Legislature(2021 - 2022)SENATE FINANCE 532
05/12/2022 01:00 PM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB265 | |
| SB124 || HB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | HB 265 | TELECONFERENCED | |
| + | SB 124 | TELECONFERENCED | |
| *+ | HB 172 | TELECONFERENCED | |
CS FOR HOUSE BILL NO. 265(FIN)
"An Act relating to telehealth; relating to the
practice of medicine and the practice of nursing;
relating to medical assistance coverage for services
provided by telehealth; and providing for an effective
date."
1:05:48 PM
Co-Chair Stedman relayed that it was the first hearing for
HB 265. The intention of the committee was to hear a bill
introduction and sectional analysis, take invited and
public testimony, and set the bill aside for further
review.
1:06:54 PM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, relayed that HB 265
was designed to expand the telehealth flexibilities that
had been enjoyed during the Covid-19 pandemic, while
ensuring patient protection and Alaskas sovereignty as it
related to licensing. She recounted that the legislature
had worked for years to expanded telehealth, including
Medicaid for telehealth for behavioral health in SB 74 and
HB 29, which passed in 2020 and required insurance coverage
for telehealth. She noted that the pandemic resulted in
people using telehealth in ways that had not been imagined.
She noted that Alaskan providers had invested in
telehealth, and she did not want to diminish the access to
care and cost savings provided by telehealth.
Representative Spohnholz continued that the state public
health emergency (which had expired one year previously)
and the federal public health emergency had allowed
flexibility in the utilization and regulation of
telehealth. She noted that the federal public health
emergency would expire July 22, and there was some urgency
to ensure Alaskans would get the needed care. She explained
that HB 265 would create a legislative framework for
continued successful delivery of telehealth while
protecting patients and reducing red tape.
Representative Spohnholz continued that Alaska did not have
telehealth payment parity, which was important because it
caused a natural disincentive for providers to offer
telehealth. She cited that 84 percent of providers that
were registered in the telemedicine business registry were
providers within Alaska. She noted that some services were
not available via telehealth. She heard from advocates with
the American Association of Retired Persons (AARP) and
other organizations that telehealth flexibilities would
help to increase access to care, particularly in rural
Alaska. She mentioned barriers to telehealth access,
including requirements for documentation of efforts to have
an in-person examination. There were barriers to basic
kinds of care, including renewals of controlled substances
or medication for ongoing treatments. The legislation
aligned with the United States Drug Enforcement Agency
(DEA) regulations.
1:10:47 PM
Representative Spohnholz continued the bill introduction.
She discussed the challenges of accessing care in rural
parts of the state. She noted that the bill supported
growth in the market of Alaska-based providers. She noted
that the bill would save money for patients and the state.
She cited that between FY 20 and FY 21, the combined
increase in telehealth spend and decreased Medicaid travel
showed a savings of about 23 percent in combined costs for
the state. She reported that elders had liked telehealth
due to easy access. The bill allowed for follow-up visits
with a provider outside the state if there was already an
in-person examination. The exemption was designed in
collaboration with the American Cancer Society and the
Alaska State Medical Association.
Representative Spohnholz reported that people in rural
Alaska reported that the ability to have an audio-only
appointment had increased attendance in behavioral health
appointments by 30 percent, which was important due to poor
broadband access. She emphasized that the bill would
protect the patient-provider relationship. She explained
that the bill did not require patients or providers to
engage in telehealth, but it did remove barriers.
Representative Spohnholz pointed out that the bill did not
open up the market for non-licensed providers with the
narrow exception for follow-up care. Earlier versions of
telehealth legislation allowed for telehealth practice by
any provider anywhere. The bill did not reduce important
protections against over-prescription of controlled
substances. There were prescription limits, requirements to
use the Prescription Drug Monitoring Program (PDMP), and
the DEA required an in-person examination first. She
asserted that the bill did not reduce the quality of care
in Alaska and was not a replacement for in-person care. She
noted that in many parts of the state, people did not have
access to care at all, and the bill was designed to provide
access and improve health and wellbeing.
Representative Spohnholz thanked the 38 stakeholder
organizations that had worked on the bill, as well as the
Department of Commerce, Community and Economic Development
and the Department of Health and Social Services. She
corrected that the federal public emergency expired on July
15 rather than July 22 as previously stated.
