03/29/2018 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| SB174 | |
| SB108 | |
| Confirmation Hearing(s) | |
| HB358 | |
| HJR32 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 174 | TELECONFERENCED | |
| += | SB 108 | TELECONFERENCED | |
| += | HB 358 | TELECONFERENCED | |
| *+ | HJR 32 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 193 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 29, 2018
3:06 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Tiffany Zulkosky, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
Representative Matt Claman (alternate)
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
HOUSE BILL NO. 193
"An Act relating to insurance trade practices and frauds; and
relating to emergency services and balance billing."
- MOVED CSHB 193(HSS) OUT OF COMMITTEE
SENATE BILL NO. 174
"An Act relating to the duties of the Department of Health and
Social Services; and relating to the administration of programs
for persons with physical and mental disabilities."
- MOVED SB 174 OUT OF COMMITTEE
CS FOR SS FOR SENATE BILL NO. 108(FIN)
"An Act relating to the State Medical Board; relating to the
licensing of physicians, osteopaths, and podiatrists; relating
to the certification of medical assistants; relating to the
practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to assault of a
medical professional; and providing for an effective date."
- MOVED CSSSSB 108(FIN) OUT OF COMMITTEE
CONFIRMATION HEARING(S)
State Medical Board
Dr. Liu Sai-Ling - Nome
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 358
"An Act relating to insurance coverage for benefits provided
through telehealth; and providing for an effective date."
- MOVED HB 358 OUT OF COMMITTEE
HOUSE JOINT RESOLUTION NO. 32
Proposing an amendment to the Constitution of the State of
Alaska relating to notice and consent before termination of a
minor's pregnancy.
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 193
SHORT TITLE: HEALTH CARE; BALANCE BILLING
SPONSOR(s): REPRESENTATIVE(s) GRENN
03/24/17 (H) READ THE FIRST TIME - REFERRALS
03/24/17 (H) HSS, L&C
03/08/18 (H) HSS AT 3:00 PM CAPITOL 106
03/08/18 (H) Heard & Held
03/08/18 (H) MINUTE(HSS)
03/27/18 (H) HSS AT 3:00 PM CAPITOL 106
03/27/18 (H) -- MEETING CANCELED --
03/29/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: SB 174
SHORT TITLE: PROGRAMS FOR PERSONS WITH DISABILITIES
SPONSOR(s): SENATOR(s) MICCICHE
02/02/18 (S) READ THE FIRST TIME - REFERRALS
02/02/18 (S) HSS
02/21/18 (S) HSS AT 1:30 PM BUTROVICH 205
02/21/18 (S) Moved SB 174 Out of Committee
02/21/18 (S) MINUTE(HSS)
02/22/18 (S) HSS RPT 5DP
02/22/18 (S) DP: WILSON, BEGICH, VON IMHOF,
MICCICHE, GIESSEL
03/01/18 (S) TRANSMITTED TO (H)
03/01/18 (S) VERSION: SB 174
03/05/18 (H) READ THE FIRST TIME - REFERRALS
03/05/18 (H) CRA, HSS
03/13/18 (H) CRA AT 8:00 AM BARNES 124
03/13/18 (H) Heard & Held
03/13/18 (H) MINUTE(CRA)
03/15/18 (H) CRA RPT 4DP
03/15/18 (H) DP: DRUMMOND, RAUSCHER, ZULKOSKY,
PARISH
03/15/18 (H) CRA AT 8:00 AM BARNES 124
03/15/18 (H) Moved SB 174 Out of Committee
03/15/18 (H) MINUTE(CRA)
03/20/18 (H) HSS AT 3:00 PM CAPITOL 106
03/20/18 (H) -- MEETING CANCELED --
03/27/18 (H) HSS AT 3:00 PM CAPITOL 106
03/27/18 (H) -- MEETING CANCELED --
03/29/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: SB 108
SHORT TITLE: MEDICAL CARE/LICENSING/MEDICAL BOARD
SPONSOR(s): SENATOR(s) GIESSEL
04/07/17 (S) READ THE FIRST TIME - REFERRALS
04/07/17 (S) L&C, FIN
01/18/18 (S) SPONSOR SUBSTITUTE INTRODUCED-REFERRALS
01/18/18 (S) L&C, FIN
02/13/18 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/13/18 (S) Moved SSSB 108 Out of Committee
02/13/18 (S) MINUTE(L&C)
02/14/18 (S) L&C RPT 5DP
02/14/18 (S) DP: COSTELLO, STEVENS, MICCICHE, MEYER,
GARDNER
02/27/18 (S) FIN AT 9:00 AM SENATE FINANCE 532
02/27/18 (S) Heard & Held
02/27/18 (S) MINUTE(FIN)
03/13/18 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/13/18 (S) Moved CSSSSB 108 Out of Committee
03/13/18 (S) MINUTE(FIN)
03/14/18 (S) FIN RPT CS 5DP 1NR SAME TITLE
03/14/18 (S) DP: HOFFMAN, MACKINNON, BISHOP, VON
IMHOF, STEVENS
03/14/18 (S) NR: OLSON
03/21/18 (S) TRANSMITTED TO (H)
03/21/18 (S) VERSION: CSSSSB 108(FIN)
03/22/18 (H) READ THE FIRST TIME - REFERRALS
03/22/18 (H) HSS, L&C, FIN
03/27/18 (H) HSS AT 3:00 PM CAPITOL 106
03/27/18 (H) -- MEETING CANCELED --
03/29/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 358
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/19/18 (H) READ THE FIRST TIME - REFERRALS
02/19/18 (H) HSS, L&C
03/08/18 (H) HSS AT 3:00 PM CAPITOL 106
03/08/18 (H) Heard & Held
03/08/18 (H) MINUTE(HSS)
03/22/18 (H) HSS AT 3:00 PM CAPITOL 106
03/22/18 (H) -- MEETING CANCELED --
03/29/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HJR 32
SHORT TITLE: CONST. AM: PARENTAL CONSENT TO ABORTION
SPONSOR(s): REPRESENTATIVE(s) LEDOUX
02/07/18 (H) READ THE FIRST TIME - REFERRALS
02/07/18 (H) HSS, STA, JUD
03/29/18 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
RYAN JOHNSTON, Staff
Representative Jason Grenn
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 193 on behalf of the bill
sponsor, Representative Grenn.
