04/29/2019 03:15 PM House LABOR & COMMERCE

         HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                      
                                                                                                                                
3:21:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX announced that the  first order of business would                                                               
be HOUSE  BILL NO. 97,  "An Act  relating to the  prescription of                                                               
drugs by a physician assistant without physical examination."                                                                   
                                                                                                                                
3:21:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL  moved to adopt  the proposed  committee substitute                                                               
(CS)  for HB  97, labeled  31-LS0695\S, Fisher,  4/23/19, as  the                                                               
working draft.   There being no further objection,  Version S was                                                               
before the committee.                                                                                                           
                                                                                                                                
3:22:57 PM                                                                                                                    
                                                                                                                                
REID  HARRIS,  Staff,   Representative  Jonathan  Kreiss-Tomkins,                                                               
Alaska  State   Legislature,  presented   HB  97  on   behalf  of                                                               
Representative  Kreiss-Tomkins, prime  sponsor.   He  paraphrased                                                               
parts  of  the  sponsor  statement  [included  in  the  committee                                                               
packet],  which  read  in  its   entirety  as  follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     The 2016 Medicaid Reform Bill  (SB 74) provided for the                                                                    
     use of telehealth, revising  Alaska statutes to require                                                                    
     the  Alaska State  Medical Board  to adopt  regulations                                                                    
     and  guidelines for  physicians rendering  a diagnosis;                                                                    
     providing  treatment;  or prescribing,  dispensing,  or                                                                    
     administering a  prescription drug to a  person without                                                                    
     first  conducting  a   physical  examination  under  AS                                                                    
     08.64.364.                                                                                                                 
                                                                                                                                
     However,  SB  74  only  addressed  physicians  and  the                                                                    
     Board's interpretation  was that the  bill's provisions                                                                    
     should not  apply to  physician assistants  (PAs). This                                                                    
     effectively  barred PAs  from practicing  telemedicine,                                                                    
     requiring    them    to   first    conduct    in-person                                                                    
     examinations.                                                                                                              
                                                                                                                                
     House Bill  97 aligns  statute with  the intent  of the                                                                    
     Medicaid Reform  Bill, clarifying that PAs  can provide                                                                    
     telemedicine  in  collaboration   with  and  under  the                                                                    
     oversight of  physicians. Under  HB97, PAs  are 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                                                                                                
                                                                                                                                
3:25:00 PM                                                                                                                    
                                                                                                                                
MR. HARRIS  directed attention to the  document labelled, "AAPA,"                                                               
from the  American Academy of  Physician Assistants  [included in                                                               
the committee  packet] and highlighted what  physician assistants                                                               
(PAs)  do,  as well  as  briefly  described their  education  and                                                               
experience.   He said  that PAs  are not  operating independently                                                               
from a physician  and must have an active,  collaborative plan of                                                               
regular  contact.   Under that  plan, physicians  authorize their                                                               
functions and  the medications  they can  prescribe.   He pointed                                                               
out that  in Alaska,  if a  physician assistant  (PA) has  a Drug                                                               
Enforcement  Administration (DEA)  authorization number  they can                                                               
prescribe schedule 2-5 substances.                                                                                              
                                                                                                                                
MR.  HARRIS  turned  attention  to   two  maps  from  the  Health                                                               
Resources  &  Services  Administration (HRSA)  [included  in  the                                                               
committee  packet]  that  display  health  professional  shortage                                                               
areas (HPSA) and medically underserved  populations in the United                                                               
States, both  of which are present  in Alaska.  He  further noted                                                               
that the  passage of HB 97  and its companion bill,  SB 44, would                                                               
allow over  700 PAs to  engage in telehealth services  within the                                                               
state of Alaska.                                                                                                                
                                                                                                                                
3:30:19 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL sought  clarification on whether the  700 PAs would                                                               
be physically present in Alaska or  if they would be out of state                                                               
and accessed via telehealth.                                                                                                    
                                                                                                                                
MR.  HARRIS  offered his  understanding  that  they would  be  in                                                               
Alaska.  He  recounted that when the  first telemedicine statutes                                                               
were passed  several years  ago there  was concern  about medical                                                               
jobs being outsourced out of  state.  However, currently, he said                                                               
that isn't happening.                                                                                                           
                                                                                                                                
CO-CHAIR   WOOL,  in   reference  to   Teladoc,  contended   that                                                               
outsourcing is happening.                                                                                                       
                                                                                                                                
MR.  HARRIS   acknowledged  that   the  company  Teladoc   is  in                                                               
Tennessee;  however, the  doctors still  reside in  the state  of                                                               
Alaska.                                                                                                                         
                                                                                                                                
CO-CHAIR WOOL offered his understanding  that the doctors working                                                               
for Teladoc are on-call 24/7 and located out of state.                                                                          
                                                                                                                                
3:32:16 PM                                                                                                                    
                                                                                                                                
DEBORAH  STOVERN, Department  of Commerce,  Community &  Economic                                                               
Development,  in response  to  Representative  Wool, stated  that                                                               
there are  approximately 700 licensed  PAs in Alaska.   She noted                                                               
that  in  order to  enter  a  collaborative agreement  between  a                                                               
physician and  a PA, they must  both be licensed in  the state of                                                               
Alaska; however,  there is no  requirement that either  reside in                                                               
the state.                                                                                                                      
                                                                                                                                
3:34:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN  asked why  the Alaska State  Medical Board                                                               
hasn't taken a position on this bill.                                                                                           
                                                                                                                                
MS. STOVERN explained  that the Board reviewed HB  97 in February                                                               
and took  a position in  support of  the legislation.   She noted                                                               
that  they  issued a  letter  referencing  their position,  which                                                               
could be provided to the committee upon request.                                                                                
                                                                                                                                
REPRESENTATIVE HANNAN  questioned whether leaving PAs  out of the                                                               
original  statute [AS  08.64.364  Prescription  of drugs  without                                                               
physical  examination]   that  gives  doctors   authorization  to                                                               
practice telemedicine was intentional.                                                                                          
                                                                                                                                
MR. HARRIS offered his understanding  that the original intent of                                                               
was to  allow both physicians  and PAs to  practice telemedicine.                                                               
He added that  it's not irrational that the  Board interpreted it                                                               
differently, as the original bill only addressed physicians.                                                                    
                                                                                                                                
MR. HARRIS  noted that HB  97 has an  effective date of  March 1,                                                               
2020, per request of the Alaska State Medical Board.                                                                            
                                                                                                                                
3:36:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX opened public testimony.                                                                                        
                                                                                                                                
3:37:00 PM                                                                                                                    
                                                                                                                                
CHRISTOPHER   DIETRICH,   Assistant   Medical   Director,   Orion                                                               
Behavioral Health  Network, informed the  committee that he  is a                                                               
PA  practicing adolescent  and child  psychiatry  in Alaska  from                                                               
Kotzebue  to  Ketchikan.    He  noted  that  he  also  serves  an                                                               
underserved   demographic  by   offering  is   services  to   the                                                               
Department of Corrections (DOC).   He stated that PAs are medical                                                               
providers who  diagnose illnesses,  develop and  manage treatment                                                               
plans, prescribe  medications, and  often service as  a patient's                                                               
principal  healthcare  provider.    With thousands  of  hours  of                                                               
medical training,  he said, PAs are  versatile and collaborative.                                                               
He expressed  his support for  HB 97  as to decrease  barriers to                                                               
his patients in rural access areas  and to make it easier for all                                                               
patients to have adequate treatment.                                                                                            
                                                                                                                                
3:38:55 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX closed  public testimony.  She  announced that HB
 was held over.