Legislature(2021 - 2022)DAVIS 106
03/10/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB297 | |
| HB265 | |
| HB292 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 265 | TELECONFERENCED | |
| += | HB 292 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 297 | TELECONFERENCED | |
HB 265-HEALTH CARE SERVICES BY TELEHEALTH
3:24:01 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be 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." [Before the committee,
adopted as a working document on 3/3/22, was the proposed
committee substitute (CS) for HB 265, Version 32-LS0754\N,
Foote, 3/1/22, ("Version N").]
3:24:58 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 1 to HB 265,
Version N, labeled 32-LS0754\N.1, Foote, 3/5/22, which read:
Page 2, line 18:
Delete "podiatrist,"
Page 2, lines 20 - 21:
Delete "or a botulinum toxin"
Page 2, line 21:
Delete "podiatrist,"
Page 2, line 29:
Delete "or a botulinum toxin."
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
3:25:15 PM
The committee took a brief at-ease.
3:25:21 PM
REPRESENTATIVE MCCARTY moved to adopt Conceptual Amendment 1 to
Amendment 1, to ensure that podiatry was included in the
language of the underlying amendment.
CO-CHAIR ZULKOSKY objected for the purpose of discussion, then
removed her objection after hearing Representative McCarty's
explanation. Three being no further objection, Conceptual
Amendment 1 to Amendment 1 was adopted.
3:26:43 PM
REPRESENTATIVE MCCARTY explained that Amendment 1, as amended,
would remove botulism treatment from the bill because it was a
treatment that cannot be done through telehealth.
3:27:28 PM
REPRESENTATIVE SPOHNHOLZ responded that the inclusion of Botox
was an artifact of drafting the bill, which used statutory
language referencing it. She stated that the intent was to
remove unnecessary barriers to telehealth such as the
requirement for on site [medical staff]. She said that allowing
for telehealth prescription of medications that cannot be
delivered through telehealth was not the intention and removing
them from the bill "only made sense."
3:28:11 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 1, as amended, was adopted.
3:28:28 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 2 to HB 265,
Version N, labeled 32-LS0754\N.4, Dunmire/Foote, 3/8/22, which
read:
Page 1, line 1, following "medicine":
Insert "and the practice of nursing"
Page 2, line 25, following "AS 11.71.140 - 11.71.190":
Insert "if the advanced practice registered nurse
complies with AS 08.68.710"
Page 4, following line 3:
Insert a new bill section to read:
"* Sec. 3. AS 08.68 is amended by adding a new
section to article 6 to read:
Sec. 08.68.710. Prescription of drugs without
physical examination. (a) The board may not impose
disciplinary sanctions on an advanced practice
registered nurse for rendering a diagnosis, providing
treatment, or prescribing, dispensing, or
administering a prescription drug that is not a
controlled substance to a person without conducting a
physical examination if
(1) the advanced practice registered nurse
or another licensed health care provider in the
medical practice is available to provide follow-up
care; and
(2) the advanced practice registered nurse
requests that the person consent to sending a copy of
all records of the encounter to the person's primary
care provider if the prescribing advanced practice
registered nurse is not the person's primary care
provider and, if the person consents, the advanced
practice registered nurse sends the records to the
person's primary care provider.
(b) The board may not impose disciplinary
sanctions on an advanced practice registered nurse for
prescribing, dispensing, or administering a
prescription drug that is a controlled substance if
the requirements under (a) of this section and
AS 08.68.705 are met and the advanced practice
registered nurse prescribes, dispenses, or administers
the controlled substance.
(c) Notwithstanding (a) and (b) of this section,
an advanced practice registered nurse may not
prescribe, dispense, or administer a prescription drug
in response to an Internet questionnaire or electronic
mail message to a person with whom the advanced
practice registered nurse does not have a prior
provider-patient relationship.
(d) In this section,
(1) "controlled substance" has the meaning
given in AS 11.71.900;
(2) "prescription drug" has the meaning
given in AS 08.80.480;
(3) "primary care provider" has the meaning
given in AS 21.07.250."
Renumber the following bill sections accordingly.
Page 8, line 24:
Delete "sec. 4"
Insert "sec. 5"
Page 8, line 27:
Delete "Section 4"
Insert "Section 5"
Page 8, line 31:
Delete "sec. 4"
Insert "sec. 5"
Page 9, line 2:
Delete "sec. 4"
Insert "sec. 5"
Page 9, line 8:
Delete "sec. 4"
Insert "sec. 5"
Page 9, line 9:
Delete "sec. 8(b)"
Insert "sec. 9(b)"
Page 9, line 11:
Delete "sec. 9"
Insert "sec. 10"
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE MCCARTY reported that Amendment 2 was based on
Board of Nursing feedback that the bill would allow advance
practice registered nurses (APRNs) to prescribe controlled
substances without any caveats, which would give ARPNs a much
broader scope of practice than what was currently in regulation.
He explained that the intent was to align the regulations for
the Board of Nursing with statutes that already exist for the
Alaska State Medical Board (SMB). He read through the specific
Alaska Statutes that would be affected by the amendment. He
stated that the amendment would reduce convolution of regulation
and provide statute for some policies already in regulation.
3:30:43 PM
REPRESENTATIVE SPOHNHOLZ agreed that the barriers to APRNs
prescribing certain substances were in regulation rather than in
statute and explained that because the bill was originally
written to clean up statute, the inadvertent expansion of ARPNs
prescribing authority was missed. She reiterated that Amendment
2 corrects that drafting error and ensures that ARPNs would have
the same prescribing authority through telehealth as doctors do,
which was an authority they already had.
3:31:40 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 2 was adopted.
3:31:58 PM
CO-CHAIR ZULKOSKY noted Amendment 3 would not be offered.
3:32:01 PM
CO-CHAIR SNYDER moved to adopt Amendment 4 to HB 265, Version N,
labeled 32-LS0754\N.9, Foote, 3/9/22, which read:
Page 5, lines 5 - 6:
Delete "and other federal waivers or
demonstrations"
Page 5, line 17:
Delete "the Alaska Commission for Behavioral
Health Certification"
Insert "a certifying entity for behavioral health
professionals in the state specified by the department
in regulation"
Page 5, line 25:
Delete "facsimile,"
Page 5, line 26:
Delete "and"
Page 5, line 29, following "substances":
Insert "; and
(12) services covered under federal waivers or
demonstrations other than home and community-based
waivers"
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
CO-CHAIR SNYDER summarized the amendment and stated that it was
created with cooperation from the Department of Health and
Social Services (DHSS) to make sure certain language was covered
in more appropriate statutes and to be less rigid in certain
areas should circumstances change in the future. She added that
it would also remove facsimile ("fax") from the context of
telehealth.
3:33:31 PM
REPRESENTATIVE SPOHNHOLZ agreed that telehealth should not be
delivered via fax and emphasized that the reorganization of
statute and language in the amendment was added at the
recommendation of DHSS.
3:34:13 PM
REPRESENTATIVE MCCARTY provided historical context around the
Health Insurance Portability and Accountability Act (HIPAA) and
fax machines and agreed that it was time to move on.
3:34:56 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 4 was adopted.
3:35:14 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 5 to HB 265,
Version N, labeled 32-LS0754\N.11, Foote, 3/9/22, which read:
Page 1, lines 6 - 7:
Delete "other than a physician licensed in
another state"
Page 1, line 10, through page 2, line 5:
Delete all material.
Reletter the following subsections accordingly.
Page 2, line 26:
Delete "(e) and (f)"
Insert "(d) and (e)"
Page 3, line 9:
Delete "(A)"
Page 3, lines 21 - 22:
Delete "and
(B) a physician licensed in another state;"
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SPOHNHOLZ explained that after discussion with
stakeholders about the out-of-state exemptions provision, she
proposed to remove the "non-licensed provider" portion of the
bill. She hoped that in the future there would be a way to find
a narrow scope of authority for practitioners not licensed in
Alaska, specifically for specialists that provide treatments not
available in state. She spoke to the complications in finding a
workable compromise between keeping Alaska patients safe and
providing telehealth access with out-of-state providers and
stated candidly that the state was "just not there yet." She
mentioned that there had been extensive work with many
stakeholders to help "thread the needle" between patient access
to care, safety, and appropriate oversight, but that more work
was still needed. She stated that she was proposing removal of
the non-licensed provider aspect of this legislation because she
did not want such a complex issue to slow down the progress of
HB 265, but that her commitment to continuing the work toward a
complete solution remained. She emphasized that without the
non-licensed provider language, HB 265 was focused on improving
access of care to Alaskans through telehealth and would still be
a "massive advance in access to care."
3:37:47 PM
REPRESENTATIVE KURKA sought clarification that if Amendment 5
was adopted, only physicians licensed in Alaska could perform
telehealth [for Alaskans].
REPRESENTATIVE SPOHNHOLZ confirmed that only those with Alaska
medical licenses could conduct telehealth in Alaska. She
clarified that there were many out-of-state physicians that
were currently licensed in Alaska and providing care to
Alaskans. She reiterated that the problem was the rare
specialty market that lacked the ability to create sustainable
businesses in Alaska. She stated that it was important to make
sure that Alaska licensed physicians did not have to pay for
unlicensed practitioners and that the SMB was able to regulate
those practitioners to hold any "bad actors" who want to take
advantage of the telehealth system accountable for their
actions. She mentioned that her office had been actively
working with SMB and the Alaska State Medical Association (SMA)
and would continue to do so on this issue, but that they both
support Amendment 5 at this time.
3:39:37 PM
REPRESENTATIVE KURKA inquired about the difficulty of the Alaska
licensure process for out of state practitioners who cannot come
to Alaska to apply.
REPRESENTATIVE SPOHNHOLZ directed the question to Director Sara
Chambers from the Department of Commerce, Community & Economic
Development (DCCED).
3:40:10 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, responded that the process was exactly the
same [for all out-of-state applicants].
REPRESENTATIVE KURKA requested a general overview of the list of
requirements for licensure, specifically mentioning cost.
MS. CHAMBERS listed several of the licensing requirements. She
said there was a fee of "a couple hundred dollars" and
applicants must have demonstration of training and education
commensurate with becoming a physician, such as a post-graduate
degree. There was also a verification of licensure in good
standing for those licensed to practice in another state, which
she described as a screening that would use a system of
databases to check for instances of malpractice or other "dings"
on the physician's record. She reported that the State of
Alaska does not require background checks for doctors but does
ask about the applicant's criminal history. She said that
hospital verification from every hospital applicants have
credentials in was also required, which can be in the hundreds
and can cause a delay in licensing. She summarized that the
state's goal was to gather enough information to determine the
applicant's education and fitness to serve as a physician.
REPRESENTATIVE MCCARTY mentioned Ms. Chamber's comment that the
hospital verification requirement can cause a delay in licensing
and questioned, in a case where an applicant had over a hundred
credentials to verify, whether there was a [threshold of
verifications completed] that the applicant could reach as a
show of good faith to speed up the process.
MS. CHAMBERS expressed her wish for an easy answer but explained
that the requirement for hospital or clinic verification had
been in the SMB's regulations for many years. She reported that
the board has emphasized the importance of discovering whether
the applicant was in good standing at each of the hospitals or
clinics in which they are credentialed. She explained that
there was an emergency courtesy license established during
COVID-19 that did not require the hospital verification, so a
physician could be granted a temporary license and start to
practice while working on obtaining their verifications. She
mentioned that there was a [non-emergency] temporary licensure
process that a physician could request for the same purpose.
She opined that the process is more complex than necessary and
stated that DCCED was working with SMB to find solutions, but
that currently all verifications were required by regulation for
the applicant to become fully licensed.
REPRESENTATIVE MCCARTY sought verification that the licensure
requirements came from board regulation rather than Alaska
Statute.
MS. CHAMBERS confirmed that the hospital verifications were only
in regulation, however many of the other requirements were in
statute.
REPRESENTATIVE MCCARTY asked whether it was under the purview of
DCCED or SMB to change that regulation.
MS. CHAMBERS explained that SMB has sole authority over its
regulations and the department cannot get involved. However,
she reported that SMB has had conversations about changing the
need for hospital verification, especially during COVID-19, and
how to improve licensure flexibility.
3:46:48 PM
REPRESENTATIVE SPOHNHOLZ added that the full process typically
takes 3-4 months, while the emergency courtesy license takes
about 4-6 weeks. She explained that this allows the many steps
of full licensure to be completed with the goal of ensuring
patient safety. She reiterated that it was within the board's
purview to regulate this process and mentioned that if members
wished to gain a better understanding of the process, the House
Labor and Commerce Standing Committee would be holding a hearing
later that week about the current process across all of the
state's licensed professions and how the legislature could help
streamline the process while maintaining safety and professional
integrity.
3:48:08 PM
REPRESENTATIVE KURKA sought clarification that a single
physician might have over a hundred credentials that required
verification.
MS. CHAMBERS confirmed that estimate.
3:48:32 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 5 was adopted.
3:48:47 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 6 to HB 265,
Version N, labeled 32-LS0754\N.10, Foote, 3/9/22, which read:
Page 8, following line 24:
Insert a new bill section to read:
"* Sec. 8. The uncodified law of the State of
Alaska is amended by adding a new section to read:
REGULATIONS. (a) Each applicable board
responsible for licensing a profession authorized to
provide telehealth services under sec. 1 of this Act
shall adopt regulations necessary to implement sec. 1
of this Act. The licensing boards shall adopt the
regulations not later than June 30, 2023.
(b) The State Medical Board shall adopt
regulations necessary to implement sec. 2 of this Act.
The State Medical Board shall adopt the regulations
not later than June 30, 2023.
(c) The Department of Health and Social Services
shall adopt regulations necessary to implement secs. 3
- 6 of this Act. The Department of Health and Social
Services shall adopt the regulations not later than
June 30, 2023."
Renumber the following bill sections accordingly.
Page 9, line 9:
Delete "sec. 8(b)"
Insert "sec. 9(b)"
Page 9, lines 11 - 12:
Delete all material and insert:
"* Sec. 11. Section 8 of this Act takes effect
immediately under AS 01.10.070(c).
* Sec. 12. Except as provided in secs. 10 and 11 of
this Act, this Act takes effect June 30, 2023."
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE MCCARTY explained that after a bill was passed it
did not go into full effect until regulations were made to fit
the content of the bill and then signed by the lieutenant
governor. He added that regulations can take a long time to be
implemented and referenced bills that were still waiting on
regulations six years after being signed by the governor. Due
to the urgent nature of improving medical access via telehealth,
he stated that the amendment would require all affected boards
to have the new regulations completed by June 30, 2023.
REPRESENTATIVE SPOHNHOLZ shared her past experience with a bill
that took several years to go into effect due to a long
regulatory process. She expressed that the wishes of physicians
across Alaska were for HB 265 to go into effect quickly and that
this amendment would make that intent explicit.
3:51:01 PM
REPRESENTATIVE PRAX asked whether the request for regulations by
June 2023 was unreasonable.
3:51:26 PM
MS. CHAMBERS stated her belief that it was possible for the
regulations to be accomplished within a year and that having the
date specified by the legislature would be helpful.
3:52:14 PM
REPRESENTATIVE KURKA wondered whether the proposed timeline was
too generous. He shared his understanding that some boards met
irregularly, but opined that regulations being completed beyond
a year would be unacceptable. He referenced the effective date
of the legislation itself and questioned whether a year for
completing regulations would be too long.
3:53:24 PM
REPRESENTATIVE SPOHNHOLZ responded that the effective date of
the bill was currently 90 days. She noted that there was a
public comment period during the creation of regulations that
was very important to the process because it ensured that the
regulations encompassed the perspectives of all stakeholders.
She posited that the full year would allow ample time for the
public to give their feedback, which in turn would allow the
boards to create practical and useful regulations.
CO-CHAIR ZULKOSKY added that the language of the amendment would
allow for an earlier completion of regulations if possible.
3:54:38 PM
REPRESENTATIVE MCCARTY agreed with Representative Kurka that he
would prefer the regulations to be enacted even faster but
stated that Legislative Legal Services had advised that giving a
deadline for regulation was "treading new waters," and that a
one-year timeline would be more prudent.
3:55:09 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 6 was adopted.
3:55:16 PM
REPRESENTATIVE MCCARTY moved Conceptual Amendment 7 to HB 265,
Version N, to add the language "health care provider licensed in
the state" to the first section of the bill describing who can
perform telehealth care.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE MCCARTY noted that with the adoption of Amendment
5, the bill allows only individuals who are licensed in Alaska
to practice telehealth in the stated. He explained that the
Conceptual Amendment 7 would provide.
REPRESENTATIVE SPOHNHOLZ stated that the language was already
included on a different page of the bill but described the
amendment as a "belt and suspenders" for clarity and there was
no reason not to include it. She mentioned that legislation can
often create layperson confusion and that this amendment would
make the requirement of Alaska licensure extra clear.
3:56:57 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Conceptual Amendment 7 was adopted.
3:57:42 PM
The committee took a brief at-ease.
3:57:49 PM
CO-CHAIR SNYDER moved to report CSHB 265, Version 32-LS0754\N,
Foote, 3/1/22, as amended, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 265(HSS) was reported out of the House Health
and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 292, LOS received since 3.10.22.pdf |
HHSS 3/10/2022 3:00:00 PM |
HB 292 |
| CSHB 297 Amendments and Actions.pdf |
HHSS 3/10/2022 3:00:00 PM |
HB 297 |
| CSHB 265 Amendments and Actions.pdf |
HHSS 3/10/2022 3:00:00 PM |
HB 265 |