Legislature(2021 - 2022)ADAMS 519
03/29/2022 01:30 PM House FINANCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB33 | |
| HB265 | |
| HB296 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 265 | TELECONFERENCED | |
| + | HB 296 | TELECONFERENCED | |
| + | HB 291 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 33 | TELECONFERENCED | |
HOUSE BILL NO. 265
"An Act relating to telehealth; relating to the
practice of medicine; relating to medical assistance
coverage for services provided by telehealth; and
providing for an effective date."
2:00:10 PM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR (via teleconference),
introduced the PowerPoint presentation: "HB 265: Health
Care Services by Telehealth" (copy on file). She explained
that the bill would continue the expansion of telehealth
flexibilities to make healthcare more accessible and reduce
unnecessary travel during the COVID-19 pandemic. The bill
would provide a legislative framework to continue the
state's success with COVID-19 related telehealth
flexibilities with regard to state and federal oversight.
She noted that patients used to have to go to in-patient
clinics in order to receive telehealth care, but it was
discovered during the pandemic that was not necessary to
ensure safe healthcare in the state.
Representative Spohnholz advanced to slide 2 and relayed
that the presentation would cover telehealth in Alaska, the
importance of HB 265, and the specific actions of the bill.
She shared that the bill was a result of collaboration with
stakeholders and there were over 33 letters of formal
support for the bill.
Representative Spohnholz discussed the current barriers to
telehealth on slide 3, such as license regulations and
payment barriers. The legislature had been working for
years to expand access to telehealth. She noted that in SB
74 in 2016, the legislature expanded Medicaid access to
behavioral healthcare and in 2020, the legislature passed
HB 229 requiring insurance coverage in a private market for
telehealth. Even with the improvements made through the
bills, there continued to be barriers to telehealth.
Barriers included the lack of telehealth parity laws, lack
of coverage of some telehealth services under Medicaid, and
a higher burden for audio-only visits. There were also in-
person requirements for select healthcare providers that
acted as a barrier to service, including prescription of
controlled substances.
2:04:28 PM
Representative Spohnholz turned to slide 4 to review the
changes to telehealth in Alaska since COVID-19. There was a
State Public Health Emergency (SPHE) and a Federal Public
Health Emergency (FPHE), which both provided telehealth
flexibility. She noted that FPHE was slated to expire in
April of 2022 and SPHE expired in April of 2021. This made
the passage of HB 265 more urgent. Currently Medicaid had
temporarily expanded access to telehealth coverage and made
it easier to bill for audio-only visits, but these changes
were not permanent.
Representative Spohnholz explained why HB 265 was needed on
slide 5. She wanted to continue some of the telehealth
flexibilities from the COVID-19 pandemic by making them
permanent in statute. The bill would also reduce
bureaucracy by eliminating the need for in-person visits
for all licensed healthcare providers prior to a telehealth
appointment. It would also expand Medicaid coverage of
telehealth services which were reimbursed during the
pandemic and increase access to behavioral healthcare.
Finally, it would ensure Alaskans had an option to access
quality care in a timely manner when an in-person visit was
unnecessary or not possible.
Representative Spohnholz moved to slide 6 to review what HB
265 would do:
1. Creates a framework for telehealth in statute.
2. Enhances the telehealth delivery of substance use
disorder treatment.
3. Expands Medicaid coverage for telehealth services and
modalities.
Representative Spohnholz advanced to slide 7 and explained
that the bill created a framework for telehealth in
statute. There was a laundry list of healthcare providers
that could provide telehealth services in Alaska. The bill
would remove additional barriers such as unnecessary
efforts to document in-person visits prior to a telehealth
appointment. She spoke about the importance of having
telehealth appointments available for the various types of
providers eligible to provide telehealth services. For
example, she had talked to a podiatrist that diagnosed a
blood clot via telehealth.
Representative Spohnholz thought it was important to note
that HB 265 would not mandate that a patient receive care
through telehealth or that a provider offer services
through telehealth. For example, if there was a patient who
exhibited opioid addiction problems, it would be important
for a provider to meet with them in person to obtain
additional information before making a diagnosis. The bill
would simply remove red tape barriers to access to care. It
would also extend telehealth services to emergency medical
services.
2:08:52 PM
Representative LeBon asked about the list of providers she
had provided on slide 7, including dentist. He was trying
to envision dental services being provided by telehealth.
He asked how an annual dental checkup could be provided via
telehealth.
Representative Spohnholz responded that an annual dental
checkup would not be provided via telehealth. She suggested
that if there was a potential emergency, an examination
could take place via telehealth. This would be helpful for
individuals in rural areas to help them determine whether
they needed to travel to see a dentist or if it was not an
urgent problem.
Representative LeBon suggested that the first step of a
dental experience might be done via telehealth, but that
eventually a patient would have to go see the dentist in
person.
2:10:24 PM
Representative Rasmussen highlighted that the provided list
offered more flexibility. She offered an example of her
daughter having a bad stomachache and using telehealth as a
first step. She ended up admitting her daughter to the
hospital based on the information she learned during the
telehealth call. She thought in-person visits would still
be necessary, but that telehealth could help in the short-
term.
Representative LeBon drew attention back to slide 5. He
noted that one of the boxes indicated that the bill would
eliminate in-person visits for all healthcare providers
licensed with the State of Alaska prior to a telehealth
appointment. He wondered if it was conceivable for a doctor
from out-of-state to provide telehealth services to an
Alaska resident. He asked if an in-person visit would be
required prior to a telehealth appointment in this
scenario.
Representative Spohnholz indicated that any provider giving
care in Alaska had to be licensed in Alaska, whether or not
the provider resided in the state. There were already many
providers who did not reside in Alaska but were eligible to
provide care in the state via telehealth. The licenses were
registered with the state and the providers were registered
with a telemedicine registry. The bill dictated that a
patient should not have to attend an in-person examination
in order to receive care via telehealth. However, it needed
to be clinically appropriate and there were times where it
would not be appropriate; for example, Representative
LeBon's example of dental care. Alternatively, it would be
appropriate to use telehealth to consult an oncologist out-
of-state that specialized in a particular type of cancer. A
person should not have to fly out of state to receive this
kind of care.
Representative LeBon clarified that the out-of-state
provider licensed in Alaska would not be required to have
had an in-person appointment with the patient before
providing telehealth services.
Representative Spohnholz responded in the affirmative.
2:14:21 PM
Representative Josephson asked if a licensed provider who
was out-of-state and providing telehealth services in
Alaska, would the provider be considered licensed in two
states.
Representative Spohnholz indicated that a provider could
choose to be licensed only in Alaska or choose to be
licensed in their home state and in Alaska. She explained
that licensing laws in the United States looked to the
state of residence of the patient, not the provider.
Representative Josephson asked about international
licensure. He wondered whether this would welcome providers
from other countries to practice in Alaska.
Representative Spohnholz deferred to Ms. Sara Chambers.
2:16:00 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, clarified that as long
as a provider met the criteria for state licensure, the
provider could practice from any location.
2:16:48 PM
Representative Spohnholz continued on slide 8 of the
presentation. She reviewed how the legislation would
enhance telehealth access for substance use disorder
treatment. The bill would remove the in-person requirement
to prescribe controlled substances through telehealth for
physicians, podiatrists, osteopaths, physician assistants
(PAs), and advanced practice registered nurses (APRNs). It
would also allow registered practitioners such as
physicians, PAs, and APRNs to prescribe medicine such as
buprenorphine via telehealth without an additional
healthcare provider present with the patient. She noted
that she had heard from providers that it was important to
prescribe these types of medicine quickly because patients
could be going through opioid withdrawals and need
immediate help. She reiterated that all prescribers of
controlled substances were still required in the bill to
comply with drug enforcement regulations.
2:18:19 PM
Representative Josephson asked if the definition of
controlled substances included narcotics and opioids.
Representative Spohnholz responded that it did include
those substances. It was important to include opioids in
the definition because there were times when an opioid
could be prescribed via telehealth in urgent scenarios and
prescribers would still be required to comply with
controlled substance regulations.
Representative Josephson suggested there would be efforts
to abuse such a privilege, by both patients and providers.
He wondered if there were protections built into the bill
that would prevent abuse of prescriptions.
Representative Spohnholz agreed that it was likely that
some people would try to abuse the privilege. She indicated
that was why it was important to continue to require
providers to participate in federal Drug Enforcement
Administration (DEA) regulations and the prescription drug
monitoring program (PDMP). There had been some recent
advancements in this area and there was no requirement that
a provider must provide medication to a patient that was
thought to be seeking drugs. She deferred to her staff to
provide some additional detail.
2:20:19 PM
GENEVIEVE MINA, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
explained that federal law required that a patient must
receive behavioral health treatment as part of any
prescription for medications for opioid use disorder. The
bill pertained to buprenorphine in particular, which was a
medication that was allowed to be prescribed via telehealth
throughout the COVID-19 pandemic. Providers registered to
prescribe buprenorphine were also required to submit to
physical monitoring tools to ensure that misuse was not
occurring, such as regular urine tests. There were
additional restrictions such as the seven-day prescription
for opioids, which required that there had to be a new
prescription on a weekly basis. She echoed Representative
Spohnholz's earlier comments regarding the importance of
the requirement for providers to participate in DEA
regulations and the PDMP.
2:21:43 PM
Representative Josephson understood the importance of the
bill and supported it. However, earlier discussions about
the PDMP in the committee made it clear that the PDMP was
not being followed religiously. He recalled an instance of
an Eagle River provider who would have quick interactions
with patients and prescribe more and more medication. He
was worried about prescriptions getting out of hand. He
asked if the physician would be required to look at a
patient on a screen or could services be provided via a
phone call.
Representative Spohnholz deferred to Ms. Mina.
Ms. Mina responded that prior to the COVID-19 pandemic, the
DEA required that patients that received medications for
opioid use disorder must receive an in-person examination.
The provision was waived during the pandemic and was tied
to the FPHE that was set to expire in April of 2022.
Additionally, the DEA allowed audio-only prescriptions of
buprenorphine during the pandemic. According to providers
that she had spoken to, patients thought that in-person
examinations were a crucial part of their treatment. Even
if the requirement for an in-person visit prior to
providing a prescription was removed, a provider could
still choose to see a patient in-person first. The bill
deferred to the patient-provider relationship and allowed
the provider to make the decision rather than always
requiring an in-person visit no matter the circumstances.
She noted that access to opioid use disorder medications
had been crucial in places like rural Alaska during the
pandemic.
2:24:44 PM
Representative Josephson thought he would likely support
the bill. However, he expressed worry about the potential
for bad actors. He relayed that the occurrences of abuse
that he had read about were egregious.
Representative Spohnholz concurred that there were bad
actors and that nothing in the bill would prevent that from
happening. However, there were robust prescription drug
limits in place and additional enforcement mechanisms in
licensing. She thought the PDMP was vital. She noted that
buprenorphine was a medication assisted treatment and
controlled substance and could be prescribed via telehealth
under the bill. There were times where people would need to
be on medication assisted treatment for many years. Some of
these individuals would be living in remote areas that
would make regularly visiting a provider very difficult. It
was important for everyone to have access to medication
assisted treatment if they needed it.
Representative Wool agreed that all bad actors could not be
eliminated. He suggested that a patient seeing a provider
for the first time via telehealth and immediately
requesting opioids would be a red flag for the provider and
assumed that it would not be applicable to first-time
patients. He thought that the bill would not apply to
veterinarians for animal prescriptions, even though they
were registered with the DEA.
Representative Spohnholz responded that the bill did not
apply to veterinarians. She indicated that it would be
possible for a first-time patient to receive a prescription
for medication assisted treatments via telehealth. She
relayed that emergency room physicians shared that they
often see patients who were going through withdrawals, and
it was imperative to ensure that the patients received
access to medication assisted treatment immediately. The
situation was time-sensitive, and telehealth made it more
possible to respond to the situation in a timely manner.
Representative Rasmussen asked if there were other
instances where it would be reasonable to expect first-time
patients to be prescribed controlled substances. She
provided potential examples of situations that would not
qualify as a first-time visit, such as a patient receiving
controlled substances after a surgery.
2:29:26 PM
Representative Spohnholz explained that there were other
examples where a first-time patient would need a
prescription immediately, such as a patient needing
Adderall, which was a controlled substance. Complete
examinations with psychiatrists could occur via telehealth
and could offer certainty to a provider that the patient
was not seeking drugs. She did not want to unnecessarily
require someone to see a provider in-person for an
examination when it could be thoroughly done via
telehealth.
Representative Spohnholz turned to slide 9 of the
presentation. She relayed that the bill would also expand
Medicaid coverage for telehealth. The bill allowed for
reimbursement for services that were already billable via
Medicaid if the services were provided in person. Such
reimbursable services included behavioral health services,
home and community-based services, Medicaid waiver and
demonstration services, and services provided at rural
clinics and federally qualified health centers.
Representative Spohnholz concluded the presentation on
slide 10. She reiterated that HB 265 would ensure robust
patient protection in Alaska while expanding some of the
flexible services that were permitted during the COVID-19
pandemic. She thanked the stakeholders that had written
letters of support for the bill.
Co-Chair Merrick indicated there were invited testifiers.
2:32:44 PM
NANCY MERRIMAN, EXECUTIVE DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION (via teleconference), expressed support for HB
265. The Alaska Primary Care Association (APCA) supported
the operations and development of Alaska's 29 federally
qualified health centers. She explained that health centers
provided comprehensive care including medical, dental,
behavioral, pharmacy, and care coordination services. She
relayed that APCA supported the bill because it increased
access to primary care and behavioral health services and
expanded telehealth access in Alaska. The bill would
directly impact health centers by allowing for audio-only
telehealth services and allowing for patients and providers
to engage outside of a clinical setting if they so choose.
The bill would also provide adequate reimbursement for
telehealth visits including for substance and behavioral
health treatments.
Ms. Merriman shared that in 2020, health centers served
over 105,000 patients and telehealth was the fastest
growing service provided by health centers. About 40
percent of patients were seen via telehealth, and about
half of total opioid use disorder patients were seen via
telehealth. The majority of telehealth patients had
experienced challenges accessing healthcare including a
long distance to reach providers, cost of care, language,
and cultural barriers. She suggested that telehealth
ultimately would lead to better health outcomes, save
lives, and save money. She urged support for the bill.
2:36:54 PM
Representative Rasmussen asked if Ms. Merriman could
identify a circumstance where a first-time patient would
require a prescription for a narcotic or opioid.
Ms. Merriman responded that she could return to the
committee with that information.
2:37:31 PM
TOM CHARD, EXECUTIVE DIRECTOR, ALASKA BEHAVIORAL HEALTH
ASSOCIATION (via teleconference), relayed that the Alaska
Behavioral Health Association (ABHA) fully supported the
bill because it improved Alaskans' access to behavioral
healthcare. He stated that the Alaska Department of Health
and Social Services' (DHSS) annual Medicaid report stated
there was a 134 percent increase in telehealth claims paid
in FY 21 as compared to FY 20. The report noted that four
out of the five top diagnosis codes delivered via
telehealth were behavioral health diagnoses. The data
suggested that Alaskans were struggling to access
behavioral healthcare, but also pointed to the economic
opportunity afforded by early intervention. National
insurance companies were rushing to offer virtual-first and
digital-first benefits because the companies realized that
it saved money to avoid expenses like travel. It also saved
money by avoiding the cost of readmission at hospitals and
higher acute care. He indicated that the state DHSS
reported that Medicaid travel costs decreased by $45
million from FY 20 to FY 21. By offering preventative care,
savings were provided to the overall budget. The economic
benefits were merely a small part of the reason ABHA
supported HB 265. He hoped that members would support the
legislation as well.
Co-Chair Merrick appreciated hearing from the testifiers.
She thanked the bill sponsor.
HB 265 was HEARD and HELD in committee for further
consideration.
2:40:48 PM
AT EASE
2:41:31 PM
RECONVENED