Legislature(2015 - 2016)BARNES 124
04/06/2016 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB372 | |
| HB234 | |
| SB148 | |
| SB142 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 234 | TELECONFERENCED | |
| + | SB 148 | TELECONFERENCED | |
| + | SB 142 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 372 | TELECONFERENCED | |
HB 234-INSURANCE COVERAGE FOR TELEMEDICINE
3:53:59 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 234, "An Act relating to insurance coverage for
mental health benefits provided through telemedicine."
3:54:42 PM
REPRESENTATIVE LIZ VAZQUEZ, Alaska State Legislature, introduced
HB 234, to be presented by Anita Halterman.
3:55:10 PM
ANITA HALTERMAN, staff to Representative Liz Vazquez, Alaska
State Legislature, speaking on behalf of Representative Vazquez,
advised that HB 234 is a mental health parity bill. The bill
requires that the health insurance industry provide
reimbursement for mental health coverage through the delivery
mode of telemedicine. Alaska Medicaid has paid for mental
health and substance abuse telemedicine for many years; however,
only one insurer in Alaska has been providing reimbursement.
The bill requires that insurers reimburse for telemedicine care
without requiring a face-to-face visit, which could improve
access to mental health services for 15 percent of the
population in Alaska. This bill does not provide new coverage,
but it provides a new means of reimbursement for a coverage
option currently available through the health insurance
industry.
3:56:21 PM
MS. HALTERMAN said one concern related to HB 234 is the
prohibition of face-to-face visits. She directed attention to a
document entitled, "The American Telemedicine Association, 50
State Telemedicine Gaps Analysis" from the National Conference
of State Legislators, which described the national status
regarding telemedicine. The analysis indicated that 22 states
have laws giving them the highest possible "grade" and Alaska
received an A+ for telemedicine Medicaid reimbursement.
However, Alaska received an F grade as to the private sector,
and this bill is an effort to correct that issue. Most private
insurers cover reimbursement for telemedicine without a face-to-
face visit; the states of Texas and Arkansas appear to be the
only states with a face-to-face requirement, and the state of
Arizona is the only state requiring a face-to-face encounter
before mental health services can be delivered. She pointed out
that HB 234 does not prohibit a health care professional from
requiring a face-to-face visit, but leaves the decision up to
the medical professional, not the insurer. Further, she
stressed that this is an insurance bill, not a medical bill.
3:59:02 PM
MS. HALTERMAN advised that the second concern raised pertained
to licensing within Alaska, and she clarified that the bill
requires a provider be licensed in Alaska in order to practice
within the state. The third concern was a request to add
substance abuse to the bill; however, the Alaska Statutes that
originally required that substance abuse be provided were
repealed in 1997. She said she has received input from
stakeholders within the industry about what definitions might be
useable, but Alaska has no clear definition of substance abuse
in statute, so the issue of including substance abuse has been
tabled. Ms. Halterman reiterated that this is a parity bill
requiring the health insurance industry to do what Medicaid has
been doing for many years.
CHAIR OLSON cautioned that the substance abuse issue would
complicate the bill.
MS. HALTERMAN agreed. Returning attention to the first concern,
she referred to a code of ethics and other guidance documents
with regard to face-to-face requirements, and other issues that
may affect this particular industry.
REPRESENTATIVE VAZQUEZ pointed out that she does not want to
attempt to micromanage the medical profession and that it is up
to them to require face-to-face visits.
REPRESENTATIVE COLVER asked for clarification that substance
abuse telemedicine is not included in the bill.
MS. HALTERMAN advised that the sponsor had been asked to
consider introducing a definition for substance abuse, but after
consulting with Legislative Legal and Research Services, and
individuals within the insurance industry, discovered there is
no clean definition available currently in Alaska that has been
vetted by stakeholders in this industry.
4:03:05 PM
REPRESENTATIVE COLVER expressed concern that this legislation
not "opt out" smoking cessation, which is generally handled over
the telephone. He also expressed concern regarding someone who
just needs counseling as to where to go for treatment services
for substance abuse. Representative Colver restated smoking
cessation can be provided over the telephone, and urged that the
proposed legislation not opt out smoking cessation services.
MS. HALTERMAN expressed her understanding that ICD-10 medical
codes are uniformly used primarily for substance abuse and
mental health. She explained that many individuals require
services that are mental health in nature, may directly be
substance abuse related, and which may be covered by this bill.
Insurers such as AETNA have indicated that much of what would be
included in a definition of substance abuse may already be
covered because of the uniform use of ICD-10 codes for
behavioral health. She advised stakeholder input is needed to
determine what is necessary to ensure that whatever additional
coverage might not be provided by this bill is considered next
session.
REPRESENTATIVE HUGHES observed that a mental health care
provider must be licensed in Alaska, and asked whether a
telemedicine, mental health care provider could be located out-
of-state. She asked whether this legislation would broaden the
scope of access for Alaskans.
MS. HALTERMAN deferred the question to an invited witness.
REPRESENTATIVE HUGHES spoke in support of consistency in
providers and questioned whether it is advisable to provide a
person's mental health services totally by telemedicine, or
whether there should be face-to-face contact. If so, out-of-
state providers could not provide that service. She stressed
the importance of knowing if the bill allows for out-of-state
providers.
4:07:27 PM
REPRESENTATIVE COLVER read from the end of the second paragraph
of an email from John DeRuytern, Hope Counseling Center,
addressed to Representative Vazquez, 1/16/16, available in the
committee packet, which read as follows [original punctuation
provided]:
However, I am very concerned that the bill's language
specifically prohibits a requirement that face-to-face
evaluation occur prior to telehealth services being
reimbursed. This prohibition is a SIGNIFICANT end run
around Best Practices and the safe delivery of mental
health services using telehealth technologies.
REPRESENTATIVE COLVER asked Ms. Halterman to address the
foregoing issue.
MS. HALTERMAN reminded the committee that the bill is an
insurance bill and does not influence medical professionals.
Therefore, the mandate of a face-to-face requirement is a
mandate on the insurance industry and not on the medical
professionals. There is no intent to change the best practices
of the medical professionals, and they retain the right to
require a face-to-face visit. This bill directs that insurers
not impose a face-to-face requirement and that the decision is
left to medical professionals.
4:09:19 PM
REPRESENTATIVE JOSEPHSON assumed that some face-to-face contact
improves the efficacy of counseling. He asked whether a Juneau
citizen could hire someone in Anchorage rather than hiring a
Juneau practitioner.
MS. HALTERMAN confirmed that the bill allows some flexibility
for the medical professional, and it will be up to that
professional to determine whether or not it is appropriate to
deliver mental health services without a face-to-face
requirement. The risk assumed for not requiring a face-to-face
visit would rest with the medical professional, who retains the
right to establish practice rules allowing them to have a face-
to-face requirement. In fact, it would be their liability if
they didn't require a face-to-face visit. She said:
... this bill is not to influence the medical
practice, but rather is trying to influence
restrictions on the insurance industry that they not
impose additional obligations. This bill is strictly
restricting them from imposing a face-to-face
requirement. It in no way restricts the medical
professional from making a decision based on risk with
their patients to require a face-to-face ...
4:11:37 PM
CHAIR OLSON asked whether using Skype would be considered face-
to-face contact.
MS. HALTERMAN referred to the previous analysis document and
opined Skype may be an option. She noted that Texas has a face-
to-face requirement, but does not clearly define whether it is a
physical face-to-face meeting. Neither Texas nor Arizona
describe "what that face-to-face obligation actually is."
CHAIR OLSON noted that a telemedicine program has been
operational in Kotzebue and around the North Slope using Skype
or something similar.
MS. HALTERMAN reiterated that Medicaid has been reimbursing for
telemedicine in Alaska since 1999-2005, when Alaska introduced
the first telemedicine regulations in the nation. She noted
Medicaid has not had any concerns with regard to mental health
or substance abuse services delivered via telemedicine in
Alaska. For instance, [Alaska Native health services] and the
[U.S. Department of Veterans Affairs] have a lot of exceptions,
and Medicaid has been openly reimbursing. Previous testimony
from Director Margaret Brodie, Health Care Services, Department
of Health and Social Services, related that the bill will
benefit Alaska Medicaid because currently, Medicaid is
reimbursing for mental health services through telemedicine, but
is unable to process a third party recovery for those
reimbursements since the private sector may not. This bill, she
said, would allow Medicaid to possibly recoup some monies from
the private sector.
CHAIR OLSON opined that Medicaid pays air travel expenses.
MS. HALTERMAN agreed that transportation from a remote area in
order for a patient to receive a face-to-face visit can be
costly in Alaska, and noted that mental health services have
been delivered and reimbursed by Medicaid in at least 36
Medicaid states, with few problems.
CHAIR OLSON opened public testimony.
4:15:40 PM
AROM EVANS M.D., Medical Director, Orion Behavioral Health
Network, advised that Orion Behavioral Health delivers
telemedicine throughout the state. Dr. Evans explained that in
the past private insurance primarily paid for services, but the
funding has been cut in the last three years, which has reduced
care to many Alaskans who subsequently lost their insurance
benefits when coverage changed to a third-party administrator.
The population served by Orion Behavioral Health Network would
not receive care without telemedicine; for example, patients who
are homebound or who live in small communities that cannot
provide direct psychiatric care. He said the bill allows
services to reach individuals, even those who do not qualify for
Medicaid, such as adolescents and developmentally delayed
adults, and may prevent an emergency situation from developing.
Dr. Evans clarified that the bill affects insurance and does not
seek to change licensing board practices and current rules
regarding face-to-face contact, which are fairly strict. At
this time the [State Medical Board, Department of Commerce,
Community & Economic Development] does not allow out-of-state
providers to practice telemedicine, except under certain,
limited circumstances.
DR. EVANS cautioned that, in some cases, if a person is unable
to receive services without a face-to-face visit, the result
will be that the patient doesn't receive services due to the
aging of Alaska's population and the limited care in rural
communities.
REPRESENTATIVE HUGHES understood that the bill would increase
access to care and asked what the best practices are for the
standard of care for treatment without ever having a face-to-
face visit. She referred to related proposed legislation.
DR. EVANS advised that proposed SB 74 requires the medical board
to adopt standards regarding out-of-state providers. Currently,
practice by out-of-state providers is allowed only in certain
circumstances. As for the standard of care, he said that most
states allow for care via telehealth without an in-person
examination, as do the ethical guidelines for the American
Telemedicine Association. In his practice, Dr. Evans said,
every effort is made to do a face-to-face visit. Face-to-face
visits are provided whenever possible, although there are
certainly times when it is just not possible, and best care
practices dictate administering service via telemedicine.
4:22:16 PM
CHAIR OLSON announced that public testimony would remain open.
[HB 234 was held over.]