Legislature(2017 - 2018)CAPITOL 106
03/08/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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 | |
| HB358 | |
| HB351 | |
| HB193 | |
| HB336 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 358 | TELECONFERENCED | |
| += | HB 351 | TELECONFERENCED | |
| *+ | HB 193 | TELECONFERENCED | |
| += | HB 336 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 358-INSURANCE COVERAGE FOR TELEHEALTH
3:21:17 PM
REPRESENTATIVE TARR announced that the first order of business
would be HOUSE BILL NO. 358, "An Act relating to insurance
coverage for benefits provided through telehealth; and providing
for an effective date."
3:21:34 PM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, paraphrased from the Sponsor Statement
[Included in members' packets] [original punctuation provided],
which read:
HB 358 will enhance access to health care services,
primarily mental health and primary care, for Alaskans
who have insurance plans with Moda, Premera Blue
Cross, United Healthcare, and Aetna Life Insurance, to
name a few. HB 358 does this by requiring the insurers
previously listed to provide insurance coverage for
health care services provided through telehealth.
Increasing access to health care services throughout
Alaska is crucial. Because of our unique geographical
landscape and our rural and aging communities spread
out across the state, telehealth can enhance access to
health care and improve clinical outcomes.
Here are some of the advantages of telehealth:
? Better access and privacy in rural, remote, and
urban areas of Alaska
? Early intervention which can lead to savings
? Greater access for referrals to providers who
specialize in treating specific health issues
? Better, and potentially quicker, access means a
potential reduction in suicides, domestic violence and
other serious events
? Zero impact on state budget
Under HB 358, telehealth benefits for all covered
health care services, including mental health
benefits, will be reimbursable for health care
providers licensed in the state without an initial in
person appointment. Depending on the patient's needs,
a telehealth appointment can provide education,
reviewing of prescriptions and checking symptoms, all
at a distance on a secure system.
Health care services delivered via telehealth is
happening all over the country, and Alaska is at the
forefront of providing telehealth services for urban,
rural, aging, and the underserved communities across
the state.
MS. NISBETT presented the definition of tele-health as it was
written in AS 47.05.27(e), and read:
the practice of health care delivery, evaluation,
diagnosis, consultation, or treatment using the
transfer of health care data through audio, visual, or
data communications performed over two or more
locations between providers who are physically
separated from the recipient or from each other or
between a provider and a recipient who are physically
separated from each other.
MS. NISBETT reported that prominent health care organizations in
Alaska had stated that tele-health can increase access, an issue
recommended by the Alaska Health Care Commission for the Alaska
State Legislature to address. She noted that the legislature
had passed Senate Bill 74 in 2016, which was primarily a
Medicaid reform bill with significant tele-health components.
She pointed out that the proposed bill would only impact
insurance plans regulated by the Division of Insurance.
3:24:49 PM
MS. NISBETT paraphrased from the Sectional Analysis [included in
members' packets], which read:
Section 1.
AS 21.42.422 has been amended to require insurance
coverage for benefits provided via telehealth.
Section 2.
AS 21.42.422 is a new subsection that defines health
care insurer as a person transacting the business of
health care insurance except for a nonfederal
governmental plan. It also adds the definition of
telehealth under 47.05.270(e) as the practice of
health care delivery, evaluation, diagnosis,
consultation, or treatment, using the transfer of
health care data through audio, visual, or data
communications, performed over two or more locations
between providers who are physically separated from
the recipient or from each other or between a provider
and a recipient who are physically separated from each
other.
Section 3
The changes to Section 1 of this bill applies to
health care insurance plans that are offered, issued,
delivered, or renewed on or after the effective date.
Section 4
The effective date is July 1, 2019.
3:26:12 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if a patient in a rural
area would need to see a primary physician prior to the use of
tele-health.
3:27:20 PM
ANNA LATHAM, Deputy Director, Juneau Division, Division of
Insurance, Department of Commerce, Community & Economic
Development, offered her belief that, although this had not been
addressed in the proposed bill, as the bill read, it was not
necessary for an in-person appointment prior to the use of tele-
health.
REPRESENTATIVE SULLIVAN-LEONARD opined that it was "really
important that we do have coverage for our tele-health process
and network for patients that don't have access to physicians."
She wanted to ensure there was not a gap in the process allowing
that someone did not receive the proper oversight from a
physician while in a rural area.
REPRESENTATIVE TARR noted that this had previously been limited
to mental health services, but, was now expanded for all
telehealth.
MS. LATHAM said that was correct.
3:29:07 PM
REPRESENTATIVE SULLIVAN-LEONARD asked to hear from a physician
or nurse practitioner for the effect of the proposed bill on
their practice.
MS. NISBETT, in response to Representative Sullivan-Leonard,
explained that providers primarily used telehealth for follow up
appointments, consultation, education, and review of
prescriptions. However, if a patient in rural Alaska had a
serious condition, it was suggested they travel to an urban area
to see a doctor. She declared that telehealth was not the
initial or primary service of care.
REPRESENTATIVE SULLIVAN-LEONARD asked to ensure that everything
was covered by the providers.
3:31:39 PM
REPRESENTATIVE CLAMAN asked, as the proposed bill restricted
telehealth to providers licensed in Alaska, if it would be more
difficult to receive telehealth services from mental health
providers from out of state.
MS. NISBETT asked for clarification.
REPRESENTATIVE CLAMAN explained that there were instances in
which mental health providers worked with social workers in
Alaska to provide person to person counseling services, even
though the medication was managed by an out of state provider
who only communicated with the patient from afar. He asked if
the out of state provider would not receive an insurance payment
because they were not licensed in Alaska.
MS. NISBETT said that she would research this.
3:33:41 PM
REPRESENTATIVE JOHNSTON asked for clarification that there was
telemedicine through the Indian Health Service (IHS), and
whether this proposed bill would expand service to community
members in rural villages not covered by the Indian Health
Service.
MS. NISBETT replied that this was correct.
3:34:13 PM
MS. LATHAM stated that the proposed bill expanded telehealth and
removed it from solely mental health benefits, for the
individual and small group market, as those markets were
regulated by the Division of Insurance.
REPRESENTATIVE JOHNSTON asked if this was covered as a Medicaid
reimbursement, rather than the IHS.
MS. LATHAM offered her belief that, as the IHS was the payer of
last resort, a plan in the individual market would cover
telehealth benefits. She stated that she was not familiar with
the benefits covered under IHS, although her understanding was
that it would be covered under both scenarios.
3:35:28 PM
REPRESENTATIVE TARR asked if the proposed changes would impact
the benefits covered by Medicaid, noting that this proposed bill
was for private and group plans.
MS. LATHAM explained that the proposed bill only covered plans
regulated by the Division of Insurance, which included large
groups, small groups, and the individual market.
REPRESENTATIVE TARR referenced House Bill 234 in 2016 which did
not include a section regarding licensure by the state.
3:36:34 PM
REPRESENTATIVE TARR said that HB 358 would be held over.