HB 29-INSURANCE COVERAGE FOR TELEHEALTH  3:57:51 PM CO-CHAIR ZULKOSKY announced that the next order of business would be HOUSE BILL NO. 29, "An Act relating to insurance coverage for benefits provided through telehealth; and providing for an effective date." 3:58:30 PM The committee took an at-ease from 3:58 p.m. to 4:00 p.m. 4:00:11 PM REPRESENTATIVE SPOHNHOLZ introduced HB 29 as the sponsor of the bill, stating that this bill increased access to and reduced the cost of health care by requiring insurers to reimburse providers for delivering health care services via telehealth. She added that telehealth was already covered and provided for by Medicaid and the Indian Health Services. She pointed out that it was so effective in these markets that it should be covered in its entirety in the private market as it increased access to health care in Rural Alaska. She shared a PowerPoint titled "House Bill 29 Insurance Coverage for Telehealth." She directed attention to slide 2, "Telehealth: Why is this important?" and pointed out that it would reduce the cost of health care by reducing travel expenses. She said that it could be used for primary, specialty, and behavioral health care. She noted that this also supported necessary innovations and transformations in health care. She pointed out that this could reduce emergency room visits. She added that the state plan did not provide for tele-health. 4:03:37 PM BERNICE NISBETT, Staff, Representative Ivy Spohnholz, paraphrased from the Sectional Analysis to HB 29 [Included in members' packets], which read: Section 1. AS 21.42.422 has been amended to require insurance coverage for health benefits provided through telehealth technology. Section 2. AS 21.42.422 is a new subsection that defines health care insurer as a person transacting the business of health care insurance except for a nonfederal governmental plan. It also adds the definition of telehealth under 47.05.270(e) as the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of health care data through audio, visual, or data communications, performed over two or more locations between providers who are physically separated from the recipient or from each other or between a provider and a recipient who are physically separated from each other. Section 3 The changes to Section 1 of this bill applies to health care insurance plans that are offered, issued, delivered, or renewed on or after the effective date. Section 4 The effective date is July 1, 2020. 4:05:21 PM REPRESENTATIVE CLAMAN asked if Department of Commerce, Community & Economic Development and the administration were in support of the proposed bill. 4:05:43 PM LORI WING-HEIER, Director, Juneau Office, Division of Insurance, Department of Commerce, Community & Economic Development, in response to Representative Claman, said that Department of Commerce, Community & Economic Development was very much in support of anything that would provide access to health care yet lower the cost at the same time. She acknowledged that the department was in support of the proposed bill. 4:06:05 PM REPRESENTATIVE PRUITT asked if it was possible to mandate this. MS. WING-HEIER reported that the Division of Insurance estimated that insured plans, which the division regulated, covered about 15 percent of Alaskans. REPRESENTATIVE PRUITT asked why there was a need to mandate this to the insurance companies, as it offered a cost savings. MS. WING-HEIER replied that this would increase access to Rural Alaska, especially for specialties and would reduce the overall costs if it could address common things and eliminate the need to visit the provider. She reported that there were data projections for virtual hospitals in the future with recuperation at home, although there were not any numbers to support this. In response to the need for a mandate, she reported that any conversation for new services prompted discussions and sometimes it was necessary to push for the offering of newer products or services. REPRESENTATIVE PRUITT asked about the options. He acknowledged that, although Moda Health had submitted a letter of support, they would not be required to provide this with their plan for the state. He questioned whether there would be support from the providers who would be required to offer telehealth. He shared his difficulty for understanding why a cost saving measure would need to be mandated. MS. WING-HEIER explained that previous attempts to deliver telehealth had not been provided by all insurance providers and that this mandate would ensure parity. REPRESENTATIVE PRUITT asked how to prevent individuals from recruiting the use of telehealth services without allowing for the best interests of the patient. He opined that the introduction of money through a mandate brought with it those who would take advantage. 4:10:51 PM MS. WING-HEIER expressed agreement that there were bad actors making "big dollars out of it" and this included doctors and insurance agents. She stated that it was necessary to use due diligence and take the necessary actions against those bad players. REPRESENTATIVE PRUITT asked how to ensure that her division had the tools to "take action as needed if there are those bad players that come up." He asked if it would be necessary for statute changes to allow the authority to pursue these people, some of whom may not even be in the state. MS. WING-HEIER reported that the agency had four investigators and she declared they were "a critical part of us being able to look at people that are the bad actors in the state. When they cross state lines, we end up working with the U.S. Attorney General or with the FBI, and that's not uncommon." She declared that these federal agencies "actually have the jurisdiction." 