                                                                                          
                                                                                                                                
SENATOR GIESSEL said that these  cost reductions should have been                                                               
seen in  the mid-1990s when  medical assistants began  to replace                                                               
licensed professional in physician offices.                                                                                     
                                                                                                                                
REPRESENTATIVE KITO pointed out  that medical costs had continued                                                               
to increase since then.                                                                                                         
                                                                                                                                
CHAIR  SPOHNHOLZ  noted that  the  requirement  that health  care                                                               
providers use  the prescription drug  database had been  added in                                                               
the last few years at a time when  they had not been able to bill                                                               
for that.                                                                                                                       
                                                                                                                                
4:19:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked whether  the role of untrained students                                                               
working in medical offices was now becoming professionalized.                                                                   
                                                                                                                                
SENATOR GIESSEL  explained that the "regular"  medical assistant,                                                               
usually high school graduates, had been  trained on the job.  She                                                               
reported  that,  as the  education  became  more formalized  over                                                               
time, the State of Alaska now needed to recognize this training.                                                                
                                                                                                                                
REPRESENTATIVE  TARR  opined  that,  as people  would  be  better                                                               
prepared  to  provide  information,  there would  be  a  positive                                                               
benefit.     She   suggested  that   many  of   these  had   been                                                               
administrative, rather than health care positions.                                                                              
                                                                                                                                
SENATOR GIESSEL  expressed her agreement  and suggested  that the                                                               
certified  medical  assistant  would now  perform  more  invasive                                                               
medical procedures,  such as immunizations.   She listed  some of                                                               
the safeguards as a result of medical training.                                                                                 
                                                                                                                                
REPRESENTATIVE TARR  questioned whether  there would be  a public                                                               
comment   period  after   the   State   Medical  Board   prepared                                                               
regulations.                                                                                                                    
                                                                                                                                
SENATOR  GIESSEL   expressed  her  agreement,  noting   that  the                                                               
regulatory  process  took  about  one  year  to  complete,  which                                                               
included a period for public comment.                                                                                           
                                                                                                                                
REPRESENTATIVE  EASTMAN directed  attention to  Section 4  of the                                                               
proposed  bill  and  asked  for the  reasons  that  immunity  was                                                               
offered.                                                                                                                        
                                                                                                                                
4:24:20 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL stated that this  was standard language in health                                                               
care statutes for providing immunity  to people making reports of                                                               
incidences.                                                                                                                     
                                                                                                                                
REPRESENTATIVE EASTMAN,  referencing AS 08.64.111,  asked whether                                                               
use of the abbreviation C.M.A.  was intended and whether it would                                                               
run "afoul of the trademark issue" mentioned previously.                                                                        
                                                                                                                                
SENATOR  GIESSEL  replied  that   this  decision  to  choose  the                                                               
certifying  body for  the trademark  C.M.A. was  up to  the State                                                               
Medical  Board,  pointing  out   that  these  initials  were  not                                                               
specified in the proposed bill.                                                                                                 
                                                                                                                                
REPRESENTATIVE EASTMAN  directed attention  to Section 12  of the                                                               
proposed bill and asked whether  the certified medical assistants                                                               
were practicing medicine.                                                                                                       
                                                                                                                                
SENATOR  GIESSEL  explained  that  Section 12  indicated  that  a                                                               
medical  assistant  licensed  under  a separate  chapter  of  the                                                               
proposed  bill  was  exempt from  practicing  without  a  medical                                                               
license.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  if  the other  chapter provided  a                                                               
comparable penalty.                                                                                                             
                                                                                                                                
SENATOR  GIESSEL  acknowledged  that  there  were  penalties  for                                                               
practicing  medicine without  a license.   She  shared the  State                                                               
Medical Board list of other licenses and certificates.                                                                          
                                                                                                                                
4:27:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO expressed  concern regarding  the definition                                                               
of medical professional in Section 14.                                                                                          
                                                                                                                                
