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