00                       CS FOR SENATE BILL NO. 91(HSS)                                                                    
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 member of a physician's multidisciplinary care team may provide a health care                                       
10 service through telehealth to a patient located in this state only if the health care                               
11 service is not reasonably available in the state. A physician shall be [, AND]                                      
12 subject to disciplinary action by the State Medical Board under AS 08.64.333, and a                                 
13 member of the physician's multidisciplinary care team shall be subject to                                           
14 disciplinary action by the department under AS 08.02.140. The privilege to                                          
01       practice under this subsection extends only to                                                                    
02 (1)  ongoing treatment or follow-up care provided by a physician                                                    
03 licensed in another state, or a member of the physician's multidisciplinary care                                    
04 team, that is related to health care services previously provided by the physician to                               
05       the patient and applies only if                                                                                   
06                      (A)  the physician and the patient have an established physician-                                  
07            patient relationship; and                                                                                    
08                      (B)  the physician has previously conducted an in-person visit                                     
09            with the patient; or                                                                                         
10 (2)  a visit with a physician licensed in another state, or a member                                                
11 of the physician's multidisciplinary care team, regarding a suspected or diagnosed                                  
12       life-threatening condition for which                                                                              
13 (A)  the patient has been referred to the physician licensed in                                                         
14 another state, or a member of the physician's multidisciplinary care team,                                          
15 by a physician licensed in this state or by a physician licensed in another                                         
16 state who meets the requirements of (1) of this subsection and that referral                                        
17            has been documented by the referring physician; and                                                          
18 (B)  the visit involves communication with the patient regarding                                                        
19 diagnostic or treatment plan options or analysis of test results for the life-                                          
20            threatening condition.                                                                                       
21    * Sec. 2. AS 08.02.130(j)(1) is amended to read:                                                                   
22                 (1)  "health care provider" means                                                                       
23 (A)  an audiologist or speech-language pathologist licensed                                                             
24 under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor                                              
25 licensed under AS 08.20; a professional counselor licensed under AS 08.29; a                                            
26 dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a                                          
27 dietitian or nutritionist licensed under AS 08.38; a naturopath licensed under                                          
28 AS 08.45; a marital and family therapist licensed under AS 08.63; a physician                                           
29 licensed under AS 08.64; a podiatrist, osteopath, or physician assistant licensed                                       
30 under AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse                                                
31 licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an                                              
01 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a                                            
02 physical therapist or occupational therapist licensed under AS 08.84; a                                                 
03 psychologist or psychological associate licensed under AS 08.86; or a social                                            
04            worker licensed under AS 08.95; [OR]                                                                         
05                      (B)  a physician licensed in another state; or                                                 
06                      (C)  a member of a multidisciplinary care team;                                                
07    * Sec. 3. AS 08.02.130(j) is amended by adding a new paragraph to read:                                            
08                 (5)  "member of a multidisciplinary care team" means an audiologist,                                    
09       speech-language pathologist, behavior analyst, professional counselor, dietitian,                                 
10 nutritionist, naturopath, marital and family therapist, podiatrist, osteopath, physician                                
11 assistant, nurse, pharmacist, physical therapist, occupational therapist, psychologist or                               
12 psychological associate, or a social worker who is a member of a team that includes a                                   
13 physician licensed in another state who meets the requirements of (b)(1) of this                                        
14       section.                                                                                                          
15    * Sec. 4. AS 08.02.130 is amended by adding a new subsection to read:                                              
16 (k)  A member of a multidisciplinary care team shall register with the                                                  
17 department before providing telehealth services to a patient located in the state. To                                   
18       register with the department, a member of a multidisciplinary care team shall submit                              
19                 (1)  the name of the physician leading the multidisciplinary care team;                                 
20 (2)  the area of health care in which the member of the                                                                 
21 multidisciplinary care team will be practicing and proof of licensure in a state or                                     
22       territory of the United States in that area;                                                                      
23                 (3)  any applicable fees, as determined by the department.                                            
24    * Sec. 5. AS 08.02 is amended by adding new sections to read:                                                      
25 Sec. 08.02.135. Grounds for imposition of disciplinary sanctions of out-of-                                           
26 state multidisciplinary care team members. The department may sanction a member                                       
27 of an out-of-state physician's multidisciplinary care team who provides health care                                     
28 services through telehealth under AS 08.02.130 if the department finds after a hearing                                  
29       that the member                                                                                                   
30 (1)  secured a license through deceit, fraud, or intentional                                                            
31       misrepresentation;                                                                                                
01                 (2)  engaged in deceit, fraud, or intentional misrepresentation while                                   
02       providing professional services or engaging in professional activities;                                           
03                 (3)  advertised professional services in a false or misleading manner;                                  
04                 (4)  has been convicted, including conviction based on a guilty plea or                                 
05       plea of nolo contendere, of                                                                                       
06                      (A)  a class A or unclassified felony or a crime in another                                        
07            jurisdiction with elements similar to a class A or unclassified felony in this                               
08            jurisdiction;                                                                                                
09                      (B)  a class B or class C felony or a crime in another jurisdiction                                
10 with elements similar to a class B or class C felony in this jurisdiction if the                                        
11 felony or other crime is substantially related to the qualifications, functions, or                                     
12            duties of the member; or                                                                                     
13 (C)  a crime involving the unlawful procurement, sale,                                                                  
14            prescription, or dispensing of drugs;                                                                        
15 (5)  has procured, sold, prescribed, or dispensed drugs in violation of a                                               
16       law regardless of whether there has been a criminal action or harm to the patient;                                
17 (6)  intentionally or negligently permitted the performance of patient                                                  
18 care by persons under the member's supervision that does not conform to minimum                                         
19       professional standards even if the patient was not injured;                                                       
20 (7)  failed to comply with AS 08.02.130 - 08.02.140, a regulation                                                       
21       adopted under AS 08.02.130 - 08.02.140, or an order of the department;                                            
22                 (8)  has demonstrated                                                                                   
23 (A)  professional incompetence, gross negligence, or repeated                                                           
24 negligent conduct; the department may not base a finding of professional                                                
25 incompetence solely on the basis that a member's practice is unconventional or                                          
26            experimental in the absence of demonstrable physical harm to a patient;                                      
27 (B)  addiction to, severe dependency on, or habitual overuse of                                                         
28            alcohol or other drugs that impairs the member's ability to practice safely;                                 
29                      (C)  unfitness because of physical or mental disability;                                           
30 (9)  engaged in unprofessional conduct, in sexual misconduct, or in                                                     
31 lewd or immoral conduct in connection with the delivery of professional services to                                     
01 patients; in this paragraph, "sexual misconduct" includes sexual contact, or attempted                                  
02 sexual contact with a patient outside the scope of generally accepted methods of                                        
03 examination or treatment of the patient, regardless of the patient's consent or lack of                                 
04 consent, during the term of the health care provider-patient relationship, unless the                                   
05 patient was the member's spouse at the time of the contact or, immediately preceding                                    
06 the health care provider-patient relationship, was in a dating, courtship, or engagement                                
07       relationship with the member;                                                                                     
08 (10)  has violated any code of ethics adopted imposed by the                                                            
09       department;                                                                                                       
10 (11)  has denied care or treatment to a patient or person seeking                                                       
11 assistance from the member if the only reason for the denial is the failure or refusal of                               
12       the patient to agree to arbitrate as provided in AS 09.55.535(a);                                                 
13 (12)  has had a license or certificate to practice health care in another                                               
14 state or territory of the United States, or a province or territory of Canada, denied,                                  
15 suspended, revoked, surrendered while under investigation for an alleged violation,                                     
16 restricted, limited, conditioned, or placed on probation unless the denial, suspension,                                 
17 revocation, or other action was caused by the failure of the member to pay fees to that                                 
18       state, territory, or province;                                                                                    
19 (13)  exceeded the scope of the member's privilege to practice in this                                                  
20       state under AS 08.02.130; or                                                                                      
21 (14)  prescribed, dispensed, or administered through telehealth to a                                                    
22       patient located in the state a controlled substance listed in AS 11.71.140 - 11.71.190.                           
23 Sec. 08.02.140. Disciplinary sanctions for an out-of-state multidisciplinary                                          
24 care team member. (a) If the department finds grounds to sanction a member of an                                      
25 out-of-state physician's multidisciplinary care team under AS 08.02.135, the                                            
26       department may                                                                                                    
27                 (1)  permanently prohibit the member from practicing in the state;                                      
28 (2)  prohibit the member from practicing in the state for a determinate                                                 
29       period;                                                                                                           
30                 (3)  censure the member;                                                                                
31                 (4)  issue a letter of reprimand to the member;                                                         
01                 (5)  place the member on probationary status under (c) of this section;                                 
02                 (6)  limit or impose conditions on the member's privilege to practice in                                
03       the state;                                                                                                        
04                 (7)  impose a civil penalty of not more than $25,000;                                                   
05 (8)  issue a cease and desist order prohibiting the member from                                                         
06 providing health care services through telehealth under AS 08.02.130; an order issued                                   
07 under this paragraph remains in effect until the member submits evidence acceptable                                     
08       to the department showing that the violation has been corrected;                                                  
09                 (9)  promptly notify the licensing authority in each state in which the                                 
10       member is licensed of a sanction imposed under this subsection.                                                   
11 (b)  In a case finding grounds for sanction under AS 08.02.135(12), the final                                           
12 findings of fact, conclusions of law, and order of the authority that suspended or                                      
13 revoked a license or certificate constitute a prima facie case that the license or                                      
14 certificate was suspended or revoked and the grounds under which the suspension or                                      
15       revocation was granted.                                                                                           
16 (c)  The department may place a member on probation under this section until                                            
17 the department finds that the deficiencies that required the imposition of a sanction                                   
18       have been remedied. The department may require a member on probation to                                           
19 (1)  report regularly to the department on matters involving the reason                                                 
20       for which the member was placed on probation;                                                                     
21 (2)  limit the member's practice in the state to those areas prescribed by                                              
22       the department;                                                                                                   
23 (3)  participate in professional education until the department                                                         
24 determines that a satisfactory degree of skill has been attained in areas identified by                                 
25       the department as needing improvement.                                                                            
26 (d)  The department may summarily prohibit a member from practicing in the                                              
27 state under AS 08.02.130 if the department finds that the member, by continuing to                                      
28 practice, poses a clear and immediate danger to public health and safety. A member                                      
29 prohibited from practicing under this subsection is entitled to a hearing conducted by                                  
30 the office of administrative hearings (AS 44.64.010) not later than seven days after the                                
31 effective date of the order prohibiting the member from practicing. The department                                      
01 may lift an order prohibiting a member from practicing if the department finds after a                                  
02 hearing that the member is able to practice with reasonable skill and safety. The                                       
03 member may appeal a decision of the department under this subsection to the superior                                    
04       court.                                                                                                            
05 (e)  The department shall take measures to recover from a member the cost of                                            
06 proceedings resulting in a sanction under (a) of this section, including the costs of                                   
07       investigation by the department, and hearing costs.                                                               
08 (f)  The department may prohibit a member from practicing in the state upon                                             
09 receiving a certified copy of evidence that a license or certificate to practice within the                             
10 member's scope of practice in another state or territory of the United States or                                        
11 province or territory of Canada has been suspended or revoked. The prohibition                                          
12       remains in effect until a hearing can be held by the department.                                                  
13 (g)  The department shall be consistent in the application of disciplinary                                              
14 sanctions. A significant departure from earlier decisions of the department involving                                   
15 similar situations must be explained in findings of fact or orders made by the                                          
16       department.                                                                                                       
17    * Sec. 6. AS 44.33.381(b) is amended to read:                                                                      
18 (b)  The department shall maintain the registry of businesses performing                                                
19 telemedicine services in the state. The registry must include the name, address, and                                    
20 contact information of businesses performing telemedicine services in the state. The                                
21 department may renew every two years the registration of a business that meets                                      
22 all renewal requirements established by regulation and pays a renewal fee every                                     
23       two years.                                                                                                    
24    * Sec. 7. AS 44.33.381 is amended by adding a new subsection to read:                                              
25 (d)  The department shall charge the following fees for businesses performing                                           
26       telemedicine services in the state:                                                                               
27 (1)  initial registration fee, $100, adjusted for inflation in a manner                                                 
28       determined by the department;                                                                                     
29 (2)  renewal fee, $100, adjusted for inflation in a manner determined by                                                
30       the department;                                                                                                   
31 (3)  fee to report changes in the business's registration information, $50.