ANNE ZINK, MD
Alaska American College of Emergency Physicians'
Palmer, Alaska
POSITION STATEMENT: Testified during discussion of HB 193.
SAMI ALI, MD
Alaska Emergency Medicine Associates
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 193.
STEVEN COMPTON, MD
President
Alaska Heart and Vascular Institute
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 193.
SENATOR PETER MICCICHE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 174 as the sponsor of the
bill.
KAITLEEN STANSBERRY, Intern
Senator Peter Micciche
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis on behalf
of the bill sponsor, Senator Micciche.
MAGGIE WINSTON, Chair
Governor's Council on Disabilities and Special Education
Kenai, Alaska
POSITION STATEMENT: Testified in support of SB 174.
MICHELLE GIRAULT, Board Member
Key Coalition
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 174.
LIZETTE STIEHR, Executive Director
Alaska Association on Developmental Disabilities
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 174.
COREY GILMORE
Governor's Council on Disabilities and Special Education
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 174.
SENATOR CATHY GIESSEL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SSSB 108 as the sponsor of the
bill.
FRED PARADY, Deputy Commissioner
Office of the Commissioner
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 108.
DANNY ROBINETTE, MD
Chief Medical Officer
Foundation Health Partners
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SB 108.
LIU SAI-LING, MD
Appointee
State Medical Board
Nome, Alaska
POSITION STATEMENT: Answered questions during the confirmation
hearings for State Medical Board.
BERNICE NISBETT, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 358 on behalf of the bill
sponsor, Representative Spohnholz.
AROM EVANS, MD
Medical Director
Orion Behavioral Health Network
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 358.
LYN FREEMAN, Ph.D.
Mind Matters Research
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 358.
VICTORIA KNAPP, Chief Operating Officer
Mat-Su Health Services
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 358.
ANNA LATHAM, Deputy Director
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
358.
REPRESENTATIVE GABRIEL LEDOUX
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HJR 32 as the sponsor of the
resolution.
ACTION NARRATIVE
3:06:37 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:06 p.m.
Representatives Spohnholz, Zulkosky, Kito, Sullivan-Leonard,
Johnston, and Eastman were present at the call to order.
Representative Tarr arrived as the meeting was in progress.
CHAIR SPOHNHOLZ announced that the Confirmation hearing would be
postponed until later in the meeting.
HB 193-HEALTH CARE; BALANCE BILLING
3:08:40 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 193, "An Act relating to insurance trade
practices and frauds; and relating to emergency services and
balance billing." [In front of the committee was Version T,
adopted as the working draft on March 8, 2018]
3:09:06 PM
RYAN JOHNSTON, Staff, Representative Jason Grenn, Alaska State
Legislature, offered a brief recap of the proposed bill, HB 193,
stating that the bill was effectively a ban on balance billing
for medical providers, while also instituting a hold harmless
clause for insurance providers. He explained that the bill
would only remove a patient from this billing situation in
emergency situations.
3:09:38 PM
CHAIR SPOHNHOLZ opened invited testimony on HB 193.
3:09:57 PM
ANNE ZINK, MD, Alaska American College of Emergency Physicians,
paraphrased from a letter of support, dated March 28, 2018,
which read: [included in members' packets]:
3:10:35 PM
Representing more than 80% of the emergency physicians providing
emergency medical care to the people of our state, the Alaska
Chapter of the American College of Emergency Physicians writes
today to support HB193.
HB 193 will protect patients and families across the
state from the high costs and sticker shock that can
come from "surprise medical bills." Both doctors and
patients support this important measure, which will
provide consumer protections for patients, strengthen
access to care, and put an end once and for all to
surprise bills.
As emergency physicians in Alaska, we know firsthand
about the gaps in patient healthcare coverage that can
cause patients to postpone or avoid treatment until
it's too late. According to a national survey, 44% of
people reported that they didn't seek treatment when
they were sick or injured because of costs. At the
same time, 35% of Americans would have trouble paying
their regular bills if faced with a $400 health
emergency. This is alarming, but not surprising, and
we must work together to ensure that patients can
safely access emergency care without worrying about
going bankrupt.
What good is insurance if it fails us in an emergency?
Insurance companies are shifting hundreds of millions
of dollars in costs to patients and doctors each year
through higher premiums, deductibles and cost-sharing
requirements. At the same time, Alaska insurance
companies are narrowing their networks making them
smaller through limiting access to doctors and care,
which means fewer options and choices for patients and
creating large coverage gaps where care patients
thought would be covered, turns out not to be. These
gaps are leading to surprise bills, adding even more
costs for patients.
Alaska patients and families deserve better. Right
now, the state has a regulation in place that requires
insurance companies to cover these unexpected out of
network costs during emergencies through fair and
appropriate payments to doctors. But, Alaska insurance
companies are working to undermine this regulation
and we need your help to ensure patients are protected
in the long run. We're working to support a new bill,
HB 193, that will end surprise billing altogether and
provide the protection patients need.
HB 193 is a comprehensive solution that protects
patients and ends surprise bills by requiring insurers
to cover unexpected, emergency out of network care,
and limiting patient financial exposure. HB 193 will
protect patients from receiving large bills that their
insurance companies have refused to pay. By
establishing an appropriate and fair reimbursement
standard between insurers and doctors, the bill takes
patients out of the middle and improves access to
care.
HB 193 sets a fair minimum standard, the 80th
percentile rule that has been working in Alaska since
2004, which insurers use as a benchmark to pay out-of-
network physicians, providers or facilities for
unexpected care. HB 193 bans balance billing, meaning
no further bills would go to patients in these
situations. Because doctors will be payed fairly,
there is no need for additional bills.
Despite negative attention created by misleading
information by insurance companies, patients support
the 80th percentile rule, and want their insurance
plans to fairly cover out-of-network emergency care.
The 80th percentile rule relies on transparent market-
based information that takes into account local market
prices for services. They are based in market costs
and not set by government or manipulated by insurance
companies.
Although critics have claimed that providers with
extremely large market share can impact prices under
this standard, there's no evidence or report of foul
play. ISER (UAA's Institute of Social and Economic
Research) is currently looking at this issue for
Alaska. Research in New York State has shown that a
similar standard did not increase cost after its
implementation there.
Without the 80th percentile rule in HB193, patients
will be left unprotected as insurance companies shirk
their responsibility to pay. In fact, insurance
companies would be allowed to set any rates they
wanted with no regard for costs or impact on
emergency room staffing or services.