SENATOR GIESSEL  directed attention  to similar positions  on the                                                               
medical board  list and acknowledged  that it was a  rather broad                                                               
definition.                                                                                                                     
                                                                                                                                
REPRESENTATIVE KITO compared this  to dental assistants who could                                                               
be delegated tasks  and asked about the  consideration of someone                                                               
as a medical professional "who has zero training."                                                                              
                                                                                                                                
SENATOR GIESSEL explained that the  purpose for the definition of                                                               
medical  professional was  to authorize  for the  routine medical                                                               
tasks, which  included the medical assistant  with certification.                                                               
She suggested that the dental assistant should be added.                                                                        
                                                                                                                                
4:31:03 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened invited testimony.                                                                                       
                                                                                                                                
4:31:15 PM                                                                                                                    
                                                                                                                                
FRED  PARADY, Deputy  Commissioner, Office  of the  Commissioner,                                                               
Department of Commerce, Community  & Economic Development, stated                                                               
his support of  the proposed bill.  He stated  that, in FY17, the                                                               
Department  of Commerce,  Community  &  Economic Development  had                                                               
processed 22  percent more medical  licenses and 31  percent more                                                               
nursing  licenses, reflecting  the  increased  demand for  health                                                               
care professionals  in Alaska.   He reported that  the department                                                               
had  initiated  a  strategic planning  process  which  identified                                                               
streamlining the application process  for health care professions                                                               
as   its  highest   priority.     This   initiative  included   a                                                               
comprehensive  examination  of  the processes,  which  identified                                                               
every  step  of   the  process  to  search   for  roadblocks  and                                                               
bottlenecks.    He  noted  that   27  of  these  roadblocks  were                                                               
identified and evaluated  for the cause in order  to determine if                                                               
this was a public safety  need, whether the process was obsolete,                                                               
and  whether the  roadblock could  be simplified.   He  explained                                                               
that  there  was a  three-pronged  approach  to implementing  the                                                               
solutions  to these  roadblocks: some  were in  board regulation,                                                               
some were improvements  to the IT process, and  some were changes                                                               
to statute.                                                                                                                     
                                                                                                                                
4:34:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked if the processing  for the                                                               
positions  in  the proposed  bill  would  be  paid by  the  State                                                               
Medical Board.                                                                                                                  
                                                                                                                                
MR. PARADY said that they would.                                                                                                
                                                                                                                                
4:35:20 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
4:35:43 PM                                                                                                                    
                                                                                                                                
DANNY  ROBINETTE, MD,  Chief Medical  Officer, Foundation  Health                                                               
Partners,  stated that  his organization  was in  support of  the                                                               
proposed  bill to  expedite  the  process.   He  reported on  the                                                               
struggle  to  bring   physicians  to  Alaska.     He  lauded  the                                                               
safeguards in the proposed bill to ensure clean applications.                                                                   
                                                                                                                                
4:37:35 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
4:37:54 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:38:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR said that the  proposed bill was an important                                                               
step forward  to hopefully result in  more access to care  and to                                                               
lower costs.   She  stated that  it would  be imperative  for the                                                               
legislature to maintain a vigil  for the regulations upon release                                                               
to the public.                                                                                                                  
                                                                                                                                
CHAIR SPOHNHOLZ said that she  had heard concerns from physicians                                                               
about the  prescription drug database requirement,  and that this                                                               
new category  would allow health  care practitioners  more office                                                               
efficiency.   She  stated  that the  temporary  licensing was  an                                                               
important aspect and that there were appropriate fail safes.                                                                    
                                                                                                                                
4:40:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY  moved  to   report  CSSSSB  108  (FIN),                                                               
Version    30-LS0740\I,    from   committee    with    individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no  objection,  CSSSSB 108  (FIN)  was  reported from  the  House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
4:40:26 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:40 p.m. to 4:42 p.m.                                                                       
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                    CONFIRMATION HEARING(S)                                                                                 
                      State Medical Board                                                                                   
                                                                                                                                
4:42:47 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be a confirmation hearing for the Alaska State Medical Board.                                                                   
                                                                                                                                
LIU SAI-LING, MD,  Appointee, State Medical Board,  said that she                                                               
was a  board-certified family  practice physician,  practicing in                                                               
Nome for  28 years.  She  was the Medical Director  for the long-                                                               
term care  facility.   She said  that she had  been on  the State                                                               
Medical Board for the past four  years, and that she was applying                                                               
for a  second term.  She  noted that the State  Medical Board had                                                               
had  a  lot  of  turnover  and that  it  was  important  to  have                                                               
continuity of service.   She declared that it was  an honor to be                                                               
on  the board,  that the  other members  were very  dedicated and                                                               
took the  responsibilities seriously,  and that it  was a  lot of                                                               
work.   She pointed  out that,  even though  travel for  the last                                                               
board meeting  had not  been approved due  to state  budget cuts,                                                               
everyone had paid their own way to Anchorage for the meeting.                                                                   
                                                                                                                                
4:45:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked if there  was full  participation from                                                               
the current state medical board  members, in order to ensure that                                                               
the license applications were addressed.                                                                                        
                                                                                                                                
DR. LIU said that it was  not an issue, and that occasionally one                                                               
person would  not be able to  attend.  She declared  that members                                                               
took their role very seriously and participated.                                                                                
                                                                                                                                
REPRESENTATIVE  TARR asked  about  board  turnover, whether  many                                                               
board members only served one term.                                                                                             
                                                                                                                                
DR. LIU explained  that in the last two years,  many of the terms                                                               
had expired, hence a lot of turnover.                                                                                           
                                                                                                                                
4:47:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZULKOSKY moved to  advance the confirmation of Dr.                                                               
Liu Sai-Ling, appointee  to the Alaska State Medical  Board, to a                                                               
joint session  of the  House and Senate  for consideration.   She                                                               
reminded  the   committee  that  signing  the   report  regarding                                                               
appointment in  no way reflects  individual members'  approval or                                                               
disapproval  of the  appointee,  and the  nominations are  merely                                                               
forwarded to the full legislature  for confirmation or rejection.                                                               
There being no objection, the confirmation was advanced.                                                                        
                                                                                                                                
            HB 358-INSURANCE COVERAGE FOR TELEHEALTH                                                                        
                                                                                                                                
4:48:11 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be HOUSE  BILL NO.  358, "An Act  relating to  insurance coverage                                                               
for benefits  provided through telehealth;  and providing  for an                                                               
effective date."                                                                                                                
                                                                                                                                
4:48:22 PM                                                                                                                    
                                                                                                                                
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State  Legislature,   declared  that  there  had   not  been  any                                                               
opposition  to the  proposed bill  and she  paraphrased from  the                                                               
Sectional Analysis [Included in members' packets], which read:                                                                  
                                                                                                                                
     Section 1.                                                                                                             
                                                                                                                                
     AS  21.42.422 has  been  amended  to require  insurance                                                                    
     coverage for benefits provided via telehealth.                                                                             
                                                                                                                                
     Section 2.                                                                                                             
                                                                                                                                
     AS 21.42.422  is a new  subsection that  defines health                                                                    
     care insurer  as a person  transacting the  business of                                                                    
     health   care  insurance   except   for  a   nonfederal                                                                    
     governmental  plan.  It  also adds  the  definition  of                                                                    
     telehealth  under  47.05.270(e)   as  the  practice  of                                                                    
     health    care    delivery,   evaluation,    diagnosis,                                                                    
     consultation,  or  treatment,  using  the  transfer  of                                                                    
     health  care  data  through   audio,  visual,  or  data                                                                    
     communications,  performed over  two or  more locations                                                                    
     between  providers who  are  physically separated  from                                                                    
     the recipient or from each  other or between a provider                                                                    
     and a recipient who  are physically separated from each                                                                    
     other.                                                                                                                     
                                                                                                                                
     Section 3                                                                                                              
                                                                                                                                
        The changes to Section 1 of this bill applies to                                                                        
     health care insurance plans that are offered, issued,                                                                      
     delivered, or renewed on or after the effective date.                                                                      
                                                                                                                                
     Section 4                                                                                                              
                                                                                                                                
     The effective date is July 1, 2019.                                                                                        
                                                                                                                                
4:49:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened invited testimony.                                                                                       
                                                                                                                                
4:49:54 PM                                                                                                                    
                                                                                                                                
AROM  EVANS,  MD,  Medical   Director,  Orion  Behavioral  Health                                                               
Network, stated support for the  proposed bill, pointing out that                                                               
telemedicine  was   an  extremely  important  service   for  many                                                               
residents of  rural villages as  it was  not realistic to  have a                                                               
psychiatrist reside  in these communities.   He pointed  out that                                                               
sometimes  private   insurance  did   not  pay   for  telehealth,                                                               
resulting  in difficulties  for many  patients.   He stated  that                                                               
neglect of  mental health issues  tended to drive up  health care                                                               
costs, and that payment by  private insurers for telehealth would                                                               
save money for the state.                                                                                                       
                                                                                                                                
4:53:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY asked  if  the  Orion Behavioral  Health                                                               
Network partnered with Alaska providers  who had encountered this                                                               
challenge.                                                                                                                      
                                                                                                                                
DR. EVANS  explained that  there were  Alaska providers  in their                                                               
network  and   they  had  encountered  difficulties   in  getting                                                               
services paid for both in and out of state providers.                                                                           
                                                                                                                                
4:55:08 PM                                                                                                                    
                                                                                                                                
LYN FREEMAN,  Ph.D., Mind Matters Research,  declared her support                                                               
for  the proposed  bill.    She shared  some  background for  her                                                               
practice, stating that she treated  patients who were referred to                                                               
her  with  chronic disease  and  behavioral  or emotional  issues                                                               
which  contributed  to  a  worsening   of  the  condition.    She                                                               
practiced  various  forms  of integrative  approaches,  including                                                               
non-pharmalogical pain  management.  She  reported that  about 40                                                               
percent of  her practice  was through  tele-health as  travel was                                                               
not  possible for  these patients.    She reported  that she  had                                                               
tested her research for  psychological interventions for patients                                                               
with  chronic  diseases  through  both live  delivery  and  tele-                                                               
health,  and that  improvement outcome  was  equivalent for  both                                                               
systems  of  delivery.    She  shared  that  she  had  maintained                                                               
training  for the  ethical aspect  in the  use of  telehealth for                                                               
mental  health  treatment.    She   reported  that  these  ethics                                                               
trainings had pointed out that  it was preferable to treat people                                                               
in  your  own state  as  it  was  easier  to know  the  resources                                                               
available   should   something   happen   during   the   distance                                                               
treatments.                                                                                                                     
                                                                                                                                
4:59:30 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
4:59:47 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
4:59:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  about  the scope  of the  benefits                                                               
being provided.                                                                                                                 
                                                                                                                                
5:00:48 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ, as  the  sponsor of  the  bill, clarified  that                                                               
receiving medical care  via telehealth did not mean  not seeing a                                                               
doctor.    As  telehealth  was  a delivery  system,  it  was  not                                                               
necessary to  limit the scope in  the proposed bill.   She shared                                                               
that she did  not want to put limits on  the creativity of health                                                               
care providers based  on the current ability to  imagine what can                                                               
and cannot be done, and that  this would allow the marketplace to                                                               
develop.                                                                                                                        
                                                                                                                                
5:01:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked if this  meant that any  benefits a                                                               
health care insurer provided coverage  for should also be covered                                                               
via telehealth.                                                                                                                 
                                                                                                                                
CHAIR  SPOHNHOLZ emphasized  that this  was intentionally  broad,                                                               
and that  this was  based on  her own  experiences for  not being                                                               
able to  access health care  services via telehealth.   This lead                                                               
to the exploration of the concept  of telehealth as it related to                                                               
private  insurance.   She stated  that,  as not  all health  care                                                               
insurers would  currently pay for  this, it  was time to  move in                                                               
that direction.                                                                                                                 
                                                                                                                                
5:03:12 PM                                                                                                                    
                                                                                                                                
VICTORIA KNAPP, Chief Operating  Officer, Mat-Su Health Services,                                                               
stated that  she was  in support  of HB 358.   She  reported that                                                               
several years  ago Mat-Su  Health Services had  moved to  a tele-                                                               
medicine  model for  some of  their  psychiatric evaluations  and                                                               
medication  management appointments  to  meet some  of the  unmet                                                               
need for these  services in the borough.  She  declared that they                                                               
were a safety net provider,  funded by the federal government and                                                               
the Division of  Behavioral Health.  She shared  that, as several                                                               
large insurance providers  in the state did  not provide coverage                                                               
for  tele-health services,  families  and  individuals were  left                                                               
with the  choice of a  very large  bill or looking  elsewhere for                                                               
psychiatry  services.    She   declared  frustration  that  these                                                               
insurers did not cover tele-health psychiatry.                                                                                  
                                                                                                                                
5:05:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY  moved to  report  HB  358, Version  30-                                                               
LS1216\J, out  of committee  with individual  recommendations and                                                               
the attached zero fiscal notes.                                                                                                 
                                                                                                                                
5:05:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN objected.  He  explained that all his U.S.                                                               
Department of  Veterans Affairs health  care through  his primary                                                               
care doctor in Orlando, Florida,  was via tele-health.  He stated                                                               
his appreciation for  the value, and opined  that, although there                                                               
were cost  savings to be gained,  the market was not  ready for a                                                               
mandate  that any  provided health  care also  be accessible  via                                                               
tele-health.   He offered his  belief that, if it  made financial                                                               
sense,  providers  would  go  that direction.    He  stated  that                                                               
telehealth  was  not  everything  it   could  be,  and  that  the                                                               
providers should have the option to not have to use it.                                                                         
                                                                                                                                
5:07:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  if  there was  a list  of                                                               
what  was approved  for telehealth  medicine  for procedures  and                                                               
oversight for patients.                                                                                                         
                                                                                                                                
5:07:39 PM                                                                                                                    
                                                                                                                                
MS.  NISBETT said  that there  was a  list of  procedures on  the                                                               
Alaska Native Medical Center website that were accepted.                                                                        
                                                                                                                                
CHAIR SPOHNHOLZ pointed out that this was a different category.                                                                 
                                                                                                                                
5:08:16 PM                                                                                                                    
                                                                                                                                
ANNA LATHAM,  Deputy Director, Division of  Insurance, Department                                                               
of  Commerce, Community  & Economic  Development, clarified  that                                                               
the  proposed bill  allowed for  insurance companies  to pay  for                                                               
telehealth  services in  both the  group and  individual markets.                                                               
She stated that  the benefits that were already in  the plans for                                                               
essential health benefits, as well  as any other benefits covered                                                               
by the plan, would be allowable  for telehealth.  She stated that                                                               
the list  of benefits for  the Alaska  Native Health plans  was a                                                               
separate program.                                                                                                               
                                                                                                                                
5:09:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZULKOSKY asked whether  the proposed bill mandated                                                               
that  an individual  utilize telehealth  services, or  whether it                                                               
just provided  the authorization  for the  insurance plans  to be                                                               
billed for those services.                                                                                                      
                                                                                                                                
MS. LATHAM replied that there was  not a mandate, that it allowed                                                               
the  insurance  companies  to cover  telehealth  services  beyond                                                               
mental health, which was currently in statute.                                                                                  
                                                                                                                                
5:09:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  whether a  current benefit  from a                                                               
health  care plan  would now  also  be provided  as a  telehealth                                                               
option.                                                                                                                         
                                                                                                                                
MS. LATHAM  explained that, with  the proposed bill,  the insurer                                                               
can pay if you utilize telehealth.                                                                                              
                                                                                                                                
5:10:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  about the  definition of  shall in                                                               
this specific context.                                                                                                          
                                                                                                                                
5:10:32 PM                                                                                                                    
                                                                                                                                
MS. LATHAM  explained that  the proposed  billed stated  that the                                                               
insurers  shall provide  coverage for  benefits provided  through                                                               
telehealth.   This  may  or may  not  require in-person  contact.                                                               
This  proposed  bill  simply  allowed  large,  small  group,  and                                                               
individual market coverage to pay for telehealth services.                                                                      
                                                                                                                                
CHAIR SPOHNHOLZ  asked for clarification  that the  proposed bill                                                               
was not requiring people to  use telehealth, but it was requiring                                                               
insurance companies to cover telehealth  services should the plan                                                               
have a provision for such  services.  She acknowledged that there                                                               
were  some services  which did  not make  sense for  delivery via                                                               
telehealth.  She  pointed out that there were a  lot of insurance                                                               
plans offered in  the State of Alaska which were  not required to                                                               
cover telehealth.  She stated that  this bill was not saying what                                                               
kind  of health  care should  be  covered by  telehealth, it  was                                                               
saying that the insurance provider  should pay for the service if                                                               
it was delivered via telehealth.                                                                                                
                                                                                                                                
5:12:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN asked  where he could go to  find out what                                                               
services were available  by telehealth.  He asked  if one insurer                                                               
decided to  provide a benefit  via telehealth, did all  the other                                                               
insurers need to match.                                                                                                         
                                                                                                                                
CHAIR  SPOHNHOLZ said  that was  a decision  between him  and his                                                               
health care provider.                                                                                                           
                                                                                                                                
5:13:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN maintained his objection.                                                                                
                                                                                                                                
5:13:27 PM                                                                                                                    
                                                                                                                                
A roll  call vote  was taken.   Representatives  Spohnholz, Tarr,                                                               
Sullivan-Leonard, Johnston, Zulkosky, and Kito  voted in favor of                                                               
HB 358.   Representatives Eastman  voted against it.   Therefore,                                                               
HB 358 was  reported out of the House Health  and Social Services                                                               
Standing Committee by a vote of 6 yeas - 1 nay.                                                                                 
                                                                                                                                
5:14:07 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 5:14 p.m. to 5:16 p.m.                                                                       
                                                                                                                                
         HJR 32-CONST. AM: PARENTAL CONSENT TO ABORTION                                                                     
                                                                                                                                
5:16:23 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be HOUSE JOINT  RESOLUTION NO. 32, Proposing an  amendment to the                                                               
Constitution  of  the State  of  Alaska  relating to  notice  and                                                               
consent before termination of a minor's pregnancy.                                                                              
                                                                                                                                
5:16:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GABRIEL LEDOUX, Alaska State Legislature,                                                                        
paraphrased from the Sponsor Statement [Included in members'                                                                    
packets], which read:                                                                                                           
                                                                                                                                
     HJR  32  seeks to  add  a  new  section to  the  Alaska                                                                    
     Constitution  allowing the  legislature  OR the  people                                                                    
     through the  initiative process, to have  the option to                                                                    
     require notice  to and consent  of the parent  or legal                                                                    
     guardian  of a  minor before  the minor's  pregnancy is                                                                    
     terminated.                                                                                                                
                                                                                                                                
     Deciding  whether to  continue a  pregnancy or  have an                                                                    
     abortion is  a decision that will  have major long-term                                                                    
     impacts on the life of  a young woman. Notification and                                                                    
     consent  laws help  pregnant teens  to get  support and                                                                    
     guidance  from their  parents  or guardians.  Currently                                                                    
     parents or guardians must give  consent for their child                                                                    
     to be treated  by a school nurse, buy  cough syrup, get                                                                    
     their ears  pierced, take a  risk assessment  survey in                                                                    
     school, go on  a field trip or watch an  R rated movie.                                                                    
     In Alaska parents cannot even  give consent for a child                                                                    
     under 18  to get  a tattoo. Parents  have the  right to                                                                    
     know about  the activities of their  underage teens and                                                                    
     especially about a  decision as big as  an abortion. As                                                                    
     a parent I would want to know.                                                                                             
                                                                                                                                
5:18:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX paraphrased from the resolution, [Included                                                                
in members' packets], which read:                                                                                               
                                                                                                                                
     Section  1. Article  I, Constitution  of  the State  of                                                                    
     Alaska, is amended by adding a new 5 section to read:                                                                      
                                                                                                                                
          Section 26. Notice and Consent before Termination                                                                     
     of  Minor's  Pregnancy.   This  constitution  does  not                                                                    
     prohibit the  legislature or the people  from requiring                                                                    
     notice  to  and the  consent  of  the parent  or  legal                                                                    
     guardian  of a  minor before  the minor's  pregnancy is                                                                    
     terminated.  The   legislature  shall   implement  this                                                                    
     section  by  law  in  a   manner  consistent  with  the                                                                    
     requirements of the Constitution  of the United States,                                                                    
     and   the  people   may  implement   this  section   by                                                                    
     initiative   in   a    manner   consistent   with   the                                                                    
     requirements of the Constitution of the United States.                                                                     
                                                                                                                                
     Sec.  2.  The  amendment proposed  by  this  resolution                                                                    
     shall be placed  before the voters of the  state at the                                                                    
     next  general election  in conformity  with art.  XIII,                                                                    
     sec. 1,  Constitution of  the State  15 of  Alaska, and                                                                    
     the election laws of the state.                                                                                            
                                                                                                                                
5:19:54 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said that the resolution would be held over.                                                                    
                                                                                                                                
5:20:18 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:20 p.m.                                                                                                          

Document Name Date/Time Subjects
SB 174 30-LS1258 D.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Sponsor Statement.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Fiscal Note.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Supporting Documents.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Public Input.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Supporting Documents - Written Testimony - Laura Bonner - 3.13.2018.pdf HCRA 3/13/2018 8:00:00 AM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Supporting Document-Support Letter 03.15.2018.pdf HCRA 3/15/2018 8:00:00 AM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB 174 Supporting Documents - Written Testimony - Laura Bonner - 3.13.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Fiscal Note DHSS-SDSA 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Sectional Analysis ver D 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Sponsor Statement 03.15.18.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 supporting Documents-2018 Alaska's Developmental Disabilities System 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Supporting Document-Support Letter-Lizette Stiehr 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HR 3
SB 174
SB174 Supporting Document-Support Letters 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Supporting Document--Written Testimony from Kenai LIO 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
SB 174
Sai-Ling Liu 2017_Redacted.pdf HHSS 3/29/2018 3:00:00 PM
Medical Board Confirmation
HB 193 Addtional Documents - Policy Implications of Legislating AlaskaCare Benefits Final 2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Document - Letter of Concern AHIP 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Documents - DOA Position Statement 3.26.18.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Document - NCSL Reports 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Document - Emergency CPT Code Table 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Supporting document - Georgetown Universtiy Health Policy Insititute 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Definitions 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Draft Proposed Blank CS ver T 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Sectional Analysis 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Sponsor Statement 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB193 Fiscal Note CED--IO 3.7.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
SSSB108 Supporting Document Backlog Stats DCCED 2-13-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Supporting Document Flow Chart 2016.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) Fiscal Note DCCED 3-14-18.PDF HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) Sectional Analysis 3-14-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) vsn I 3-14-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Power Point 3-24-18_cg.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Version U 1-18-18.PDF HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) Explanation of Changes 3-14-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 CS (FIN) Sponsor Statement 3-13-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support - Foundation Health Partners 2-7-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support ASMA 2-27-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support ASMB 2-9-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support Cmmsr Navarre 2-2-16.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Support Letter AK State Medical Bd 1-24-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
HB358 Sectional Analysis ver J 03.07.18.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 358
HJR032 Sponsor Statement 2.27.18.pdf HHSS 3/29/2018 3:00:00 PM
HJR 32