4:13:29 PM REPRESENTATIVE JACKSON asked if this would cover all Alaskans or just those through certain health care facilities or certain insurance companies. REPRESENTATIVE SPOHNHOLZ replied that the intent of the proposed bill was to ensure that insurers operating in the private market be required to cover telehealth services. She reported that telehealth services were already authorized and paid for under Medicaid, as well as tribal health. This proposed bill would expand the market for access to telehealth into the private market. She stated that self-insured plans which were governed by federal law, including the insurance plan by the State of Alaska, could not be included in state law. MS. WING-HEIER said that the State of Alaska had adopted a tele- doc option in its retirement and benefit plan. REPRESENTATIVE JACKSON declared that this was beneficial and saved a lot of time, travel, and money. She asked that this be shared with our federal delegation. REPRESENTATIVE SPOHNHOLZ expressed her intention to coordinate with the federal delegation. She expressed agreement that the state plan now allowed tele-doc, which she described as "a virtual form of an urgent care," although this was not quite the complete service that she supported for lasting relationships. 4:17:28 PM REPRESENTATIVE CLAMAN asked about the tele-doc coverage. REPRESENTATIVE SPOHNHOLZ, in response, explained that it depended on the provider. She said that Aetna had a requirement that providers go through a process to determine participation in telehealth. REPRESENTATIVE CLAMAN said that it was available if they followed the steps. He noted that there was a zero fiscal note and asked if there would be additional costs due to enforcement authority. MS. WING-HEIER replied that it was not expected to change the workload. 4:19:54 PM VICTORIA KNAPP, Chief Operations Officer, Mat-Su Health Services, Inc., stated that they relied on telehealth to provide specialty psychiatric services for individuals with mental health issues. She noted that there were "huge shortages of psychiatric providers in the State of Alaska." She reported that they had providers both in-state and out-of-state who were licensed in the State of Alaska. She declared that they were a safety net provider and had gone to telehealth services several years prior due to a shortage of available in-person psychiatric providers. She added that, as they did not want to have a wait list for psychiatric services, they moved to telehealth services. She noted that, on those occasions when a private health plan did not cover these services, the patient had to decide whether to make out of pocket payment or not receive the services. She expressed a desire for everyone to be covered for telehealth. 4:21:54 PM AROM EVANS, MD, Orion Behavioral Health Network, said that his organization primarily provided services for children and adolescents. He said there was a need for medical service providers for children, and that many of them were out of state and could only be accessed through telehealth. He stated his support for HB 29. He said that tele-doc was an important and useful service but that it was a very different service than telehealth. With tele-doc, as it was an on-demand service and you could not schedule a follow-up appointment, you may not have the same provider. 4:23:48 PM REPRESENTATIVE TARR asked whether, since with telehealth there were no in-person meetings, there was a potential to not build a strong relationship that would make the care as effective. DR. EVANS said they used a hybrid model as they maintained four physical clinics around the state. He acknowledged that many patients and family members needed that reassurance and they treated this on a case by case basis. 4:26:02 PM REPRESENTATIVE JACKSON asked about genetic work-ups through telehealth. DR. EVANS explained that genetic work-ups were conducted primarily in the laboratory, as they reviewed symptoms to determine the necessary tests, and these work-ups included a physical exam that could be provided by a local doctor. 4:27:09 PM ROBERT BARATTA, National Consultant, Teladoc Health, referenced the earlier discussion for fraud and abuse, and pointed out that prior to access of the service, there had to be a valid physician - patient relationship established. He pointed out that Alaska had such a statute as well as guidelines from the State Board of Medicine, for the way this relationship must be established. For reimbursement, the service had to be provided in accordance with that valid relationship. He pointed out that most insurance plans had the authority to make sure that it was medically necessary. REPRESENTATIVE JACKSON asked about the difference between charges from a tele-doc and an office visit. MR. BARATTA explained that there was a tele-medicine platform which a patient could access through their computer for a virtual visit with a physician. He said it mimicked the experience of a visit to an Urgent Care center with a board certified and Alaska licensed physician. 4:30:02 PM CO-CHAIR ZULKOSKY opened public testimony. 4:30:24 PM CYNTHIA MARK, Teladoc Health, emphasized that it was possible to establish an on-going relationship with an Alaska provider through telehealth and to see that same provider on an on-going basis. She stated support for HB 29, pointing out that it was good policy and good legislation. 4:32:02 PM CHRISTOPHER DIETRICH, Assistant Medical Director, Orion Behavioral Health Network, stated his support for HB 29. He offered an example of a patient released from API (Alaska Psychiatric Institute) who moved to Rural Alaska, and the option for telehealth. 4:33:44 PM CO-CHAIR ZULKOSKY closed public testimony. [HB 29 was held over.]