Alaska patients and families need this full protection
from surprise bills. This bill with strengthen the
healthcare system, offering protection first and
foremost to patients, and ensuring the doctors and
emergency rooms can keep their doors open and keep
staffed with needed specialists and providers to best
treat patients in emergencies.
We hope we can count on your support for HB 193.
3:12:28 PM
REPRESENTATIVE JOHNSTON, noting that there were two major
insurance providers in Alaska, asked if her business was
currently in-network for either of those providers.
DR. ZINK expressed agreement that her group was in-network.
REPRESENTATIVE JOHNSTON asked if her group contracted with out
of network physicians.
DR. ZINK replied that her group covered the emergency department
at the Mat-Su Regional Medical Center, and, as they billed as a
unified group, they were in-network with all the major
providers. She explained that most providers wanted to be in-
network and did not want to shift that burden to patients. She
stated that they did not have any contract negotiations, and, as
they were busy with patients, they "just take what the insurance
companies give us." She declared "that's the reason why this
legislation is really important."
DR. ZINK expressed her agreement with Representative Johnston,
that the bulk of their emergency room visits, if insured, were
in-network.
3:14:00 PM
REPRESENTATIVE JOHNSTON asked about the operations in other
emergency room facilities in Alaska.
DR. ZINK replied that there was a similar model throughout the
state for emergency providers, that most were independent groups
contracted with a hospital. She pointed out that the networks
were shrinking in the Lower 48, resulting in larger insurance
gaps. She expressed her hope that this proposed legislation
would get in front of that. She declared that her group did not
send many balance bills, although this was a huge issue in the
Lower 48.
3:15:04 PM
CHAIR SPOHNHOLZ opened public testimony on HB 193.
3:15:33 PM
SAMI ALI, MD, Alaska Emergency Medicine Associates, explained
that her group of physicians staffed the emergency room at the
Providence Alaska Medical Center and provided care to all
patients who came through the emergency room. She pointed out
that the facility did not use mid-level providers. She asked
that the 80th percentile rule be preserved to prevent any
reduction in quality care or to accessibility for medical care
for patients in Alaska. She declared support for proposed HB
193 as it would enable physician groups in Alaska to recruit and
retain high quality physicians, as this was a difficulty in
Alaska.
3:18:38 PM
STEVEN COMPTON, MD, President, Alaska Heart and Vascular
Institute, stated that practicing cardiology in Anchorage was a
challenge, as it was difficult to recruit physicians to come to
Alaska. He reported that to attain the same ratio of
cardiologists to population as the Lower 48, it would be
necessary to more than double the number of cardiologists in the
state. He noted that, as the Baby Boomer demographic was
entering the age for needing more cardiology care, the demand
for services had "accelerated tremendously in the last decade
and will continue to do so," and that the state was already
underserved. He stated that it was a fundamental commitment of
his organization to provide care to anyone who walked through
the door. He reported that his group served 30 percent of the
state Medicare population, and noted that all Medicare clinics
lost money and were heavily subsidized by the hospitals. He
said that the "way we keep the lights on is by cost shifting."
He explained that the Medicare charges were paid with funds from
private payers, allowing them to maintain access to care. He
declared support for the proposed bill.
3:23:10 PM
CHAIR SPOHNHOLZ closed public testimony on HB 193.
3:23:28 PM
REPRESENTATIVE ZULKOSKY moved to report CSHB 193, Version 30-
LS0466\T, Wallace, 3/6/18, out committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 193(HSS) was moved from the House Health and
Social Services Standing Committee.
3:23:55 PM
The committee took a brief at-ease.
SB 174-PROGRAMS FOR PERSONS WITH DISABILITIES
3:26:18 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be SENATE BILL NO. 174, "An Act relating to the duties of the
Department of Health and Social Services; and relating to the
administration of programs for persons with physical and mental
disabilities."
3:26:44 PM
SENATOR PETER MICCICHE, Alaska State Legislature, paraphrased
from the Sponsor Statement [Included in members' packets], which
read:
When Alaskans with physical and mental disabilities
are able to actively participate in the system of
their care, a higher quality of life is achieved as
well as a sense of independence. SB 174 will provide a
clear pathway to achieve both of these things by
allowing the Department of Health and Social Services
to take a more flexible approach to administering
programs. A positive, person-centered approach should
be embedded within all decisions made at both systems
design and service delivery levels.
So why establish an avenue for participation? All
persons deserve the right to be treated with respect
and dignity. Higher quality of life is achieved by
encouraging individuals with physical and mental
disabilities to participate fully in the social and
economic environment of their homes, communities, and
the State.
Improved stewardship of public monies requires
stakeholder input from a broad cross-section of
Alaskan urban and rural communities to ensure
effectiveness of program redesign efforts. Five
project teams comprised of over 70 people are already
working to make this a reality by focusing on areas of
person-directed culture change, workforce enhancement,
community awareness, legislative engagement, and
measuring success.
SB 174 does not create the right to self-direct care
or supersede laws related to eligibility programs. It
will not have a financial impact on the State. SB 174
does provide a long overdue unifying vision to assure
that the available resources, whether great or small,
are allocated and applied in a manner that maximizes
the contributions to community that Alaskans
experiencing disabilities can make, and the
flexibility of systems to utilize those resources with
responsible stewardship now and in perpetuity.
3:28:34 PM
SENATOR MICCICHE emphasized that Alaskans experiencing
disabilities were not cattle, they were not a number, but that
they were individual, amazing Alaskans who had hopes and dreams
and wanted to accomplish the very most they could in their
lives. He noted that when past services had been delegated
without their participation, they had sometimes felt more like
numbers than amazing individuals. He offered his belief that we
would all want the same input.
3:29:47 PM
KAITLEEN STANSBERRY, Intern, Senator Peter Micciche, Alaska
State Legislature, paraphrased from the Sectional Analysis
[Included in members' packets], which read:
Section 1
AS 47.80.095. Legislative Findings Related to Person
with Disabilities. Adds a new section titled
Legislative Findings Related to Persons with
Disabilities. It presents how Alaskans with physical
and mental disabilities quality of life is enhanced
when allowed to actively participate in their support
services.
Section 2
Adds new language allowing the Department of Health
and Social Services to take a flexible approach in
allowing active participation for those with physical
and mental disabilities.
3:30:47 PM
CHAIR SPOHNHOLZ opened invited testimony on SB 174.
3:31:09 PM
MAGGIE WINSTON, Chair, Governor's Council on Disabilities and
Special Education, shared her background as an individual who
had experienced a disability at 21 years of age which took away
functional use of her arms and her legs. She said that the
services she received allowed her to live in her own home, to be
a mom, to go to her job at a center for independent living, and
to be an advocate for other individuals that experienced
disabilities. She asked for support for the proposed bill as it
would make individuals feel supported with this flexible shared
vision for services and it solidified the spirit of self-
determination, as things can often seem chaotic and out of
control. She declared that this offered her support toward a
meaningful life, something that we all wanted.
3:33:18 PM
REPRESENTATIVE SULLIVAN-LEONARD asked how the proposed bill
would assist her in the Medicaid process.
MS. WINSTON offered her belief that the bill language solidified
something more sustainable for service provision in the future,
so that individuals looking for services in the future would
have a language to empower and enable them to be self-
determining.
REPRESENTATIVE SULLIVAN-LEONARD mused that it would allow better
communication with a health care professional or other support
services for inclusion in the decision-making process.
MS. WINSTON said that it would establish a foundation of self-
directedness, so that she did not need to accept something that
would not work for her. The proposed bill would declare support
for her in her individuality and her needs.
3:35:21 PM
REPRESENTATIVE ZULKOSKY asked whether the proposed bill would
allow statutory support for individuals to opt out of services
they might not need, and have self-directed conversations with
the department for the services they desired.
MS. WINSTON expressed her agreement.
3:36:20 PM
MICHELLE GIRAULT, Board Member, Key Coalition, stated that the
Key Coalition was very supportive of the proposed bill to put
into statute a foundational language that was value driven and
upheld and supported those primary stakeholders across Alaska.
She declared that the proposed bill would enable departments to
work together to provide more synchronous delivery systems.
3:38:29 PM
LIZETTE STIEHR, Executive Director, Alaska Association on
Developmental Disabilities, paraphrased from a letter, dated
March 13, 2018, which read: [Included in members' packets]
AADD, the Alaska Association on Developmental
Disabilities, is the professional association
representing the voice of forty-six organizations in
Alaska that provide home and community-based services
to individuals who experience intellectual and
developmental disabilities. The Association has been
an active and strong supporter of the development of
the Shared Vision. The Vision brings a renewed energy
and excitement to the work the provider community. The
Shared Vision reminds each of us why we have dedicated
our professional life to this field and where we want
the focus of services to be, on the individual being
supported.
We are so appreciative of Senator Micciche's SB174
that embeds the Shared Vision in statue. In statue
this Shared Vision will provide a consistent and
strong platform for individuals to lead their own
services, rather than a bureaucracy. It enriches their
lives and the fabric of the community in which they
participate. Services matching the Shared Vision will
provide for a more independence life and greater
personal confidence for individuals. This will help
stretch limited funds farther with greater
participation in the community involving unpaid
natural supports.
Having the Shared Vision in stature will assure that
the underlying philosophy of dignity, respect and
choice doesn't change with shifts in funding or
political leaders. Thank you again for your time,
attention and efforts on behalf of so many individuals
in Alaska both providing and receiving services and
supports.
3:41:03 PM
CHAIR SPOHNHOLZ opened public testimony on SB 174.
3:41:26 PM
COREY GILMORE, Governor's Council on Disabilities and Special
Education, shared that he was a recipient of services. He
explained that services were provided based on a document of
care for what other people think they may need. These plans of
care were decided in a large conference while "people talk about
you." Right at the end of the meeting, these people would ask
him what he would like to work on. He declared that it was
necessary "to turn that on its head," make these plans of care
about what the individual wants to do, and that the individual
needed to be control of that. He pointed to the difficulties
for his staff as they tried to follow the plan, even though he
stated that he had not agreed to that goal. If he refused to
work on a goal, he would receive less service. He emphasized
that the plan of care should be the individual's plan, and that
"we can all stand to work on" these goals. He pointed out that
he hated to work on goals that were not his own.
3:45:36 PM
REPRESENTATIVE TARR said that she did not know that by not
working on the goals in the plan of care, an individual could
lose those services. She asked if this was based on non-
participation for those services.
MR. GILMORE declared that he was all for participation, that
life required audience participation. He stated that currently
the goals were not participatory, they were meant to be
habilitative, which was often difficult for individuals. He
noted that, as he was 42 years old and had cerebral palsy, his
philosophy was that if he could be habilitated, none of his
staff would need to be here. He expressed support for goals
that he could live with, pointing out that currently he did not
have the ability to say "no, I didn't agree to that goal. We
have to do it because it's in our plan of care. If we don't do
it, we can lose services." He explained that habilitation was a
means to justify the cost.
3:48:19 PM
CHAIR SPOHNHOLZ closed public testimony on SB 174.
3:48:27 PM
REPRESENTATIVE EASTMAN offered Conceptual Amendment 1, as
follows:
Delete "can achieve a meaningful life"
Replace with "can be more active"
REPRESENTATIVE EASTMAN said that would remove the question for
the philosophical components for the meaning of life.
3:49:53 PM
SENATOR MICCICHE offered an example for activity and opined that
he was unsure that this activity would lead to a more active, or
meaningful, life. He declared that this was not about activity,
but was about self-determination for personal treatment, and the
"most value out of life how you see fit." He declared that this
was not about physical activity, but was about accomplishment,
opportunity, and fulfillment.
CHAIR SPOHNHOLZ expressed her agreement.
REPRESENTATIVE EASTMAN moved to adopt Conceptual Amendment 1.
CHAIR SPOHNHOLZ objected for discussion. She pointed out that
the proposed bill had been drafted in collaboration with the
Governor's Council on Disabilities and Special Education.
3:51:25 PM
REPRESENTATIVE TARR directed attention to the top of page 2 of
the proposed bill. She offered her belief that "having a
meaningful life" was language often used per the reasons stated
by Senator Micciche. She declared that recognition, no matter
the physical or intellectual challenges or limitations, for the
opportunity to have a full and meaningful life should be
supported.
3:52:23 PM
REPRESENTATIVE EASTMAN said that he supported the idea of more
and increase and other words; however, the current wording
indicated that, without this program, a person cannot achieve a
meaningful life. He offered his belief that, as the proposed
bill was not intended to give a meaningful life when the person
did not otherwise have a meaningful life, philosophically, it
was more than could be achieved through the program. He
acknowledged that, although there were many good things that
could "come of this program, but giving someone meaningful life,
even if we were just talking about more meaningful life, I think
that would be an entirely different concept." He said that the
proposed bill was currently written in such a way that a person
could not achieve a meaningful life without this program, and
that he did not agree with that.
