CSSB 91(HSS): "An Act relating to telehealth; relating to multidisciplinary care teams; and relating to the practice of medicine."
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.