Legislature(2021 - 2022)BUTROVICH 205
09/07/2021 01:30 PM Senate LABOR & COMMERCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB3006 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB3006 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
September 7, 2021
1:31 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Joshua Revak, Vice Chair
Senator Gary Stevens
Senator Elvi Gray-Jackson
MEMBERS ABSENT
Senator Peter Micciche
OTHER LEGISLATORS PRESENT
Senator Lora Reinbold
COMMITTEE CALENDAR
SENATE BILL NO. 3006
"An Act relating to utilization review requirements; making
temporary changes to state law in response to the novel
coronavirus disease (COVID-19); relating to telemedicine and
telehealth; relating to background checks; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB3006
SHORT TITLE: HEALTH CARE REQS; COVID-19; TELEHEALTH
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
09/02/21 (S) READ THE FIRST TIME - REFERRALS
09/02/21 (S) L&C
09/07/21 (S) L&C AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
ADAM CRUM, Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Introduced SB 3006 on behalf of the
administration.
SARA CHAMBERS, Director
Division of Corporations, Business &Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB
3006.
RENEE GAYHART, Director
Division of Health Care Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
3006.
STACIE KRALY, Chief Assistant Attorney General
Civil Division
Human Services Section
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
3006.
ANNA LATHAM, Deputy Director
Division of Insurance
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
3006.
ALEXIS APPLE, Policy Associate
American Telemedicine Association
Arlington, Virginia
POSITION STATEMENT: Testified in support of SB 3006.
JARED KOSIN, President and CEO
Alaska State Hospital and Nursing Home Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 3006.
ACTION NARRATIVE
1:31:12 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:31 p.m. Present at the call to
order were Senators Stevens (via teleconference), Gray-Jackson
(via teleconference), and Chair Costello. Senator Revak arrived
soon thereafter.
SB3006-HEALTH CARE REQS; COVID-19; TELEHEALTH
1:31:50 PM
CHAIR MIA COSTELLO announced the consideration of SENATE BILL
NO. 3006 "An Act relating to utilization review requirements;
making temporary changes to state law in response to the novel
coronavirus disease (COVID-19); relating to telemedicine and
telehealth; relating to background checks; and providing for an
effective date."
She noted that this was the first hearing of the governor's bill
that was introduced after the special session call was amended.
1:33:05 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services, Anchorage, Alaska, stated that SB 3006 provides
specific tools that health care leadership has identified as
necessary to support Alaska's health care system and workforce
respond to the Delta variant of the COVID-19 virus. Despite
robust testing, education, and vaccines for every Alaskan who
wishes to get vaccinated, he said the surge of infections has
negatively impacted the already fatigued and stressed health
care system and workforce that has been on the front line for
more than 19 months.
COMMISSIONER CRUM said specific tools are required to address
this health care emergency. He reported that over the last
month, the executive branch has had extensive contact with
Alaska's health care providers and facilities to identify what
hospitals and caregivers need and the most appropriate mechanism
to provide those tools. He said these partners have identified:
1) the need to reduce barriers to training, licensing, and
employing health care professionals, 2) the need to reduce
barriers to telehealth and telemedicine to Alaskans by providers
outside of Alaska, 3) the need for insurers to waive utilization
review requirements and for consenting patients to be seen in a
lower acuity setting than an emergency department.
COMMISSIONER CRUMB advised that a number of tools that were
identified could be accomplished through the authority the
legislature provided in HB 76. Other tools could be implemented
with the emergency regulations for programs that are currently
in place. For example, the Alaska Board of Nursing recently
adopted regulations to amend the Certified Nursing Assistant
(CNA) program by establishing a CNA emergency curtesy license.
He said this will allow additional human resources to be
deployed to strengthen the health care system safety net.
COMMISSIONER CRUMB stated that SB 3006 was selected instead of a
disaster declaration because the latter does not provide the
specific tools needed or the authority for the governor to
draft, suspend, or amend existing statutes. That authority
resides with the legislative branch. He concluded that this
legislation is a critical component in assisting Alaska's health
care network.
1:37:36 PM
SENATOR REVAK joined the committee.
1:38:01 PM
SARA CHAMBERS, Director, Division of Corporations, Business &
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, presented the
sectional analysis for SB 3006 that read as follows:
Section 1.
States the purpose of this Act is to provide for
mitigation measures that will enhance the state's
ongoing efforts to reduce the spread of COVID-19 under
the uncodified law.
Section 2.
Allows the DOI director to order health care insurers
to waive utilization review requirements by adding a
new subsection (f) to AS 21.06.080: General Powers,
Duties; Catastrophes.
MS. CHAMBERS noted that the foregoing would be a permanent
change.
Section 3.
Suspends the requirements, under AS 08.64.170
(medical) and AS 08.68.160 (nursing), to allow health
care providers licensed, permitted, or certified in
good standing in another jurisdiction to provide
telehealth and telemedicine services to patients in
Alaska without being required to obtain an Alaska
license or first conduct an in person physical exam,
from the effective date of this Act to July 1, 2022.
This does not allow a health care professional not
licensed in Alaska to provide in-person treatment in
Alaska or to prescribe a controlled substance.
1:39:53 PM
MS. CHAMBERS advised that Section 3 contains the same
language the legislature previously passed to address
COVID-19.
Section 4.
Suspends the requirements, under AS 47.05.300 AS
47.05.390, as these statutes pertain to background
checks for employees of hospitals and nursing
facilities, from the effective date of this Act to
July 1, 2022. It requires hospitals and nursing
facilities to provide sufficient information to attest
to the hiring process for all employees at the
facility and confirm that a background check has been
conducted as part of the hiring process.
Section 5.
Provides for an immediate effective date.
1:41:06 PM
SENATOR STEVENS referenced [page 1] line 11 and asked
Commissioner Crum to clarify where the state is in terms of
either a disaster or emergency.
COMMISSION CRUM replied that is referring to the federal public
health emergency that the U.S. Department of Health and Human
Services put in place, some provisions of which will be in place
until the end of calendar year 2021. He noted that some health
departments have requested extensions, particularly for the 1135
blanket waivers that provide flexibility for alternate care
sites.
SENATOR STEVENS summarized his understanding that subsection (f)
allows DHSS to move ahead under the federal public health
emergency so there is no need for a state disaster or emergency
declaration.
1:43:36 PM
COMMISSIONER CRUM replied subsection (f) has to do with things
that fall under the Department of Commerce, Community and
Economic Development, particularly related to insurance
preauthorizations.
1:44:28 PM
SENATOR COSTELLO referenced page 2 lines 29-30 and asked for an
example of a law or regulation that the commissioner of health
and social services might waive.
COMMISSIONER CRUM cited the example of a regulation requiring
finger printing. If that is an impediment to hiring health care
providers that come from outside and enter Alaska's health care
system, he would consult the Department of Law to determine
whether or not that requirement should be temporarily waived.
CHAIR COSTELLO noted that Section 4 suspends the requirement for
individuals hired to work in hospitals or nursing facilities to
undergo background checks, but the facility has to be able to
confirm that a background check was conducted as part of the
hiring process. She asked if that was correct.
1:46:22 PM
COMMISSIONER CRUM answered yes; Alaska State Hospital and
Nursing Home Association (ASHNHA) facilities typically check an
applicant's background as part of the hiring process and then
send the application to the state [for DHSS to conduct a
background check, as provided by statute]. He said this is an
extra hurdle that SB 3006 temporarily suspends.
He also clarified that when he responded to her first question
he failed to recognize that the provision that allows the DHSS
commissioner to waive a state law or regulation is specifically
related to telemedicine and telehealth. The example he cited to
waive the fingerprinting requirement was not in the correct
context. He apologized for the misstatement.
CHAIR COSTELLO asked how many individuals work on the background
check team and what the time frame is for turning the
information around.
COMMISSIONER CRUM deferred the question to Renee Gayhart.
1:48:03 PM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health and Social Services (DHSS), Juneau, Alaska,
explained that the DHSS background unit currently has five
permanent fulltime employees and two short term nonpermanent
employees. The division is also in the process of hiring one
long term nonpermanent employee. Other people within the
division are also assisting with certain components of the
background check. Regarding flow, she said it is taking the
division about 12 business days to complete an application with
fingerprints and payment, which is within the allotted 15 days.
1:49:31 PM
CHAIR COSTELLO how many applications are being processed in a
month.
MS. GAYHART replied the division is processing about 30,000
background checks over the course of a year, which translates to
an average of 2,500 per month.
CHAIR COSTELLO asked what the process is when an individual
fails a background check.
MS. GAYHART replied the applicant is notified that they failed.
The employer may request a waiver and the variance committee
will review the request and evaluate the barring crime(s). The
request may be approved, denied, or approved with limitations.
For example, an individual may be able to work in the facility
for a certain number of hours per day as long as they are under
supervision.
CHAIR COSTELLO asked how many individuals are currently working
under a variance.
MS. GAYHART replied the national background system that tracks
the status of all applications is down so she did not have an
accurate report. She offered to provide the information by
running a manual report.
CHAIR COSTELLO asked if that was the reason for this portion of
the bill.
MS. GAYHART answered no; the intention is to relieve the
administrative burden from hospitals and nursing facilities and
keep them fully staffed during the surge of infections.
1:52:26 PM
CHAIR COSTELLO highlighted the disparity between her comments
and the language on page 3, lines 11-12 that indicates that
hospitals and nursing facilities will be conducting background
checks.
1:52:49 PM
MS. GAYHART clarified that many hospitals and nursing facilities
use a third party to do certain registry checks and the
hospitals and nursing facilities are attesting that those checks
have been done. This is tracked at the commissioner's office
where a determination is made regarding a suspension. If the
commissioner makes the determination to end the suspension,
those individuals may go through the application process. That
means that those nurses and skilled professionals, and with this
extension some non-Title 8 providers, will have to attest that
they have done that third-party check. She noted that this
bypasses some civil registries within the state.
CHAIR COSTELLO asked how this legislation helps a hospital or
nursing facility that has a nursing shortage. She added that
this indicates that a number of people are waiting for their
background checks to be processed so they can be hired.
MS. GAYHART answered that what happens now is that individuals
coming to the state or already in Alaska would have to go
through the background check process. That takes from 12
business days to several weeks after an individual has submitted
their completed application. With the suspension, hospitals may
hire and immediately put to work those individuals who have gone
through that third-party background work. They do not need to
wait to go through the department's background process.
CHAIR COSTELLO asked her to state on the record what the public
value is to having background checks and why they have been done
in the past.
MS. GAYHART answered that, "The reality of the background check
is really just trying to protect our most vulnerable recipients
that are on Medicaid." She suggested that Commissioner Crum and
Stacie Kraly may want to supplement her answer.
CHAIR COSTELLO asked Commissioner Crum if he supported the
legislation completely.
1:56:24 PM
COMMISSIONER CRUM answered yes because the more fully a hospital
is staffed, the faster it can turn over beds. He said the surge
in COVID-19 cases is the big reason for wanting this legislation
but the cyberattack is also a factor. That slowed the system as
a whole and affected smaller groups that may not have the
capacity to do third-party background checks.
CHAIR COSTELLO asked if the state would be exposed to increased
liability if it suspended the department's background checks.
COMMISSIONER CRUM deferred the question to Stacie Kraly.
1:58:14 PM
STACIE KRALY, Chief Assistant Attorney General, Civil Division,
Human Services Section, Juneau, Alaska, advised that the
provision articulated in Section 4 mitigates any liability
because it requires the attestation by the facility that a
third-party background check was conducted for the doctors,
nurses, and other medical professionals licensed under Title 8.
She opined that the need for this flexibility outweighs the
liability at this time.
She referenced a question posed earlier regarding variances and
further advised that the majority of individuals are not tied to
facilities but to different types of providers that must submit
to background checks.
CHAIR COSTELLO referenced subsection (c) on page 2 that gives
the DHSS commissioner the authority to waive certain state laws
or regulations. She asked Commissioner Crum if he said he was
considering waiving fingerprinting for telemedicine.
2:00:05 PM
COMMISSIONER CRUM apologized that when he used the example of
waiving fingerprinting it was not in the context of telemedicine
and telehealth. He was referring to something else that did not
move forward.
CHAIR COSTELLO invited Anna Latham to provide her testimony.
2:01:05 PM
ANNA LATHAM, Deputy Director, Division of Insurance, Department
of Commerce, Community and Economic Development (DCCED), Juneau,
Alaska, advised that she would speak to Section 2 that gives the
director of insurance the ability to order health care insurers
to waive utilization requirements during a federal or state
public health disaster or emergency. She said the division did
this previously when the governor issued a public health
disaster emergency declaration in December 2020. She added that
while the division's regulatory authority of insurance is
nominal, SB 3006 does allow any preauthorization to be waived
during a public health emergency.
CHAIR COSTELLO asked if this applies to a federally declared
emergency.
MS. LATHAM answered yes; it would be a federal emergency through
the U.S. Department of Health and Human Services.
2:02:51 PM
CHAIR COSTELLO asked for confirmation that there is no state
voice in a declaration that is made at the federal level.
MS. LATHAM answered that the director of the Division of
Insurance would have that authority in both a federal emergency
and a state public health disaster.
CHAIR COSTELLO asked for an explanation of the value of a
utilization review that this legislation waives.
MS. LATHAM explained that the statutes governing the Division of
Insurance allow insurers to require a utilization review (UR)
before a procedure. For example, before hip surgery the insurer
would receive medical documentation that the procedure is
appropriate or required so insurance would pay for the
procedure.
CHAIR COSTELLO asked if individuals have found in the past when
UR was waived that their insurance would not pay for the
procedure because it was not preauthorized.
2:04:15 PM
MS. LATHAM answered no; the Division of Insurance has not
received any complaints or heard from insurers that procedures
were denied when the preauthorization was suspended or waived.
CHAIR COSTELLO asked for an explanation of the purpose of
Section 2 other than speeding the process for procedures and the
release of patients from the hospital.
MS. LATHAM answered that Section 2 allows health care providers
to deliver service without first fulfilling the preauthorization
requirements. For example, before a surgery an insurer may
require a specific diagnosis and additional tests such as MRIs
and ultrasounds. With the waiver, those tests would not
absolutely be required before the patient is treated.
SENATOR STEVENS asked when the current federal waiver ends and
how it would be extended if needed.
2:04:48 PM
MS. LATHAM offered her understanding that the current federal
health emergency ends on October 15, 2021 unless it is extended
at the federal level.
CHAIR COSTELLO asked if she was saying that Section 2 would
remain in effect as long as there is a federally declared
disaster or emergency that extends beyond July 1, 2022.
MS. LATHAM offered her understanding that the dates in Section 3
pertain to telemedicine, whereas Section 2 pertains to waiving
the utilization review and that ends on October 15, 2021 with
the federal emergency declaration.
CHAIR COSTLLO summarized that Section 2 is tied to the federal
declaration whereas the other sections are effective until July
1, 2022.
She advised that because this was the only committee of referral
for the legislation, the committee would review the fiscal notes
once they were all available.
2:08:11 PM
CHAIR COSTELLO opened public testimony on SB 3006.
2:08:24 PM
ALEXIS APPLE, Policy Associate, American Telemedicine
Association (ATA), Arlington, Virginia, stated support for SB
3006 on behalf of ATA and the more than 400 organizations it
represents. She reported that ATA is the only national
organization whose sole mission is to advance telemedicine in
the U.S. Ensuring access to affordable quality healthcare is a
priority. She said ATA members believe that SB 3006 will serve
as a rational and timely supplement to Alaska's telemedicine
statutes. It would permit a licensure waiver until January 1,
2022 for out of state physicians and nurses who use appropriate
telemedicine technologies to treat patients located in Alaska.
She listed the reasons to support the legislation, including
that it expands all Alaskans' access to high quality health
care. She concluded that this is appropriate as long as the
practitioners are using appropriate technology to uphold the
established standard of care and can be held accountable for the
care they render by their respective regulatory boards and state
agencies.
2:11:21 PM
CHAIR COSTELLO asked if other states are addressing telemedicine
and telehealth with legislation that is similar to SB 3006.
MS. APPLE answered yes; more than 23 states have permanently
implemented similar legislation and others are looking at it on
a temporary basis. She offered to follow up with the names of
the individual states.
2:12:17 PM
CHAIR COSTELLO asked if any licensed professionals residing in
those states are pushing back.
MS. APPLE replied some hospital systems have pushed back in an
effort to control competition but ATA has not received negative
feedback from practitioners. In fact, a large number of
physicians have said they would like to practice outside their
state of licensure to meet patient needs.
2:12:56 PM
JARED KOSIN, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNA), Anchorage, Alaska, stated
support for SB 3006 and urged its swift passage. He reported
that Alaska has risen to the worst point of the COVID-19
pandemic. Health care staffing is severely strained and
caregivers are exhausted. SB 3006 offers important measures to
accelerate background checks for health care employees,
reinstate telehealth flexibility, and create opportunities for
more efficient patient throughput to maximize limited hospital
resources.
2:14:13 PM
CHAIR COSTELLO asked if he could provide details to the
legislature about the extent and nature of the emergency
situation in hospitals that the bill is addressing. She noted
that while the bill provides extensive authority to the DHSS
commissioner to waive relevant state laws and regulations, the
legislature has not received any specific data.
MR. KOSIN offered his belief that the public testimony and the
public dialog from hospital operators has painted a transparent
picture of the challenges hospitals and nursing facilities are
experiencing. Nevertheless, he said he was willing to respond to
specific questions and requests for information. He suggested
the members email him directly.
CHAIR COSTELLO asked for details about the capacity of hospitals
in Alaska and whether people are being turned away.
2:16:37 PM
MR. KOSIN agreed to provide initial information in writing to
her office and the legislature in general and to share more as
needed.
2:17:22 PM
CHAIR COSTELLO closed public testimony on SB 3006.
SENATOR STEVENS asked how quickly she intended to move the bill
because he would be traveling on Thursday and he didn't want to
miss an important meeting.
CHAIR COSTELLO replied the intention is to thoroughly vet the
bill and work with the administration to get missing fiscal
notes. She noted that meetings were scheduled for tomorrow and
Thursday.
SENATOR STEVENS said he looked forward to the next two meetings.
[SB 3006 was held in committee.]
2:19:19 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor and Commerce Standing
Committee meeting at 2:19 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 3006 Transmittal Letter.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Sectional Analysis (Version A).pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Fiscal Note 1 DCCED - CBPL.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Fiscal Note 3 DCCED - Insurance.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Governor Letter to Presiding Officers 9.3.21.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - ATA.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |