04/24/2019 03:15 PM House LABOR & COMMERCE

            HB  29-INSURANCE COVERAGE FOR TELEHEALTH                                                                        
                                                                                                                                
4:42:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX announced that the  final 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."                                                                                                                
                                                                                                                                
4:43:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   IVY   SPOHNHOLZ,   Alaska   State   Legislature,                                                               
introduced HB 29, as prime  sponsor, and paraphrased parts of the                                                               
sponsor statement [included in the  committee packet], which read                                                               
in its entirety as follows [original punctuation provided]:                                                                     
                                                                                                                                
     HB  29  will  enhance access  to  healthcare  services,                                                                    
     primarily mental health and  primary care, for Alaskans                                                                    
     who  have insurance  plans regulated  by  the state  of                                                                    
     Alaska.  HB  29 does  this  by  allowing providers  who                                                                    
     contract  with  insurers  regulated  by  the  state  of                                                                    
     Alaska  to  reimburse  for services  delivered  through                                                                    
     telehealth.  Healthcare  services are  currently  being                                                                    
     delivered through telehealth all  over the country, and                                                                    
     Alaska  is at  the  forefront  of providing  telehealth                                                                    
     services for  urban, rural, aging, and  the underserved                                                                    
     communities   across  the   state,  primarily   through                                                                    
     Medicaid and tribal health care.                                                                                           
                                                                                                                                
     Some of the advantages of telehealth include:                                                                              
          ? Better access and  privacy in rural, remote, and                                                                    
          urban areas of Alaska.                                                                                                
          ? Early intervention which can lead to savings.                                                                       
          ? Greater  access for  referrals to  providers who                                                                    
          specialize in treating specific health issues.                                                                        
          ? Better, and potentially  quicker, access means a                                                                    
          potential   reduction    in   suicides,   domestic                                                                    
          violence and other serious events.                                                                                    
          ? Zero impact on state budget.                                                                                        
          ? Reduces the need for expensive medical travel.                                                                      
                                                                                                                                
     Under   HB   29,   telehealth  benefits   for   covered                                                                    
     healthcare services, including  mental health benefits,                                                                    
     will   be  reimbursable   for  health   care  providers                                                                    
     licensed  in the  state  without  an initial  in-person                                                                    
     appointment.  Depending  on   the  patient's  needs,  a                                                                    
     telehealth    appointment   can    provide   education,                                                                    
     reviewing of  prescriptions and checking  symptoms, all                                                                    
     at a distance on a secure system.                                                                                          
                                                                                                                                
     Expanding  access   to  healthcare   delivered  through                                                                    
     telehealth  will  help  to  address  some  of  Alaska's                                                                    
     unique  challenges due  to our  large geography,  rural                                                                    
     and   aging   communities,  and   statewide   addiction                                                                    
     epidemic. Telehealth can help  Alaska improve access to                                                                    
     healthcare,  improve   clinical  outcomes   and  reduce                                                                    
     health care costs.                                                                                                         
                                                                                                                                
4:45:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  LEDOUX sought  clarification  on what  it  means for  a                                                               
patient to be "monitored."                                                                                                      
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ  related   a   personal  anecdote   to                                                               
illustrate "self-monitoring" via telehealth.   She explained that                                                               
it's a  method of  transmitting information  to a  doctor without                                                               
having  to be  there in  person, adding  that it's  a way  to use                                                               
technology  to improve  access to  care  and reduce  some of  the                                                               
burden of time and travel that comes with monitoring healthcare.                                                                
                                                                                                                                
CO-CHAIR  LEDOUX asked  if insurance  would cover  a consultation                                                               
via telehealth.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ answered  yes,  consultations could  be                                                               
covered under  insurance if this  bill were  to pass.   She noted                                                               
that  some  insurers in  Alaska  already  cover telehealth,  like                                                               
Medicaid and tribal health, but not all private insurers do.                                                                    
                                                                                                                                
4:50:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ returned  to  her  introduction of  the                                                               
bill.  She stated that HB  29 would increase access to healthcare                                                               
in Alaska,  especially for rural  communities, without  having to                                                               
travel  for it.   Referencing  SB 74,  she said  one of  the main                                                               
reasons  that telehealth  coverage was  included was  to increase                                                               
access  to substance  abuse and  behavioral health  treatment for                                                               
individuals in  rural Alaska.   She said not every  community can                                                               
have  their own  behavioral  healthcare  provider; however,  they                                                               
could get  access to  telehealth care to  speak with  a substance                                                               
abuse counselor,  for example.   She noted that  Health Insurance                                                               
Portability  and Accountability  Act  (HIPAA)  compliance is  the                                                               
reason special  technology is  used in  telehealth communication.                                                               
She  offered  her  belief  that HB  29  will  reduce  unnecessary                                                               
medical  travel, as  well as  unnecessary emergency  room visits.                                                               
She  opined that  even in  urban  communities where  access to  a                                                               
doctor is readily  available, telehealth is a  better option than                                                               
going in person.                                                                                                                
                                                                                                                                
4:53:29 PM                                                                                                                    
                                                                                                                                
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State Legislature,  on behalf of Representative  Spohnholz, prime                                                               
sponsor  of  HB  29,  presented  the  sectional  analysis.    She                                                               
informed  the committee  that section  1 amends  AS 21.42.422  to                                                               
require insurance  coverage for health benefits  provided through                                                               
telehealth technology.   Section  2 provides the  definitions for                                                               
health care insurer and telehealth.   Finally, sections 3 through                                                               
4,  she said,  speak to  the  insurance plans  and the  effective                                                               
date, which is July 1, 2020.                                                                                                    
                                                                                                                                
4:55:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS   asked  if   the  state  of   Alaska  has                                                               
quantified  the amount  of money  spent on  weekend ER  or urgent                                                               
care  visits  and  how  much   money  could  be  saved  by  using                                                               
telehealth instead.                                                                                                             
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ replied  that  the state  has not  been                                                               
able  to  quantify  cost-savings,   adding  that  there  is  cost                                                               
avoidance, but there's  no analysis that tracks  the reduction in                                                               
ER visits with the introduction  of new telehealth services.  She                                                               
clarified  that HB  29 is  not covered  by the  Alaska Care  plan                                                               
because it's federally regulated.                                                                                               
                                                                                                                                
REPRESENTATIVE FIELDS  asked what  the potential savings  are for                                                               
plans covered by this bill.                                                                                                     
                                                                                                                                
4:58:31 PM                                                                                                                    
                                                                                                                                
LORI WING-HEIER,  Director, Division of Insurance,  Department of                                                               
Commerce, Community  & Economic Development, replied  she did not                                                               
have that answer right now.                                                                                                     
                                                                                                                                
4:58:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  asked if any "strictly  telehealth medical                                                               
facilities" currently exist.                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  confirmed   that  they  do,  including                                                               
Capstone Express and Teladoc.                                                                                                   
                                                                                                                                
REPRESENTATIVE  STUTES questioned  whether  these facilities  use                                                               
FaceTime.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ replied  that they  don't use  FaceTime                                                               
because  it's not  HIPAA compliant;  however,  there are  several                                                               
similar   video  conferencing   technologies  that   are  readily                                                               
available to them.                                                                                                              
                                                                                                                                
5:01:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   HANNAN  asked   how  many   insurance  companies                                                               
currently use telehealth in Alaska.                                                                                             
                                                                                                                                
MS.   WING-HEIER  offered   her  understanding   that  currently,                                                               
insurance  companies are  split on  offering this  as a  benefit,                                                               
adding that the reimbursement is what's in question.                                                                            
                                                                                                                                
5:03:01 PM                                                                                                                    
                                                                                                                                
MS.  WING-HEIER,   responding  to   a  follow-up   question  from                                                               
Representative Hannan,  said she sees telehealth  as an excellent                                                               
way  to allow  innovation and  reduce the  cost of  healthcare in                                                               
Alaska, while increasing access to it.                                                                                          
                                                                                                                                
CO-CHAIR LEDOUX  sought clarification on how  someone would reach                                                               
their doctor after hours via telehealth communication.                                                                          
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ explained that  it depends on the clinic                                                               
and the  individual provider, noting  that Teladoc,  for example,                                                               
is available 24/7.                                                                                                              
                                                                                                                                
CO-CHAIR LEDOUX asked why FaceTime isn't HIPAA compliant.                                                                       
                                                                                                                                
5:07:08 PM                                                                                                                    
                                                                                                                                
WADE ERICKSON, MD, Capstone Family Medicine, replied that HIPAA                                                                 
compliance requires certain encryption standards that FaceTime                                                                  
doesn't have.                                                                                                                   
                                                                                                                                
CO-CHAIR LEDOUX asked if a regular telephone or cellphone can be                                                                
used.                                                                                                                           
                                                                                                                                
DR. ERICKSON answered yes.  He said it's the app on the phone                                                                   
that makes the difference.                                                                                                      
                                                                                                                                
5:08:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX announced that HB 29 was held over.