3:53:20 PM
CHAIR SPOHNHOLZ maintained her objection.
3:53:31 PM
A roll call vote was taken. Representative Eastman voted in
favor of Conceptual Amendment 1. Representatives Spohnholz,
Kito, Tarr, Sullivan-Leonard, and Zulkosky voted against it.
Therefore, Conceptual Amendment 1 failed by a vote of 1 yea - 5
nays.
3:54:23 PM
REPRESENTATIVE TARR expressed her pleasure that this proposed
bill and another bill regarding supportive decision making were
both moving forward, as they seemed long overdue.
CHAIR SPOHNHOLZ declared that the concept of self-determination
was one of the most important concepts that we have, as
individuals, to allow control of our own bodies and our own
destinies. She stated that most of us don't like to be told
what to do, and that we should be able to make the choices for
our own lives that best fit with our values. She added that we
should be able to build our skills in ways that are meaningful
to us, and not necessarily to other people.
3:55:48 PM
REPRESENTATIVE ZULKOSKY moved to report SB 174, Version 30-
LS1258\D, out of committee with individual recommendations and
the accompanying zero fiscal notes. There being no objection,
SB 174 was moved from the House Health and Social Services
Standing Committee.
3:56:11 PM
The committee took an at-ease from 3:56 p.m. to 3:58 p.m.
SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD
3:58:22 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 108(FIN), "An
Act relating to the State Medical Board; relating to the
licensing of physicians, osteopaths, and podiatrists; relating
to the certification of medical assistants; relating to the
practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to assault of a
medical professional; and providing for an effective date."
3:58:30 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, explained that
the proposed bill included requests by the State Medical Board
for changes to their statutes. She presented a PowerPoint
titled "SB 108, State Medical Board," and introduced slide 2,
"Purpose," which listed the two purposes of the bill: to
streamline physician licensing and to address the need for both
licensed and unlicensed office assistants.
3:59:58 PM
SENATOR GIESSEL addressed slide 3, "Streamline MD licensing,"
which was addressed by the proposed bill in Sections 1, 2, 8,
and 9 [and 10] for changes to the process for license approval.
She declared that the reason to the delay for approval was the
need for the license application to first be reviewed, and then
forwarded to the State Medical Board for evaluation during its
quarterly meeting. She explained that the proposed bill would
authorize the executive administrator to look at the license
applications, and if it was complete, and there were not any
concerns, the administrator would be authorized to approve the
license and issue temporary licenses, as well as grant
certifications. The proposed bill also spelled out prohibitions
for the board to limit the executive administrator's authority
in this realm. She added that this process had already been in
use by the Department of Commerce, Community & Economic
Development for 20 years. She declared that it was a safe,
efficient, and proven system.
4:01:49 PM
SENATOR GIESSEL moved on to slide 4, "Streamline MD licensing,"
and reported that Sections 10 and 11 of the proposed bill added
an additional second person to issue temporary licenses should
the executive administrator not be available. She declared that
that this would help streamline the license approvals between
those quarterly board meetings. She reported that there were
approximately 290 licenses in backlog, although some of these
may not be complete. She noted that only about 5 percent of the
applications were complete when submitted.
SENATOR GIESSEL directed attention to slide 5, "Unlicensed
Assistive Personnel," which was addressed in Section 3 of the
proposed bill. She reported that, in the mid-1990s, physician
offices began to hire unlicensed personnel for routine medical
duties in order to reduce overhead costs. She pointed out that,
as the state medical laws prohibited the delegation of any
medical duties to an unlicensed person, the proposed bill would
correct that gap in the laws and it would authorize delegation
of routine medical tasks, as defined by the State Medical Board,
to an unlicensed person.
4:05:15 PM
SENATOR GIESSEL addressed slide 6, "2.a. Unlicensed Personnel
Medical assistants," and noted that Sections 6, 12, and 14 added
additional clean up language, and put "routine medical duties"
under the exception to the license to practice medicine as the
law currently prohibited any of these medical activities being
delegated to unlicensed people. She reported that Section 12
added medical assistant to the practice of medicine, and Section
14 added medical assistants to the definition of medical
professional under the Title 12 Criminal Procedure.
SENATOR GIESSEL directed attention to a second category of
medical assistant created in the proposed bill to again correct
a problem identified by practicing physicians, slides 7 - 8,
"2.b. Medical assistants - license/certification." She relayed
that earlier legislation had prohibited unlicensed people from
looking into the prescription drug database, as it contained
sensitive information. She stated that this had now caused
problems in the offices of pain or cancer doctors, as these
doctors did not have staff licensed to perform this task. She
relayed that the proposed bill created an entity of medical
assistants who were certified through recognized training and
certification programs. She added that Alaska's community
colleges had training programs for certified medical assistants,
which were recognized in many other states. She explained that
Section 4 of the proposed bill defined the certifying process in
regulation by the board, slide 9, "Medical assistant with
certification Process defined." She stated that Section 5
listed specific limitations for use of the term "certified," and
that Section 13 included certification in the definition of a
license. She pointed out that these certified assistants would
be qualified to look into the prescription drug database for a
physician, as well as being assigned more complex medical duties
as determined by the medical board.
4:10:04 PM
SENATOR GIESSEL emphasized that the proposed bill would provide
a more efficient, expeditious, and effective licensing of
physicians, it would provide legal clarity for the delegation of
routine medical duties to unlicensed personnel, and create more
stringent licensing for a person certified or licensed by the
board, slides 10 - 11, "Urgent need for SB 108." She declared
that the state medical board "really needs this" and that there
had not been any opposition to the proposed bill.
4:11:09 PM
REPRESENTATIVE SULLIVAN-LEONARD acknowledged that other medical
professionals had indicated the time element to manage all the
tasks. She relayed that certified medical assistants (CMA) were
very beneficial and asked if the CMAs could apply a prescription
or write a prescription.
SENATOR GIESSEL offered her belief that the board intended that
CMAs not be allowed to do any prescribing or management of
opioids other than accessing the data base. She cautioned that
the term CMA was a registered trademark by one of the certifying
bodies, and that neither the term or the words were used in the
proposed bill.
4:13:00 PM
REPRESENTATIVE KITO mused that the proposed bill was providing
for licensing, registration, or certification of a medical
assistant, as well as allowing medical professionals to
designate routine tasks to unlicensed medical assistants. He
asked if this created two classes of medical assistants,
licensed and unlicensed.
SENATOR GIESSEL acknowledged that there were two categories of
medical assistants. One was a regular medical assistant whereas
the other had sought on-going education, had taken the national
certifying examination, and was qualified to pursue licensing by
the State Medical Board.
REPRESENTATIVE KITO expressed concern for the ability to oversee
a doctor's office which could have both categories of medical
assistant.
SENATOR GIESSEL stated that the medical board would define the
limitations on both entities, and that it would be up to the
facility to monitor that the clinicians were practicing within
the scope of their license. She said that these were all
logistics that the medical profession would work out.
4:15:22 PM
REPRESENTATIVE KITO asked about the applicability of the medical
board asking to authorize a new category of medical professional
when they were not in support of a similar request by the
naturopath board. He expressed concern for leaving this
entirely to the medical board while not knowing the
requirements.
SENATOR GIESSEL acknowledged that he had identified a turf
situation which occurred in medicine. She shared an anecdote
for the nursing profession putting in statute and regulation the
authority to delegate to unlicensed assistive personnel. She
said that it was "pretty routine" to trust professional boards
with this.
REPRESENTATIVE KITO said that, although he appreciated areas of
turf, it was necessary to carefully understand what was being
added. He expressed his concern for the new certification of
medical assistants without fully understanding their task. He
asked for a commitment from the medical profession that this
would result in decreases in cost, as there would be a
delegation of tasks from a licensed professional to unlicensed
individuals. He expressed concern that the public would not be
receiving the benefit.
SENATOR GIESSEL said that these cost reductions should have been
seen in the mid-1990s when medical assistants began to replace
licensed professional in physician offices.
REPRESENTATIVE KITO pointed out that medical costs had continued
to increase since then.
CHAIR SPOHNHOLZ noted that the requirement that health care
providers use the prescription drug database had been added in
the last few years at a time when they had not been able to bill
for that.
4:19:25 PM
REPRESENTATIVE TARR asked whether the role of untrained students
working in medical offices was now becoming professionalized.
SENATOR GIESSEL explained that the "regular" medical assistant,
usually high school graduates, had been trained on the job. She
reported that, as the education became more formalized over
time, the State of Alaska now needed to recognize this training.
REPRESENTATIVE TARR opined that, as people would be better
prepared to provide information, there would be a positive
benefit. She suggested that many of these had been
administrative, rather than health care positions.
SENATOR GIESSEL expressed her agreement and suggested that the
certified medical assistant would now perform more invasive
medical procedures, such as immunizations. She listed some of
the safeguards as a result of medical training.
REPRESENTATIVE TARR questioned whether there would be a public
comment period after the State Medical Board prepared
regulations.
SENATOR GIESSEL expressed her agreement, noting that the
regulatory process took about one year to complete, which
included a period for public comment.
REPRESENTATIVE EASTMAN directed attention to Section 4 of the
proposed bill and asked for the reasons that immunity was
offered.
4:24:20 PM
SENATOR GIESSEL stated that this was standard language in health
care statutes for providing immunity to people making reports of
incidences.
REPRESENTATIVE EASTMAN, referencing AS 08.64.111, asked whether
use of the abbreviation C.M.A. was intended and whether it would
run "afoul of the trademark issue" mentioned previously.
SENATOR GIESSEL replied that this decision to choose the
certifying body for the trademark C.M.A. was up to the State
Medical Board, pointing out that these initials were not
specified in the proposed bill.
REPRESENTATIVE EASTMAN directed attention to Section 12 of the
proposed bill and asked whether the certified medical assistants
were practicing medicine.
SENATOR GIESSEL explained that Section 12 indicated that a
medical assistant licensed under a separate chapter of the
proposed bill was exempt from practicing without a medical
license.
REPRESENTATIVE EASTMAN asked if the other chapter provided a
comparable penalty.
SENATOR GIESSEL acknowledged that there were penalties for
practicing medicine without a license. She shared the State
Medical Board list of other licenses and certificates.
4:27:51 PM
REPRESENTATIVE KITO expressed concern regarding the definition
of medical professional in Section 14.
SENATOR GIESSEL directed attention to similar positions on the
medical board list and acknowledged that it was a rather broad
definition.
REPRESENTATIVE KITO compared this to dental assistants who could
be delegated tasks and asked about the consideration of someone
as a medical professional "who has zero training."
SENATOR GIESSEL explained that the purpose for the definition of
medical professional was to authorize for the routine medical
tasks, which included the medical assistant with certification.
She suggested that the dental assistant should be added.
4:31:03 PM
CHAIR SPOHNHOLZ opened invited testimony on SB 108.
4:31:15 PM
FRED PARADY, Deputy Commissioner, Office of the Commissioner,
Department of Commerce, Community & Economic Development, stated
his support of the proposed bill. He stated that, in FY17, the
Department of Commerce, Community & Economic Development had
processed 22 percent more medical licenses and 31 percent more
nursing licenses, reflecting the increased demand for health
care professionals in Alaska. He reported that the department
had initiated a strategic planning process which identified
streamlining the application process for health care professions
as its highest priority. This initiative included a
comprehensive examination of the processes, which identified
every step of the process to search for roadblocks and
bottlenecks. He noted that 27 of these roadblocks were
identified and evaluated for the cause in order to determine if
this was a public safety need, whether the process was obsolete,
and whether the roadblock could be simplified. He explained
that there was a three-pronged approach to implementing the
solutions to these roadblocks: some were in board regulation,
some were improvements to the IT process, and some were changes
to statute.
4:34:50 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if the processing for the
positions in the proposed bill would be paid by the State
Medical Board.
MR. PARADY said that they would.
4:35:20 PM
CHAIR SPOHNHOLZ opened public testimony on SB 108.
4:35:43 PM
DANNY ROBINETTE, MD, Chief Medical Officer, Foundation Health
Partners, stated that his organization was in support of the
proposed bill to expedite the process. He reported on the
struggle to bring physicians to Alaska. He lauded the
safeguards in the proposed bill to ensure clean applications.
4:37:35 PM
CHAIR SPOHNHOLZ closed public testimony on SB 108.
4:37:54 PM
The committee took a brief at-ease.
4:38:22 PM
REPRESENTATIVE TARR said that the proposed bill was an important
step forward to hopefully result in more access to care and to
lower costs. She stated that it would be imperative for the
legislature to maintain a vigilance for the regulations upon
release to the public.
CHAIR SPOHNHOLZ said that she had heard concerns from physicians
about the prescription drug database requirement, and that this
new category would allow health care practitioners more office
efficiency. She stated that the temporary licensing was an
important aspect and that there were appropriate fail safes.
4:40:03 PM
REPRESENTATIVE ZULKOSKY moved to report CSSSSB 108 (FIN),
Version 30-LS0740\I, from committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSSSSB 108 (FIN) was reported from the House
Health and Social Services Standing Committee.
4:40:26 PM
The committee took an at-ease from 4:40 p.m. to 4:42 p.m.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
State Medical Board
4:42:47 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be a confirmation hearing for the Alaska State Medical Board.
LIU SAI-LING, MD, Appointee, State Medical Board, said that she
was a board-certified family practice physician, practicing in
Nome for 28 years. She was the Medical Director for the long-
term care facility. She said that she had been on the State
Medical Board for the past four years, and that she was applying
for a second term. She noted that the State Medical Board had
had a lot of turnover and that it was important to have
continuity of service. She declared that it was an honor to be
on the board, that the other members were very dedicated and
took the responsibilities seriously, and that it was a lot of
work. She pointed out that, even though travel for the last
board meeting had not been approved due to state budget cuts,
everyone had paid their own way to Anchorage for the meeting.
4:45:18 PM
REPRESENTATIVE TARR asked if there was full participation from
the current state medical board members, in order to ensure that
the license applications were addressed.
DR. LIU said that it was not an issue, and that occasionally one
person would not be able to attend. She declared that members
took their role very seriously and participated.
REPRESENTATIVE TARR asked about board turnover, whether many
board members only served one term.
DR. LIU explained that in the last two years, many of the terms
had expired, hence a lot of turnover.
4:47:29 PM
REPRESENTATIVE ZULKOSKY moved to advance the confirmation of Dr.
Liu Sai-Ling, appointee to the Alaska State Medical Board, to a
joint session of the House and Senate for consideration. She
reminded the committee that signing the report regarding
appointment in no way reflects individual members' approval or
disapproval of the appointee, and the nominations are merely
forwarded to the full legislature for confirmation or rejection.
There being no objection, the confirmation was advanced.
HB 358-INSURANCE COVERAGE FOR TELEHEALTH
4:48:11 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 358, "An Act relating to insurance coverage
for benefits provided through telehealth; and providing for an
effective date."
4:48:22 PM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, declared that there had not been any
opposition to the proposed bill and she paraphrased from the
Sectional Analysis [Included in members' packets], which read:
Section 1.
AS 21.42.422 has been amended to require insurance
coverage for benefits provided via telehealth.
Section 2.
AS 21.42.422 is a new subsection that defines health
care insurer as a person transacting the business of
health care insurance except for a nonfederal
governmental plan. It also adds the definition of
telehealth under 47.05.270(e) as the practice of
health care delivery, evaluation, diagnosis,
consultation, or treatment, using the transfer of
health care data through audio, visual, or data
communications, performed over two or more locations
between providers who are physically separated from
the recipient or from each other or between a provider
and a recipient who are physically separated from each
other.
Section 3
The changes to Section 1 of this bill applies to
health care insurance plans that are offered, issued,
delivered, or renewed on or after the effective date.
Section 4
The effective date is July 1, 2019.
4:49:44 PM
CHAIR SPOHNHOLZ opened invited testimony on HB 358.
4:49:54 PM
AROM EVANS, MD, Medical Director, Orion Behavioral Health
Network, stated support for the proposed bill, pointing out that
telemedicine was an extremely important service for many
residents of rural villages as it was not realistic to have a
psychiatrist reside in these communities. He pointed out that
sometimes private insurance did not pay for telehealth,
resulting in difficulties for many patients. He stated that
neglect of mental health issues tended to drive up health care
costs, and that payment by private insurers for telehealth would
save money for the state.
4:53:19 PM
REPRESENTATIVE ZULKOSKY asked if the Orion Behavioral Health
Network partnered with Alaska providers who had encountered this
challenge.
DR. EVANS explained that there were Alaska providers in their
network and they had encountered difficulties in getting
services paid for both in and out of state providers.
4:55:08 PM
LYN FREEMAN, Ph.D., Mind Matters Research, declared her support
for the proposed bill. She shared some background for her
practice, stating that she treated patients who were referred to
her with chronic disease and behavioral or emotional issues
which contributed to a worsening of the condition. She
practiced various forms of integrative approaches, including
non-pharmalogical pain management. She reported that about 40
percent of her practice was through tele-health as travel was
not possible for these patients. She reported that she had
tested her research for psychological interventions for patients
with chronic diseases through both live delivery and tele-
health, and that improvement outcome was equivalent for both
systems of delivery. She shared that she had maintained
training for the ethical aspect in the use of telehealth for
mental health treatment. She reported that these ethics
trainings had pointed out that it was preferable to treat people
in your own state as it was easier to know the resources
available should something happen during the distance
treatments.
4:59:30 PM
CHAIR SPOHNHOLZ opened public testimony and after determining no
one wished to testify, closed public testimony on HB 358.
4:59:56 PM
REPRESENTATIVE EASTMAN asked about the scope of the benefits
being provided.
5:00:48 PM
CHAIR SPOHNHOLZ, as the sponsor of HB 358, clarified that
receiving medical care via telehealth did not mean not seeing a
doctor. As telehealth was a delivery system, it was not
necessary to limit the scope in the proposed bill. She shared
that she did not want to put limits on the creativity of health
care providers based on the current ability to imagine what can
and cannot be done, and that this would allow the marketplace to
develop.
5:01:53 PM
REPRESENTATIVE EASTMAN asked if this meant that any benefits a
health care insurer provided coverage for should also be covered
via telehealth.
CHAIR SPOHNHOLZ emphasized that this was intentionally broad,
and that this was based on her own experiences for not being
able to access health care services via telehealth. This led to
the exploration of the concept of telehealth as it related to
private insurance. She stated that, as not all health care
insurers would currently pay for this, it was time to move in
that direction.
5:03:12 PM
VICTORIA KNAPP, Chief Operating Officer, Mat-Su Health Services,
stated that she was in support of HB 358. She reported that
several years ago Mat-Su Health Services had moved to a tele-
medicine model for some of their psychiatric evaluations and
medication management appointments to meet some of the unmet
need for these services in the borough. She declared that they
were a safety net provider, funded by the federal government and
the Division of Behavioral Health. She shared that, as several
large insurance providers in the state did not provide coverage
for tele-health services, families and individuals were left
with the choice of a very large bill or looking elsewhere for
psychiatry services. She declared frustration that these
insurers did not cover tele-health psychiatry.
5:05:24 PM
REPRESENTATIVE ZULKOSKY moved to report HB 358, Version 30-
LS1216\J, out of committee with individual recommendations and
the attached zero fiscal notes.
5:05:37 PM
REPRESENTATIVE EASTMAN objected. He explained that all his U.S.
Department of Veterans Affairs health care through his primary
care doctor in Orlando, Florida, was via tele-health. He stated
his appreciation for the value, and opined that, although there
were cost savings to be gained, the market was not ready for a
mandate that any provided health care also be accessible via
tele-health. He offered his belief that, if it made financial
sense, providers would go that direction. He stated that
telehealth was not everything it could be, and that the
providers should have the option to not have to use it.
5:07:12 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if there was a list of
what was approved for telehealth medicine for procedures and
oversight for patients.
5:07:39 PM
MS. NISBETT said that there was a list of procedures on the
Alaska Native Medical Center website that were accepted.
CHAIR SPOHNHOLZ pointed out that this was a different category.
5:08:16 PM
ANNA LATHAM, Deputy Director, Division of Insurance, Department
of Commerce, Community & Economic Development, clarified that
the proposed bill allowed for insurance companies to pay for
telehealth services in both the group and individual markets.
She stated that the benefits that were already in the plans for
essential health benefits, as well as any other benefits covered
by the plan, would be allowable for telehealth. She stated that
the list of benefits for the Alaska Native Health plans was a
separate program.
5:09:06 PM
REPRESENTATIVE ZULKOSKY asked whether the proposed bill mandated
that an individual utilize telehealth services, or whether it
just provided the authorization for the insurance plans to be
billed for those services.
MS. LATHAM replied that there was not a mandate, that it allowed
the insurance companies to cover telehealth services beyond
mental health, which was currently in statute.
5:09:37 PM
REPRESENTATIVE EASTMAN asked whether a current benefit from a
health care plan would now also be provided as a telehealth
option.
MS. LATHAM explained that, with the proposed bill, the insurer
can pay if you utilize telehealth.
5:10:11 PM
REPRESENTATIVE EASTMAN asked about the definition of shall in
this specific context.
5:10:32 PM
MS. LATHAM explained that the proposed billed stated that the
insurers shall provide coverage for benefits provided through
telehealth. This may or may not require in-person contact.
This proposed bill simply allowed large, small group, and
individual market coverage to pay for telehealth services.
CHAIR SPOHNHOLZ asked for clarification that the proposed bill
was not requiring people to use telehealth, but it was requiring
insurance companies to cover telehealth services should the plan
have a provision for such services. She acknowledged that there
were some services which did not make sense for delivery via
telehealth. She pointed out that there were a lot of insurance
plans offered in the State of Alaska which were not required to
cover telehealth. She stated that this bill was not saying what
kind of health care should be covered by telehealth, it was
saying that the insurance provider should pay for the service if
it was delivered via telehealth.
5:12:41 PM
REPRESENTATIVE EASTMAN asked where he could go to find out what
services were available by telehealth. He asked if one insurer
decided to provide a benefit via telehealth, did all the other
insurers need to match.
CHAIR SPOHNHOLZ said that was a decision between him and his
health care provider.
5:13:21 PM
REPRESENTATIVE EASTMAN maintained his objection.
5:13:27 PM
A roll call vote was taken. Representatives Spohnholz, Tarr,
Sullivan-Leonard, Johnston, Zulkosky, and Kito voted in favor of
HB 358. Representatives Eastman voted against it. Therefore,
HB 358 was reported out of the House Health and Social Services
Standing Committee by a vote of 6 yeas - 1 nay.
5:14:07 PM
The committee took an at-ease from 5:14 p.m. to 5:16 p.m.
HJR 32-CONST. AM: PARENTAL CONSENT TO ABORTION
5:16:23 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE JOINT RESOLUTION NO. 32, Proposing an amendment to the
Constitution of the State of Alaska relating to notice and
consent before termination of a minor's pregnancy.
5:16:30 PM
REPRESENTATIVE GABRIEL LEDOUX, Alaska State Legislature,
paraphrased from the Sponsor Statement [Included in members'
packets], which read:
HJR 32 seeks to add a new section to the Alaska
Constitution allowing the legislature OR the people
through the initiative process, to have the option to
require notice to and consent of the parent or legal
guardian of a minor before the minor's pregnancy is
terminated.
Deciding whether to continue a pregnancy or have an
abortion is a decision that will have major long-term
impacts on the life of a young woman. Notification and
consent laws help pregnant teens to get support and
guidance from their parents or guardians. Currently
parents or guardians must give consent for their child
to be treated by a school nurse, buy cough syrup, get
their ears pierced, take a risk assessment survey in
school, go on a field trip or watch an R rated movie.
In Alaska parents cannot even give consent for a child
under 18 to get a tattoo. Parents have the right to
know about the activities of their underage teens and
especially about a decision as big as an abortion. As
a parent I would want to know.
5:18:41 PM
REPRESENTATIVE LEDOUX paraphrased from the resolution, [Included
in members' packets], which read:
Section 1. Article I, Constitution of the State of
Alaska, is amended by adding a new 5 section to read:
Section 26. Notice and Consent before Termination
of Minor's Pregnancy. This constitution does not
prohibit the legislature or the people from requiring
notice to and the consent of the parent or legal
guardian of a minor before the minor's pregnancy is
terminated. The legislature shall implement this
section by law in a manner consistent with the
requirements of the Constitution of the United States,
and the people may implement this section by
initiative in a manner consistent with the
requirements of the Constitution of the United States.
Sec. 2. The amendment proposed by this resolution
shall be placed before the voters of the state at the
next general election in conformity with art. XIII,
sec. 1, Constitution of the State 15 of Alaska, and
the election laws of the state.
5:19:54 PM
CHAIR SPOHNHOLZ announced that HJR 32 would be held over.
5:20:18 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:20 p.m.