04/09/2019 09:00 AM Senate FINANCE

SENATE BILL NO. 44                                                                                                            
                                                                                                                                
     "An  Act relating  to the  prescription of  drugs by  a                                                                    
    physician assistant without physical examination."                                                                          
                                                                                                                                
9:06:43 AM                                                                                                                    
                                                                                                                                
SENATOR CATHY  GIESSEL, SPONSOR, explained that  the goal of                                                                    
SB  44 was  to  increase access  to  medical and  behavioral                                                                    
health  in the  state.  She shared  that  the 2016  Medicaid                                                                    
Reform bill  (SB 74) provided  for the use of  telehealth by                                                                    
revising  Alaska  statutes  to   require  the  Alaska  State                                                                    
Medical  Board  to  adopt  regulations  and  guidelines  for                                                                    
physicians  rendering a  diagnosis, providing  treatment, or                                                                    
prescribing,  dispensing,  or administering  a  prescription                                                                    
drug to  a person without conducting  a physical examination                                                                    
under AS 08.64.364. She furthered  that SB 74 only addressed                                                                    
physicians, and  the Board's  interpretation was  the bill's                                                                    
provisions should  not apply to physician  assistants (PAs),                                                                    
and issued  guidelines outlining different  requirements for                                                                    
PAs  and physicians.  This has  effectively barred  PAs from                                                                    
practicing  telemedicine, requiring  them  to first  conduct                                                                    
in-person examinations.  She offered a brief  history of the                                                                    
role of  PAs. She  spoke to a  document in  members  packets                                                                    
that outlined the education and  experience required for Pas                                                                    
(copy on  file). She relayed that  education included taking                                                                    
medical histories,  doing physical  exams, lab  testing, and                                                                    
prescribing  medications. She  shared  that, typically,  the                                                                    
education  of a  PA  lasted 27  months,  with usual  medical                                                                    
rotations:  medical   and  surgical,  family   and  internal                                                                    
medicine,  pediatrics,  obstetrics, emergency  medicine  and                                                                    
psychiatry.  She  said  that PAs  complete  2,000  hours  of                                                                    
supervised  clinical practice.  Nearly  all PAs  educational                                                                    
programs were masters   degrees and would be  required to be                                                                    
so by 2020.                                                                                                                     
                                                                                                                                
9:10:11 AM                                                                                                                    
                                                                                                                                
Senator  Giessel  noted  the   Alaska  State  Medical  Board                                                                    
guidelines  for  PAs  (copy  on file).  She  said  that  the                                                                    
collaborative  practice agreement  must  be maintained  with                                                                    
the  PAs physician  supervisor. The  collaborating physician                                                                    
authorized where the PA could  practice and what medications                                                                    
they could  prescribe. The  agreement also  required monthly                                                                    
contact with the supervision physician.  She shared that, in                                                                    
Alaska, PAs were authorized  to prescribe certain controlled                                                                    
substances.   She  said   that   SB  44   would  allow   the                                                                    
approximately 700  PAs in the  state the ability  to provide                                                                    
telemedicine in the same manner  as physicians. She revealed                                                                    
that  prior to  SB 74,  PAs had  been able  to provide  this                                                                    
function, she  lamented that this  was a consequence  of the                                                                    
passage  of that  bill. She  detailed  the available  backup                                                                    
that could be found in member packets and online.                                                                               
                                                                                                                                
9:12:58 AM                                                                                                                    
                                                                                                                                
Senator Shower thought the bill might drive down costs. He                                                                      
asked whether there was potential to lower healthcare costs                                                                     
by providing telemedicine rather than paying for travel.                                                                        
                                                                                                                                
Senator Giessel answered in the affirmative.                                                                                    
                                                                                                                                
9:13:58 AM                                                                                                                    
                                                                                                                                
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, discussed the                                                                        
Sectional Analysis (copy on file):                                                                                              
                                                                                                                                
     Section 1:                                                                                                             
     Amends  AS 08.64.101(a)(6)  by requiring  the board  to                                                                    
     adopt regulations for  a physician assistant practicing                                                                    
     telehealth   under   AS   08.64.364,   and   that   the                                                                    
     regulations must  use a  recognized national  model for                                                                    
     standards of telehealth care.                                                                                              
                                                                                                                                
     Section 2:                                                                                                             
     Amends  AS  08.64.364(a)  by saying  that  disciplinary                                                                    
     action cannot be directed  toward a physician assistant                                                                    
     for prescribing  drugs via telehealth if  the drugs are                                                                    
     not  controlled substances,  if follow  up care  can be                                                                    
     provided  from its  medical group,  and if  consent has                                                                    
     been  given by  the  patient for  care  and sharing  of                                                                    
     records to the primary care provider.                                                                                      
                                                                                                                                
     Section 3:                                                                                                             
     Amends  AS  08.64.364(b)  by saying  that  a  physician                                                                    
     assistant  may administer  botulinum  toxin (Botox)  if                                                                    
     they  meet all  the requirements  set out  in 08.64.363                                                                    
     and  is supervised  by an  appropriate licensed  health                                                                    
     care provider.                                                                                                             
                                                                                                                                
     Section 4:                                                                                                             
     Amends AS  08.64.364(c) by renumbering and  adds that a                                                                    
     physician  or physician  assistant  may not  prescribe,                                                                    
     dispense  or  administer  a prescription  drug  via  an                                                                    
     Internet questionnaire or  email message without having                                                                    
     a prior patient/doctor relationship.                                                                                       
                                                                                                                                
     Section 5:                                                                                                             
     Adds an effective date of March 1, 2020                                                                                    
                                                                                                                                
9:16:19 AM                                                                                                                    
Senator Wielechowski asked for the rationale for changing                                                                       
 patient to person in Sections 2 and 3.                                                                                         
                                                                                                                                
Ms.  Conway  thought  "patient" was  medically  terminology,                                                                    
while "person"  was legal terminology; the  drafter chose to                                                                    
use the legal terminology.                                                                                                      
                                                                                                                                
9:16:54 AM                                                                                                                    
                                                                                                                                
Senator  Shower was  curious about  Section 3  pertaining to                                                                    
Botox. He asked  why botulinum toxin had  to be specifically                                                                    
named.                                                                                                                          
                                                                                                                                
Senator  Giessel  informed  that  there  had  been  existing                                                                    
statute and believed that because  botulinum was a paralytic                                                                    
agent, it had been specifically named.                                                                                          
                                                                                                                                
9:17:56 AM                                                                                                                    
                                                                                                                                
Co-Chair von  Imhof addressed  Section 5  and asked  why the                                                                    
effective date was chosen.                                                                                                      
                                                                                                                                
Ms. Conway relayed that the  sponsor had conferred with Sara                                                                    
Chambers from  the Division of Corporations,  Businesses and                                                                    
Professional Licensing who had recommended the date.                                                                            
                                                                                                                                
9:18:40 AM                                                                                                                    
                                                                                                                                
Co-Chair von Imhof OPENED public testimony.                                                                                     
                                                                                                                                
CHRISTOPHER  DIETRICH,  ORION   BEHAVIORAL  HEALTH  NETWORK,                                                                    
PALMER  (via teleconference),  testified in  support of  the                                                                    
bill. He provided  an overview of his work in  the state. He                                                                    
believed that the bill would  make it easier for patients to                                                                    
receive adequate treatment, particularly rural patients.                                                                        
                                                                                                                                
9:20:35 AM                                                                                                                    
                                                                                                                                
Co-Chair von Imhof CLOSED public testimony.                                                                                     
                                                                                                                                
Co-Chair  von  Imhof  asked if  the  committee  had  further                                                                    
comments.                                                                                                                       
                                                                                                                                
9:20:57 AM                                                                                                                    
                                                                                                                                
Senator   Wielechowski  felt   that  he   needed  a   better                                                                    
understanding of Section 4, (c)  (1), and the administration                                                                    
of abortion-inducing drugs.                                                                                                     
                                                                                                                                
DEBORA  STOVERN,  EXECUTIVE   ADMINISTRATOR,  STATE  MEDICAL                                                                    
BOARD,  ANCHORAGE  (via teleconference),  addressed  Senator                                                                    
Wielechowski's question  pertaining to the change  from  or                                                                     
to  and   under Section 4.   She did not know  the answer to                                                                    
the question  about changing "or"  to "and," and  mused that                                                                    
there  had been  a decision  by the  bill drafter  to assure                                                                    
that both  items (1) and  (2) would  be limited.   She added                                                                    
that the limitation already applied to physicians.                                                                              
                                                                                                                                
9:23:24 AM                                                                                                                    
                                                                                                                                
Senator Wielechowski  said that he would  research the issue                                                                    
further.                                                                                                                        
                                                                                                                                
Co-Chair von Imhof  relayed that her office  would assist in                                                                    
answering committee questions.                                                                                                  
                                                                                                                                
9:24:02 AM                                                                                                                    
                                                                                                                                
Senator  Micciche reviewed  FN 1  from DCCED,  OMB Component                                                                    
2360:                                                                                                                           
                                                                                                                                
     SB044  adds Physician  Assistants  (PAs) as  authorized                                                                    
     practitioners of  telemedicine.  When  the telemedicine                                                                    
     bill was  passed during a previous  Legislature, it was                                                                    
     specific  to physicians.  This bill  would expand  that                                                                    
     authority to physician assistants.                                                                                         
                                                                                                                                
     If the  bill passes the  division will require  $5.3 to                                                                    
     cover legal  costs to amend regulations,  printing, and                                                                    
     postage in the first year.                                                                                                 
                                                                                                                                
     Professional licensing programs  within the Division of                                                                    
     Corporations, Business  and Professional  Licensing are                                                                    
     funded by Receipt Supported  Services, fund source 1156                                                                    
     Rcpt  Svcs (DGF).  Licensing fees  for each  occupation                                                                    
     are  set  per  AS  08.01.065 so  the  total  amount  of                                                                    
     revenue    collected     approximately    equals    the                                                                    
     occupation's actual regulatory costs.                                                                                      
                                                                                                                                
SB  44  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
9:25:36 AM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
9:29:52 AM                                                                                                                    
RECONVENED