Legislature(2021 - 2022)BELTZ 105 (TSBldg)

09/08/2021 01:30 PM LABOR & COMMERCE

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Audio Topic
01:33:28 PM Start
01:34:20 PM SB3006
02:29:27 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB3006 HEALTH CARE REQS; COVID-19; TELEHEALTH TELECONFERENCED
Moved CSSB 3006(L&C) Out of Committee
-- Testimony <Invitation Only> --
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE LABOR AND COMMERCE STANDING COMMITTEE                                                                        
                       September 8, 2021                                                                                        
                           1:33 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Mia Costello, Chair                                                                                                     
Senator Joshua Revak, Vice Chair                                                                                                
Senator Peter Micciche                                                                                                          
Senator Gary Stevens (via teleconference)                                                                                       
Senator Elvi Gray-Jackson (via teleconference)                                                                                  
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
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."                                                                                                                
                                                                                                                                
     - MOVED CSSB 3006(L&C) OUT OF COMMITTEE                                                                                    
                                                                                                                                
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                                                                           
09/07/21       (S)       Heard & Held                                                                                           
09/07/21       (S)       MINUTE(L&C)                                                                                            
09/08/21       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                    
                                                                                                                              
WITNESS REGISTER                                                                                                              
                                                                                                                                
ADAM CRUM, Commissioner                                                                                                         
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided opening comments during  the second                                                             
hearing on SB 3006.                                                                                                             
                                                                                                                                
JARED KOSIN, President and CEO                                                                                                  
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions and  provided information                                                             
related to SB 3006.                                                                                                             
                                                                                                                                
RENEE GAYHART, Director                                                                                                         
Division of Health Care Services                                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT: Commented  on Amendment  2 and  reviewed the                                                             
DHSS fiscal note for SB 3006.                                                                                                   
                                                                                                                                
SARA CHAMBERS, Director                                                                                                         
Division  of Corporations,  Business, and  Professional Licensing                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions related to SB 3006.                                                                    
                                                                                                                                
KATHRYN MONFREDA, Director                                                                                                      
Division of Statewide Services                                                                                                  
Department Public Safety                                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Discussed the DPS fiscal note for SB 3006.                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:33:28 PM                                                                                                                    
CHAIR MIA COSTELLO called the  Senate Labor and Commerce Standing                                                             
Committee meeting  to order at 1:33  p.m. Present at the  call to                                                               
order  were  Senators  Micciche,  Stevens  (via  teleconference),                                                               
Revak, Gray-Jackson (via teleconference) and Chair Costello.                                                                    
                                                                                                                                
                                                                                                                              
         SB3006-HEALTH CARE REQS; COVID-19; TELEHEALTH                                                                      
                                                                                                                                
1:34:20 PM                                                                                                                    
CHAIR  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."                                                                                                                
                                                                                                                                
CHAIR  COSTELLO   listed  the   individuals  who   would  provide                                                               
testimony  or  were  available to  answer  questions,  and  asked                                                               
Commissioner Crum to offer any additional comments on SB 3006.                                                                  
                                                                                                                                
1:36:27 PM                                                                                                                    
ADAM  CRUM,   Commissioner,  Department  of  Health   and  Social                                                               
Services  (DHSS), Anchorage,  Alaska, expressed  appreciation for                                                               
the hearing and said he  looked forward to the conversation about                                                               
the  bill  and  the  amendments,  which  he  and  the  chair  had                                                               
discussed earlier.                                                                                                              
                                                                                                                                
CHAIR  COSTELLO asked  Jared Kosin  to  provide information  that                                                               
would set the stage and provide context for the legislation.                                                                    
                                                                                                                                
1:37:25 PM                                                                                                                    
JARED  KOSIN,  President  and  CEO,  Alaska  State  Hospital  and                                                               
Nursing  Home Association  (ASHNHA),  Anchorage, Alaska,  advised                                                               
that  he would  start by  responding to  the questions  that were                                                               
asked  yesterday. After  that he  would  make observations  about                                                               
COVID-19  hospital volumes  compared to  the December  2020 peak,                                                               
and conclude by addressing why SB 3006 will help.                                                                               
                                                                                                                                
MR.  KOSIN  addressed  the four  questions  the  committee  asked                                                               
during the previous hearing.                                                                                                    
                                                                                                                              
   1.  How many hospitals are in Alaska?                                                                                    
     Alaska  has 26  hospitals: 13  critical access  hospitals, 5                                                               
     sole community  hospitals, 3  general acute  care hospitals,                                                               
     and  5   specialty  hospitals,  2  of   which  are  military                                                               
     hospitals.  He said  it  should  be noted  that  8 of  these                                                               
     hospitals are run by a robust tribal health system.                                                                        
                                                                                                                                
   2. How many hospital beds are in Alaska?                                                                                   
     Alaska  hospitals  have  1,500 acute  care  beds,  including                                                               
     about 160  intensive care unit  (ICU) beds. Due  to Alaska's                                                               
     unique  geography, approximately  21  percent  of the  acute                                                               
     care  beds  are not  accessible  from  the road  system.  To                                                               
     provide  context  for  this figure,  he  said  the  national                                                               
     average  is  2.5  acute  care  beds  per  1,000  people.  If                                                               
     military  hospitals,  psychiatric hospitals,  and  specialty                                                               
     hospitals are not  counted, Alaska has about  2.0 acute care                                                               
     beds per 1,000 Alaskans.                                                                                                   
                                                                                                                                
   3. Are people currently being turned away from hospitals?                                                                  
     No;  hospitals  are  subject to  federal  Emergency  Medical                                                               
     Treatment and  Labor Act (EMTALA),  which means they  have a                                                               
     legal  duty  to  treat  all individuals  who  present  at  a                                                               
     hospital emergency  room. No patients have  been turned away                                                               
     but there  is the possibility  that care could  be rationed,                                                               
     as is happening in northern Idaho hospitals.                                                                               
                                                                                                                                
   4. What is staffing capacity?                                                                                              
     Staff  capacity reflects  the  number of  beds  that can  be                                                               
     filled at any one time. A  hospital could have 500 beds, but                                                               
     if there is  only enough staff to care for  50 patients, the                                                               
     capacity  of  the  facility  at   that  point  is  50  beds.                                                               
     Throughout  the pandemic,  staffing  has  been the  limiting                                                               
     factor  on hospital  capacity, not  the  physical number  of                                                               
     beds.                                                                                                                      
                                                                                                                                
MR. KOSIN asked if there were any questions.                                                                                    
                                                                                                                                
1:41:31 PM                                                                                                                    
SENATOR  MICCICHE asked  for the  current  magnitude of  staffing                                                               
shortages and how much is related to COVID-19.                                                                                  
                                                                                                                                
MR.  KOSIN replied  staffing is  the largest  issue inside  these                                                               
facilities. For example, two weeks  ago ASHNHA issued an emergent                                                               
request for  staffing from member  facilities to share  with DHSS                                                               
to support  efforts to  get help from  the federal  government. A                                                               
mix of  17 hospitals  and nursing  homes responded  and requested                                                               
support to fill  approximately 450 positions, most  of which were                                                               
for nurses  and certified nursing  assistants. He  said testimony                                                               
from   hospital  operators   over  the   last  few   months  also                                                               
demonstrates  the critical  nature  of  staffing shortages.  They                                                               
have repeatedly  highlighted that  strain on staff  and shortages                                                               
is the number one issue right now.                                                                                              
                                                                                                                                
MR. KOSIN said some of  the current COVID statistics provide even                                                               
more clarity. On  September 6, 182 Alaskans were  in the hospital                                                               
with COVID-19.  This is 52 percent  more than a month  ago and 21                                                               
percent higher  than the hospitalizations during  the December 5,                                                               
2020  peak.  As the  COVID-19  population  increases, staff  must                                                               
focus on fewer  patients because COVID-19 patients  are much more                                                               
complex.  When these  patients end  up  on ventilators,  staffing                                                               
capacity is further reduced. According  to clinical staff at some                                                               
facilities, a  patient who ends up  on a ventilator and  does not                                                               
pass away within the first seven days,  may be in that bed in the                                                               
ICU for 21-28  days. Not only is  there a surge in  the number of                                                               
COVID-19 patients, COVID-19 patients also  stay longer and tie up                                                               
the hospital's assets and staffing.                                                                                             
                                                                                                                                
MR. KOSIN recounted that one month  ago, 14 percent of the adults                                                               
in a hospital had a  COVID-19 diagnosis. During the December 2020                                                               
peak,  that number  was  18  percent. Today,  22  percent of  the                                                               
hospital population  has COVID-19, and  half of the  182 COVID-19                                                               
hospitalizations  are  in  Anchorage. During  the  December  2020                                                               
peak,  61 percent  of the  COVID-19 patients  were in  Anchorage.                                                               
This means  there are  a significant  number of  complex COVID-19                                                               
patients  in   outlier  facilities,  primarily   MatSu  Regional,                                                               
Fairbanks  Memorial,   and  Central  Peninsula   Hospital.  Those                                                               
facilities account  for close to  40 percent  of hospitalizations                                                               
statewide.                                                                                                                      
                                                                                                                                
1:49:02 PM                                                                                                                    
MR.  KOSIN said  his last  observation  is about  the meaning  of                                                               
staffing  capacity.   On  September  6  occupancy   at  Anchorage                                                               
hospitals was  about 91 percent  with two of the  three hospitals                                                               
showing no beds available. The  ICU occupancy was 95 percent, but                                                               
that did  not include  the 12-18 patients  in the  emergency room                                                               
waiting for  a bed on  the hospital floor.  Practically speaking,                                                               
he  said  these hospitals  have  been  running  at or  above  100                                                               
percent  occupancy  for  some time.  He  said  Central  Peninsula                                                               
Hospital put  out a graphic last  week showing it was  running at                                                               
120 percent occupancy  when all the people in  the emergency room                                                               
waiting for a bed were factored.                                                                                                
                                                                                                                                
MR. KOSIN  said staff  cannot keep  up at  these levels  and this                                                               
does  not  consider  days  off,  vacation,  burnout,  and  people                                                               
exiting markets for  other reasons. The fact that  about half the                                                               
ASHNHA  facilities have  requested  help to  fill  more than  400                                                               
positions to support the current  surge, and occupancy levels are                                                               
what they are, staffing is unquestionably the largest problem.                                                                  
                                                                                                                                
He asked if  there were questions before he  briefly discussed SB
3006.                                                                                                                           
                                                                                                                                
CHAIR COSTELLO determined  there were no questions  and asked him                                                               
to continue.                                                                                                                    
                                                                                                                                
1:51:28 PM                                                                                                                    
MR.  KOSIN shared  that  a director  of  an emergency  department                                                               
cries on  the way to and  from work to  be able to be  strong for                                                               
the  staff during  the work  day.  In another  facility, the  ICU                                                               
directors are all  in counseling because they  have witnessed the                                                               
deaths  of so  many young,  health, vibrant  people. He  said the                                                               
obvious  answer going  forward is  to  hit the  peak, but  nobody                                                               
knows when that  will be. Some hospital operators  feel this will                                                               
be around at significant levels  for a month or two, particularly                                                               
in the  hospital environment. He  said the second thing  that can                                                               
help  is  any  and  all resources  around  staffing.  He  thanked                                                               
Commissioner Crum and  his team for trying to  procure staff from                                                               
federal contracting agencies; it means a lot to his facilities.                                                                 
                                                                                                                                
1:54:00 PM                                                                                                                    
MR. KOSIN  said he  views SB  3006 as a  series of  one-off tools                                                               
that  can  make  the  current   situation  a  little  easier.  He                                                               
described the  background check provision  as the  most important                                                               
tool in the  bill because the 10-15 business days  to turn around                                                               
a background  check is not  feasible when facilities have  such a                                                               
need for clinical and non-clinical  staff. He pointed out that if                                                               
there is a  shortage of environmental service workers  to clean a                                                               
room after  somebody is  discharged, that  bed is  not available.                                                               
The longer  it takes to make  that bed available, the  bigger the                                                               
bottleneck.  He said  eliminating the  duplicative processes  for                                                               
background checks will save time.                                                                                               
                                                                                                                                
1:57:04 PM                                                                                                                    
MR. KOSIN said  SB 3006 also reinstates telehealth and  that is a                                                               
win-win from  the standpoint of  preventing spread of  the virus.                                                               
It  also potentially  paves the  way to  restart in-home  patient                                                               
monitoring, which  is a program Providence  Alaska Medical Center                                                               
ran. It saves  beds when patients do not have  to enter the acute                                                               
care setting.                                                                                                                   
                                                                                                                                
MR.  KOSIN said  SB 3006  also suspends  the utilization  review.                                                               
This  has to  do with  prior  authorization before  a service  is                                                               
provided to  a patient, and it  can be a real  barrier. He opined                                                               
that waiving  this requirement provides  an opportunity  for more                                                               
efficient patient  throughput. For example,  it can take  days to                                                               
get  authorization  for  a  patient to  be  discharged  from  the                                                               
hospital into a  nursing home. He said this  provision provides a                                                               
tool that will help the  department and the Division of Insurance                                                               
speed the process along and free up the acute care bed.                                                                         
                                                                                                                                
MR. KOSIN  concluded that  SB 3006  provides a  practical toolkit                                                               
that ASHNHA believes will be very helpful.                                                                                      
                                                                                                                                
1:59:03 PM                                                                                                                    
CHAIR COSTELLO thanked  him for connecting the dots as  to how SB
3006 will help.  She described the comments  about the background                                                               
checks as  helpful and expressed  appreciation that  he clarified                                                               
that the  telemedicine provisions  in the bill  are a  very small                                                               
slice  of   the  topic  of   telemedicine.  Alaska   already  has                                                               
telemedicine statutes  in place and the  telehealth provisions in                                                               
this  legislation relate  specifically to  health care  providers                                                               
who are  not in  this jurisdiction. These  provisions accommodate                                                               
Alaskans who do  not want to have to travel  to receive care from                                                               
their health care providers who reside outside the state.                                                                       
                                                                                                                                
2:00:32 PM                                                                                                                    
SENATOR  STEVENS said  it is  tangential  but he  would like  Mr.                                                               
Kosin to comment  on mandatory vaccinations to  work in hospitals                                                               
because he  is hearing from  constituents who are very  upset and                                                               
threatening to leave.                                                                                                           
                                                                                                                                
CHAIR COSTELLO  responded that is  not addressed in SB  3006, but                                                               
she  too  has  constituents  who  have  expressed  concern  about                                                               
mandatory vaccinations to  keep a job. She asked Mr.  Kosin if he                                                               
was aware of the issue.                                                                                                         
                                                                                                                                
2:01:28 PM                                                                                                                    
MR.  KOSIN  replied  the federal  government  currently  requires                                                               
health care workers  in nursing homes to be  vaccinated, and that                                                               
order is in the process of  being implemented. He noted that some                                                               
facilities  are  also taking  independent  steps  to align  their                                                               
vaccine  protocols  with  measures   like  the  flu  vaccine.  He                                                               
acknowledged that  it is a  tense issue, but said  ASHNHA members                                                               
have  not  expressed concern  to  date  about potentially  losing                                                               
staff because of a vaccination mandate.                                                                                         
                                                                                                                                
SENATOR STEVENS thanked the chair for allowing the discussion.                                                                  
                                                                                                                                
CHAIR COSTELLO said she was not  sure this was the legislation to                                                               
address the issue  but she would be happy to  look at it together                                                               
if he wanted to move forward.                                                                                                   
                                                                                                                                
2:03:56 PM                                                                                                                    
At ease to distribute amendments.                                                                                               
                                                                                                                                
2:06:26 PM                                                                                                                    
CHAIR COSTELLO  reconvened the meeting  and advised that  she had                                                               
four amendments for the committee to consider.                                                                                  
                                                                                                                                
2:07:02 PM                                                                                                                    
SENATOR MICCICHE moved Amendment 1, work order 32-GS3384\A.2.                                                                   
                                                                                                                                
                                                 32-GS3384\A.2                                                                  
                                                       Fisher                                                                   
                                                       9/8/21                                                                   
                                                                                                                                
                                                                                                                                
                         AMENDMENT 1                                                                                        
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE                  BY SENATOR COSTELLO                                                                 
     TO:  SB 3006                                                                                                               
                                                                                                                                
                                                                                                                                
     Page 2, line 28, through page 3, line 2:                                                                                   
          Delete all material.                                                                                                  
                                                                                                                                
     Reletter the following subsection accordingly.                                                                             
                                                                                                                                
SENATOR REVAK objected for discussion purposes.                                                                                 
                                                                                                                                
2:07:24 PM                                                                                                                    
CHAIR COSTELLO  advised that Amendment  1 deletes  subsection (c)                                                               
in bill Section  3. She said it gives the  commissioner the broad                                                               
authority to  "waive any  state law  or regulation  if compliance                                                               
would  substantially prevent  or impede  the provision  of health                                                               
care services under this section."  yet it was not even mentioned                                                               
in the  sectional analysis the  committee heard yesterday  and it                                                               
is not in the title.                                                                                                            
                                                                                                                                
She  asked Commissioner  Crum to  tell the  committee whether  he                                                               
supports Amendment  1, what  powers and  authorities he  has now,                                                               
and how  it will  affect his  ability to  address COVID-19  if it                                                               
were removed from the bill.                                                                                                     
                                                                                                                                
COMMISSIONER CRUM stated support for  Amendment 1, saying it gets                                                               
rid of  superfluous language that  does not affect the  intent of                                                               
the section.                                                                                                                    
                                                                                                                                
SENATOR MICCICHE  asked if he  already has some ability  to waive                                                               
certain regulations if  they are impeding the  delivery of health                                                               
care.                                                                                                                           
                                                                                                                                
COMMISSIONER CRUM  answered that  HB 76 granted  the commissioner                                                               
public health emergency powers and he  has used but at this point                                                               
he  wanted to  make sure  that the  state powers  align with  the                                                               
federal standard  under Appendix  K of  the Centers  for Medicare                                                               
and Medicaid  Services (CMS) 1135  Waiver. He said  inserting the                                                               
suspension of statute seemed like the easiest way to do that.                                                                   
                                                                                                                                
2:10:43 PM                                                                                                                    
SENATOR REVAK withdrew his objection.                                                                                           
                                                                                                                                
2:11:26 PM                                                                                                                    
CHAIR  COSTELLO  found  no  further  objection  and  Amendment  1                                                               
passed.                                                                                                                         
                                                                                                                                
2:11:43 PM                                                                                                                    
SENATOR MICCICHE moved Amendment 2, work order 32-GS3384\A.5.                                                                   
                                                                                                                                
                                                      32-GS3384\A.5                                                             
                                                            Fisher                                                              
                                                            9/8/21                                                              
                                                                                                                                
                                                                                                                                
                          AMENDMENT 2                                                                                       
                                                                                                                                
                                                                                                                                
OFFERED IN THE SENATE                       BY SENATOR COSTELLO                                                                 
     TO:  SB 3006                                                                                                               
                                                                                                                                
                                                                                                                                
Page 2, line 7:                                                                                                                 
     Delete "beginning from the effective date of this Act and                                                                  
until July 1, 2022,"                                                                                                            
                                                                                                                                
Page 2, lines 28 - 29:                                                                                                          
     Delete "beginning from the effective date of this Act and                                                                  
until July 1, 2022,"                                                                                                            
                                                                                                                                
Page 3, lines 7 - 12:                                                                                                           
     Delete all material and insert:                                                                                            
     "BACKGROUND CHECKS; APPLICABILITY. Notwithstanding any                                                                     
other  provision  of law,  a  hospital  or nursing  facility  may                                                               
employ a  person without  obtaining a  background check  from the                                                               
Department  of Health  and  Social Services  if  the hospital  or                                                               
nursing facility                                                                                                                
          (1)  provides sufficient information to the department                                                                
attesting to the  hiring process for each person  employed at the                                                               
facility and confirms that a  background check has been conducted                                                               
as part of the hiring process; and                                                                                              
          (2)  not later than July 1, 2022, obtains a background                                                                
check from the Department of  Health and Social Services for each                                                               
person  hired by  the hospital  or nursing  facility between  the                                                               
effective date of this Act and July 1, 2022.                                                                                    
   * Sec.  5. Sections 3 and  4 of this Act  are repealed July 1,                                                             
2022."                                                                                                                          
                                                                                                                                
Renumber the following bill section accordingly.                                                                                
                                                                                                                                
2:11:55 PM                                                                                                                    
SENATOR REVAK objected for discussion purposes.                                                                                 
                                                                                                                                
2:12:03 PM                                                                                                                    
CHAIR  COSTELLO  explained  that  Amendment 2  clarifies  that  a                                                               
hospital  or  nursing  facility initially  may  employ  a  person                                                               
without  obtaining   a  background  check  from   DHSS,  but  the                                                               
department must  come back  and process  a full  background check                                                               
for those individuals by July 1, 2022.                                                                                          
                                                                                                                                
She asked Renee Gayhart to comment on the intent of Amendment 1.                                                                
                                                                                                                                
2:14:13 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:16:13 PM                                                                                                                    
CHAIR COSTELLO reconvened the meeting.                                                                                          
                                                                                                                                
2:16:54 PM                                                                                                                    
RENEE  GAYHART,  Director,  Division  of  Health  Care  Services,                                                               
Department of Health and Social  Services (DHSS), Juneau, Alaska,                                                               
stated  support   for  Amendment   2.  She  confirmed   that  the                                                               
department   would  process   the  full   background  check   for                                                               
individuals hired  during this time  and have those  completed by                                                               
July 1, 2022.                                                                                                                   
                                                                                                                                
CHAIR COSTELLO restated what Amendment 2 would do.                                                                              
                                                                                                                                
2:17:57 PM                                                                                                                    
SENATOR REVAK removed his objection.                                                                                            
                                                                                                                                
2:18:07 PM                                                                                                                    
CHAIR  COSTELLO  found  no  further  objection  and  Amendment  2                                                               
passed.                                                                                                                         
                                                                                                                                
2:18:13 PM                                                                                                                    
SENATOR MICCICHE moved Amendment 3, work order 32-GS3384\A.4.                                                                   
                                                                                                                                
                                                      32-GS3384\A.4                                                             
                                                            Fisher                                                              
                                                            9/8/21                                                              
                                                                                                                                
                          AMENDMENT 3                                                                                       
                                                                                                                                
                                                                                                                                
OFFERED IN THE SENATE                       BY SENATOR COSTELLO                                                                 
     TO:  SB 3006                                                                                                               
                                                                                                                                
                                                                                                                                
Page 2, following line 14:                                                                                                      
     Insert a new paragraph to read:                                                                                            
          "(2)  the health care provider or the employer of the                                                                 
health   care  provider   obtains   a   business  license   under                                                               
AS 43.70.020 and pays the required fee under AS 43.70.030;"                                                                     
                                                                                                                                
Renumber the following paragraphs accordingly.                                                                                  
                                                                                                                                
Page 2, line 26:                                                                                                                
     Delete "(a)(3)"                                                                                                            
     Insert "(a)(4)"                                                                                                            
                                                                                                                                
SENATOR REVAK objected for discussion purposes.                                                                                 
                                                                                                                                
CHAIR COSTELLO  explained that Amendment 4  requires out-of-state                                                               
telehealth providers who  are not licensed in Alaska  to obtain a                                                               
business  license. She  asked Ms.  Chambers  if this  requirement                                                               
would be cumbersome for the telehealth providers.                                                                               
                                                                                                                                
2:19:19 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development  (DCCED),   Juneau,  Alaska,  advised  that                                                               
existing  state law  requires  health care  providers  to have  a                                                               
business  license and  register  with  the Telemedicine  Business                                                               
Registry. Amendment 3 would not change the existing requirement.                                                                
                                                                                                                                
2:19:55 PM                                                                                                                    
CHAIR COSTELLO withdrew Amendment 3.                                                                                            
                                                                                                                                
2:20:03 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:20:08 PM                                                                                                                    
CHAIR COSTELLO reconvened the meeting and solicited a motion.                                                                   
                                                                                                                                
2:21:17 PM                                                                                                                    
SENATOR MICCICHE moved to report  SB 3006, work order 32-GS3384\A                                                               
as amended,  from committee  with individual  recommendations and                                                               
attached fiscal note(s).                                                                                                        
                                                                                                                                
CHAIR COSTELLO asked if there was objection to moving the bill.                                                                 
                                                                                                                                
2:21:50 PM                                                                                                                    
SENATOR GRAY-JACKSON asked what happened to the last amendment.                                                                 
                                                                                                                                
CHAIR COSTELLO replied it was not offered.                                                                                      
                                                                                                                                
2:22:03 PM                                                                                                                    
SENATOR  STEVENS said  he had  questions about  the fiscal  notes                                                               
that he would like to be addressed before the bill moves.                                                                       
                                                                                                                                
CHAIR COSTELLO  asked Renee Gayhart  to speak to the  DHSS fiscal                                                               
note.                                                                                                                           
                                                                                                                                
2:22:52 PM                                                                                                                    
MS. GAYHART  advised that the  DHSS fiscal note  reflects delayed                                                               
revenue  based  on projections  from  previous  fiscal years.  On                                                               
average,  4,800   applications  come   through  the   system  for                                                               
hospitals and nursing homes and  each applicant is charged $88.25                                                               
for the background check. DHSS  takes $40.00 as a processing fee,                                                               
which  amounts  to $192,000  for  the  department. The  remaining                                                               
$48.25 per  application goes to  the Department of  Public Safety                                                               
(DPS).                                                                                                                          
                                                                                                                                
SENATOR STEVENS asked if the revenue would be delayed to 2023.                                                                  
                                                                                                                                
MS. GAYHART  said she  should back  up and clarify  that it  is a                                                               
zero fiscal note.  The numbers are an estimate  based on previous                                                               
fiscal years and  the delayed revenue will start to  come in once                                                               
the department restarts the background check process.                                                                           
                                                                                                                                
2:26:16 PM                                                                                                                    
SENATOR  MICCICHE  observed that  the  delayed  revenue could  be                                                               
either higher or lower than  the $192,000 projection depending on                                                               
how many applications actually come in.                                                                                         
                                                                                                                                
MS. GAYHART  agreed that the  revenue would depend on  the number                                                               
of  applications that  come through.  She  reiterated that  4,800                                                               
applications was an estimate based  on previous fiscal years. She                                                               
described the figure as well within the mark.                                                                                   
                                                                                                                                
CHAIR  COSTELLO   asked  Kathryn  Monfreda  to   talk  about  the                                                               
Department of Public Safety (DPS) fiscal note.                                                                                  
                                                                                                                                
2:27:01 PM                                                                                                                    
KATHRYN  MONFREDA,  Director,  Division  of  Statewide  Services,                                                               
Department Public Safety, Anchorage,  Alaska, stated that the DPS                                                               
fiscal  note is  based on  the DHSS  estimated numbers.  However,                                                               
passage of Amendment 2 [A.5]  means the background checks will be                                                               
completed  before the  end  of  the fiscal  year  so the  delayed                                                               
revenue will  be realized in  FY2022. She opined that  the fiscal                                                               
note  should be  revised to  make it  truly zero  and remove  the                                                               
discussion about it being indeterminate  with $177,600 in delayed                                                               
revenue.                                                                                                                        
                                                                                                                                
2:28:23 PM                                                                                                                    
CHAIR COSTELLO found no further objection and CSSB 3006(L&C) was                                                                
reported from the Senate Labor and Commerce Standing Committee                                                                  
                                                                                                                                
2:29:27 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Senator Costello adjourned the Senate Labor and Commerce                                                                        
Committee meeting at 2:29 p.m.                                                                                                  
                                                                                                                                

Document Name Date/Time Subjects
SB 3006 Fiscal Note DHSS.pdf SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Fiscal Note DPS.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Letter of Support - ASHNHA.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Letter of Support - Providence.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Letter of Support - AK Native Health Board.pdf SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Letter of Support - Teledoc Health.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Amendment A.2.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Amendment A.3.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Amendment A.4.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Amendment A.5.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006
SB 3006 Letter of Support - ASMA.pdf HHSS 9/11/2021 3:00:00 PM
SL&C 9/8/2021 1:30:00 PM
SB3006