03/03/2022 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB265 | |
| HB292 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HSCR 2 | TELECONFERENCED | |
| += | HB 265 | TELECONFERENCED | |
| *+ | HB 292 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 3, 2022
3:05 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Mike Prax
Representative Christopher Kurka
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 265
"An Act relating to telehealth; relating to the practice of
medicine; relating to medical assistance coverage for services
provided by telehealth; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 292
"An Act relating to home and community-based services; and
providing for an effective date."
- HEARD & HELD
CONFIRMATION HEARING(S):
State Medical Board; Mental Health Trust Authority
Kevin Fimon - Anchorage
- SCHEDULED BUT NOT HEARD
HOUSE SPECIAL CONCURRENT RESOLUTION NO. 2
Disapproving Executive Order No. 121.
- BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: HB 265
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
01/18/22 (H) PREFILE RELEASED 1/14/22
01/18/22 (H) READ THE FIRST TIME - REFERRALS
01/18/22 (H) HSS, FIN
02/01/22 (H) HSS AT 3:00 PM DAVIS 106
02/01/22 (H) -- MEETING CANCELED --
02/03/22 (H) HSS AT 3:00 PM DAVIS 106
02/03/22 (H) -- MEETING CANCELED --
02/17/22 (H) HSS AT 3:00 PM DAVIS 106
02/17/22 (H) Heard & Held
02/17/22 (H) MINUTE(HSS)
03/03/22 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 292
SHORT TITLE: HOME AND COMMUNITY-BASED WAIVER SERVICES
SPONSOR(s): REPRESENTATIVE(s) SNYDER
01/27/22 (H) READ THE FIRST TIME - REFERRALS
01/27/22 (H) HSS, FIN
02/24/22 (H) HSS AT 3:00 PM DAVIS 106
02/24/22 (H) <Bill Hearing Canceled>
03/03/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
GENEVIEVE MINA, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Spohnholz,
prime sponsor, reviewed the summary of changes for the proposed
CS for HB 265, Version N.
GENNIFER MOREAU-JOHNSON, Director
Division of Behavioral Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the discussion of
the proposed CS for HB 265, Version N.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
the proposed CS for HB 265, Version N.
RENEE GAYHART, Director
Division of Health Care Services
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the discussion of
the proposed CS for HB 265, Version N.
JULIA LUEY, Vice President
Integrated and Residential Services
Volunteers of America Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
SARAH ELIASSEN, representing self
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
SUZANNE ISHII-REGAN, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
PAMELA SAMASH, representing self
Nenena, Alaska
POSITION STATEMENT: Provided testimony on HB 265, Version N.
KYLE ZEBLEY, Executive Director
American Telemedicine Association Action
Washington DC
POSITION STATEMENT: Provided testimony on HB 265, Version N.
JACKI CHURCHILL, representing self
Chugiak, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
TIFFANY HALL, Executive Director
Recover Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
LIZETTE STIEHR, Executive Director
Alaska Association on Developmental Disabilities
Chugiak, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
JESSICA ESTES, member
Alaska Advanced Practice Registered Nurse Alliance
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
LANCE JOHNSON, Administrative Director
Behavior Health Services
Norton Sound Health Corporation
Nome, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
LARRY JOHANSEN, representing self
Haines, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
ANN RINGSTAD, Executive Director
National Alliance on Mental Illness Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 265, Version N.
ALLIANA SALANGUIT, Staff
Representative Liz Snyder
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Snyder, prime
sponsor, presented the sectional analysis of HB 292.
KATHERINE BACON, representing self
Palmer, Alaska
POSITION STATEMENT: Provided invited testimony during the
hearing on HB 292.
LEIONILEI JOHNSON, representing self
Juneau, Alaska
POSITION STATEMENT: Provided invited testimony during the
hearing on HB 292.
AMANDA COLLINS, representing self
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony during the
hearing on HB 292.
ALEXIS RODICH, Lobbyist
Service Employees International 775
Seattle, Washington
POSITION STATEMENT: Provided invited testimony during the
hearing on HB 292.
JOHN LEE, Director
Division of Senior and Disabilities Services
Department of Health and Social Services
Palmer, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 292.
ACTION NARRATIVE
3:05:42 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:05 p.m.
Representatives McCarty, Spohnholz, Snyder, Fields, and Zulkosky
were present at the call to order. Representatives Prax and
Kurka arrived as the meeting was in progress.
HB 265-HEALTH CARE SERVICES BY TELEHEALTH
3:06:46 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be HOUSE BILL NO. 265, "An Act relating to telehealth;
relating to the practice of medicine; relating to medical
assistance coverage for services provided by telehealth; and
providing for an effective date."
3:06:55 PM
CO-CHAIR SNYDER moved to adopt the proposed committee substitute
(CS) for HB 265, Version 32-LS0754\N, Foote, 3/1/22, as a
working document.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
3:07:18 PM
REPRESENTATIVE SPOHNHOLZ, as prime sponsor, presented the
proposed CS for HB 265, Version N. She stated that HB 265,
Version N, is designed to create a framework for access to
telehealth while ensuring patients' safety and choice in the
state.
3:07:41 PM
The committee took a brief at-ease at 3:07 p.m.
3:07:57 PM
REPRESENTATIVE SPOHNHOLZ continued that the intention of the
proposed legislation would be to remove barriers to telehealth
and allow the state to make regulations based on quality-of-care
metrics with individual practitioners. She stated that the
three changes the CS would make are at the request of several
stakeholders. The first proposed change would allow physicians
licensed outside of Alaska to provide health care to Alaskans
who have an established relationship with the physician through
an in-person exam. She explained that follow-up exams could
take place via telehealth, allowing for continuity of care. The
second proposed change would remove the in-person requirement
for advanced nurse practitioners to prescribe controlled
substances. She said one of the major objectives would be to
allow flexibility for prescribing behavioral health medications
in rural Alaska. The third proposed change would add facilities
authorized by the Department of Health and Social Services
(DHSS) to telehealth provisions so they could deliver behavioral
health services.
3:11:20 PM
GENEVIEVE MINA, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, on behalf of Representative Spohnholz, prime
sponsor, paraphrased the explanation of changes of the proposed
CS for HB 265, Version N, [included in the committee packet],
which read as follows [original punctuation provided]:
Section 1 Replaces any reference to "examination" with
"visit," and updates corresponding language throughout
the bill, except for providers licensed in another
state. Removes language in subsection (a) of version W
related to the telehealth authority of providers
licensed in another state. This language is replaced
with subsection (b), which creates an exemption for
physicians licensed in another state to deliver health
care services within their scope of practice if there
is an established physician-patient relationship, the
non-resident physician has given the patient an in-
person physical exam, and the services are related to
ongoing treatment or follow-up care related to past
treatment. Cleans up the provisions regarding
medication assisted treatment by removing subsection
(d) in version W, which pertained to services
addressing opioid use disorder. This language was
deemed unnecessary to ensure the telehealth delivery
of medication assisted treatment to treat opioid use
disorder (i.e., medication, counseling, and behavioral
health therapies). Revises the prescribing authority
provisions by separating physicians, podiatrists,
osteopaths, and physician assistants in subsection (e)
from advanced practice registered nurses (APRNs) in
subsection (f). Amends the APRN language in subsection
(f) to remove the in-person requirement for
prescribing controlled substances (including
buprenorphine) via telehealth. This does not change
the prescribing scope for these providers. Creates
subsection (h) to remove requirements to document all
attempts for an in-person visit and prevents the
department or board from limiting the physical setting
of a health care provider delivering telehealth.
Clarifying language is inserted under subsection
(j)(2) defining all providers in this section as
licensed in good standing. 2 Section 3 Creates
subsection (h) under Title 18 to remove requirements
to document all attempts for an inperson visit. This
section replicates the same provisions on
documentation and physical setting for emergency
medical services as Section 1. Section 4 Amends
telehealth services included in Alaska Medicaid by
explicitly including home and community-based waiver
services in subsection (a)(2) and adding services
provided under a state plan option (e.g., 1915(k)
services) in subsection (a)(3). Adds language in
subsection (b), line 13 to ensure the department must
revise regulatory language to include telehealth in
the definition of a "visit." Section 5-6 These are new
sections adding telehealth provisions to entities in
Title 47, which are grantees that deliver community
mental health services, or facilities approved by the
department to deliver substance use disorder
treatment. Their authority to deliver telehealth was
previously unaddressed in version W because they are
not applicable to the provisions in Title 8, or the
Alaska Medicaid provisions in Title 47. Both sections
replicate the same telehealth provisions on cost,
scope of services, patient protections, documentation,
and physical setting as Section 1. Section 5 creates
AS 47.30.585 to include entities designated under AS
47.30.520 AS 47.30.620, which are approved to
receive grant funding by the Department of Health and
Social Services to deliver community mental health
services. Section 6 creates AS 47.37.145 to include
public or private treatment facilities approved by the
Department of Health and Social Services in AS
47.37.140 to deliver services designated under AS
47.37.40 AS 47.37.270 addressing substance use
disorders.
3:16:13 PM
REPRESENTATIVE MCCARTY shared his personal involvement with
telehealth and telemedicine. He questioned whether the medical-
assisted treatment (MAT) service would be in the induction
process or part of the continued medication service.
3:17:10 PM
REPRESENTATIVE SPOHNHOLZ responded that the intention of the
proposed legislation would be to let the boards determine the
adoption of individual regulatory packages. She expressed the
assumption that clinicians would want initial assessment and
treatment plans to be developed in person. She stated that
defining this in [the legislation] was avoided so the governing
boards, which are committed to the best practices, could
determine the appropriate modality. She explained that some of
the language focuses on quality of care, but quality should not
be "the enemy of access," because in many parts of Alaska there
is no access to care. She pointed out that Sara Chambers could
answer questions concerning the adoption of regulations and
oversite, and Director Gennifer Moreau-Johnson could address
behavioral health.
REPRESENTATIVE MCCARTY, with a follow-up question, referenced a
situation when a patient was not given "great care" while under
distance medication services. He argued that when a client is
physically present, abreactions can be detected. He expressed
the concern that in the induction process of MAT, when a client
is transitioning to medication from [addictive] substances,
nuances cannot be detected using telemedicine. He requested
additional information concerning this.
3:20:25 PM
REPRESENTATIVE SPOHNHOLZ responded that boards would adopt
regulations based on the appropriate standards of practice and
scope of training. She added that there is nothing in the
legislation which would require a provider to deliver a certain
type of care via telehealth, or for a patient to receive care
via telehealth. Both the patient and the provider would have to
consent to telehealth delivery within the proposed framework.
She argued that boards should make the appropriate telehealth
regulations, not legislators.
3:22:10 PM
GENNIFER MOREAU-JOHNSON, Director, Division of Behavioral
Health, Department of Health and Social Services, in response to
Representative McCarty, stated that induction via telehealth had
been allowed during the COVID-19 pandemic. She expressed the
belief that there are federal requirements for face-to-face
induction, and the state would refer to the federal
requirements.
3:22:44 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, in response to Representative McCarty,
stated that the division has been working closely with the
sponsor to ensure the intent would be clear. She said, "The
regulations would be the appropriate place for any siderails or
narrowing to happen on a case-by-case basis." She added that
this is also the understanding of the medical and nursing
boards. She stated that the [proposed legislation] would lift
the requirement for in-person care, but it would also give the
boards the ability to further restrict [the care] under certain
circumstances.
3:23:39 PM
REPRESENTATIVE PRAX questioned the language in Section 1 of the
[proposed CS] which would restrict providers residing in other
states. He argued, "Once you get on the telephone, Seattle is
sort of the same as Anchorage."
3:24:16 PM
REPRESENTATIVE SPOHNHOLZ responded that the original draft of
the legislation allowed providers not licensed in Alaska to have
more access to deliver services to Alaskans via telehealth. She
explained that there is an enforcement issue because Alaska does
not have licensure compacting, and there is no enforcement
mechanism to hold a provider accountable.
3:26:17 PM
REPRESENTATIVE PRAX, with a follow-up comment, stated that an
alternative would be to address the compacting issue, which
would be an entirely different subject.
REPRESENTATIVE SPOHNHOLZ responded in the affirmative,
explaining that an assortment of licensing standards would have
to be changed. She expressed the opinion that compacts can be
controversial, and this would not be the responsible thing to do
for the state.
3:26:54 PM
REPRESENTATIVE FIELDS, in response to Representative Prax's
question, stated that another reason for [restricting outside
providers] would be to limit the incentive for large, multi-
state providers, as their services could push patients to
primary care outside of Alaska, undermining the provider
workforce in the state. He acknowledged that some people would
need to access specialists outside the state, and this should be
"the balance."
REPRESENTATIVE SPOHNHOLZ explained that outside providers can
still get licensed in Alaska, and if a provider wants to
practice in the state, but not live here, he/she can still
obtain a license.
3:28:19 PM
REPRESENTATIVE MCCARTY commented that many providers consider
Alaska a place to make a good amount of money while living in
another state. Concerning "usual and customary" reimbursement
rates, he questioned [which state] would be considered [the
rate] origin. In example, he said a provider may be licensed in
a state with a "usual and customary" reimbursement three-times
less than the [standard charge] in Alaska.
3:30:00 PM
REPRESENTATIVE SPOHNHOLZ responded that Alaska's rates are
higher, and nonresident providers licensed in Alaska already can
charge Alaska's rates. The proposed legislation would make no
changes to this. She explained that compensating a provider at
a lower rate would be a disincentive to provide telehealth care
and not support the business model. She indicated that
different rates cannot be set for non-Alaska providers. She
expressed the understanding that Alaska providers support the
payment parity provision because it supports expanding
telehealth in the state. In reference to the point made by
Representative Fields, she stated that the marketplace needs to
be built for Alaska providers, especially in rural Alaska, where
there are few providers.
3:32:11 PM
REPRESENTATIVE KURKA questioned the process to become licensed
in Alaska for a physician who lives outside of Alaska. He
expressed the understanding that obtaining the initial license
in Alaska would require residency at a hospital. He questioned
the process and practicality of someone living outside of the
state while practicing in Alaska.
REPRESENTATIVE SPOHNHOLZ responded that there are many
nonresident providers practicing in Alaska. She deferred to Ms.
Chambers.
3:33:20 PM
MS. CHAMBERS explained that there is no residency requirement to
be licensed in Alaska. The term "residency" refers to a phase
of professional progression in becoming a physician and not a
physical home. She stated that there are many providers in the
state who have never "set foot" in the state. She gave a quick
overview of the process for providers to become licensed in
Alaska, adding that it is the same for nonresidents and
residents.
3:34:52 PM
REPRESENTATIVE KURKA, with a follow up, questioned whether the
residency requirement would be a part of attending medical
school in any state.
MS. CHAMBERS responded in the affirmative.
3:35:33 PM
CO-CHAIR ZULKOSKY removed her objection.
REPRESENTATIVE MCCARTY objected for the purpose of an additional
question. He stated that insurance companies make payments
according to the point of service billing code. He questioned
whether the location [of a telehealth visit] has an impact on
the payment.
3:36:32 PM
CO-CHAIR ZULKOSKY, referring to time constraints, suggested that
the question be addressed at a later time.
REPRESENTATIVE MCCARTY removed his objection. There being no
further objection, Version N was before the committee.
3:37:08 PM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health and Social Services, responding to
Representative McCarty's question, explained that currently
telehealth is considered the same as an in-office service. She
continued that "usual and customary" rates are paid in
[accordance with where the provider's office] is located.
3:38:50 PM
CO-CHAIR ZULKOSKY re-opened public testimony on HB 265, Version
N.
3:39:14 PM
JULIA LUEY, Vice President and interim CEO, Integrated and
Residential Services, Volunteers of America (VOA) Alaska,
explained that VOA Alaska is a nonprofit, behavioral health
organization specializing in therapeutic services for youth,
young adults, and families. She offered VOA's support for the
proposed legislation, as it would maintain and expand Alaskan's
access to vital behavioral health services. She explained that
telehealth platforms had been significantly broadened during the
pandemic through temporary allowances and emergency declarations
at the state and federal levels, and more Alaskans had been able
to be reached. Prior to the pandemic, telehealth for behavioral
health services had been restricted to master's level
clinicians. During those services one party had to be within
four walls of a clinic. This created barriers in meeting
individuals in their recovery and healing process. She
expressed the opinion that telehealth, phone, and text are
avenues for helping individuals across Alaska's unique
landscape. She thanked the committee for the legislation, as it
would be a great enhancement to the behavioral health system of
care.
3:41:27 PM
SARAH ELIASSEN, representing self, voiced support for the bill.
She stated that at 96 years old, telehealth is important because
she could visit with her physician and get the attention needed
without having to obtain transportation to Anchorage from Eagle
River, and back. She emphasized that telehealth is important to
seniors. She shared that it had never occurred to her as a
young person that one day she would not be able to drive. She
said, "I want to impress upon you that it is important all over
the state, where people do not have transportation to get to a
doctor." She said it is impossible for her to get to Anchorage
without imposing on friends or family, adding that these people
are not responsible for taking her to the doctor. She said this
method of health care is a "blessing."
3:45:08 PM
SUZANNE ISHII-REGAN, representing self, thanked the state and
its disability services for quickly pivoting and being flexible
during the pandemic. She stated that she has a family member
who uses a ventilator and is immunocompromised, and telehealth
during the pandemic helped her family stay connected with their
physician while reducing contact with the public. The ability
to access telehealth reduced barriers concerning mobility issues
and weather.
3:48:08 PM
PAMELA SAMASH, representing self, explained that she supports
the proposed legislation because telehealth is a "great" option
for rural Alaskans, seniors, and doctors. She commented that
during telehealth meetings physicians often would see only a
patient's face. She stated that physicians may be missing other
issues without seeing the entire body, as "body language is 99
percent of communication." She said that with a "little TLC
this could be just perfect."
3:51:21 PM
KYLE ZEBLEY, Executive Director, American Telemedicine
Association (ATA) Action, stated that ATA Action is the ATA
affiliated trade association focused on advocacy. He stated
that ATA Action supports the legislature's effort to expand
access to high-quality care by allowing Alaska's licensed
providers to treat patients via telehealth without a prior in-
person examination. He stated that ATA Action approves of the
legislature's effort to allow physicians, osteopaths,
[podiatrists], and physician assistants to prescribe controlled
substances, when appropriate, via telehealth without an in-
person exam. He said ATA Action maintains that a care plan,
including telehealth, should be the choice between a patient and
his/her provider. He stated that patients should be able to use
telehealth to receive prescriptions for substances that fall
under Schedule III and Schedule IV categories, and certain
patients with substance abuse disorders should receive
prescriptions via telehealth for stimulants in the Schedule II
category. He stated that, [in addition to providers already
mentioned], ATA Action "strongly" encourages the legislature to
allow advanced practice registered nurses the permission to
prescribe controlled substances without an in-person exam. He
acknowledged the effort to permit out-of-state providers not
licensed in Alaska to render telehealth services to patients
referred by an Alaska-licensed provider, but he urged the
committee to remove barriers and allow out-of-state providers
licensed and in good standing within their home states to
practice without having to navigate the current licensure
requirements. He commented that there are aspects of the
proposed legislation to support.
3:54:06 PM
JACKI CHURCHILL, representing self, shared that she has an
immune compromised family member. She voiced support for HB
265. She stated that she is a nurse and expressed the opinion
that the options for telehealth should be available to all
Alaskans, whether or not they are established with an out-of-
state provider. She said, "Many times an opinion is needed more
than an exam when it comes to life-saving decisions," and an
important benefit of telehealth is that, before travel, a
patient and a provider can ensure they are a "good fit." She
explained in detail the benefits of telehealth with a physician
in Seattle during her spouse's cancer treatment, referencing an
appointment over the phone which turned out to be "lifesaving."
She summarized the benefits of telehealth as minimizing health
risks, mitigating inconveniences, and reducing out-of-pocket
costs.
3:58:00 PM
TIFFANY HALL, Executive Director, Recover Alaska, voiced support
for [Version N]. She stated that Recover Alaska works across
the state to reduce the harms of excessive alcohol use. She
cited that before the pandemic at least 44,000 Alaskans
experienced an alcohol-use disorder, but only 15 percent of
those who qualified received treatment. She related that the
location of services and stigma are barriers for people not
receiving treatment. She cited that during the pandemic roughly
one-third of Alaskans increased their alcohol use in order to
cope with stress. She expressed the opinion that there has been
a long need for treatment. She argued that the legislation
would help close the gap. One critical equity aspect is the
inclusion of multiple modalities, such as video, audio only, and
text options. She shared that she is in long-term recovery and
had relied heavily on telehealth opportunities during the
pandemic. She stated that mental health disorders often trick
people into thinking they do not need help, and any initial
barriers [to ask for help] "feel too big." She stated that
expanding telehealth is a great step forward for the state, and
a great step forward in terms of equity and reducing health
disparities across the state.
4:00:43 PM
LIZETTE STIEHR, Executive Director, Alaska Association on
Developmental Disabilities (AADD), voiced support for [Version
N]. She stated that AADD is a trade association of
organizations across the state which provides services to people
with developmental disabilities. She stated that the
utilization of remote services moved forward during the
pandemic, and many service providers for the developmentally
disabled were able to reach isolated clients. She stated that
the Alaska Mental Health Trust Authority had provided a grant
which supported training, provided handbooks, and facilitated
on-going meetings between providers. She added that these
providers continue to deliver robust services today. She stated
that AADD strongly supports the financial parity in the
[proposed] legislation.
4:03:36 PM
JESSICA ESTES, member, Alaska APRN Alliance, voiced support for
[Version N]. She stated that the legislation is important to
the clients that she serves, as they can be offered telehealth
regardless of their location, which ensures continuity of care.
She stated that continuing established relationships with
providers is also important for patients receiving end-of-life
care. She thanked the bill sponsor for the opportunity to
continue the services created during the pandemic.
4:05:06 PM
LANCE JOHNSON, Administrative Director, Behavior Health
Services, Norton Sound Health Corporation, spoke in support of
[Version N]. He voiced the preference for audio-only health
services. He explained that using audio-only services allows
people to be in an environment of their choosing, where they
feel safe. For example, he said, using telehealth in a village
office leaves a client feeling "exposed." He referenced a
housebound client who effectively completed an intensive
substance abuse program. He argued that without the ability to
receive treatment through audio-only services, the individual
would not be here today. He expressed the opinion that
telephone services allow people to be more vulnerable;
therefore, their progress is consistent. He added that audio-
only health services are also important because of the internet
issues which "plague" rural Alaska. He said having limited
internet does not make telehealth the best option, while audio
services allow people a greater choice in getting the needed
support. He thanked the committee, especially the bill sponsor.
4:07:20 PM
LARRY JOHANSEN, representing self, voiced support for the
legislation. He stated that as a lifelong Alaskan he has
experienced difficulties being reached in the remote places in
the state, and the pandemic taught people to be comfortable
using video as a form of communication. He shared that he has
had Parkinson's disease for 14 years, and, because of [his
disability] and the necessity to take ferries and flights, it
has taken him up to 10 days to travel to Seattle to see his
physician. He noted the expense of this travel. He said the
proposed legislation would benefit not only people like himself,
who stand to lose a great deal by not having medical services,
but it would increase all Alaskan's ability to receive medical
attention. He shared that in-person visits often allow only one
hour for a patient to cover everything that has happened to
him/her in the last six months. Personally, he does not know
how a medication will work until he is "in the real world," and
issues can be addressed much quicker using telehealth. He
concluded that the [proposed] legislation is important for a
large state.
4:12:13 PM
ANN RINGSTAD, Executive Director, National Alliance on Mental
Illness (NAMI) Alaska, stated that NAMI Alaska advocates for
access to mental health services, treatment, support, and
research and is steadfast in its commitment to raising awareness
and building a community of hope for all of those in need
throughout Alaska. She stated that in some cases telehealth
access is the only support available in the community. She
cited statistics on Alaskans with mental health issues and
argued that the proposed legislation would help many who do not
have access to mental health care. She stated that telehealth
has been a pivotal development in creating the ability to access
care in Alaska where resources are limited. She said that it
has been "a silver lining" from the pandemic and possibilities
continue to grow. She stated that NAMI Alaska supports the
legislation. She thanked the bill sponsor.
4:14:35 PM
CO-CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony on HB 265.
CO-CHAIR ZULKOSKY announced HB 265 was held over.
HB 292-HOME AND COMMUNITY-BASED WAIVER SERVICES
4:15:02 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 292, "An Act relating to home and
community-based services; and providing for an effective date."
4:15:41 PM
CO-CHAIR SNYDER, as prime sponsor, presented HB 292. She
explained that the proposed legislation is needed because of the
demand for in-home, long-term services and associated support.
She stated that stakeholders have reported service level cuts
for seniors, people with disabilities, and those who receive
Home and Community-Based Services (HCBS) waivers and Community
First Choice Medicaid State Plan K. She stated that these
people are facing barriers to services, such as long waitlists
and the inability to obtain the personal care assistant (PCA) of
their choice. She observed that caregivers have seen fewer
hours and lower pay over the last decade. She noted that rural
communities have been impacted by the lack of homecare
infrastructure. Because homecare is the only option which
allows these individuals to stay in their rural communities,
many Alaskans are forced to move away, denying them the option
of maintaining dignity and independence.
CO-CHAIR SNYDER stated that the proposed legislation outlines
the following issues: declining wages of PCAs; the impact on the
mostly female workforce; longer time spent on waitlists; budget
cuts; service level reductions; and the over reliance on unpaid
care. She stated that despite the growing need for personal
care services, services decreased from 2016 to 2020 by 23
percent. These cuts have left individuals reliant on the unpaid
labor of untrained friends and family, costing the state money
in terms of economic productivity. She expressed hesitancy in
reducing quality of life issues to economics, but "it is our job
as legislators."
4:21:09 PM
CO-CHAIR SNYDER explained that HB 292 would begin to help by
preventing unwanted service-level cuts for personal care
services by fixing the weak points in the statute. She
explained that assessments which result in service level
reductions would be required to go through the same detailed
process for service level terminations. She added that previous
service level cuts would be restored from 2019 to present.
Finally, she stated the proposed legislation would permit
legally responsible individuals to become PCAs under HCBS
waivers and Medicaid State Plan K. She concluded with the
example of a constituent who would be impacted by the proposed
legislation. She described the individual as having cerebral
palsy and using a wheelchair. The individual recently moved to
Anchorage for better access to PCAs, but in the 8-month search
one has not been found. It has not been economically feasible
for the family to travel back and forth to Anchorage to provide
care while working to support themselves. Recently the hours
allocated for the individual to have homecare were cut. She
described the situation as "a negative feedback loop." She
maintained that HB 292 would begin to address these issues.
4:25:11 PM
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska
State Legislature, on behalf of Representative Snyder, prime
sponsor, paraphrased the sectional analysis of HB 292 [included
in the committee packet], which read as follows [original
punctuation provided]:
Sec. 1: Amends AS 47.07.045(a) Home and community-
based services for provisions in the section to apply
also to Community First Choice and Medicaid personal
care services programs.
Sec. 2: Amends AS 47.07.045(a) Home and community-
based services by:
Introducing a process in statute for reducing
hours or payment for home and community-based
services provided under 1915(k) state plan option
and Medicaid personal care services that mirrors
the process for terminating services.
• Adding "and live independently" as a condition
for terminating services.
• Requiring the department to continue following
notice requirements provided in later sections.
MS. SALANGUIT specified that the requirements for notification
indicated in Section 2 are further laid out in Section 8.
Passing ahead, she paraphrased from Section 8, which read as
follows [original punctuation provided]:
Sec. 8: Establishes the act will take effect only upon
federal approval of the state plan for medical
assistance, and that if approved, the Commissioner of
the Department of Health and Social Services must
notify the revisor of statute not later than 30 days
after receiving notice.
MS. SALANGUIT, picking up at Section 3, continued paraphrasing
the remaining sectional analysis, which read as follows
[original punctuation provided]:
Sec. 3: Amends AS 47.07.045(d) Home and community-
based services by:
• Moving definitions for "independent qualified
health care professional" and "independent
qualified waiver" to this section. It does not
create any new definitions.
"Independent qualified health care
professional" for an intellectual or
developmental disability waiver is defined as a
qualified intellectual disability professional
under 42 C.F.R. 483.430.
• For other allowable waivers, "Independent
health care professional" is defined as a person
who can provide personal care services under the
1915(k) state plan or a registered nurse with
specific qualifications relevant to the waivers.
Sec. 4: Adds a new subsection to AS 47.07.045 Home and
community-based services that:
• Establishes that once the department receives
the results of an assessment they have 10 days to
notify, in writing, the recipients or individuals
with legal authority to act on the recipient's
behalf of the assessment results.
• Establishes that after the department decides
if there will be a change in levels of services
or payments for services, they have 10 days after
the decision is made to notify the recipient or
individuals with legal authority to act on the
recipient's behalf of the decision. This notice
must be done in writing and 30 days before the
new determination goes into effect. The
department must also inform them they have a
right to appeal the decision.
• Allows legally responsible persons to provide
personal care services to an individual eligible
for home and community-based services waivers and
Community First Choice.
Sec. 5: Adds a new section that creates a path for
hours to be restored through the proposed reassessment
process for recipients of care whose payment for
services were reduced between January 1, 2019 and
January 1, 2022.
Sec. 6: Adds a new section to instruct the Department
of Health and Social Services to amend and submit a
state plan for medical services to the Centers for
Medicare and Medicaid Services (CMS).
Sec. 7: Makes section 5 retroactive to January 1,
2019.
Sec. 9-10: Create two effective dates:
• For sections 1 4, effective date will be the
day after the revisor of statutes receives
notification from the Commissioner of Health and
Social Services of federal approval of state plan
amendments.
• Sections 5 and 7 take effect immediately upon
passage
4:29:50 PM
KATHERINE BACON, representing self, stated that she had been the
primary caregiver for her medically fragile granddaughter. She
stated that her family had had no experience with special needs
individuals, "but we learned." Her granddaughter is now 24
years old. She continued that beginning in 2003 she became the
primary caregiver to her late husband suffering with Alzheimer's
disease. Now she is the primary caregiver [to his grandson,
Michael]. He had a traumatic brain injury when he was 3 months
old, which resulted in multiple lifelong issues. Even though he
was not expected to live, she said he would soon be 30 years
old. She shared that over the years she has hired and worked
"alongside more caregivers than I can count." She indicated
that she does not blame the caregivers, as they receive
inadequate pay and too few hours. She stated that caregivers
often have to "cobble together" full-time schedules by juggling
multiple clients or taking other jobs, and then, often, they
leave to take better jobs. The caregivers who stay cannot
provide sufficient care because they are overburdened and
exhausted. She stated that the needs of individuals do not go
away when hours are cut or caregivers are not available. She
explained that she is now Michael's sole care provider, 24 hours
a day, 7 days a week. She is fortunate she is paid to care for
Michael, but the process for families to be qualified to receive
care services, let alone to be paid, is long and hard. She
argued that the people who know and love the individual should
be able to care for them. She expressed the opinion that many
caregivers struggle, and there is a "breaking point," and the
proposed legislation would take the first step to repair the
broken system by reducing barriers for vulnerable Alaskans. She
thanked the bill sponsor.
4:35:14 PM
MS. BACON, in response to Representative Spohnholz, explained
that the process for her to be Michael's caregiver was not hard
because she is not biologically related to him; otherwise, there
are many steps, and it takes months. She stated that once the
process seems to be final, there will be "another whole list of
hoops." She added that she knows people who have been
disheartened and gave up. She expressed the opinion that it
would be better for individuals to be at home with family
[caregivers] as opposed to hiring people who may not "have their
heart in it." She suggested [caregivers may not be invested in
their clients] because of the low pay.
4:37:20 PM
The committee took a brief at-ease at 4:37 p.m.
4:37:29 PM
LEIONILEI JOHNSON, representing self, spoke in support of HB
292. She stated that she is a professional home health
provider. She shared that she is Tlingit and an Eagle from the
Thunderbird Clan. She said when she was a young girl, she had
helped her mother care for her grandmother. Without their help
her grandmother had no way to buy groceries, keep herself clean,
and take care of her home. She expressed pride in her ability
to help. She stated that she has been a professional caregiver
for 10 years and has witnessed hours cut for client care, even
for those who cannot get out of bed. In example, she shared
that a client with Parkinson's disease needed help with many
things. The client fell when left alone, but the state only
approved 15 hours of care a week. She stated that she was
worried, and the client was upset. After being in the hospital
with a broken hip, the client's home was lost, and she lost her
job. Against her convictions, she said, she applied for
government assistance. Working in a different job, she said
that she "made more money as a food runner in a restaurant" than
she made as a professional caregiver. She said the restaurant
job had been seasonal, and she became unemployed again. She
stated she is doing her best to help elders in the community,
but the system "is broken and it's hurting us all." She
asserted that restoring cut hours would help clients be safe and
help caregivers make a living.
4:42:47 PM
AMANDA COLLINS, representing self, spoke in support of HB 292.
She shared that she is a single mother and has been a caregiver
for her 10-year-old child with disabilities for the child's
entire life. She stated that her daughter's condition is
complex, with many challenges, and she lost her job because of
the needed full-time care. She indicated that she had applied
for government assistance, and her daughter was deemed eligible
for services, but the list had been so long the application
expired before services could be received. She stated that she
has had to reapply multiple times, but they still receive no
services. She expressed the opinion that she is the most
qualified person to take care of her daughter, but the
circumstances weigh heavily emotionally, financially, mentally,
and spiritually because she is totally dependent on social
services for the basics to survive "day to day." She said, "I
would love more than anything to be able to work and provide a
stable income," but this is impossible because of her daughter's
24-hour care. She argued that HB 292 would help by providing
pay to caregivers for the work they are already selflessly
doing. She stated it would give her a chance to be less
dependent on public assistance and an opportunity "not only to
survive, but to thrive."
4:46:03 PM
ALEXIS RODICH, Lobbyist, Service Employees International Union
(SEIU) 775, stated that over the last year SEIU has spent
significant time with caregivers in Alaska, speaking to them
about their experiences in making ends meet while "doing the
work they love." She stated that these caregivers are often
women, people of color, and from immigrant communities. She
cited that, while inflation is up, the wages of PCAs in Alaska
are lower than they were a decade ago. She opined that wages
are higher for jobs which have far less pressure or
consequences, yet "their love for the work" makes caregivers
want to stay in the profession. She said caregivers often take
on two or three jobs, or they are forced out of the profession,
which makes it much harder for those looking for a caregiver.
She cited that while pervasive budget cuts have resulted in
reductions in personal care services, Alaska has the fastest
growing senior population per capita in the country. She
reiterated that when caregiver's hours are cut the need does not
go away; friends and family end up providing unpaid labor, and
individuals are put in situations which could result in injury
or hospitalization. She stated that HB 292 would create the
initial steps to ensure those who need services and support are
getting the level of care they need, allowing for dignity and
independence in their own homes. It would also give stability
to caregivers providing these services. She thanked the bill
sponsor and the committee.
4:50:11 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services, in response
to Representative Prax, explained that PCA certification depends
on the agency and its requirements. The basic requirements
would be passing a background check, completing first aid
training, and completing training related to the skills needed
for the client. He said there are various requirements
depending on whether the individual will be supporting a client
on a waiver program or a state plan.
REPRESENTATIVE PRAX, repeating the question for Ms. Johnson,
stated that he is trying to understand the effort required to
obtain certification.
4:53:54 PM
MS. JOHNSON explained it depends on the client because each
client would require a certain type of care. She stated that an
individual would need a background check, certification in first
aid, and whatever training the company requires.
REPRESENTATIVE PRAX questioned whether the requirements would be
determined by the employer or prescribed by regulation.
MS. JOHNSON responded that in her training she was certified to
use a belt around the waist for helping the client move, to
change the bed if the client is bedridden, to use a lift on a
client, to bathe and clothe a client, and to use a feeding tube
and catheter. She stated that a nurse would administer
medication, and a physical therapist would work with the client.
4:56:39 PM
REPRESENTATIVE FIELDS voiced an observation that there has been
a net migration out of the state, which is a negative thing for
the economy. He stated that he has observed an entire
multigenerational family leave the state because they were
unable to find care for an elderly family member. He expressed
the opinion that keeping multigenerational families in the state
would be good from a humane perspective and an economic
perspective. He commented that the fiscal note on the bill is
"tiny," and it is a small price to pay for supporting families
in the state.
4:57:45 PM
CO-CHAIR ZULKOSKY announced that HB 292 was held over.
4:58:14 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 |
|---|---|---|
| CS HB 265 v N 03.01.22.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| CS HB 265 v N Summary of Changes 03.02.22.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 03.02.22 - 1.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 03.02.22 - 2.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 03.02.22 - 3.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Presentation 02.16.22.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 292, Sponsor Statement, Ver. A.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 292 |
| HB 292, Sectional Analysis.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 292 |
| HB0292A.PDF |
HHSS 3/3/2022 3:00:00 PM |
HB 292 |
| Kevin Fimon Resume 2021 AMHTA_Redacted.pdf |
HHSS 3/3/2022 3:00:00 PM |
Gov Appointee to Mental Health Trust Authority |