Legislature(2019 - 2020)CAPITOL 106
03/26/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB22 | |
| HB29 | |
| HB97 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 22 | TELECONFERENCED | |
| *+ | HB 29 | TELECONFERENCED | |
| *+ | HB 86 | TELECONFERENCED | |
| *+ | HB 97 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 26, 2019
3:05 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Sharon Jackson
Representative Lance Pruitt
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 22
"An Act extending the termination date of the Statewide Suicide
Prevention Council; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 29
"An Act relating to insurance coverage for benefits provided
through telehealth; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 97
"An Act relating to the prescription of drugs by a physician
assistant without physical examination."
- HEARD & HELD
HOUSE BILL NO. 86
"An Act relating to a state-owned inpatient mental health
treatment hospital; and providing for an effective date."
- BILL HEARING RESCHEDULED TO 3/28/19
PREVIOUS COMMITTEE ACTION
BILL: HB 22
SHORT TITLE: EXTEND SUICIDE PREVENTION COUNCIL
SPONSOR(s): REPRESENTATIVE(s) TARR
02/20/19 (H) PREFILE RELEASED 1/7/19
02/20/19 (H) READ THE FIRST TIME - REFERRALS
02/20/19 (H) HSS, FIN
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 29
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/20/19 (H) PREFILE RELEASED 1/11/19
02/20/19 (H) READ THE FIRST TIME - REFERRALS
02/20/19 (H) HSS, L&C
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 97
SHORT TITLE: TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS
03/15/19 (H) READ THE FIRST TIME - REFERRALS
03/15/19 (H) HSS, L&C
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
LINDA DAY, Audit Manager
Legislative Audit Division
Legislative Agencies and Offices
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 22.
BEVERLY SCHOONOVER, Acting Executive Director
Statewide Suicide Prevention Council
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 22.
BARBARA FRANKS, Chairperson
Statewide Suicide Prevention Council
Ninilchik, Alaska
POSITION STATEMENT: Testified during discussion of HB 22.
NICOLE BORROMEO, Executive Vice President and General Council
Alaska Federation of Natives (AFN)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 22.
BRENDA MOORE
Statewide Suicide Prevention Council
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 22.
SAM TRIVETTE
Juneau Suicide Prevention Coalition
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 22.
MONIQUE ANDREWS
Statewide Suicide Prevention Council
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 22.
KRISTINA JAGER
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 22.
PATTY OWEN
Alaska Public Health Association (ALPHA)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 22.
BERNICE NISBETT, Staff
Representative Ivy Spohnholz
Juneau, Alaska
POSITION STATEMENT: Introduced the Sectional Analysis for HB 29
on behalf of the sponsor, Representative Spohnholz.
LORI WING-HEIER, Director
Juneau Office
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 29.
VICTORIA KNAPP, Chief Operations Officer
Mat-Su Health Services, Inc.
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 29.
AROM EVANS, MD
Orion Behavioral Health Network
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 29 and HB 97.
ROBERT BARATTA
National Consultant
Teladoc Health
Richmond, Virginia
POSITION STATEMENT: Testified during discussion of HB 29.
CYNTHIA MARK
Teladoc Health
Michigan
POSITION STATEMENT: Testified in support of HB 29.
CHRISTOPHER DIETRICH, Assistant Medical Director
Orion Behavioral Health Network
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 29 and HB 97.
REID HARRIS, Staff
Representative Jonathan Kreiss-Tomkins
Alaska State Legislature
POSITION STATEMENT: Presented HB 97 on behalf of the bill
sponsor, Representative Kreiss-Tomkins.
DEBORAH STOVERN, Executive Administrator
State Medical Board
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
97.
ACTION NARRATIVE
3:05:16 PM
CO-CHAIR ZULKOSKY called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Zulkosky, Spohnholz, Tarr, and Drummond were
present at the call to order. Representatives Claman, Pruitt,
and Jackson arrived as the meeting was in progress.
HB 22-EXTEND SUICIDE PREVENTION COUNCIL
3:05:48 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be HOUSE BILL NO. 22, "An Act extending the termination
date of the Statewide Suicide Prevention Council; and providing
for an effective date."
3:06:33 PM
REPRESENTATIVE TARR introduced HB 22, as the sponsor of the
bill, and stated that the proposed bill was more than simply an
extension for the termination date of the Statewide Suicide
Prevention Council. She pointed to the recent 2019 Alaska
statistics for suicide prevention which indicated that one
person died by suicide every 44 hours. She reported that this
was the fifth leading cause of death in Alaska, while being the
leading cause of death in ages 15 - 24. She added that Alaska
was second in the nation with suicide deaths per capita. She
pointed to an increase in the recent rate of suicide, declaring
that this was an impact upon too many Alaskans. She emphasized
the need for a Suicide Prevention Council, and that even more
needed to be done. She pointed to the 20,976 calls during 2018
to the CARE line, an annual increase of almost 30 percent. She
reported that the Statewide Suicide Prevention Council was
comprised of 14 individuals, which included 4 legislators, as
non-voting members.
3:10:13 PM
REPRESENTATIVE TARR paraphrased from the sponsor statement
[Included in members' packets][original punctuation provided],
which read:
House Bill 22 would extend the termination date of the
Statewide Suicide Prevention Council to 2027, ensuring
another eight years of support for suicide prevention
efforts in Alaska. The Council would otherwise be
terminated on June 30, 2019. According to the Alaska
Department of Health and Social Services Section of
Epidemiology, the suicide rate in Alaska increased by
13 percent between 2012 and 2017, making suicide the
leading cause of death for Alaskans between the ages
of 10 and 64. As a matter of public health, the state
has a responsibility to address this disturbing trend
and must actively continue to pursue strategies to
prevent suicide in Alaska. The Statewide Suicide
Prevention Council was created in 2001 and consists of
14 public and private members, including four state
legislators. Under AS 44.39.350, the Council is
statutorily responsible for: ? Advising legislators
and the Governor on ways to improve Alaskans' health
and wellness by reducing suicide; ? Improving public
awareness of suicide and risk factors; ? Enhancing
suicide prevention efforts; ? Working with partners
and faith-based organizations to develop healthier
communities; ? Creating a statewide suicide prevention
plan and putting it in action; and ? Building and
strengthening partnerships to prevent suicide. The
Council holds public meetings, publishes a 5-Year
State Suicide Prevention Plan, and works with schools
and community groups to provide resources that educate
Alaskans on how to prevent suicide. Last year, the
Council partnered with the Alaska Community Foundation
and Alaska Children's Trust to continue the GCI
Suicide Prevention Grant Program. Nine grants were
funded in 2017 across the state, totaling $100,000.
The Council also helped secure funding for a 5-year
grant from the National Institute of Mental Health to
create the Alaska Native Collaborative Hub for
Resilience Research, which will help Alaska Native
communities share knowledge, guide research, and
identify culturally-relevant suicide prevention
strategies in rural Alaska. Terminating the Statewide
Suicide Prevention Council would jeopardize the
state's efforts at addressing this heartbreaking, but
preventable, issue. I respectfully ask for your
support of HB 22 this year.
REPRESENTATIVE TARR pointed out that there was a recommendation
by the Legislative Audit Division to extend the council for
eight years. She directed attention to the fiscal note, labeled
OMB Component Number 2651 [Included in members' packets] and
explained that this included not only the expenditures for
staffing, but the bulk was directed for grants to the Department
of Education and Early Development. She concluded and pointed
to the checklists [Included in members' packets] for families,
communities, and individuals which offered ways to make a
difference for Alaskans impacted by suicide.
3:15:16 PM
REPRESENTATIVE JACKSON asked if the $648,000 requested on the
fiscal note was an annual request.
REPRESENTATIVE TARR replied, "that's true, yes." She directed
attention to the grants and benefits line, noting that this was
the bulk of the requested funding and that it was for "really,
really important work in the schools."
REPRESENTATIVE JACKSON expressed her concern that this money be
directed toward education, but instead be directed toward mental
services. She offered her belief that investment through the
schools may not be the best place to funnel the money as it may
be the "last place young people want to talk about it because
they will feel ridicule." She declared the need to shift the
perspective as the suicide numbers were not coming down. She
stated her support for the proposed bill and added that she
would be a member of the council.
3:18:32 PM
REPRESENTATIVE TARR said that she would follow up with her and
explained that there was now an understanding for "the trauma
informed approach" to be effective. She noted that some of the
materials had been developed for educators. She acknowledged
that although the program infrastructure appeared to be the
same, the actual work completed through these grants was now
very relevant and based on what was currently understood as the
best practices. She expressed her hope that this was the best
and most effective use of the dollars.
REPRESENTATIVE JACKSON replied that she would wait to hear from
the various organizations.
REPRESENTATIVE TARR offered that there could be responses from
the testifiers directed toward her concerns.
3:20:28 PM
REPRESENTATIVE CLAMAN shared his agreement with the expansion to
an eight-year renewal, noting that there was a cost to the
shorter time frames.
REPRESENTATIVE TARR replied that the issues facing the council
were very challenging and took time and generational change.
3:21:41 PM
LINDA DAY, Audit Manager, Legislative Audit Division,
Legislative Agencies and Offices, directed attention to the
sunset audit of the Suicide Prevention Council [Included in
members' packets] dated August 3, 2018. She explained that the
purpose of a sunset audit was to determine whether a board or
commission was serving the public interest and whether it should
be extended. She declared that the Statewide Suicide Prevention
Council was authorized by statute to serve in an advisor
capacity to the Alaska State Legislature and the governor
regarding suicide awareness and prevention. She reported that
it had been found that overall the council operated in the
public's interest by actively broadening the public's awareness
of suicide prevention and coordinating the efforts of other
suicide prevention entities which included state agencies,
regional groups, coalitions, and local communities. She added
that the council had fulfilled its statutory duty by issuing the
2018 - 2022 Suicide Prevention plan while working closely with
the stakeholders to add and refine the plan's strategies,
resources, and indicators. She directed attention to page 4 of
the audit which listed the schedule of expenditures and funding
sources. She noted that the council was funded by general fund
appropriations for about $650,000 in FY18, with the majority of
its expenditures for suicide awareness prevention programs with
the Department of Education and Early Development. She pointed
to pages 9 - 10 of the audit which listed a detailed list of the
council activities, and she shared two administrative
recommendations. On page 12, it was recommended that the
executive director develop and implement procedures to ensure
that public notice for the meetings was published accurately and
in a timely manner. Also, on page 12, it was recommended that
the chair of the council develop and implement written
procedures to ensure performance evaluations were completed
annually for the executive director, as this was required in
statute. She concluded by stating that the division recommended
an extension for the council termination date of eight years.
3:25:50 PM
BEVERLY SCHOONOVER, Acting Executive Director, Statewide Suicide
Prevention Council, Division of Behavioral Health, Department of
Health and Social Services, reported that she had only been
acting executive director for two months.
3:26:50 PM
BARBARA FRANKS, Chairperson, Statewide Suicide Prevention
Council, shared her personal story as a mother of a child who
died by suicide. She noted that she had travelled more than
700,000 miles in Alaska for trainings to teach the signs for how
to help someone. She reported that there had been 2,224,408
calls to the national helpline in 2018.
3:31:09 PM
CO-CHAIR SPOHNHOLZ thanked Ms. Franks for sharing her personal
experience, stating how important this was, and she shared her
own personal experiences with suicide. She pointed out the
difficulty for knowing what to say to someone impacted by a
suicide and the need for honest, transparent conversations about
suicide as the way to address the issue over the long term.
3:32:55 PM
NICOLE BORROMEO, Executive Vice President and General Council,
Alaska Federation of Natives (AFN), stated the support of AFN
for three main reasons: Alaska Natives and American Indians are
the only ethnic populations specifically listed as at-risk for
suicide by the U.S. Substance Abuse and Mental Health Services
Administration. Since suicide disproportionately affects Alaska
Natives and American Indians, the suicide prevention council
connects the public to state government resources, raises
awareness, increases outreach, and helps secure funding for
projects and programs that help our communities develop
community and culturally relevant programs to build our
collective resilience. She stated support of continuation of
the council and support to the Alaska Native Health Board's
efforts to expand the membership of the council to include a
subject matter expert in prevention who has experience working
in the tribal health care system. Finally, AFN was supportive
of HB 22 because the council promoted community wellness and
used the most current data and research to inform its upstream
approach. She stated that there had been too many instances
where suicide had reached epidemic levels throughout Alaska and
that all Alaskans needed to know that suicide was preventable.
3:35:12 PM
CO-CHAIR ZULKOSKY opened public testimony.
3:35:40 PM
BRENDA MOORE, Statewide Suicide Prevention Council, reported
that she was the representative to the council from the Alaska
Mental Health Board. She stated that prevention was primarily
about reducing risk and building resilience and that the council
worked to coordinate, advocate, and educate. She relayed that
the grants were for primary prevention and had touched the lives
of more than 200,000 people. These learning modules allowed the
public to understand the signs and symptoms of suicide, and the
impacts of toxic stress and trauma that create a greater risk
for suicide. She explained that a key role for the council was
to coordinate among the various local groups. She cautioned
that there were other chronic illnesses that also needed
prevention. She declared that it was necessary to develop
resiliency and deal with trauma and toxic stress, hence the need
to start with youth. She emphasized that the work with
Department of Education and Early Development was key to
addressing primary prevention.
3:41:10 PM
SAM TRIVETTE, Juneau Suicide Prevention Coalition, said that
there had been a suicide death in Juneau today and shared a
personal experience with suicide. He stated his support for HB
22. He said that there had been progress made in many areas
around the state, pointing out that, as the CARE line calls had
dramatically increased, people were willing to call and connect
with experts. He offered his belief that the programs in the
schools had "opened up kids, they understand the signs of
suicide" and that there were programs that dealt with sources of
strength and resilience. He reported that several hospitals and
clinics were screening for suicide prevention. He added that
the council was developing new programs that were extremely
effective and would become best practices.
3:46:01 PM
MONIQUE ANDREWS, Statewide Suicide Prevention Council, stated
that she was a member of the Alaska Army National Guard and she
shared how the suicide prevention efforts were working in the
military. She reported that the increase of suicides in Alaska
was on par with the national and the military increase. She
said that although there were a multitude of variables
contributing to the increase, the efforts for prevention
intervention were not in vain. She pointed out that most
military recruiters were working with 15 - 24-year olds, which
was the most vulnerable group as they were still physically and
emotionally developing. This was also the highest group for
suicide. She stated that the Suicide Prevention Council worked
in the schools with this age group to teach skills of resiliency
and effective communication, and that these skills were taken
with them into the military. She pointed out how stressful it
was for these young people in the military and the need for
these skills. She spoke about the perceptions of prevention, as
many people thought that prevention was solely intervention.
She declared that prevention happened even before a crisis,
while there were still other options and resources available,
and that the council provided an avenue to connect with these
resources.
3:52:25 PM
KRISTINA JAGER shared her personal story as a survivor of
suicide and that she had worked in the mental health field with
individuals in crisis for the past seven years. She relayed
that the council gave hope and provided a consolidated,
concerted, strategic plan to "recast the net upstream" as
primary prevention was the key. She stated the importance of
getting to youth before the at-risk period of their lives so
they would have the necessary coping and resilience skills. She
declared that it was crucial to continue to provide the grant
funding to the Department of Education and Early Development for
primary prevention. She stated support for HB 22.
3:55:31 PM
PATTY OWEN, Alaska Public Health Association (ALPHA), stated
support for extension of the council until 2027 and she read
from a prepared statement [original punctuation provided]:
The Alaska Public Health Association (ALPHA) is a non-
profit membership organization with over 150 health
members dedicated to improving the health and well-
being for all Alaskans. ALPHA is also the state
affiliate of the American Public Health Association.
ALPHA strongly supports HB 22, to extend Alaska's
Statewide Suicide Prevention Council to June 30, 2027.
As outlined in Alaska Statute 44.29.350, the functions
of the Council are necessary to improve health and
wellness throughout the state by reducing suicide and
its effects on individuals, families and communities.
The Statewide Suicide Council has done a remarkable
job of raising awareness; coordinating and improving
statewide prevention programs and resources;
collaborating with national, state and local
stakeholders and resources; and developing, updating,
and implementing statewide prevention plans.
Reducing suicide rates in Alaska has been one of the
goals of the State's Healthy Alaskans 2020 and is also
a priority of ALPHA. Unfortunately, despite best
efforts, suicide rates in Alaska remain high and still
much higher than the national average.
It is crucial that the Statewide Suicide Council
continue its work and remain the primary entity in
Alaska for Alaska's collective approach to preventing
suicide.
3:57:31 PM
CO-CHAIR ZULKOSKY closed public testimony.
[HB 22 was held over.]
HB 29-INSURANCE COVERAGE FOR TELEHEALTH
3:57:51 PM
CO-CHAIR ZULKOSKY announced that the next 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."
3:58:30 PM
The committee took an at-ease from 3:58 p.m. to 4:00 p.m.
4:00:11 PM
REPRESENTATIVE SPOHNHOLZ introduced HB 29 as the sponsor of the
bill, stating that this bill increased access to and reduced the
cost of health care by requiring insurers to reimburse providers
for delivering health care services via telehealth. She added
that telehealth was already covered and provided for by Medicaid
and the Indian Health Services. She pointed out that it was so
effective in these markets that it should be covered in its
entirety in the private market as it increased access to health
care in Rural Alaska. She shared a PowerPoint titled "House
Bill 29 Insurance Coverage for Telehealth." She directed
attention to slide 2, "Telehealth: Why is this important?" and
pointed out that it would reduce the cost of health care by
reducing travel expenses. She said that it could be used for
primary, specialty, and behavioral health care. She noted that
this also supported necessary innovations and transformations in
health care. She pointed out that this could reduce emergency
room visits. She added that the state plan did not provide for
tele-health.
4:03:37 PM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz,
paraphrased from the Sectional Analysis to HB 29 [Included in
members' packets], which read:
Section 1.
AS 21.42.422 has been amended to require insurance
coverage for health benefits provided through
telehealth technology.
Section 2.
AS 21.42.422 is a new subsection that defines health
care insurer as a person transacting the business of
health care insurance except for a nonfederal
governmental plan. It also adds the definition of
telehealth under 47.05.270(e) as the practice of
health care delivery, evaluation, diagnosis,
consultation, or treatment, using the transfer of
health care data through audio, visual, or data
communications, performed over two or more locations
between providers who are physically separated from
the recipient or from each other or between a provider
and a recipient who are physically separated from each
other.
Section 3
The changes to Section 1 of this bill applies to
health care insurance plans that are offered, issued,
delivered, or renewed on or after the effective date.
Section 4
The effective date is July 1, 2020.
4:05:21 PM
REPRESENTATIVE CLAMAN asked if Department of Commerce, Community
& Economic Development and the administration were in support of
the proposed bill.
4:05:43 PM
LORI WING-HEIER, Director, Juneau Office, Division of Insurance,
Department of Commerce, Community & Economic Development, in
response to Representative Claman, said that Department of
Commerce, Community & Economic Development was very much in
support of anything that would provide access to health care yet
lower the cost at the same time. She acknowledged that the
department was in support of the proposed bill.
4:06:05 PM
REPRESENTATIVE PRUITT asked if it was possible to mandate this.
MS. WING-HEIER reported that the Division of Insurance estimated
that insured plans, which the division regulated, covered about
15 percent of Alaskans.
REPRESENTATIVE PRUITT asked why there was a need to mandate this
to the insurance companies, as it offered a cost savings.
MS. WING-HEIER replied that this would increase access to Rural
Alaska, especially for specialties and would reduce the overall
costs if it could address common things and eliminate the need
to visit the provider. She reported that there were data
projections for virtual hospitals in the future with
recuperation at home, although there were not any numbers to
support this. In response to the need for a mandate, she
reported that any conversation for new services prompted
discussions and sometimes it was necessary to push for the
offering of newer products or services.
REPRESENTATIVE PRUITT asked about the options. He acknowledged
that, although Moda Health had submitted a letter of support,
they would not be required to provide this with their plan for
the state. He questioned whether there would be support from
the providers who would be required to offer telehealth. He
shared his difficulty for understanding why a cost saving
measure would need to be mandated.
MS. WING-HEIER explained that previous attempts to deliver
telehealth had not been provided by all insurance providers and
that this mandate would ensure parity.
REPRESENTATIVE PRUITT asked how to prevent individuals from
recruiting the use of telehealth services without allowing for
the best interests of the patient. He opined that the
introduction of money through a mandate brought with it those
who would take advantage.
4:10:51 PM
MS. WING-HEIER expressed agreement that there were bad actors
making "big dollars out of it" and this included doctors and
insurance agents. She stated that it was necessary to use due
diligence and take the necessary actions against those bad
players.
REPRESENTATIVE PRUITT asked how to ensure that her division had
the tools to "take action as needed if there are those bad
players that come up." He asked if it would be necessary for
statute changes to allow the authority to pursue these people,
some of whom may not even be in the state.
MS. WING-HEIER reported that the agency had four investigators
and she declared they were "a critical part of us being able to
look at people that are the bad actors in the state. When they
cross state lines, we end up working with the U.S. Attorney
General or with the FBI, and that's not uncommon." She declared
that these federal agencies "actually have the jurisdiction."
4:13:29 PM
REPRESENTATIVE JACKSON asked if this would cover all Alaskans or
just those through certain health care facilities or certain
insurance companies.
REPRESENTATIVE SPOHNHOLZ replied that the intent of the proposed
bill was to ensure that insurers operating in the private market
be required to cover telehealth services. She reported that
telehealth services were already authorized and paid for under
Medicaid, as well as tribal health. This proposed bill would
expand the market for access to telehealth into the private
market. She stated that self-insured plans which were governed
by federal law, including the insurance plan by the State of
Alaska, could not be included in state law.
MS. WING-HEIER said that the State of Alaska had adopted a tele-
doc option in its retirement and benefit plan.
REPRESENTATIVE JACKSON declared that this was beneficial and
saved a lot of time, travel, and money. She asked that this be
shared with our federal delegation.
REPRESENTATIVE SPOHNHOLZ expressed her intention to coordinate
with the federal delegation. She expressed agreement that the
state plan now allowed tele-doc, which she described as "a
virtual form of an urgent care," although this was not quite the
complete service that she supported for lasting relationships.
4:17:28 PM
REPRESENTATIVE CLAMAN asked about the tele-doc coverage.
REPRESENTATIVE SPOHNHOLZ, in response, explained that it
depended on the provider. She said that Aetna had a requirement
that providers go through a process to determine participation
in telehealth.
REPRESENTATIVE CLAMAN said that it was available if they
followed the steps. He noted that there was a zero fiscal note
and asked if there would be additional costs due to enforcement
authority.
MS. WING-HEIER replied that it was not expected to change the
workload.
4:19:54 PM
VICTORIA KNAPP, Chief Operations Officer, Mat-Su Health
Services, Inc., stated that they relied on telehealth to provide
specialty psychiatric services for individuals with mental
health issues. She noted that there were "huge shortages of
psychiatric providers in the State of Alaska." She reported
that they had providers both in-state and out-of-state who were
licensed in the State of Alaska. She declared that they were a
safety net provider and had gone to telehealth services several
years prior due to a shortage of available in-person psychiatric
providers. She added that, as they did not want to have a wait
list for psychiatric services, they moved to telehealth
services. She noted that, on those occasions when a private
health plan did not cover these services, the patient had to
decide whether to make out of pocket payment or not receive the
services. She expressed a desire for everyone to be covered for
telehealth.
4:21:54 PM
AROM EVANS, MD, Orion Behavioral Health Network, said that his
organization primarily provided services for children and
adolescents. He said there was a need for medical service
providers for children, and that many of them were out of state
and could only be accessed through telehealth. He stated his
support for HB 29. He said that tele-doc was an important and
useful service but that it was a very different service than
telehealth. With tele-doc, as it was an on-demand service and
you could not schedule a follow-up appointment, you may not have
the same provider.
4:23:48 PM
REPRESENTATIVE TARR asked whether, since with telehealth there
were no in-person meetings, there was a potential to not build a
strong relationship that would make the care as effective.
DR. EVANS said they used a hybrid model as they maintained four
physical clinics around the state. He acknowledged that many
patients and family members needed that reassurance and they
treated this on a case by case basis.
4:26:02 PM
REPRESENTATIVE JACKSON asked about genetic work-ups through
telehealth.
DR. EVANS explained that genetic work-ups were conducted
primarily in the laboratory, as they reviewed symptoms to
determine the necessary tests, and these work-ups included a
physical exam that could be provided by a local doctor.
4:27:09 PM
ROBERT BARATTA, National Consultant, Teladoc Health, referenced
the earlier discussion for fraud and abuse, and pointed out that
prior to access of the service, there had to be a valid
physician - patient relationship established. He pointed out
that Alaska had such a statute as well as guidelines from the
State Board of Medicine, for the way this relationship must be
established. For reimbursement, the service had to be provided
in accordance with that valid relationship. He pointed out that
most insurance plans had the authority to make sure that it was
medically necessary.
REPRESENTATIVE JACKSON asked about the difference between
charges from a tele-doc and an office visit.
MR. BARATTA explained that there was a tele-medicine platform
which a patient could access through their computer for a
virtual visit with a physician. He said it mimicked the
experience of a visit to an Urgent Care center with a board
certified and Alaska licensed physician.
4:30:02 PM
CO-CHAIR ZULKOSKY opened public testimony.
4:30:24 PM
CYNTHIA MARK, Teladoc Health, emphasized that it was possible to
establish an on-going relationship with an Alaska provider
through telehealth and to see that same provider on an on-going
basis. She stated support for HB 29, pointing out that it was
good policy and good legislation.
4:32:02 PM
CHRISTOPHER DIETRICH, Assistant Medical Director, Orion
Behavioral Health Network, stated his support for HB 29. He
offered an example of a patient released from API (Alaska
Psychiatric Institute) who moved to Rural Alaska, and the option
for telehealth.
4:33:44 PM
CO-CHAIR ZULKOSKY closed public testimony.
[HB 29 was held over.]
HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS
4:34:07 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 97, "An Act relating to the prescription
of drugs by a physician assistant without physical examination."
4:34:29 PM
CO-CHAIR SPOHNHOLZ moved to adopt the proposed committee
substitute (CS) for HB 97, labeled 31-LS0695\M, Marx, 3/21/19 as
the working draft.
CO-CHAIR ZULKOSKY objected for discussion.
4:34:53 PM
REID HARRIS, Staff, Representative Jonathan Kreiss-Tomkins,
stated that HB 97 was "about increasing patient access to care,
particularly for rural and medically underserved areas." He
directed attention to maps [Included in members' packets] which
portrayed that the entire state, except for the Railbelt, was
considered to be a medically underserved area. He stated that
it could be problematic for many rural communities to find fair
and cheap access to health care. He paraphrased from the
Sponsor Statement [Included in members' packets] which read:
The 2016 Medicaid Reform bill (SB 74) provided for the
use of telehealth by revising Alaska statutes to
require the Alaska Board of Medicine to adopt
regulations and guidelines for physicians rendering a
diagnosis, providing treatment, or prescribing,
dispensing, or administering a prescription drug to a
person without conducting a physical examination under
AS 08.64.364.
Unintentionally, SB 74 only addressed physicians, and
the Board issued guidelines that made different
requirements for physician assistants (PAs) and
physicians, citing a lack of legislative intent that
the provisions of SB 74 should apply to PAs.
The omission of PAs from the Medicaid Reform bill led
to them being subject to limitations on the use of
telemedicine. Specifically, the Medical Board released
guidelines stating that physician assistants could not
treat a patient via telemedicine without first
conducting an in-person examination, or with a
collaborating physician or other practitioner in the
same group practice.
House Bill 97 aligns the law with the intent of the
Medicaid Reform bill, clarifying that PAs can provide
telemedicine in the same manner as physicians. Under
HB97, the PA would be subject to the same statutory
oversight as physicians regarding the practice of
telemedicine, as well as the same disciplinary
sanctions when appropriate.
Alaska, with its vast geographical challenges and
limited access to vital healthcare, stands to benefit
from this legislation. HB 97 will increase patient
access to care, extending the reach of medicine to
medically underserved areas.
MR. HARRIS pointed out that, although it was legislative intent
to allow physician assistants (PAs) to practice telemedicine,
the "Medical Board didn't see it that way hence we have these
two fix-it bills before both bodies."
MR. HARRIS directed attention to the PA Scope of Practice
document [Included in members' packets] and paraphrased from the
document, which read:
A broad, generalist medical education prepares PAs to
take medical histories, perform physical examinations,
order and interpret laboratory tests, diagnose
illness, develop and manage treatment plans for their
patients, prescribe medications and assist in surgery.
MR. HARRIS stated that PAs could prescribe Schedule II - V
medications, and he paraphrased from the "Drug Schedule"
[Included in members' packets], which read:
Schedule I
Schedule I drugs, substances, or chemicals are defined
as drugs with no currently accepted medical use and a
high potential for abuse. Some examples of Schedule I
drugs are: heroin, lysergic acid diethylamide (LSD),
marijuana (cannabis), 3,4-
methylenedioxymethamphetamine (ecstasy), methaqualone,
and peyote
Schedule II
Schedule II drugs, substances, or chemicals are
defined as drugs with a high potential for abuse, with
use potentially leading to severe psychological or
physical dependence. These drugs are also considered
dangerous. Some examples of Schedule II drugs are:
Combination products with less than 15 milligrams of
hydrocodone per dosage unit (Vicodin), cocaine,
methamphetamine, methadone, hydromorphone (Dilaudid),
meperidine (Demerol), oxycodone (OxyContin), fentanyl,
Dexedrine, Adderall, and Ritalin
Schedule III
Schedule III drugs, substances, or chemicals are
defined as drugs with a moderate to low potential for
physical and psychological dependence. Schedule III
drugs abuse potential is less than Schedule I and
Schedule II drugs but more than Schedule IV. Some
examples of Schedule III drugs are: Products
containing less than 90 milligrams of codeine per
dosage unit (Tylenol with codeine), ketamine, anabolic
steroids, testosterone
Schedule IV
Schedule IV drugs, substances, or chemicals are
defined as drugs with a low potential for abuse and
low risk of dependence. Some examples of Schedule IV
drugs are Xanax, Soma, Darvon, Darvocet, Valium,
Ativan, Talwin, Ambien, Tramadol
Schedule V
Schedule V drugs, substances, or chemicals are defined
as drugs with lower potential for abuse than Schedule
IV and consist of preparations containing limited
quantities of certain narcotics. Schedule V drugs are
generally used for antidiarrheal, antitussive, and
analgesic purposes. Some examples of Schedule V drugs
are: cough preparations with less than 200 milligrams
of codeine or per 100 milliliters (Robitussin AC),
Lomotil, Motofen, Lyrica, Parepectolin
MR. HARRIS explained that a Physician Assistant must have an
active and collaborative plan that was maintained with a
supervisor and, under the guidance of their collaborating
physician, would be authorized to prescribe Schedule II - V
drugs. He added that the PA must have an authorization and
license from the Drug Enforcement Administration. He summarized
and stated that the proposed bill would allow approximately 700
licensed PAs in Alaska to provide telemedicine in the same
manner as physicians and extend the reach of medicine to
patients in underserved areas. He pointed to the supporting
letters from physician assistants practicing in rural areas
[Included in members' packets]. He reported that the State
Medical Board assumed a neutral position on the proposed bill,
and that the fiscal note for $5300 was for the first year only,
to pay for legal fees and to update the regulations.
4:41:29 PM
REPRESENTATIVE JACKSON asked if this proposed bill could be part
of the telehealth bill as it allowed for physician assistants to
prescribe drugs.
4:42:06 PM
CO-CHAIR SPOHNHOLZ replied that the proposed bill was in a
different section of law, even though it intersected to allow
physician assistants to participate in telehealth.
4:42:28 PM
REPRESENTATIVE CLAMAN asked why the bill did not include nurse
practitioners as they were also allowed to prescribe
medications.
MR. HARRIS explained that registered nurse practitioners were
not overseen by the State Medical Board.
CO-CHAIR SPOHNHOLZ interjected that nurse practitioners were
already allowed to practice telehealth, adding that nurses were
overseen by the Board of Nursing. She stated that physician
assistants were the only group of providers that had been
inadvertently omitted in earlier legislation, Senate Bill 74.
REPRESENTATIVE CLAMAN asked if nurse practitioners had been
allowed to practice telehealth in Senate Bill 74.
CO-CHAIR SPOHNHOLZ replied, "yes."
4:43:37 PM
MR. HARRIS, in response to Representative Jackson, directed
attention to the AAPA guidelines [Included in members' packets]
and paraphrased from the Education and Experience, which read:
The intensive PA program curriculum is modeled on the
medical school curriculum. The typical PA program
extends over 27 continuous months and begins with
classroom instruction in basic medical sciences. This
is followed by rotations in medical and surgical
disciplines including family medicine, internal
medicine, general surgery, pediatrics, obstetrics and
gynecology, emergency medicine and psychiatry. PA
students complete at least 2,000 hours of supervised
clinical practice in various settings and locations by
graduation. Almost all PA programs now award master's
degrees, and by 2020 all programs must do so.
4:45:01 PM
REPRESENTATIVE PRUITT asked if PAs would be required to use the
drug database.
MR. HARRIS said that was correct.
REPRESENTATIVE PRUITT asked why the PAs had been omitted from
previous legislation.
MR. HARRIS offered his understanding that the legislative intent
was for physicians to engage in telemedicine with an assumption,
incorrect as it was, that PAs working under the physician would
also be allowed. After passage of Senate Bill 74, the State
Medical Board stated that the new language would not include PAs
because they were not directly named.
4:46:54 PM
DEBORAH STOVERN, Executive Administrator, State Medical Board,
Division of Corporations, Business, and Professional Licensing,
Department of Commerce, Community & Economic Development, said
that the State Medical Board did not feel that "they could make
the call that the legislative intent was to include physician
assistants because the language of the statute said physicians
only." She offered her understanding the proposed bill was an
attempt to correct that.
REPRESENTATIVE PRUITT asked for clarification that, although the
intent may have been there, she could not "jump to that
conclusion because the statute wasn't clear enough." He asked
if this was "clean-up" and if she did support this opportunity.
MS. STOVERN said that was her understanding of the position by
the State Medical Board on this legislation. She pointed out
that the State Medical Board had reviewed Senate Bill 44, which
was identical legislation, and had issued a letter of support.
4:49:24 PM
REPRESENTATIVE PRUITT asked for clarification to the changes in
the proposed committee substitute.
MR. HARRIS replied that the proposed committee substitute added
a section with an effective bill date of March 1, 2020, which
had been requested by the division.
4:50:25 PM
The committee took a brief at-ease.
4:50:46 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, the proposed committee substitute (CS) for HB 97,
labeled 31-LS0695\M, Marx, 3/21/19 was adopted as the working
draft.
4:51:05 PM
REPRESENTATIVE TARR asked if the State Medical Board had
concerns with the prescription of drugs by physician assistants
or with other interactions with the patient.
4:51:56 PM
MS. STOVERN said that the State Medical Board had issues with
both subject to the collaborative plan between the supervising
physician and the physician assistant.
REPRESENTATIVE TARR asked if the collaborative practice was
necessary for both issues.
MS. STOVERN replied, yes it was correct that the physician
assistant would only have authority for whatever the supervising
physician allowed.
4:53:35 PM
CHRISTOPHER DIETRICH, Orion Behavioral Health Network, stated
that currently the PA could not establish care without a face to
face examination and that the proposed bill would now allow
this.
4:55:09 PM
REPRESENTATIVE TARR questioned whether the requirement for the
first face to face meeting was the snafu.
MR. DIETRICH expressed his agreement that the proposed bill
would clarify this and expedite the necessary care.
4:56:09 PM
AROM EVANS, MD, Orion Behavioral Health, stated his support for
proposed HB 97 and that his practice had the collaborative plan
in place.
[HB 97 was held over.]
4:57:48 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:58 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB022 Supporting Document-Letter of Support from American Foundation for Suicide Prevention - Alaska Chapter 03.07.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document-Letter of Support from Suicide Prevention Council 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Fiscal Note DHSS-SPC-3.22.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document-Letter of Support from NAMI Alaska 3.6.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Sponsor Statement 03.15.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document Legislative Audit of Suicide Prevention Council 3.6.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB029 Sectional Analysis ver A 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM |
HB 29 |
| HB029 Sponsor Statement 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Supporting Document-Letter of Support 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Fiscal Note DCCED-DOI 3.22.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Letter of Support Moda Health 03.25.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Presentation 03.25.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM |
HB 29 |
| HB0097 Supporting Document AK State Medical Bd Roster.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document AAPA general overview.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document AK State Medical Bd PA scope of practice.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document DEA Drug Schedules.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document Medically Underserved Areas HRSA.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document PA guidelines AK State Medical Bd.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document PA Prescriptive Authority (AAC).pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB097 Draft Proposed Blank CS ver M 3.21.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB097 Fiscal Note DCCED-CBPL-3.22.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB097 Supporting Document Letters of Support for companion legislation SB44.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM SFIN 4/9/2019 9:00:00 AM |
HB 97 SB 44 |
| HB0097 Sectional.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB0097 Sponsor Statement.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |