Legislature(2021 - 2022)ADAMS 519
04/14/2022 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB239 || SB240 | |
| HB265 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 265 | TELECONFERENCED | |
| + | HB 409 | TELECONFERENCED | |
| + | HB 410 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | SB 239 | TELECONFERENCED | |
| + | SB 240 | 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."
4:12:51 PM
Co-Chair Merrick gave the bill sponsor the opportunity to
make opening comments but Representative Spohnholz
declined.
Co-Chair Merrick OPENED public testimony.
4:13:44 PM
AT EASE
4:14:10 PM
RECONVENED
LANCE JOHNSON, NORTON SOUND HEALTH, NOME (via
teleconference), spoke in support of HB 265. He noted that
the COVID-19 pandemic highlighted the positive impact of
telehealth. He emphasized the importance of keeping audio-
only services accessible. Some people preferred to access
treatment via telephone because they could engage in an
appointment in an environment of their choosing. He shared
that many patients indicated they would elect to not
receive care rather than have to make video or in-person
appointments. Reducing access to audio-only care would
create unnecessary barriers for people in need of care.
Providers had also been able to provide a Medicaid covered
crisis intervention service via telephone for over ten
years. If providers could stabilize a person in-crisis at
their most vulnerable over the phone, it should certainly
be possible to offer other effective treatments in the same
manner.
4:17:09 PM
WINN DAVIS, SENIOR POLICY ANALYST, ALASKA NATIVE HEALTH
BOARD, ANCHORAGE (via teleconference), supported HB 265. He
spoke of the benefits of expanded behavioral health
services in Alaska with the option of telehealth access.
Continued access to telehealth would decrease travel costs
and decrease the frequency of no-shows at appointments.
Many Alaskans who lived in villages did not have reliable
access to the internet which meant that access to telephone
services was vital. He emphasized the importance of
continuing to allow the telehealth services to be
reimbursable through Medicaid. There would also be
increased burn-out rates for providers having to travel to
provide care. He suggested Alaskans were at risk without
extending telehealth services. He urged members to support
the bill.
4:20:53 PM
Co-Chair Merrick CLOSED public testimony.
4:21:01 PM
AT EASE
4:21:50 PM
RECONVENED
Co-Chair Merrick RE-OPENED public testimony due to
technical difficulties.
4:22:21 PM
EMILY NENON, AMERICAN CANCER SOCIETY, CANCER ACTION
NETWORK, ANCHORAGE (via teleconference), encouraged members
to make HB 265 a reality. The bill would make a huge
difference for cancer patients. When the COVID-19 emergency
declaration ended, she had to start calling Alaska patients
to cancel their telehealth appointments. Many of these
patients did not have other options without extensive
travel. She shared an example of a rural patient receiving
an introductory educational appointment about radiation
treatment via telehealth. The telehealth appointment made
it possible for the patient to be able to consult with
their family and determine that they wanted to go forward
with the radiation treatment. By the time the patient
arrived in Anchorage, all of the necessary prep work had
already been completed. She looked forward to increasing
access to care.
4:25:18 PM
Co-Chair Merrick CLOSED public testimony.
4:25:25 PM
Representative Josephson MOVED to ADOPT Amendment 1, 32-
LS0754\D.4, (Foote, 4/9/22) (copy on file):
Page 9, line 2, through page 10, line 7:
Delete all material and insert:
""' Sec. 8. This Act takes effect immediately under AS
01.10.070(c)."
Representative Carpenter OBJECTED for discussion.
Representative Josephson explained the amendment. He
indicated the bill sponsor had asked him to offer the
amendment to expedite and simplify the intent of the
legislation. There would be a gap of a year before the
effective date took hold, and the amendment would make the
act take effect immediately. The bill did not need to delay
its effective date.
Representative Carpenter WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 1 was ADOPTED.
4:28:49 PM
Representative Rasmussen MOVED to ADOPT Amendment 2, 32-
LS0754\D.2 (FOOTE, 4/12/22) (copy on file):
Page 1, following line 9:
Insert a new subsection to read:
"(b) A physician licensed in another state may
provide health care services through telehealth
to a patient located in the state as provided in
this subsection, subject to the investigative and
enforcement powers of the department under AS
08.01.087, and subject to disciplinary action by
the State Medical Board under AS 08.64.333. The
privilege to practice under this subsection
extends only to ongoing treatment or follow-up
care related to health care services previously
provided by the physician to the patient and
applies only if
(1) the physician and the patient have an
established physician-patient relationship;
and
(2) the physician has previously conducted
a physical examination of the patient in
person."
Reletter the following subsections accordingly.
Page 2, line 16:
Delete "(d) and (e)"
Insert "(e) and (f)"
Page 2, line 28, following "means":
Insert "(A)"
Page 3, line 8, following "08.95;":
Insert "or
(B) a physician licensed in another state;"
Page 3, following line 10:
Insert a new bill section to read:
"* Sec. 2. AS 08.64 is amended by adding a new
section to read:
Sec. 08.64.333. Disciplinary sanctions: physician
licensed in another state. (a) The board may
sanction a physician licensed in another state
who provides health care services through
telehealth under AS 08.01.085(b) if the board
finds after a hearing that the physician
(1) committed an act that constitutes grounds to
sanction a physician licensed in this state under
AS 08.64.326(a)(1) - (13);
(2) exceeded the scope of the physician's
privilege to practice in this state under AS
08.01.085; or
(3) prescribed, dispensed, or administered
through telehealth to a patient located in the
state a controlled substance listed in AS
11.71.140 - 11.71.190.
(b) If the board finds grounds to sanction a
physician under (a) of this section, the board may
(1) permanently prohibit the physician from
practicing in the state;
(2) prohibit the physician from practicing in
the state for a determinate period;
(3) censure the physician;
(4) issue a letter of reprimand to the
physician;
(5) place the physician on probationary status
under (d) of this section;
(6) limit or impose conditions on the
physician's privilege to practice in the state;
(7) impose a civil fine of not more than
$25,000;
(8) issue a cease and desist order prohibiting
the physician from providing health care services
through telehealth under AS 08.01.085(b); an
order issued under this paragraph remains in
effect until the physician submits evidence
acceptable to the board showing that the
violation has been corrected;
(9) promptly notify the licensing authority in
each state in which the physician is licensed of
a sanction imposed under this subsection.
(c) In a case involving a physician alleged to have
committed an act under AS 08.64.326(a)(13), the final
findings of fact, conclusions of law, and order of the
authority that suspended or revoked a license or
certificate constitute a prima facie case that the
license or certificate was suspended or revoked and
the grounds under which the suspension or revocation
was granted.
(d) The board may place a physician on probation
under this section until the board finds that the
deficiencies that required the imposition of a
sanction have been remedied. The board may require a
physician on probation to
(A) report regularly to the board on matters
involving the reason for which the physician was
placed on probation;
(B) limit the physician's practice in the state to
those areas prescribed by the board;
(C) participate in professional education until the
board determines that a satisfactory degree of skill
has been attained in areas identified by the board as
needing improvement.
(e) The board may summarily prohibit a physician from
practicing in the state under AS 08.01.085(b) if the
board finds that the physician, by continuing to
practice, poses a clear and immediate danger to public
health and safety. A physician prohibited from
practicing under this subsection is entitled to a
hearing conducted by the office of administrative
hearings (AS 44.64.010) not later than seven days
after the effective date of the order prohibiting the
physician from practicing. The board may lift an order
prohibiting a physician from practicing if the board
finds after a hearing that the physician is able to
practice with reasonable skill and safety. The
physician may appeal a decision of the board under
this subsection to the superior court.
(f) The board may recover from a physician the cost
of proceedings resulting in a sanction under (b) of
this section, including the costs of investigation by
the board and department, and hearing costs.
(g) The board may prohibit a physician from
practicing in the state upon receipt of a certified
copy of evidence that a license to practice medicine
in another state or territory of the United States or
province or territory of Canada has been suspended or
revoked. The prohibition remains in effect until a
hearing can be held by the board.
(h) The board shall be consistent in the application
of disciplinary sanctions. A significant departure
from earlier decisions of the board involving similar
situations must be explained in findings of fact or
orders made by the board."
Renumber the following bill sections accordingly.
Page 9, line 7:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 14:
Delete "sec. 2"
Insert "secs. 2 and 3"
Page 9, line 17:
Delete "secs. 4 - 7"
Insert "secs. 5 - 8"
Page 9, line 21:
Delete "Section 5"
Insert "Section 6"
Page 9, line 25:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 27:
Delete "sec. 5"
Insert "sec. 6"
Page 10, line 2:
Delete "sec. 5"
Insert "sec. 6"
Page 10, lines 3 - 4:
Delete "sec. 10(b)"
Insert "sec. 11(b)"
Page 10, line 5:
Delete "Section 9"
Insert "Section 10"
Page 10, line 6:
Delete "secs. 11 and 12"
Insert "secs. 12 and 13"
Co-Chair Merrick OBJECTED for discussion.
Representative Rasmussen explained she was offering the
amendment at the request of the bill sponsor. Many Alaskans
sought treatment for cancer care out-of-state that was not
available within the state. The amendment would allow
patients to avoid unnecessary travel expenses while still
getting the care they need. Alaska had not joined any
inter-state healthcare compacts and the amendment was a
significant step forward in modernizing Alaska's healthcare
access via telehealth.
4:29:56 PM
Representative LeBon asked if an out-of-state provider was
required to have an Alaska license.
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, replied that the
very narrow exclusion that was being advanced was for
follow-up care for medical providers who had already
delivered in-person care. In the particular example
provided by Representative Rasmussen, it was not required
that the provider be licensed in Alaska. The language was a
result of a compromise to ensure that Alaskans could get
access to specialty care without unnecessary travel, but
also without reducing Alaska's state sovereignty. It would
not reduce Alaska's ability to enforce sanctions against
potential bad actors.
4:32:01 PM
Representative Carpenter asked how an accused physician
would be afforded due process.
Representative Spohnholz deferred to Ms. Chambers.
4:32:44 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT (via teleconference),
explained the amendment allowed the board the ability to
work with the Division of Corporations, Business and
Professional Licensing to investigate and gather
information regarding a complaint filed against a physician
that did not have an Alaska license. The process would
ultimately culminate in a decision by the Medical Board to
determine whether the physician should be relieved of the
ability to practice under the proposed exemption. It would
be the same process that was currently in place.
4:34:03 PM
Representative Carpenter asked what the process would be
for a doctor that was practicing from out-of-state. He did
not see how the doctor would be allowed a rebuttal to the
accusations.
Ms. Chambers replied that there was a process under the
Administrative Procedures Act that was echoed on page 3,
line 22 of the amendment. A physician had the ability to
have a hearing for a short period of time up to seven days.
It was already in statute and was not superseding other
areas of statute. It reinforced the physician's ability to
have a hearing if the board reached a decision that might
relieve them of their ability to practice in Alaska. The
act also included an appeals process that allowed a
physician the chance to challenge the decision. There was a
robust process in place with which the amendment aligned.
Representative Carpenter asked whether the process of
notifying the licensing authority of each involved state
occurred before or after the appeals process had completed.
Ms. Chambers replied that once there was a sanction
proposed by the board, the board was bound by existing
statute and federal requirements to make sure that other
states were notified. It was consistent with the current
processes.
4:37:01 PM
Representative Spohnholz thought that the amendment would
create a process that exactly mirrored the process already
used for license holders in Alaska. It was a narrow
exception that would only apply to providers who were not
licensed in Alaska and were providing follow-up care.
Representative Rasmussen asked for members' support.
Co-Chair Merrick WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 2 was ADOPTED.
4:38:21 PM
Vice-Chair Ortiz MOVED to ADOPT Amendment 3, 32-LS0754\D.3
(Foote, 04/12/22) (copy on file):
Page 2, line 11, following "AS 08.64.364":
Insert "and any federal law governing the
prescription, dispensing, or administering of a
controlled substance"
Page 2, line 15, following "AS 08.68.710":
Insert "and any federal law governing the
prescription, dispensing, or administering of a
controlled substance
Page 2, line 17:
Delete "or in another state"
Page 3, following line 20:
Insert a new bill section to read:
"* Sec. 3. AS 08.68.l0O(a) is amended to read:
(a) The board shall
(1) adopt regulations necessary to implement
this chapter, including regulations
(A) pertaining to practice as an
advanced practice registered nurse, including
requirements for an advanced practice
registered nurse to practice as a certified
registered nurse anesthetist, certified
clinical nurse specialist, certified nurse
practitioner, or certified nurse midwife;
regulations for an advanced practice
registered nurse who holds a valid federal
Drug Enforcement Administration registration
number must address training in pain
management and opioid use and addiction;
(B) necessary to implement AS 08.68.331
- 08.68.336 relating to certified nurse aides
in order to protect the health, safety, and
welfare of clients served by nurse aides;
(C) pertaining to retired nurse status;
[AND]
(D) establishing criteria for approval
of practical nurse education programs that
are not accredited by a national nursing
accrediting body; and
(E) establishing guidelines for
rendering a diagnosis, providing treatment,
or prescribing, dispensing, or administering
a prescription drug to a person without
conducting a physical examination under AS
08.68.710; the guidelines must include a
nationally recognized model policy for
standards of care of a patient who is at a
different location than the advanced practice
registered nurse;
(2) approve curricula and adopt standards
for basic education programs that prepare persons
for licensing under AS 08.68.190;
(3) provide for surveys of the basic nursing
education programs in the state at the times it
considers necessary;
(4) approve education programs that meet
the requirements of this chapter and of the
board, and deny, revoke, or suspend approval of
education programs for failure to meet the
requirements;
(5) examine, license, and renew the licenses
of qualified applicants;
(6) prescribe requirements for competence
before a former registered, advanced practice
registered, or licensed practical nurse may
resume the practice of nursing under this
chapter;
(7) define by regulation the qualifications
and duties of the executive administrator and
delegate authority to the executive administrator
that is necessary to conduct board business;
(8) develop reasonable and uniform standards
for nursing practice;
(9) publish advisory opinions regarding
whether nursing practice procedures or policies
comply with acceptable standards of nursing
practice as defined under this chapter;
(10) require applicants under this chapter
to submit fingerprints and the fees required by
the Department of Public Safety under AS
12.62.160 for criminal justice information and a
national criminal history record check; the
department shall submit the fingerprints and fees
to the Department of Public Safety for a report
of criminal justice information under AS 12.62
and a national criminal history record check
under AS 12.62.400;
(11) require that a licensed advanced
practice registered nurse who has a federal Drug
Enforcement Administration registration number
register with the controlled substance
prescription database under AS l 7.30.200(n)."
Renumber the following bill sections accordingly.
Page 9, line 7:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 17:
Delete "secs. 4 - 7"
Insert "secs. 5 - 8"
Page 9, line 21:
Delete "Section 5"
Insert "Section 6"
Page 9, line 25:
Delete "sec. 5"
Insert "sec. 6"
Page 9, line 27:
Delete "sec. 5"
Insert "sec. 6"
Page 10, line 2:
Delete "sec. 5"
Insert "sec. 6"
Page 10, lines 3-4:
Delete "sec. l0(b)"
Insert "sec. 11(b)"
Page 10, line 5:
Delete "Section 9"
Insert "Section 10"
Page 10, line 6:
Delete "secs. 11 and 12"
Insert "secs. 12 and 13"
Representative Carpenter OBJECTED for discussion.
Vice-Chair Ortiz explained the amendment would clean up the
controlled substance language per the recommendations of
the sponsor and of Ms. Chambers, who was online for
additional questions. It ensured that the bill complied
with federal law and ensured regulatory equity with the
Medical Board and the Board of Nursing on tele-prescribing
controlled substances.
4:39:34 PM
Representative Carpenter asked for an example of cleaned up
language.
Ms. Chambers asked for clarification of Representative
Carpenter's question.
Representative Carpenter restated his question.
Ms. Chambers responded that she had be working with the
sponsor to clean up language that ensured that the state
was aligning with federal law. A previous version of the
bill might have gone too far in superseding the federal
law. On page 3, line 20 of the amendment, there was an edit
to give the Board of Nursing additional authority which
would allow and require the board to establish guidelines
for the prescribing of drugs. The guidelines were currently
unclear in statute and the amendment would add clarity.
4:41:41 PM
Representative Spohnholz added that the amendment was of
significant importance because it clarified that controlled
substances in Alaska could only be prescribed in compliance
with the state's drug enforcement statute. It would not
allow prescription of an opioid without an in-person visit.
Inadvertently, she had excluded the Board of Nursing from
the ability to adopt prescribing regulations in an earlier
draft of the bill. The amendment would give the Board of
Nursing the necessary authority.
4:42:32 PM
Representative Carpenter asked who identified the
oversight.
Representative Spohnholz responded, "Director Chambers."
Representative Carpenter suggested that the amendment was
significant. It was a policy decision that he did not
understand.
4:43:25 PM
AT EASE
4:44:21 PM
RECONVENED
Vice-Chair Ortiz provided wrap-up comments. He indicated
that Amendment 3 would ensure that the bill aligned with
federal law. It fixed language which could be interpreted
to open out-of-state tele-prescribing authority. It deleted
the phrase "In another state" which clarified that only
providers licensed in Alaska could tele-prescribe
controlled substances. There was a federal law for a Drug
Enforcement Administration (DEA) registered practitioner to
conduct an in-person examination in order to tele-prescribe
controlled substances, which was waived during the COVID-19
pandemic. However, there was federal interest to change the
in-person requirement, and if it was changed, it was
important to ensure the bill aligned with any changes in
federal law while limiting state barriers to telehealth.
Representative Carpenter WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 3 was ADOPTED.
Co-Chair Foster MOVED to report CSHB 265(FIN) out of
committee with individual recommendations and the
accompanying fiscal notes.
There being NO OBJECTION, it was so ordered.
CSHB 265(FIN) was REPORTED out of committee with six "do
pass" recommendations and two "no recommendation"
recommendations and with one new zero fiscal note by
Department of Health, one new fiscal impact note by the
Department of Commerce, Community and Economic Development,
and two new fiscal impact notes by the Department of
Health.
4:48:31 PM
AT EASE
4:49:15 PM
RECONVENED
Co-Chair Merrick announced the agenda for the following
meeting at 1:30 p.m. on Friday.