00 SENATE BILL NO. 91 01 "An Act relating to telehealth; relating to multidisciplinary care teams; and relating to 02 the practice of medicine." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04  * Section 1. AS 08.02.130(b) is amended to read: 05 (b) A physician licensed in another state or an out-of-state member of the  06 physician's multidisciplinary care team may provide health care services through 07 telehealth to a patient located in the state as provided in this subsection, subject to the 08 investigative and enforcement powers of the department under AS 08.01.087. A  09 physician shall be [, AND] subject to disciplinary action by the State Medical Board 10 under AS 08.64.333, and a member of the physician's multidisciplinary care team  11 shall be subject to disciplinary action by the department under AS 08.02.140. The 12 privilege to practice under this subsection extends only to 13 (1) ongoing treatment or follow-up care provided by a physician  14 licensed in another state, or a member of the physician's multidisciplinary care  01 team, that is related to health care services previously provided by the physician to 02 the patient and applies only if 03 (A) the physician and the patient have an established physician- 04 patient relationship; and 05 (B) the physician has previously conducted an in-person visit 06 with the patient; or 07 (2) a visit with a physician licensed in another state, or a member  08 of the physician's multidisciplinary care team, regarding a suspected or diagnosed 09 life-threatening condition for which 10 (A) the patient has been referred to the physician licensed in 11 another state, or a member of the physician's multidisciplinary care team, 12 by a physician licensed in this state or by a physician licensed in another  13 state who meets the requirements of (1) of this subsection and that referral 14 has been documented by the referring physician; and 15 (B) the visit involves communication with the patient regarding 16 diagnostic or treatment plan options or analysis of test results for the life- 17 threatening condition. 18  * Sec. 2. AS 08.02.130(j)(1) is amended to read: 19 (1) "health care provider" means 20 (A) an audiologist or speech-language pathologist licensed 21 under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor 22 licensed under AS 08.20; a professional counselor licensed under AS 08.29; a 23 dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a 24 dietitian or nutritionist licensed under AS 08.38; a naturopath licensed under 25 AS 08.45; a marital and family therapist licensed under AS 08.63; a physician 26 licensed under AS 08.64; a podiatrist, osteopath, or physician assistant licensed 27 under AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse 28 licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an 29 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a 30 physical therapist or occupational therapist licensed under AS 08.84; a 31 psychologist or psychological associate licensed under AS 08.86; or a social 01 worker licensed under AS 08.95; [OR] 02 (B) a physician licensed in another state; or 03 (C) a member of a multidisciplinary care team that includes  04 a physician licensed in another state who meets the requirements of (b)(1)  05 of this section; 06  * Sec. 3. AS 08.02 is amended by adding new sections to read: 07 Sec. 08.02.135. Grounds for imposition of disciplinary sanctions of out-of- 08 state multidisciplinary care team members. The department may sanction a member 09 of an out-of-state physician's multidisciplinary care team who provides health care 10 services through telehealth under AS 08.02.130 if the department finds after a hearing 11 that the member 12 (1) secured a license through deceit, fraud, or intentional 13 misrepresentation; 14 (2) engaged in deceit, fraud, or intentional misrepresentation while 15 providing professional services or engaging in professional activities; 16 (3) advertised professional services in a false or misleading manner; 17 (4) has been convicted, including conviction based on a guilty plea or 18 plea of nolo contendere, of 19 (A) a class A or unclassified felony or a crime in another 20 jurisdiction with elements similar to a class A or unclassified felony in this 21 jurisdiction; 22 (B) a class B or class C felony or a crime in another jurisdiction 23 with elements similar to a class B or class C felony in this jurisdiction if the 24 felony or other crime is substantially related to the qualifications, functions, or 25 duties of the member; or 26 (C) a crime involving the unlawful procurement, sale, 27 prescription, or dispensing of drugs; 28 (5) has procured, sold, prescribed, or dispensed drugs in violation of a 29 law regardless of whether there has been a criminal action or harm to the patient; 30 (6) intentionally or negligently permitted the performance of patient 31 care by persons under the member's supervision that does not conform to minimum 01 professional standards even if the patient was not injured; 02 (7) failed to comply with AS 08.02.130 - 08.02.140, a regulation 03 adopted under AS 08.02.130 - 08.02.140, or an order of the department; 04 (8) has demonstrated 05 (A) professional incompetence, gross negligence, or repeated 06 negligent conduct; the department may not base a finding of professional 07 incompetence solely on the basis that a member's practice is unconventional or 08 experimental in the absence of demonstrable physical harm to a patient; 09 (B) addiction to, severe dependency on, or habitual overuse of 10 alcohol or other drugs that impairs the member's ability to practice safely; 11 (C) unfitness because of physical or mental disability; 12 (9) engaged in unprofessional conduct, in sexual misconduct, or in 13 lewd or immoral conduct in connection with the delivery of professional services to 14 patients; in this paragraph, "sexual misconduct" includes sexual contact, or attempted 15 sexual contact with a patient outside the scope of generally accepted methods of 16 examination or treatment of the patient, regardless of the patient's consent or lack of 17 consent, during the term of the health care provider-patient relationship, unless the 18 patient was the member's spouse at the time of the contact or, immediately preceding 19 the health care provider-patient relationship, was in a dating, courtship, or engagement 20 relationship with the member; 21 (10) has violated any code of ethics adopted imposed by the 22 department; 23 (11) has denied care or treatment to a patient or person seeking 24 assistance from the member if the only reason for the denial is the failure or refusal of 25 the patient to agree to arbitrate as provided in AS 09.55.535(a); 26 (12) has had a license or certificate to practice health care in another 27 state or territory of the United States, or a province or territory of Canada, denied, 28 suspended, revoked, surrendered while under investigation for an alleged violation, 29 restricted, limited, conditioned, or placed on probation unless the denial, suspension, 30 revocation, or other action was caused by the failure of the member to pay fees to that 31 state, territory, or province; 01 (13) exceeded the scope of the member's privilege to practice in this 02 state under AS 08.02.130; or 03 (14) prescribed, dispensed, or administered through telehealth to a 04 patient located in the state a controlled substance listed in AS 11.71.140 - 11.71.190. 05 Sec. 08.02.140. Disciplinary sanctions for an out-of-state multidisciplinary  06 care team member. (a) If the department finds grounds to sanction a member of an 07 out-of-state physician's multidisciplinary care team under AS 08.02.135, the 08 department may 09 (1) permanently prohibit the member from practicing in the state; 10 (2) prohibit the member from practicing in the state for a determinate 11 period; 12 (3) censure the member; 13 (4) issue a letter of reprimand to the member; 14 (5) place the member on probationary status under (c) of this section; 15 (6) limit or impose conditions on the member's privilege to practice in 16 the state; 17 (7) impose a civil penalty of not more than $25,000; 18 (8) issue a cease and desist order prohibiting the member from 19 providing health care services through telehealth under AS 08.02.130; an order issued 20 under this paragraph remains in effect until the member submits evidence acceptable 21 to the department showing that the violation has been corrected; 22 (9) promptly notify the licensing authority in each state in which the 23 member is licensed of a sanction imposed under this subsection. 24 (b) In a case finding grounds for sanction under AS 08.02.135(12), the final 25 findings of fact, conclusions of law, and order of the authority that suspended or 26 revoked a license or certificate constitute a prima facie case that the license or 27 certificate was suspended or revoked and the grounds under which the suspension or 28 revocation was granted. 29 (c) The department may place a member on probation under this section until 30 the department finds that the deficiencies that required the imposition of a sanction 31 have been remedied. The department may require a member on probation to 01 (1) report regularly to the department on matters involving the reason 02 for which the member was placed on probation; 03 (2) limit the member's practice in the state to those areas prescribed by 04 the department; 05 (3) participate in professional education until the department 06 determines that a satisfactory degree of skill has been attained in areas identified by 07 the department as needing improvement. 08 (d) The department may summarily prohibit a member from practicing in the 09 state under AS 08.02.130 if the department finds that the member, by continuing to 10 practice, poses a clear and immediate danger to public health and safety. A member 11 prohibited from practicing under this subsection is entitled to a hearing conducted by 12 the office of administrative hearings (AS 44.64.010) not later than seven days after the 13 effective date of the order prohibiting the member from practicing. The department 14 may lift an order prohibiting a member from practicing if the department finds after a 15 hearing that the member is able to practice with reasonable skill and safety. The 16 member may appeal a decision of the department under this subsection to the superior 17 court. 18 (e) The department shall take measures to recover from a member the cost of 19 proceedings resulting in a sanction under (a) of this section, including the costs of 20 investigation by the department, and hearing costs. 21 (f) The department may prohibit a member from practicing in the state upon 22 receiving a certified copy of evidence that a license or certificate to practice within the 23 member's scope of practice in another state or territory of the United States or 24 province or territory of Canada has been suspended or revoked. The prohibition 25 remains in effect until a hearing can be held by the department. 26 (g) The department shall be consistent in the application of disciplinary 27 sanctions. A significant departure from earlier decisions of the department involving 28 similar situations must be explained in findings of fact or orders made by the 29 department.