Legislature(2019 - 2020)CAPITOL 106

03/26/2019 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 22 EXTEND SUICIDE PREVENTION COUNCIL TELECONFERENCED
Heard & Held
-- Testimony <Public/Invited> --
*+ HB 29 INSURANCE COVERAGE FOR TELEHEALTH TELECONFERENCED
Heard & Held
-- Testimony <Public/Invited> --
*+ HB 86 MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS TELECONFERENCED
<Bill Hearing Rescheduled to 3/28/19>
*+ HB 97 TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS TELECONFERENCED
Heard & Held
-- Testimony <Public/Invited> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 26, 2019                                                                                         
                           3:05 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
Representative Lance Pruitt                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 22                                                                                                               
"An Act extending the termination date of the Statewide Suicide                                                                 
Prevention Council; and providing for an effective date."                                                                       
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 29                                                                                                               
"An Act relating to insurance coverage for benefits provided                                                                    
through telehealth; and providing for an effective date."                                                                       
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 97                                                                                                               
"An Act relating to the prescription of drugs by a physician                                                                    
assistant without physical examination."                                                                                        
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 86                                                                                                               
"An Act relating to a state-owned inpatient mental health                                                                       
treatment hospital; and providing for an effective date."                                                                       
                                                                                                                                
     - BILL HEARING RESCHEDULED TO 3/28/19                                                                                      
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 22                                                                                                                   
SHORT TITLE: EXTEND SUICIDE PREVENTION COUNCIL                                                                                  
SPONSOR(s): REPRESENTATIVE(s) TARR                                                                                              
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/7/19                                                                                
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       HSS, FIN                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 29                                                                                                                   
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH                                                                                  
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/11/19                                                                               
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       HSS, L&C                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 97                                                                                                                   
SHORT TITLE: TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                            
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS                                                                                    
                                                                                                                                
03/15/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/15/19       (H)       HSS, L&C                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
LINDA DAY, Audit Manager                                                                                                        
Legislative Audit Division                                                                                                      
Legislative Agencies and Offices                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 22.                                                                    
                                                                                                                                
BEVERLY SCHOONOVER, Acting Executive Director                                                                                   
Statewide Suicide Prevention Council                                                                                            
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of HB 22.                                                                    
                                                                                                                                
BARBARA FRANKS, Chairperson                                                                                                     
Statewide Suicide Prevention Council                                                                                            
Ninilchik, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 22.                                                                    
                                                                                                                                
NICOLE BORROMEO, Executive Vice President and General Council                                                                   
Alaska Federation of Natives (AFN)                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 22.                                                                           
                                                                                                                                
BRENDA MOORE                                                                                                                    
Statewide Suicide Prevention Council                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 22.                                                                    
                                                                                                                                
SAM TRIVETTE                                                                                                                    
Juneau Suicide Prevention Coalition                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 22.                                                                           
                                                                                                                                
MONIQUE ANDREWS                                                                                                                 
Statewide Suicide Prevention Council                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 22.                                                                           
                                                                                                                                
KRISTINA JAGER                                                                                                                  
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 22.                                                                           
                                                                                                                                
PATTY OWEN                                                                                                                      
Alaska Public Health Association (ALPHA)                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 22.                                                                           
                                                                                                                                
BERNICE NISBETT, Staff                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced the Sectional Analysis for HB 29                                                              
on behalf of the sponsor, Representative Spohnholz.                                                                             
                                                                                                                                
LORI WING-HEIER, Director                                                                                                       
Juneau Office                                                                                                                   
Division of Insurance                                                                                                           
Department of Commerce, Community & Economic Development                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified and answered questions during                                                                  
discussion of HB 29.                                                                                                            
                                                                                                                                
VICTORIA KNAPP, Chief Operations Officer                                                                                        
Mat-Su Health Services, Inc.                                                                                                    
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of HB 29.                                                                           
                                                                                                                                
AROM EVANS, MD                                                                                                                  
Orion Behavioral Health Network                                                                                                 
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 29 and HB 97.                                                                 
                                                                                                                                
ROBERT BARATTA                                                                                                                  
National Consultant                                                                                                             
Teladoc Health                                                                                                                  
Richmond, Virginia                                                                                                              
POSITION STATEMENT:  Testified during discussion of HB 29.                                                                    
                                                                                                                                
CYNTHIA MARK                                                                                                                    
Teladoc Health                                                                                                                  
Michigan                                                                                                                        
POSITION STATEMENT:  Testified in support of HB 29.                                                                           
                                                                                                                                
CHRISTOPHER DIETRICH, Assistant Medical Director                                                                                
Orion Behavioral Health Network                                                                                                 
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 29 and HB 97.                                                                 
                                                                                                                                
REID HARRIS, Staff                                                                                                              
Representative Jonathan Kreiss-Tomkins                                                                                          
Alaska State Legislature                                                                                                        
POSITION STATEMENT:  Presented HB 97 on behalf of the bill                                                                    
sponsor, Representative Kreiss-Tomkins.                                                                                         
                                                                                                                                
DEBORAH STOVERN, Executive Administrator                                                                                        
State Medical Board                                                                                                             
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community & Economic Development                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
97.                                                                                                                             
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:05:16 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:05   p.m.                                                               
Representatives  Zulkosky,  Spohnholz,  Tarr, and  Drummond  were                                                               
present at  the call to  order.  Representatives  Claman, Pruitt,                                                               
and Jackson arrived as the meeting was in progress.                                                                             
                                                                                                                                
            HB 22-EXTEND SUICIDE PREVENTION COUNCIL                                                                         
                                                                                                                                
3:05:48 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY announced  that  the first  order of  business                                                               
would be  HOUSE BILL  NO. 22, "An  Act extending  the termination                                                               
date of  the Statewide Suicide Prevention  Council; and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
3:06:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR introduced  HB  22, as  the  sponsor of  the                                                               
bill, and stated  that the proposed bill was more  than simply an                                                               
extension  for  the termination  date  of  the Statewide  Suicide                                                               
Prevention  Council.   She  pointed  to  the recent  2019  Alaska                                                               
statistics  for  suicide  prevention  which  indicated  that  one                                                               
person died  by suicide every 44  hours.  She reported  that this                                                               
was the fifth  leading cause of death in Alaska,  while being the                                                               
leading cause of  death in ages 15  - 24.  She  added that Alaska                                                               
was second  in the nation  with suicide  deaths per capita.   She                                                               
pointed to an  increase in the recent rate  of suicide, declaring                                                               
that this was  an impact upon too many Alaskans.   She emphasized                                                               
the need  for a  Suicide Prevention Council,  and that  even more                                                               
needed to be  done.  She pointed to the  20,976 calls during 2018                                                               
to the CARE  line, an annual increase of almost  30 percent.  She                                                               
reported  that  the  Statewide  Suicide  Prevention  Council  was                                                               
comprised  of 14  individuals, which  included 4  legislators, as                                                               
non-voting members.                                                                                                             
                                                                                                                                
3:10:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  paraphrased   from  the  sponsor  statement                                                               
[Included  in members'  packets][original punctuation  provided],                                                               
which read:                                                                                                                     
                                                                                                                                
     House Bill 22 would extend  the termination date of the                                                                    
     Statewide Suicide Prevention  Council to 2027, ensuring                                                                    
     another eight  years of support for  suicide prevention                                                                    
     efforts  in  Alaska.  The Council  would  otherwise  be                                                                    
     terminated on  June 30, 2019.  According to  the Alaska                                                                    
     Department  of Health  and Social  Services Section  of                                                                    
     Epidemiology, the  suicide rate in Alaska  increased by                                                                    
     13 percent  between 2012 and  2017, making  suicide the                                                                    
     leading cause  of death for  Alaskans between  the ages                                                                    
     of 10 and  64. As a matter of public  health, the state                                                                    
     has a  responsibility to address this  disturbing trend                                                                    
     and  must actively  continue  to  pursue strategies  to                                                                    
     prevent  suicide  in   Alaska.  The  Statewide  Suicide                                                                    
     Prevention Council was created  in 2001 and consists of                                                                    
     14  public and  private members,  including four  state                                                                    
     legislators.  Under   AS  44.39.350,  the   Council  is                                                                    
     statutorily  responsible  for: ?  Advising  legislators                                                                    
     and the  Governor on ways  to improve  Alaskans' health                                                                    
     and wellness  by reducing  suicide; ?  Improving public                                                                    
     awareness  of suicide  and  risk  factors; ?  Enhancing                                                                    
     suicide  prevention efforts;  ?  Working with  partners                                                                    
     and  faith-based  organizations  to  develop  healthier                                                                    
     communities; ? Creating  a statewide suicide prevention                                                                    
     plan  and putting  it  in action;  and  ? Building  and                                                                    
     strengthening  partnerships  to  prevent  suicide.  The                                                                    
     Council  holds  public  meetings,  publishes  a  5-Year                                                                    
     State Suicide  Prevention Plan, and works  with schools                                                                    
     and community groups to  provide resources that educate                                                                    
     Alaskans  on how  to prevent  suicide.  Last year,  the                                                                    
     Council partnered with  the Alaska Community Foundation                                                                    
     and  Alaska  Children's  Trust   to  continue  the  GCI                                                                    
     Suicide  Prevention  Grant  Program. Nine  grants  were                                                                    
     funded  in 2017  across the  state, totaling  $100,000.                                                                    
     The  Council also  helped secure  funding for  a 5-year                                                                    
     grant from  the National Institute of  Mental Health to                                                                    
     create   the  Alaska   Native  Collaborative   Hub  for                                                                    
     Resilience  Research,  which  will help  Alaska  Native                                                                    
     communities  share   knowledge,  guide   research,  and                                                                    
     identify    culturally-relevant   suicide    prevention                                                                    
     strategies in  rural Alaska. Terminating  the Statewide                                                                    
     Suicide   Prevention  Council   would  jeopardize   the                                                                    
     state's efforts  at addressing this  heartbreaking, but                                                                    
     preventable,  issue.   I  respectfully  ask   for  your                                                                    
     support of HB 22 this year.                                                                                                
                                                                                                                                
REPRESENTATIVE TARR  pointed out that there  was a recommendation                                                               
by  the Legislative  Audit  Division to  extend  the council  for                                                               
eight years.  She directed  attention to the fiscal note, labeled                                                               
OMB  Component Number  2651 [Included  in  members' packets]  and                                                               
explained  that  this  included not  only  the  expenditures  for                                                               
staffing, but the bulk was  directed for grants to the Department                                                               
of Education  and Early Development.   She concluded  and pointed                                                               
to the  checklists [Included in  members' packets]  for families,                                                               
communities,  and  individuals  which  offered  ways  to  make  a                                                               
difference for Alaskans impacted by suicide.                                                                                    
                                                                                                                                
3:15:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JACKSON asked  if the  $648,000 requested  on the                                                               
fiscal note was an annual request.                                                                                              
                                                                                                                                
REPRESENTATIVE TARR  replied, "that's  true, yes."   She directed                                                               
attention to the  grants and benefits line, noting  that this was                                                               
the bulk  of the requested funding  and that it was  for "really,                                                               
really important work in the schools."                                                                                          
                                                                                                                                
REPRESENTATIVE JACKSON  expressed her concern that  this money be                                                               
directed toward education, but instead  be directed toward mental                                                               
services.   She offered  her belief  that investment  through the                                                               
schools may not be  the best place to funnel the  money as it may                                                               
be the  "last place young  people want  to talk about  it because                                                               
they will  feel ridicule."   She declared  the need to  shift the                                                               
perspective as  the suicide  numbers were not  coming down.   She                                                               
stated  her support  for the  proposed  bill and  added that  she                                                               
would be a member of the council.                                                                                               
                                                                                                                                
3:18:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  said that she  would follow up with  her and                                                               
explained that  there was  now an  understanding for  "the trauma                                                               
informed approach" to  be effective.  She noted that  some of the                                                               
materials  had been  developed for  educators.   She acknowledged                                                               
that  although  the program  infrastructure  appeared  to be  the                                                               
same,  the actual  work completed  through these  grants was  now                                                               
very relevant and  based on what was currently  understood as the                                                               
best practices.   She expressed her  hope that this was  the best                                                               
and most effective use of the dollars.                                                                                          
                                                                                                                                
REPRESENTATIVE JACKSON replied  that she would wait  to hear from                                                               
the various organizations.                                                                                                      
                                                                                                                                
REPRESENTATIVE TARR  offered that  there could be  responses from                                                               
the testifiers directed toward her concerns.                                                                                    
                                                                                                                                
3:20:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN shared his  agreement with the expansion to                                                               
an  eight-year renewal,  noting  that  there was  a  cost to  the                                                               
shorter time frames.                                                                                                            
                                                                                                                                
REPRESENTATIVE TARR  replied that  the issues facing  the council                                                               
were very challenging and took time and generational change.                                                                    
                                                                                                                                
3:21:41 PM                                                                                                                    
                                                                                                                                
LINDA   DAY,   Audit   Manager,   Legislative   Audit   Division,                                                               
Legislative  Agencies  and  Offices, directed  attention  to  the                                                               
sunset  audit  of the  Suicide  Prevention  Council [Included  in                                                               
members' packets] dated  August 3, 2018.  She  explained that the                                                               
purpose of  a sunset audit  was to  determine whether a  board or                                                               
commission was serving the public  interest and whether it should                                                               
be extended.  She declared  that the Statewide Suicide Prevention                                                               
Council  was  authorized  by  statute  to  serve  in  an  advisor                                                               
capacity  to  the  Alaska  State  Legislature  and  the  governor                                                               
regarding suicide  awareness and  prevention.  She  reported that                                                               
it  had been  found  that  overall the  council  operated in  the                                                               
public's interest  by actively broadening the  public's awareness                                                               
of  suicide  prevention and  coordinating  the  efforts of  other                                                               
suicide  prevention  entities   which  included  state  agencies,                                                               
regional groups,  coalitions, and  local communities.   She added                                                               
that the council had fulfilled  its statutory duty by issuing the                                                               
2018 -  2022 Suicide Prevention  plan while working  closely with                                                               
the  stakeholders  to  add  and  refine  the  plan's  strategies,                                                               
resources, and indicators.   She directed attention to  page 4 of                                                               
the audit which  listed the schedule of  expenditures and funding                                                               
sources.  She  noted that the council was funded  by general fund                                                               
appropriations for about  $650,000 in FY18, with  the majority of                                                               
its expenditures  for suicide awareness prevention  programs with                                                               
the Department of  Education and Early Development.   She pointed                                                               
to pages 9 - 10 of the audit  which listed a detailed list of the                                                               
council   activities,   and   she   shared   two   administrative                                                               
recommendations.    On  page  12, it  was  recommended  that  the                                                               
executive  director develop  and implement  procedures to  ensure                                                               
that public notice for the  meetings was published accurately and                                                               
in a  timely manner.  Also,  on page 12, it  was recommended that                                                               
the  chair   of  the  council   develop  and   implement  written                                                               
procedures  to  ensure  performance  evaluations  were  completed                                                               
annually  for the  executive director,  as this  was required  in                                                               
statute.  She concluded by  stating that the division recommended                                                               
an extension for the council termination date of eight years.                                                                   
                                                                                                                                
3:25:50 PM                                                                                                                    
                                                                                                                                
BEVERLY SCHOONOVER, Acting  Executive Director, Statewide Suicide                                                               
Prevention Council, Division of  Behavioral Health, Department of                                                               
Health  and Social  Services,  reported that  she  had only  been                                                               
acting executive director for two months.                                                                                       
                                                                                                                                
3:26:50 PM                                                                                                                    
                                                                                                                                
BARBARA   FRANKS,  Chairperson,   Statewide  Suicide   Prevention                                                               
Council, shared  her personal story  as a  mother of a  child who                                                               
died by  suicide.   She noted  that she  had travelled  more than                                                               
700,000 miles in Alaska for trainings  to teach the signs for how                                                               
to  help someone.   She  reported that  there had  been 2,224,408                                                               
calls to the national helpline in 2018.                                                                                         
                                                                                                                                
3:31:09 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  thanked Ms.  Franks for sharing  her personal                                                               
experience, stating  how important this  was, and she  shared her                                                               
own  personal experiences  with  suicide.   She  pointed out  the                                                               
difficulty  for knowing  what to  say  to someone  impacted by  a                                                               
suicide and the need for  honest, transparent conversations about                                                               
suicide as the way to address the issue over the long term.                                                                     
                                                                                                                                
3:32:55 PM                                                                                                                    
                                                                                                                                
NICOLE BORROMEO,  Executive Vice  President and  General Council,                                                               
Alaska Federation  of Natives  (AFN), stated  the support  of AFN                                                               
for three main reasons:   Alaska Natives and American Indians are                                                               
the only  ethnic populations specifically  listed as  at-risk for                                                               
suicide by  the U.S. Substance  Abuse and Mental  Health Services                                                               
Administration.  Since  suicide disproportionately affects Alaska                                                               
Natives  and American  Indians,  the  suicide prevention  council                                                               
connects  the  public  to   state  government  resources,  raises                                                               
awareness,  increases  outreach,  and helps  secure  funding  for                                                               
projects  and   programs  that   help  our   communities  develop                                                               
community  and   culturally  relevant   programs  to   build  our                                                               
collective  resilience.   She stated  support of  continuation of                                                               
the  council and  support  to the  Alaska  Native Health  Board's                                                               
efforts  to expand  the membership  of the  council to  include a                                                               
subject matter  expert in prevention  who has  experience working                                                               
in the  tribal health care  system.  Finally, AFN  was supportive                                                               
of  HB 22  because the  council promoted  community wellness  and                                                               
used the  most current data  and research to inform  its upstream                                                               
approach.   She  stated that  there had  been too  many instances                                                               
where suicide  had reached epidemic levels  throughout Alaska and                                                               
that all Alaskans needed to know that suicide was preventable.                                                                  
                                                                                                                                
3:35:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY opened public testimony.                                                                                      
                                                                                                                                
3:35:40 PM                                                                                                                    
                                                                                                                                
BRENDA  MOORE,  Statewide  Suicide Prevention  Council,  reported                                                               
that she  was the representative  to the council from  the Alaska                                                               
Mental Health  Board.  She  stated that prevention  was primarily                                                               
about reducing risk and building  resilience and that the council                                                               
worked to  coordinate, advocate, and  educate.  She  relayed that                                                               
the grants were for primary  prevention and had touched the lives                                                               
of more than 200,000 people.   These learning modules allowed the                                                               
public to understand  the signs and symptoms of  suicide, and the                                                               
impacts of  toxic stress  and trauma that  create a  greater risk                                                               
for suicide.   She explained that a key role  for the council was                                                               
to  coordinate among  the various  local groups.   She  cautioned                                                               
that  there  were  other  chronic   illnesses  that  also  needed                                                               
prevention.    She declared  that  it  was necessary  to  develop                                                               
resiliency and deal with trauma  and toxic stress, hence the need                                                               
to  start  with  youth.    She  emphasized  that  the  work  with                                                               
Department  of  Education  and   Early  Development  was  key  to                                                               
addressing primary prevention.                                                                                                  
                                                                                                                                
3:41:10 PM                                                                                                                    
                                                                                                                                
SAM  TRIVETTE, Juneau  Suicide  Prevention  Coalition, said  that                                                               
there  had been  a suicide  death in  Juneau today  and shared  a                                                               
personal experience with  suicide.  He stated his  support for HB                                                               
22.   He said  that there  had been progress  made in  many areas                                                               
around the state,  pointing out that, as the CARE  line calls had                                                               
dramatically increased,  people were willing to  call and connect                                                               
with experts.   He offered  his belief  that the programs  in the                                                               
schools  had  "opened  up  kids, they  understand  the  signs  of                                                               
suicide" and that there were  programs that dealt with sources of                                                               
strength and resilience.  He  reported that several hospitals and                                                               
clinics were  screening for  suicide prevention.   He  added that                                                               
the  council  was developing  new  programs  that were  extremely                                                               
effective and would become best practices.                                                                                      
                                                                                                                                
3:46:01 PM                                                                                                                    
                                                                                                                                
MONIQUE  ANDREWS, Statewide  Suicide  Prevention Council,  stated                                                               
that she was  a member of the Alaska Army  National Guard and she                                                               
shared how  the suicide  prevention efforts  were working  in the                                                               
military.  She  reported that the increase of  suicides in Alaska                                                               
was on  par with  the national  and the  military increase.   She                                                               
said  that   although  there  were   a  multitude   of  variables                                                               
contributing  to   the  increase,  the  efforts   for  prevention                                                               
intervention  were  not in  vain.    She  pointed out  that  most                                                               
military recruiters  were working with  15 - 24-year  olds, which                                                               
was the most  vulnerable group as they were  still physically and                                                               
emotionally  developing.   This was  also the  highest group  for                                                               
suicide.  She  stated that the Suicide  Prevention Council worked                                                               
in the schools with this age  group to teach skills of resiliency                                                               
and  effective communication,  and that  these skills  were taken                                                               
with them  into the military.   She pointed out how  stressful it                                                               
was  for these  young people  in the  military and  the need  for                                                               
these skills.  She spoke  about the perceptions of prevention, as                                                               
many  people thought  that  prevention  was solely  intervention.                                                               
She  declared  that prevention  happened  even  before a  crisis,                                                               
while  there were  still other  options and  resources available,                                                               
and that  the council  provided an avenue  to connect  with these                                                               
resources.                                                                                                                      
                                                                                                                                
3:52:25 PM                                                                                                                    
                                                                                                                                
KRISTINA  JAGER  shared  her  personal story  as  a  survivor  of                                                               
suicide and that  she had worked in the mental  health field with                                                               
individuals  in crisis  for the  past seven  years.   She relayed                                                               
that  the   council  gave  hope  and   provided  a  consolidated,                                                               
concerted,  strategic  plan  to  "recast  the  net  upstream"  as                                                               
primary prevention  was the  key.  She  stated the  importance of                                                               
getting  to youth  before the  at-risk period  of their  lives so                                                               
they would have the necessary  coping and resilience skills.  She                                                               
declared that  it was  crucial to continue  to provide  the grant                                                               
funding to the Department of  Education and Early Development for                                                               
primary prevention.  She stated support for HB 22.                                                                              
                                                                                                                                
3:55:31 PM                                                                                                                    
                                                                                                                                
PATTY  OWEN, Alaska  Public  Health  Association (ALPHA),  stated                                                               
support  for extension  of the  council until  2027 and  she read                                                               
from a prepared statement [original punctuation provided]:                                                                      
                                                                                                                                
     The Alaska Public Health Association (ALPHA) is a non-                                                                     
     profit membership organization with over 150 health                                                                        
     members dedicated to improving the health and well-                                                                        
     being for all Alaskans. ALPHA is also the state                                                                            
     affiliate of the American Public Health Association.                                                                       
     ALPHA strongly supports HB 22, to extend Alaska's                                                                          
     Statewide Suicide Prevention Council to June 30, 2027.                                                                     
     As outlined in Alaska Statute 44.29.350, the functions                                                                     
     of the Council are necessary to improve health and                                                                         
     wellness throughout the state by reducing suicide and                                                                      
     its effects on individuals, families and communities.                                                                      
     The Statewide Suicide Council has done a remarkable                                                                        
     job of raising awareness; coordinating and improving                                                                       
     statewide prevention programs and resources;                                                                               
     collaborating with national, state and local                                                                               
     stakeholders and resources; and developing, updating,                                                                      
     and implementing statewide prevention plans.                                                                               
     Reducing suicide rates in Alaska has been one of the                                                                       
     goals of the State's Healthy Alaskans 2020 and is also                                                                     
     a priority of ALPHA. Unfortunately, despite best                                                                           
     efforts, suicide rates in Alaska remain high and still                                                                     
     much higher than the national average.                                                                                     
     It  is  crucial  that  the  Statewide  Suicide  Council                                                                    
     continue  its work  and remain  the  primary entity  in                                                                    
     Alaska for  Alaska's collective approach  to preventing                                                                    
     suicide.                                                                                                                   
                                                                                                                                
3:57:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY closed public testimony.                                                                                      
                                                                                                                                
[HB 22 was held over.]                                                                                                          
                                                                                                                                
            HB 29-INSURANCE COVERAGE FOR TELEHEALTH                                                                         
                                                                                                                                
3:57:51 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  announced that  the  next  order of  business                                                               
would  be  HOUSE BILL  NO.  29,  "An  Act relating  to  insurance                                                               
coverage for benefits provided  through telehealth; and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
3:58:30 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:58 p.m. to 4:00 p.m.                                                                       
                                                                                                                                
4:00:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ introduced  HB 29 as the  sponsor of the                                                               
bill, stating that this bill  increased access to and reduced the                                                               
cost of health care by  requiring insurers to reimburse providers                                                               
for delivering  health care services  via telehealth.   She added                                                               
that telehealth was already covered  and provided for by Medicaid                                                               
and the Indian  Health Services.  She pointed out  that it was so                                                               
effective  in these  markets that  it  should be  covered in  its                                                               
entirety in the  private market as it increased  access to health                                                               
care  in Rural  Alaska.   She shared  a PowerPoint  titled "House                                                               
Bill  29  Insurance  Coverage  for  Telehealth."    She  directed                                                               
attention to  slide 2, "Telehealth:  Why is this  important?" and                                                               
pointed  out that  it would  reduce the  cost of  health care  by                                                               
reducing travel  expenses.  She  said that  it could be  used for                                                               
primary, specialty, and  behavioral health care.   She noted that                                                               
this also supported necessary  innovations and transformations in                                                               
health care.   She pointed  out that this could  reduce emergency                                                               
room visits.   She added that the state plan  did not provide for                                                               
tele-health.                                                                                                                    
                                                                                                                                
4:03:37 PM                                                                                                                    
                                                                                                                                
BERNICE   NISBETT,    Staff,   Representative    Ivy   Spohnholz,                                                               
paraphrased from  the Sectional  Analysis to  HB 29  [Included in                                                               
members' packets], which read:                                                                                                  
                                                                                                                                
     Section 1.                                                                                                             
     AS  21.42.422 has  been  amended  to require  insurance                                                                    
     coverage   for   health   benefits   provided   through                                                                    
     telehealth technology.                                                                                                     
                                                                                                                                
     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, 2020.                                                                                        
                                                                                                                                
4:05:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN asked if  Department of Commerce, Community                                                               
& Economic Development and the  administration were in support of                                                               
the proposed bill.                                                                                                              
                                                                                                                                
4:05:43 PM                                                                                                                    
                                                                                                                                
LORI WING-HEIER, Director, Juneau  Office, Division of Insurance,                                                               
Department  of Commerce,  Community  &  Economic Development,  in                                                               
response  to  Representative  Claman,  said  that  Department  of                                                               
Commerce,  Community  & Economic  Development  was  very much  in                                                               
support of anything that would  provide access to health care yet                                                               
lower  the cost  at the  same time.   She  acknowledged that  the                                                               
department was in support of the proposed bill.                                                                                 
                                                                                                                                
4:06:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT asked if it was possible to mandate this.                                                                 
                                                                                                                                
MS. WING-HEIER reported that the  Division of Insurance estimated                                                               
that insured  plans, which the division  regulated, covered about                                                               
15 percent of Alaskans.                                                                                                         
                                                                                                                                
REPRESENTATIVE PRUITT asked why there  was a need to mandate this                                                               
to the insurance companies, as it offered a cost savings.                                                                       
                                                                                                                                
MS. WING-HEIER replied  that this would increase  access to Rural                                                               
Alaska, especially  for specialties and would  reduce the overall                                                               
costs if  it could address  common things and eliminate  the need                                                               
to  visit  the provider.    She  reported  that there  were  data                                                               
projections   for   virtual   hospitals  in   the   future   with                                                               
recuperation  at home,  although there  were not  any numbers  to                                                               
support  this.   In  response  to the  need  for  a mandate,  she                                                               
reported  that   any  conversation  for  new   services  prompted                                                               
discussions  and  sometimes it  was  necessary  to push  for  the                                                               
offering of newer products or services.                                                                                         
                                                                                                                                
REPRESENTATIVE PRUITT  asked about the options.   He acknowledged                                                               
that, although  Moda Health  had submitted  a letter  of support,                                                               
they would  not be required to  provide this with their  plan for                                                               
the state.   He  questioned whether there  would be  support from                                                               
the  providers who  would be  required to  offer telehealth.   He                                                               
shared  his  difficulty  for  understanding  why  a  cost  saving                                                               
measure would need to be mandated.                                                                                              
                                                                                                                                
MS.  WING-HEIER  explained  that  previous  attempts  to  deliver                                                               
telehealth had not  been provided by all  insurance providers and                                                               
that this mandate would ensure parity.                                                                                          
                                                                                                                                
REPRESENTATIVE  PRUITT  asked  how to  prevent  individuals  from                                                               
recruiting the  use of telehealth  services without  allowing for                                                               
the  best  interests  of  the   patient.    He  opined  that  the                                                               
introduction of  money through  a mandate  brought with  it those                                                               
who would take advantage.                                                                                                       
                                                                                                                                
4:10:51 PM                                                                                                                    
                                                                                                                                
MS.  WING-HEIER expressed  agreement that  there were  bad actors                                                               
making  "big dollars  out of  it" and  this included  doctors and                                                               
insurance agents.   She stated that  it was necessary to  use due                                                               
diligence  and  take  the necessary  actions  against  those  bad                                                               
players.                                                                                                                        
                                                                                                                                
REPRESENTATIVE PRUITT asked  how to ensure that  her division had                                                               
the  tools to  "take  action as  needed if  there  are those  bad                                                               
players that  come up."   He asked if  it would be  necessary for                                                               
statute changes  to allow the  authority to pursue  these people,                                                               
some of whom may not even be in the state.                                                                                      
                                                                                                                                
MS. WING-HEIER  reported that the  agency had  four investigators                                                               
and she declared  they were "a critical part of  us being able to                                                               
look at people that  are the bad actors in the  state.  When they                                                               
cross  state lines,  we end  up  working with  the U.S.  Attorney                                                               
General or with the FBI, and  that's not uncommon."  She declared                                                               
that these federal agencies "actually have the jurisdiction."                                                                   
                                                                                                                                
4:13:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON asked if this  would cover all Alaskans or                                                               
just  those through  certain health  care  facilities or  certain                                                               
insurance companies.                                                                                                            
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ replied that  the intent of the proposed                                                               
bill was to ensure that  insurers operating in the private market                                                               
be  required to  cover telehealth  services.   She reported  that                                                               
telehealth services  were already  authorized and paid  for under                                                               
Medicaid, as  well as  tribal health.   This proposed  bill would                                                               
expand  the market  for  access to  telehealth  into the  private                                                               
market.  She  stated that self-insured plans  which were governed                                                               
by  federal law,  including the  insurance plan  by the  State of                                                               
Alaska, could not be included in state law.                                                                                     
                                                                                                                                
MS. WING-HEIER said that the State  of Alaska had adopted a tele-                                                               
doc option in its retirement and benefit plan.                                                                                  
                                                                                                                                
REPRESENTATIVE  JACKSON declared  that  this  was beneficial  and                                                               
saved a lot of  time, travel, and money.  She  asked that this be                                                               
shared with our federal delegation.                                                                                             
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ expressed  her intention  to coordinate                                                               
with the  federal delegation.   She expressed agreement  that the                                                               
state  plan  now allowed  tele-doc,  which  she described  as  "a                                                               
virtual form of an urgent care,"  although this was not quite the                                                               
complete service that she supported for lasting relationships.                                                                  
                                                                                                                                
4:17:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN asked about the tele-doc coverage.                                                                        
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ,  in   response,  explained   that  it                                                               
depended on the provider.  She  said that Aetna had a requirement                                                               
that providers  go through a  process to  determine participation                                                               
in telehealth.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  CLAMAN  said  that   it  was  available  if  they                                                               
followed the steps.   He noted that there was  a zero fiscal note                                                               
and asked if  there would be additional costs  due to enforcement                                                               
authority.                                                                                                                      
                                                                                                                                
MS. WING-HEIER  replied that  it was not  expected to  change the                                                               
workload.                                                                                                                       
                                                                                                                                
4:19:54 PM                                                                                                                    
                                                                                                                                
VICTORIA   KNAPP,  Chief   Operations   Officer,  Mat-Su   Health                                                               
Services, Inc., stated that they  relied on telehealth to provide                                                               
specialty  psychiatric  services   for  individuals  with  mental                                                               
health  issues.   She noted  that there  were "huge  shortages of                                                               
psychiatric  providers in  the State  of Alaska."   She  reported                                                               
that they had  providers both in-state and  out-of-state who were                                                               
licensed in the  State of Alaska.  She declared  that they were a                                                               
safety net provider  and had gone to  telehealth services several                                                               
years prior due to a  shortage of available in-person psychiatric                                                               
providers.  She added  that, as they did not want  to have a wait                                                               
list  for   psychiatric  services,   they  moved   to  telehealth                                                               
services.   She  noted that,  on those  occasions when  a private                                                               
health  plan did  not cover  these services,  the patient  had to                                                               
decide whether to  make out of pocket payment or  not receive the                                                               
services.  She expressed a desire  for everyone to be covered for                                                               
telehealth.                                                                                                                     
                                                                                                                                
4:21:54 PM                                                                                                                    
                                                                                                                                
AROM EVANS,  MD, Orion Behavioral  Health Network, said  that his                                                               
organization  primarily   provided  services  for   children  and                                                               
adolescents.   He  said  there  was a  need  for medical  service                                                               
providers for children,  and that many of them were  out of state                                                               
and could  only be  accessed through telehealth.   He  stated his                                                               
support for  HB 29.  He  said that tele-doc was  an important and                                                               
useful  service but  that it  was a  very different  service than                                                               
telehealth.   With tele-doc, as  it was an on-demand  service and                                                               
you could not schedule a  follow-up appointment, you may not have                                                               
the same provider.                                                                                                              
                                                                                                                                
4:23:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked whether,  since with  telehealth there                                                               
were no in-person meetings, there was  a potential to not build a                                                               
strong relationship that would make the care as effective.                                                                      
                                                                                                                                
DR. EVANS said  they used a hybrid model as  they maintained four                                                               
physical clinics  around the  state.   He acknowledged  that many                                                               
patients  and family  members needed  that  reassurance and  they                                                               
treated this on a case by case basis.                                                                                           
                                                                                                                                
4:26:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JACKSON  asked  about  genetic  work-ups  through                                                               
telehealth.                                                                                                                     
                                                                                                                                
DR.  EVANS   explained  that  genetic  work-ups   were  conducted                                                               
primarily  in  the  laboratory,  as  they  reviewed  symptoms  to                                                               
determine  the necessary  tests,  and these  work-ups included  a                                                               
physical exam that could be provided by a local doctor.                                                                         
                                                                                                                                
4:27:09 PM                                                                                                                    
                                                                                                                                
ROBERT BARATTA,  National Consultant, Teladoc  Health, referenced                                                               
the earlier discussion for fraud  and abuse, and pointed out that                                                               
prior  to  access  of  the  service, there  had  to  be  a  valid                                                               
physician  - patient  relationship established.   He  pointed out                                                               
that Alaska  had such a  statute as  well as guidelines  from the                                                               
State Board  of Medicine, for  the way this relationship  must be                                                               
established.  For  reimbursement, the service had  to be provided                                                               
in accordance with that valid  relationship.  He pointed out that                                                               
most insurance plans  had the authority to make sure  that it was                                                               
medically necessary.                                                                                                            
                                                                                                                                
REPRESENTATIVE  JACKSON   asked  about  the   difference  between                                                               
charges from a tele-doc and an office visit.                                                                                    
                                                                                                                                
MR.  BARATTA explained  that there  was a  tele-medicine platform                                                               
which  a  patient  could  access through  their  computer  for  a                                                               
virtual  visit  with  a  physician.   He  said  it  mimicked  the                                                               
experience  of a  visit to  an Urgent  Care center  with a  board                                                               
certified and Alaska licensed physician.                                                                                        
                                                                                                                                
4:30:02 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY opened public testimony.                                                                                      
                                                                                                                                
4:30:24 PM                                                                                                                    
                                                                                                                                
CYNTHIA MARK, Teladoc Health, emphasized  that it was possible to                                                               
establish  an  on-going  relationship  with  an  Alaska  provider                                                               
through telehealth and  to see that same provider  on an on-going                                                               
basis.   She stated support for  HB 29, pointing out  that it was                                                               
good policy and good legislation.                                                                                               
                                                                                                                                
4:32:02 PM                                                                                                                    
                                                                                                                                
CHRISTOPHER   DIETRICH,   Assistant   Medical   Director,   Orion                                                               
Behavioral  Health Network,  stated his  support for  HB 29.   He                                                               
offered  an  example  of  a patient  released  from  API  (Alaska                                                               
Psychiatric Institute) who moved to  Rural Alaska, and the option                                                               
for telehealth.                                                                                                                 
                                                                                                                                
4:33:44 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY closed public testimony.                                                                                      
                                                                                                                                
[HB 29 was held over.]                                                                                                          
                                                                                                                                
         HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                      
                                                                                                                                
4:34:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY announced  that  the final  order of  business                                                               
would be HOUSE BILL NO. 97,  "An Act relating to the prescription                                                               
of drugs by a physician assistant without physical examination."                                                                
                                                                                                                                
4:34:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ   moved  to  adopt  the   proposed  committee                                                               
substitute (CS) for HB 97,  labeled 31-LS0695\M, Marx, 3/21/19 as                                                               
the working draft.                                                                                                              
                                                                                                                                
CO-CHAIR ZULKOSKY objected for discussion.                                                                                      
                                                                                                                                
4:34:53 PM                                                                                                                    
                                                                                                                                
REID  HARRIS,  Staff,   Representative  Jonathan  Kreiss-Tomkins,                                                               
stated that HB  97 was "about increasing patient  access to care,                                                               
particularly  for rural  and medically  underserved  areas."   He                                                               
directed attention  to maps [Included in  members' packets] which                                                               
portrayed that  the entire  state, except  for the  Railbelt, was                                                               
considered to  be a medically  underserved area.  He  stated that                                                               
it could be  problematic for many rural communities  to find fair                                                               
and  cheap  access to  health  care.    He paraphrased  from  the                                                               
Sponsor Statement [Included in members' packets] which read:                                                                    
                                                                                                                                
     The 2016 Medicaid Reform bill  (SB 74) provided for the                                                                    
     use  of  telehealth  by  revising  Alaska  statutes  to                                                                    
     require  the   Alaska  Board   of  Medicine   to  adopt                                                                    
     regulations and  guidelines for physicians  rendering a                                                                    
     diagnosis,   providing   treatment,   or   prescribing,                                                                    
     dispensing, or  administering a prescription drug  to a                                                                    
     person without conducting  a physical examination under                                                                    
     AS 08.64.364.                                                                                                              
                                                                                                                                
     Unintentionally, SB  74 only addressed  physicians, and                                                                    
     the  Board   issued  guidelines  that   made  different                                                                    
     requirements   for  physician   assistants  (PAs)   and                                                                    
     physicians, citing  a lack  of legislative  intent that                                                                    
     the provisions of SB 74 should apply to PAs.                                                                               
                                                                                                                                
     The omission of  PAs from the Medicaid  Reform bill led                                                                    
     to  them being  subject to  limitations on  the use  of                                                                    
     telemedicine. Specifically, the  Medical Board released                                                                    
     guidelines stating that  physician assistants could not                                                                    
     treat   a  patient   via  telemedicine   without  first                                                                    
     conducting   an  in-person   examination,  or   with  a                                                                    
     collaborating  physician or  other practitioner  in the                                                                    
     same group practice.                                                                                                       
                                                                                                                                
     House Bill  97 aligns  the law with  the intent  of the                                                                    
     Medicaid Reform  bill, clarifying that PAs  can provide                                                                    
     telemedicine in  the same  manner as  physicians. Under                                                                    
     HB97, the  PA would  be subject  to the  same statutory                                                                    
     oversight  as  physicians  regarding  the  practice  of                                                                    
     telemedicine,   as  well   as  the   same  disciplinary                                                                    
     sanctions when appropriate.                                                                                                
                                                                                                                                
     Alaska,  with  its  vast  geographical  challenges  and                                                                    
     limited access  to vital healthcare, stands  to benefit                                                                    
     from  this legislation.  HB  97  will increase  patient                                                                    
     access  to care,  extending the  reach  of medicine  to                                                                    
     medically underserved areas.                                                                                               
                                                                                                                                
MR. HARRIS pointed  out that, although it  was legislative intent                                                               
to  allow physician  assistants (PAs)  to practice  telemedicine,                                                               
the "Medical Board didn't see it that way hence we have these                                                                   
two fix-it bills before both bodies."                                                                                           
                                                                                                                                
MR. HARRIS directed attention to the PA Scope of Practice                                                                       
document [Included in members' packets] and paraphrased from the                                                                
document, which read:                                                                                                           
                                                                                                                                
     A broad,  generalist medical education prepares  PAs to                                                                    
     take medical histories,  perform physical examinations,                                                                    
     order   and   interpret  laboratory   tests,   diagnose                                                                    
     illness, develop  and manage treatment plans  for their                                                                    
     patients, prescribe medications and assist in surgery.                                                                     
                                                                                                                                
MR. HARRIS stated that PAs could prescribe Schedule II - V                                                                      
medications, and he paraphrased from the "Drug Schedule"                                                                        
[Included in members' packets], which read:                                                                                     
                                                                                                                                
     Schedule I                                                                                                               
     Schedule I drugs, substances,  or chemicals are defined                                                                    
     as drugs with  no currently accepted medical  use and a                                                                    
     high potential  for abuse. Some examples  of Schedule I                                                                    
     drugs  are: heroin,  lysergic acid  diethylamide (LSD),                                                                    
     marijuana                (cannabis),               3,4-                                                                    
     methylenedioxymethamphetamine  (ecstasy), methaqualone,                                                                    
     and peyote                                                                                                                 
                                                                                                                                
     Schedule II                                                                                                              
     Schedule  II   drugs,  substances,  or   chemicals  are                                                                    
     defined as drugs with a  high potential for abuse, with                                                                    
     use  potentially  leading  to severe  psychological  or                                                                    
     physical  dependence. These  drugs are  also considered                                                                    
     dangerous.  Some examples  of  Schedule  II drugs  are:                                                                    
     Combination products  with less  than 15  milligrams of                                                                    
     hydrocodone   per  dosage   unit  (Vicodin),   cocaine,                                                                    
     methamphetamine,  methadone, hydromorphone  (Dilaudid),                                                                    
     meperidine (Demerol),  oxycodone (OxyContin), fentanyl,                                                                    
     Dexedrine, Adderall, and Ritalin                                                                                           
                                                                                                                                
     Schedule III                                                                                                             
     Schedule  III  drugs,   substances,  or  chemicals  are                                                                    
     defined as drugs  with a moderate to  low potential for                                                                    
     physical  and  psychological dependence.  Schedule  III                                                                    
     drugs  abuse  potential is  less  than  Schedule I  and                                                                    
     Schedule  II  drugs but  more  than  Schedule IV.  Some                                                                    
     examples   of   Schedule   III  drugs   are:   Products                                                                    
     containing  less  than  90 milligrams  of  codeine  per                                                                    
     dosage unit (Tylenol  with codeine), ketamine, anabolic                                                                    
     steroids, testosterone                                                                                                     
                                                                                                                                
     Schedule IV                                                                                                              
     Schedule  IV   drugs,  substances,  or   chemicals  are                                                                    
     defined as  drugs with  a low  potential for  abuse and                                                                    
     low risk  of dependence.  Some examples of  Schedule IV                                                                    
     drugs  are  Xanax,   Soma,  Darvon,  Darvocet,  Valium,                                                                    
     Ativan, Talwin, Ambien, Tramadol                                                                                           
                                                                                                                                
     Schedule V                                                                                                               
     Schedule V drugs, substances,  or chemicals are defined                                                                    
     as drugs  with lower potential for  abuse than Schedule                                                                    
     IV  and  consist  of  preparations  containing  limited                                                                    
     quantities of  certain narcotics. Schedule V  drugs are                                                                    
     generally  used  for  antidiarrheal,  antitussive,  and                                                                    
     analgesic purposes.  Some examples of Schedule  V drugs                                                                    
     are: cough  preparations with less than  200 milligrams                                                                    
     of  codeine or  per  100  milliliters (Robitussin  AC),                                                                    
     Lomotil, Motofen, Lyrica, Parepectolin                                                                                     
                                                                                                                                
MR.  HARRIS explained  that a  Physician Assistant  must have  an                                                               
active  and  collaborative  plan   that  was  maintained  with  a                                                               
supervisor  and,  under  the   guidance  of  their  collaborating                                                               
physician,  would be  authorized  to prescribe  Schedule  II -  V                                                               
drugs.   He  added that  the PA  must have  an authorization  and                                                               
license from the Drug Enforcement  Administration.  He summarized                                                               
and stated that  the proposed bill would  allow approximately 700                                                               
licensed  PAs  in Alaska  to  provide  telemedicine in  the  same                                                               
manner  as  physicians  and  extend  the  reach  of  medicine  to                                                               
patients  in underserved  areas.   He pointed  to the  supporting                                                               
letters  from  physician  assistants practicing  in  rural  areas                                                               
[Included  in members'  packets].   He  reported  that the  State                                                               
Medical Board  assumed a neutral  position on the  proposed bill,                                                               
and that the  fiscal note for $5300 was for  the first year only,                                                               
to pay for legal fees and to update the regulations.                                                                            
                                                                                                                                
4:41:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON asked if this  proposed bill could be part                                                               
of the telehealth bill as  it allowed for physician assistants to                                                               
prescribe drugs.                                                                                                                
                                                                                                                                
4:42:06 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  replied that  the  proposed  bill was  in  a                                                               
different section  of law,  even though  it intersected  to allow                                                               
physician assistants to participate in telehealth.                                                                              
                                                                                                                                
4:42:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN  asked why the  bill did not  include nurse                                                               
practitioners   as   they   were  also   allowed   to   prescribe                                                               
medications.                                                                                                                    
                                                                                                                                
MR.  HARRIS explained  that registered  nurse practitioners  were                                                               
not overseen by the State Medical Board.                                                                                        
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  interjected  that nurse  practitioners  were                                                               
already allowed  to practice telehealth, adding  that nurses were                                                               
overseen  by the  Board of  Nursing.   She stated  that physician                                                               
assistants  were  the  only  group of  providers  that  had  been                                                               
inadvertently omitted in earlier legislation, Senate Bill 74.                                                                   
                                                                                                                                
REPRESENTATIVE  CLAMAN  asked  if nurse  practitioners  had  been                                                               
allowed to practice telehealth in Senate Bill 74.                                                                               
                                                                                                                                
CO-CHAIR SPOHNHOLZ replied, "yes."                                                                                              
                                                                                                                                
4:43:37 PM                                                                                                                    
                                                                                                                                
MR.  HARRIS,  in  response to  Representative  Jackson,  directed                                                               
attention to  the AAPA guidelines [Included  in members' packets]                                                               
and paraphrased from the Education and Experience, which read:                                                                  
                                                                                                                                
     The intensive  PA program curriculum is  modeled on the                                                                    
     medical  school  curriculum.  The  typical  PA  program                                                                    
     extends  over  27  continuous months  and  begins  with                                                                    
     classroom instruction  in basic medical  sciences. This                                                                    
     is  followed  by  rotations  in  medical  and  surgical                                                                    
     disciplines   including   family   medicine,   internal                                                                    
     medicine, general  surgery, pediatrics,  obstetrics and                                                                    
     gynecology,  emergency  medicine   and  psychiatry.  PA                                                                    
     students complete  at least  2,000 hours  of supervised                                                                    
     clinical practice in various  settings and locations by                                                                    
     graduation. Almost  all PA programs now  award master's                                                                    
     degrees, and by 2020 all programs must do so.                                                                              
                                                                                                                                
4:45:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT asked  if PAs would be required  to use the                                                               
drug database.                                                                                                                  
                                                                                                                                
MR. HARRIS said that was correct.                                                                                               
                                                                                                                                
REPRESENTATIVE PRUITT  asked why  the PAs  had been  omitted from                                                               
previous legislation.                                                                                                           
                                                                                                                                
MR. HARRIS offered his understanding  that the legislative intent                                                               
was for physicians to engage  in telemedicine with an assumption,                                                               
incorrect as it  was, that PAs working under  the physician would                                                               
also be  allowed.   After passage  of Senate  Bill 74,  the State                                                               
Medical Board stated that the  new language would not include PAs                                                               
because they were not directly named.                                                                                           
                                                                                                                                
4:46:54 PM                                                                                                                    
                                                                                                                                
DEBORAH  STOVERN, Executive  Administrator, State  Medical Board,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department of  Commerce, Community  & Economic  Development, said                                                               
that the State  Medical Board did not feel that  "they could make                                                               
the call  that the  legislative intent  was to  include physician                                                               
assistants because  the language  of the statute  said physicians                                                               
only."   She offered her  understanding the proposed bill  was an                                                               
attempt to correct that.                                                                                                        
                                                                                                                                
REPRESENTATIVE PRUITT asked for  clarification that, although the                                                               
intent  may  have  been  there,  she  could  not  "jump  to  that                                                               
conclusion because  the statute wasn't  clear enough."   He asked                                                               
if this was "clean-up" and if she did support this opportunity.                                                                 
                                                                                                                                
MS. STOVERN  said that was  her understanding of the  position by                                                               
the State  Medical Board  on this legislation.   She  pointed out                                                               
that the State  Medical Board had reviewed Senate  Bill 44, which                                                               
was identical legislation, and had issued a letter of support.                                                                  
                                                                                                                                
4:49:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT  asked for clarification to  the changes in                                                               
the proposed committee substitute.                                                                                              
                                                                                                                                
MR. HARRIS  replied that the proposed  committee substitute added                                                               
a section  with an effective  bill date  of March 1,  2020, which                                                               
had been requested by the division.                                                                                             
                                                                                                                                
4:50:25 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:50:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY removed her objection.   There being no further                                                               
objection,  the proposed  committee  substitute (CS)  for HB  97,                                                               
labeled  31-LS0695\M, Marx,  3/21/19 was  adopted as  the working                                                               
draft.                                                                                                                          
                                                                                                                                
4:51:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked  if   the  State  Medical  Board  had                                                               
concerns with  the prescription of drugs  by physician assistants                                                               
or with other interactions with the patient.                                                                                    
                                                                                                                                
4:51:56 PM                                                                                                                    
                                                                                                                                
MS. STOVERN  said that  the State Medical  Board had  issues with                                                               
both subject  to the collaborative  plan between  the supervising                                                               
physician and the physician assistant.                                                                                          
                                                                                                                                
REPRESENTATIVE  TARR  asked  if the  collaborative  practice  was                                                               
necessary for both issues.                                                                                                      
                                                                                                                                
MS.  STOVERN  replied, yes  it  was  correct that  the  physician                                                               
assistant would only have authority  for whatever the supervising                                                               
physician allowed.                                                                                                              
                                                                                                                                
4:53:35 PM                                                                                                                    
                                                                                                                                
CHRISTOPHER  DIETRICH, Orion  Behavioral  Health Network,  stated                                                               
that currently the PA could not  establish care without a face to                                                               
face  examination and  that  the proposed  bill  would now  allow                                                               
this.                                                                                                                           
                                                                                                                                
4:55:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  questioned whether  the requirement  for the                                                               
first face to face meeting was the snafu.                                                                                       
                                                                                                                                
MR.  DIETRICH  expressed his  agreement  that  the proposed  bill                                                               
would clarify this and expedite the necessary care.                                                                             
                                                                                                                                
4:56:09 PM                                                                                                                    
                                                                                                                                
AROM EVANS, MD,  Orion Behavioral Health, stated  his support for                                                               
proposed HB 97  and that his practice had  the collaborative plan                                                               
in place.                                                                                                                       
                                                                                                                                
[HB 97 was held over.]                                                                                                          
                                                                                                                                
4:57:48 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 4:58 p.m.                                                                                                          

Document Name Date/Time Subjects
HB022 Supporting Document-Letter of Support from American Foundation for Suicide Prevention - Alaska Chapter 03.07.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document-Letter of Support from Suicide Prevention Council 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Fiscal Note DHSS-SPC-3.22.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document-Letter of Support from NAMI Alaska 3.6.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Sponsor Statement 03.15.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document Legislative Audit of Suicide Prevention Council 3.6.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB029 Sectional Analysis ver A 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Sponsor Statement 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Supporting Document-Letter of Support 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Fiscal Note DCCED-DOI 3.22.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Letter of Support Moda Health 03.25.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Presentation 03.25.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB0097 Supporting Document AK State Medical Bd Roster.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document AAPA general overview.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document AK State Medical Bd PA scope of practice.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document DEA Drug Schedules.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document Medically Underserved Areas HRSA.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document PA guidelines AK State Medical Bd.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document PA Prescriptive Authority (AAC).pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB097 Draft Proposed Blank CS ver M 3.21.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB097 Fiscal Note DCCED-CBPL-3.22.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB097 Supporting Document Letters of Support for companion legislation SB44.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
SFIN 4/9/2019 9:00:00 AM
HB 97
SB 44
HB0097 Sectional.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB0097 Sponsor Statement.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97