1:15:14 PM
GENEVIEVE MINA, STAFF FOR REPRESENTATIVE SPOHNHOLZ,
addressed a Sectional Analysis (copy on file):
Section 1 Adds a new section on telehealth under Title
8 for all health care providers licensed with the
State of Alaska.
? Subsection (a) removes the requirement for an in-
person visit prior to a telehealth appointment.
? Subsection (b) narrowly exempts physicians licensed
in another state to deliver health care services via
telehealth if there is an established physician-
patient relationship, an in-person physical exam, and
the services are related to ongoing treatment or
follow-up care related to past treatment. The language
also references new enforcement language in Section 2.
? Subsections (c) and (d) create limits for a
telehealth appointment. If a telehealth appointment
falls outside of a provider's authorized scope of
practice, they may refer a patient to an appropriate
clinician. The cost of a service delivered through
telehealth must be the same as if it were delivered in
person.
? Subsections (e), (f), and (g) ensure that only
authorized providers licensed with the State of Alaska
can prescribe controlled substances (e.g.,
buprenorphine, Adderall, etc.) via telehealth without
conducting an in-person visit. These providers must
comply with the state and federal laws regarding the
prescription of controlled substances via telehealth.
o Subsection (e) pertains to providers in Title
8, Chapter 64 (Medicine) (i.e., physicians,
podiatrists, osteopaths and physician
assistants).
o Subsection (f) pertains to Advanced Practice
Registered Nurses (APRNs) in Title 8, Chapter 68
(Nursing).
? Subsection (h) removes requirements to document all
attempts for an in-person visit and prevents the
department or board from limiting the physical setting
of a health care provider delivering telehealth.
? Subsection (i) confirms that health care providers
under this section are not required to deliver
telehealth services.
? Subsection (j) provides definitions for all health
care providers applicable to this section, specifies
that the provider must be licensed in good standing,
and defines telehealth.
1:17:33 PM
Ms. Mina continued to address the Sectional Analysis:
Section 2
Creates AS 08.64.33 defining the State Medical Board's
authority to enforce against exempted physicians in
Section 1 and ensures these providers must comply with
Alaska laws for licensed physicians.
o Subsection (a) describes the grounds for the
board to sanction a physician licensed in another
state providing telehealth services in Section 1:
if they violate Alaska laws for Alaska-licensed
physicians; exceed the defined scope of
telehealth services in Section 1; or prescribe,
administer, or dispense a controlled substance to
an Alaska patient located in the state.
o Subsection (b) and (c) ensures that the board
can enforce exempted physicians in the same
manner as Alaska-licensed physicians. In addition
to this authority, they can issue a cease and-
desist order and notify the licensing authority
for each state the physician is licensed.
o Subsection (d), (e), (g), and (h) details the
board's disciplinary actions for exempted
physicians, mirroring similar language regarding
sanctions for Alaska-licensed physicians.
o Subsection (f) ensures that the board can
recover costs related to the proceedings and
investigation directly from an exempted physician
in Section 1.
Section 3
Amends language related to the prescription of
controlled substances via telehealth under the State
Medical Board. This deletes language requiring an
additional health care provider to assist a patient
during a telehealth appointment with a physician or
physician assistant regarding the prescription,
dispensing, and administration of controlled
substances.
Section 4-5
Adds sections related to the prescription of
controlled substances via telehealth under the Board
of Nursing. This does not change the Board of
Nursing's authority or the scope of practice for APRNs
ensures regulatory equity between the Board of Nursing
and the State Medical Board regarding the prescription
of controlled substances via telehealth for all DEA-
registered practitioners.
? Section 4 amends the Board of Nursing's regulatory
authority to include controlled substances via
telehealth in Section 5, mirroring statutory language
for the State Medical Board.
? Section 5 creates a new section AS 08.68.710
defining the telehealth prescriptive authority of
APRNs in statute. This section removes the regulatory
in-person requirement for APRNs under 12 AAC
44.925(c), mirroring the deletion of language for the
State Medical Board in Section 3.
Section 6
Adds a new section on telehealth under Title 18 for
emergency medical services. This section removes the
requirement for an in-person examination prior to a
telehealth encounter. This section replicates the same
provisions on cost, scope of services, documentation,
physical setting, and patient protections as Section
1.
Section 7
Adds a new section on telehealth payment under Title
47 for Alaska Medicaid.
? Subsection (a) requires the Department of Health to
pay for telehealth services in the same manner as an
in person service for the following: behavioral health
services, home and community based services (HCBS),
services provided by a community health aide or
community health practitioner, behavioral health aide
or behavioral health practitioner, dental health aide
therapist, chemical dependency counselor, non-HCBS
services covered under a federal waiver or
demonstration, other services provided by an
individual or entity eligible for department
certification and Medicaid reimbursement, and services
provided at rural clinics and federally qualified
health centers.
This subsection also allows for a telehealth visit to
be conducted through any means which could be useful
in a patient-provider relationship, including an
audio-only (i.e., phone call) appointment.
? Subsection (b) requires the department to adopt
regulations regarding payment of telehealth services.
This provision also allows the department to limit or
restrict Medicaid coverage under this section if a
service delivered via telehealth cannot be safely
delivered according to substantial medical evidence,
or if the federal government will not reimburse the
delivery of the service via telehealth.
? Subsection (c) specifies that the coverage of
services in Alaska Medicaid must be HIPAA compliant.
Ms. Mina continued to address the Sectional Analysis:
Section 8-9
Adds sections on telehealth under Title 47 for
grantees that deliver community mental health
services, or facilities approved by the department to
deliver substance use disorder treatment. Both
sections replicate the same telehealth provisions on
cost, scope of services, patient protections,
documentation, and physical setting as Section 1.
? Section 8 creates AS 47.30.585 to include entities
approved to receive grant funding by the Department of
Health to deliver community mental health services.
? Section 9 creates AS 47.37.145 to include public or
private treatment facilities approved by the
Department of Health to deliver services addressing
substance use disorders.
Section 10
Provides an immediate effective date.
1:23:21 PM
APRIL KYLE, PRESIDENT AND CEO, SOUTHCENTRAL FOUNDATION,
ANCHORAGE (via teleconference), spoke in favor of the bill.
She explained that Southcentral Foundation was a tribal
organization that served 65,000 Alaskans had 2,500
employees. She mentioned innovations in healthcare that
were learned during the Covid-19 pandemic to help create a
better system. She mentioned telehealth previous to the
pandemic, which was not reimbursable. She mentioned the
lack of video capabilities in certain areas of the state
and costly and delayed care. She mentioned the flexibility
of delivering telehealth, and the ability to make decisions
about interventions.
Ms. Kyle continued her testimony. She wanted the committee
to know that the Southcentral Foundation was concerned
about young people and suicide. She emphasized the
importance of timely care, which was aided by telehealth.
She emphasized the importance for reimbursable telehealth
care to be available after the public health emergency
ended. She thought the bill was a clinically sound bill
that allowed for good care, and it was also financially
responsible and cost-effective.
Senator Olson assumed the Southcentral Foundation was a 638
contractor.
Ms. Kyle answered affirmatively.
Senator Olson asked if Ms. Kyle was speaking in support of
the bill on behalf of regional health corporations
throughout the state.
Ms. Kyle stated that the tribal health system supported the
bill, and she spoke on behalf of Southcentral Foundation.
1:27:19 PM
KEVIN MUNSON, CEO, MAT-SU HEALTH SERVICES, WASILLA (via
teleconference), testified in support of the bill. He
relayed that Mat-Su Health Services was a federally
qualified community health center and a comprehensive
community behavioral health center that serviced the
greater Wasilla and Palmer Areas. He continued that Mat-Su
Health Services (MHS) provided a variety of services
including primary care, dental, psychiatric, behavioral
health, and 1115 waiver specialty mental health services.
He noted that telehealth services had been a part of MHS
delivery system for many years. He recounted that the
pandemic and subsequent relaxation of regulations around
telehealth had permitted the expansion of telehealth
services, resulting in greater and easier access to care
and other improvements. He cited that telehealth made up to
approximately 30 percent of MHSs billable contact.
Mr. Munson continued his testimony and thought the bill
would provide statutory framework needed to codify the
lessons learned. He thought the bill would protect patient
access and provide flexibility. He thought that absent the
bill there would be a sizable disruption in patient care.
He discussed parity reimbursement as proposed in the bill.
He thought there was a mistaken notion that telehealth
visits were less costly and could be reimbursed at a lower
rate, which he contended was not true. He cited that the
largest component of a telehealth visit was direct
personnel cost of those delivering care, followed by the
cost of all the other staff. He discussed brick and
mortar costs and emphasized that telehealth appointments
were as costly as in-person appointments.
Mr. Munson mentioned that telehealth had costs that face-
to-face care did not, including specialized training,
supervision, and compliance costs. He thought the failure
to reimburse for telehealth had several downsides such as
disenfranchised patients, increased travel costs, and
diminished access and continuity of care.
1:31:34 PM
Co-Chair Stedman OPENED public testimony.
WINN DAVIS, SENIOR POLICY ANALYST, ALASKA NATIVE HEALTH
BOARD, ANCHORAGE (via teleconference), spoke in support of
the bill. He explained that the Alaska Native Health Board
(ANHB) was the statewide voice for the Alaska tribal health
system and had been active for over 50 years in tribal
health. He asserted that telehealth access during the
Covid-19 pandemic had improved access to healthcare. He
mentioned expanded behavioral health access and increased
care in rural Alaska. He emphasized that the flexibility of
telehealth had saved lives in rural Alaska. He noted that
the legislation ensured Medicaid reimbursement for services
provided via telehealth, such as behavioral healthcare. He
discussed the importance of telephonic audio-only services
in rural Alaska.
Mr. Davis continued his testimony and discussed further
advantages such as a decrease in no-show rates. He
discussed patients that would be without care if there were
not access to telehealth. He reminded that village staff
managed multiple appointments with little resources and
emphasized potential real-world ramifications with the loss
of telehealth access.
1:34:13 PM
EMILY NENON, ALASKA GOVERNMENT RELATIONS, AMERICAN CANCER
SOCIETY CANCER ACTION NETWORK, ANCHORAGE (via
teleconference), testified in support of the bill. She
discussed calls from patients and patient navigators
regarding the need for telehealth. She thought it was time
to modernize the states telehealth regulations and laws.
She referenced an amendment that would allow for local
doctors to get more information and access for patients.
1:36:30 PM
Co-Chair Stedman CLOSED public testimony.
Senator Wielechowski asked if there was anyone from the
Department of Health and Social Services available to
answer questions.
Senator Wielechowski was curious about the reimbursement
provision and wondered if the change would cause an
increase in rates. He commented on the high medical rates
in Alaska. He thought it appeared that under the provision
on page 10, line 20 of the bill, would allow outside
doctors to significantly increase rates. He wondered if
there had been a cost analysis.
1:37:58 PM
RENEE GAYHART, DIRECTOR, HEALTH CARE SERVICES, DEPARTMENT
OF HEALTH AND SOCIAL SERVICES (via teleconference), relayed
that the payment rates for telehealth would be the same as
an in-office visit. She continued that out-of-state
providers were paid their own state rates rather than the
Alaska rate.
Co-Chair Stedman asked committee members to look at the
bill and bring forward any potential amendments for
consideration by Friday, May 13.
HB 265 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 172 Transmittal Letter.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 Definitions in AS 47.30.915.pdf |
HHSS 3/8/2022 3:00:00 PM SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Supporting Document - Letters of Support.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - SFIN Presenation 5.12.2022.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Sectional Anaylsis Ver. D.A.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Letter of Support - DPS.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Letter of Support - Alaska ACEP.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Explanation of Changes Ver. D.A.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Crosswalk with SB 124 (updated).pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 SB 124 |
| SB 124 Transmittal Letter.pdf |
SFIN 5/12/2022 1:00:00 PM SHSS 4/27/2021 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| HB 265 Sponsor Statement v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Sectional Analysis v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Explanation of Changes v. W to v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Supporting Document - New HFIN Testimony Received as of 04.13.22.pdf |
HFIN 4/14/2022 1:30:00 PM SFIN 5/12/2022 1:00:00 PM |
HB 265 |
| HB 265 Support.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 265 |
| HB 265 Support Kantiyavong.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 265 |
| HB 172 Opposition.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |