03/02/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

            SB  78-HEALTH CARE SERVICES BY TELEHEALTH                                                                       
                                                                                                                                
                                                                                                                                
2:37:07 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 78                                                                  
"An Act  relating to telehealth."  He asked Senator  Costello and                                                               
her staff to the table.                                                                                                         
                                                                                                                                
2:37:40 PM                                                                                                                    
KATIE  MCCALL,   Staff,  Senator   Mia  Costello,   Alaska  State                                                               
Legislature, Juneau, Alaska, said  that in January 2021, Governor                                                               
Dunleavy  asked  the  legislature  to extend  the  public  health                                                               
disaster emergency  with the  passage of  SB 56,  a comprehensive                                                               
bill with  numerous provisions. The legislature  instead passed a                                                               
resolution asking the governor to  issue a new emergency disaster                                                               
declaration as there was not enough  time for SB 56 to go through                                                               
the legislative  process before the  expiration of  the emergency                                                               
disaster declaration in effect at  the time. In the meantime, the                                                               
legislature  has taken  individual sections  from the  governor's                                                               
bill  and  created  separate  legislation  to  address  different                                                               
provisions.  SB 78  was  taken  directly from  Section  6 of  the                                                               
governor's bill  to address telehealth expansion.  The purpose of                                                               
introducing  this bill  is  to give  the  legislative branch  the                                                               
opportunity to  determine whether  statutes should be  more COVID                                                               
aware rather  than rely on  an emergency disaster  declaration in                                                               
order  to  keep  the  state operational.  The  Senate  Labor  and                                                               
Commerce Committee intends to rely  heavily on the administration                                                               
to explain why  certain sections in the  disaster extension bill,                                                               
such as  the provisions now  found in  SB 78, are  necessary. The                                                               
Senate  Labor and  Commerce  Committee has  no  position on  this                                                               
bill.  The committee  is  introducing  it as  a  courtesy to  the                                                               
administration due to the expiration  of the disaster declaration                                                               
and provisions in the bill have no way to continue.                                                                             
                                                                                                                                
2:39:52 PM                                                                                                                    
SENATOR COSTELLO  explained that  this is  one of  several pieces                                                               
moving through the  process and that her office  has been working                                                               
with  the  committee  chair, administration,  and  Director  Sara                                                               
Chambers in  the Department of  Commerce, Community  and Economic                                                               
Development (DCCED,) in addition  to stakeholders. Changes can be                                                               
made to  the bill  to address  temporary needs  of the  state and                                                               
long-term  changes  to  make  statutes   more  COVID  aware.  The                                                               
committee  will probably  hear testimony  today in  opposition to                                                               
this version  of the bill, but  she is hopeful that  based on her                                                               
conversations with  the stakeholders and the  administration that                                                               
the bill  can be  crafted to meet  the needs of  the state  as it                                                               
moves  into the  recovery stage  of the  pandemic. The  chair has                                                               
also introduced a  measure that has passed the  Senate that makes                                                               
some laws more COVID aware.                                                                                                     
                                                                                                                                
2:41:17 PM                                                                                                                    
SENATOR  BEGICH noted  that the  bill  has no  effective date  or                                                               
expiration. He asked if that is intentional.                                                                                    
                                                                                                                                
MS. MCCALL  replied that the chair  of this committee and  of the                                                               
Senate   Labor  and   Commerce  Committee,   [Senator  Costello],                                                               
discussed adding  a sunset  date to the  bill. If  providers from                                                               
out  of  state never  become  licensed  in  the state,  they  can                                                               
continue  to  practice telehealth  as  long  as  the bill  is  in                                                               
effect. A sunset date would  not allow those services to continue                                                               
indefinitely.                                                                                                                   
                                                                                                                                
SENATOR  BEGICH said  that without  an effective  date, the  bill                                                               
would take effect 90 days after the end of the session.                                                                         
                                                                                                                                
MS. MCCALL replied that is something to look at changing.                                                                       
                                                                                                                                
SENATOR  BEGICH  pointed out  that  without  an expiration  date,                                                               
there  will be  a loss  of  professional licensing  fees for  the                                                               
state of  Alaska. He asked if  there had an analysis  of that and                                                               
any  other  impact  that  it   would  have  on  licensed  Alaskan                                                               
residents.                                                                                                                      
                                                                                                                                
2:43:17 PM                                                                                                                    
SENATOR   COSTELLO   replied   that   the   governor's   disaster                                                               
declaration stated  that there would  be no changes  to licensing                                                               
fees.  The  administration  intention  would  be  no  changes  or                                                               
impacts to the  fees with the disaster declaration,  but the fees                                                               
are directly  related to  activities that have  to be  pursued by                                                               
the licensing  board. She  had a  concern about  that. This  is a                                                               
good opportunity for the administration  to explain its rationale                                                               
for that.  She understands that  some Alaskans who  have traveled                                                               
outside the  state for care.  For example, one  person's daughter                                                               
has cancer.  With the ability  to travel curtailed by  COVID, the                                                               
parent  wants to  continue to  see that  provider who  is out  of                                                               
state.  Not many  Alaskans are  affected by  this provision,  but                                                               
enough Alaskans are that it  is necessary to allow that continuum                                                               
of care to  continue. It would make sense for  the bill to become                                                               
effective  immediately with  a  sunset  date so  that  it can  be                                                               
reviewed.  She  does  not  know   what  the  impact  will  be  on                                                               
licensure, but perhaps Sara Chambers does.                                                                                      
                                                                                                                                
2:44:55 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development (DCCED),  Juneau, Alaska,  said her  agency                                                               
submitted  an  indeterminate  fiscal  note because  the  bill  as                                                               
written would change  policy permanently and has  no sunset date.                                                               
Her agency could not determine the loss of revenue to self-                                                                     
funded  boards. This  is potentially  a short-term  bill in  this                                                               
season  of COVID,  so  there  is less  concern  about the  fiscal                                                               
impact. It is  focused on a smaller constituency and  not a long-                                                               
term change  to do away  with licensing for all  telemedicine. As                                                               
the bill  is written now,  the fiscal note is  indeterminate, but                                                               
it would create a loss of revenue.                                                                                              
                                                                                                                                
SENATOR REINBOLD  said that SB  56 is a  big bill. It  is amazing                                                               
that  Senator  Costello  pulled  this  section  out  to  work  on                                                               
independently.  She  thanked  Senator   Costello  for  that.  The                                                               
legislature has worked on telehealth  in the past and worked hard                                                               
with  physicians on  Alaskan preference  for telehealth.  That is                                                               
important.  She supports  telehealth  but there  is nothing  like                                                               
meeting someone in person. She  wants sidebars on that. She wants                                                               
to  review  the  committee  discussion  on  SB  56  and  work  on                                                               
amendments.                                                                                                                     
                                                                                                                                
SENATOR  HUGHES asked  if this  applies to  behavioral health  as                                                               
there are a lot of mental  health needs right now. Telehealth has                                                               
been  the  platform  for  that  during  the  pandemic.  For  some                                                               
families  in rural  areas, it  could still  be helpful  even when                                                               
there is not  a pandemic. She asked if the  bill covers a variety                                                               
of provider types, including behavioral health providers.                                                                       
                                                                                                                                
2:48:38 PM                                                                                                                    
MS. MCCALL  replied that the  bill does not  specifically address                                                               
behavioral health providers,  but the topic came up  in a meeting                                                               
with  the   administration.  Department  of  Health   and  Social                                                               
Services (DHSS)  mentioned that  federal public  health addresses                                                               
that issue.                                                                                                                     
                                                                                                                                
CHAIR WILSON  said that  through federal  regulations, behavioral                                                               
health is covered  in the federal disaster  declaration, so their                                                               
guidance for  telehealth and some  of the waivers  will continue.                                                               
The department  has assurance from the  Biden administration that                                                               
that will  continue through  the end of  calendar year  2021. His                                                               
office  has been  working on  that. It  is clear  that behavioral                                                               
health is covered.                                                                                                              
                                                                                                                                
SENATOR HUGHES thanked  the chair for looking  into that. Because                                                               
of Alaska's  geography and  how spread  out the  state is,  it is                                                               
important that  behavioral health  providers continue  to provide                                                               
services through  telehealth. She asked  if anyone is  working on                                                               
that for once the federal disaster declaration ends.                                                                            
                                                                                                                                
CHAIR WILSON said that his office  is looking to continue that as                                                               
an  end-state  license process.  Through  working  with the  bill                                                               
sponsor, his  understanding is that  an end date is  being looked                                                               
out   for  the   out-of-state  licensees.   Regular  boards   and                                                               
commissions  will  still  have jurisdiction  over  those  medical                                                               
providers  in the  state  and  they follow  the  same process  to                                                               
become licensed medical providers.                                                                                              
                                                                                                                                
SENATOR HUGHES  clarified that she  is asking  specifically about                                                               
behavioral health.                                                                                                              
                                                                                                                                
CHAIR WILSON  replied all health practitioners  of healthcare and                                                               
behavioral health and  dental would be covered.  They are looking                                                               
at any licensed person obligated to provide telehealth.                                                                         
                                                                                                                                
SENATOR BEGICH  said that federal behavioral  health waivers will                                                               
go away  at the end of  the calendar year. He  clarified that the                                                               
chair  is  looking at  something  more  comprehensive that  would                                                               
apply to any provider. He  is in agreement with Senator Reinbold.                                                               
Parameters  or sideboards  are important  to  protect the  Alaska                                                               
workforce. He  knows the chair will  be looking at that  in terms                                                               
of expiration  dates and licensing  issues. That is the  issue in                                                               
all his questions.  He asked who is going to  enforce and monitor                                                               
the healthcare  practitioners who  are not licensed  and residing                                                               
in the state and who ensures  they are in good standing. The bill                                                               
doesn't seem  to address  that. He doesn't  know what  will cover                                                               
that or  to ensure practitioners  are acting within the  scope of                                                               
their  expertise. The  committee has  discussed the  Prescription                                                               
Drug Monitoring  Program with the  State Medical Board.  He asked                                                               
what the  prescribing process is.  There could be  different laws                                                               
around  prescriptions.  These are  the  issues  he wants  to  see                                                               
addressed. Those  monitoring costs  have to  be reflected  in the                                                               
fiscal note at some point.                                                                                                      
                                                                                                                                
MS.  MCCALL said  that  for prescribing,  the  bill mentions  the                                                               
services provided have to be  within the scope of practice within                                                               
the   jurisdiction  that   providers  are   licensed.  Based   on                                                               
conversations she  has had with Legislative  Legal, licenses tend                                                               
to be  fairly uniform. Her  office hasn't  had a chance  to reach                                                               
out  to  Legislative  Research to  look  at  different  licensing                                                               
provisions and  where there  might be  discrepancies. Legislative                                                               
Legal was  not concerned that  there would be  major differences,                                                               
but that will be looked at more.                                                                                                
                                                                                                                                
SENATOR  BEGICH said  that an  easier answer  might be  to simply                                                               
require providers to meet Alaska's own standards.                                                                               
                                                                                                                                
2:54:38 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
2:54:46 PM                                                                                                                    
SARAH  HETEMI, representing  self, Anchorage,  Alaska, said  that                                                               
she was  happy that  Governor Dunleavy  asked the  legislature to                                                               
extend the public  health disaster emergency with  the passage of                                                               
SB 56.  She was  especially happy  about Section  6 of  the bill,                                                               
which related to the issue  of telehealth expansion. Telemedicine                                                               
is  a big  part of  the future.  COVID-19 showed  that more  than                                                               
ever.  The state  needs to  empower its  healthcare providers  to                                                               
deliver telemedicine as  it is a crucial  component of healthcare                                                               
reform  that   will  increase   access  to   all.  It   could  be                                                               
lifechanging in terms of cost  savings. Individuals who reside in                                                               
underserved  rural and  urban communities  have  to wait  longer,                                                               
travel further, and  ultimate pay more for  healthcare. The state                                                               
has the ability and opportunity  to significantly improve service                                                               
to these  individuals. This bill should  have bipartisan support.                                                               
It is  an opportunity to make  statutes more up to  date and more                                                               
COVID-19 aware  instead of relying  on the  emergency declaration                                                               
alone.                                                                                                                          
                                                                                                                                
2:56:53 PM                                                                                                                    
PORTIA  NOBLE, representing  self, Anchorage,  Alaska, said  that                                                               
Alaskans  need  more  accessibility  and  convenience,  not  just                                                               
during  a pandemic.  In December  of 2020,  over 30  policy think                                                               
tanks and  grassroots organizations united to  urge policy makers                                                               
across the  country to permanently  enact and  enhance telehealth                                                               
capabilities and remove as many  barriers as possible. Healthcare                                                               
groups,  clinics,  and  hospitals  in the  last  two  years  have                                                               
innovated and  invested in  telehealth capabilities.  Pandemic or                                                               
not, there is a great opportunity  to embrace and expand the free                                                               
market  in  healthcare.  Alaska   has  seen  barriers  eliminated                                                               
specifically  because of  telemedicine. She  agrees with  Senator                                                               
Reinbold about the in-person relationship  with a doctor, but she                                                               
sees interesting  statistics that providers increased  the number                                                               
of weekly  telehealth consultations  for Medicare  enrollees from                                                               
13,000  to 1.7  million.  That statistic  should  be embraced  to                                                               
support elders in  Alaska and across the  country. She encouraged                                                               
the committee  to move forward with  SB 78 and other  free market                                                               
health  bills to  improve accessibility  and convenience  for all                                                               
Alaskans.                                                                                                                       
                                                                                                                                
2:58:47 PM                                                                                                                    
RYAN MCKEE, Americans for Prosperity,  Wasilla, Alaska, said this                                                               
is a  great step in  giving the public  an easier way  to connect                                                               
with doctors.  Some may choose  to go  out of state,  but Senator                                                               
Reinbold is  a big supporter  of choice. Individuals  should have                                                               
this choice in healthcare of  whether to seek healthcare in state                                                               
or out  of state.  Across the  nation more  states are  moving to                                                               
allow telemedicine to be used  more widely. Alaska has many rural                                                               
communities  where  access to  healthcare  is  often a  struggle.                                                               
Telehealth can help. Many cancer  patients are doing telemedicine                                                               
appointments right now.  That is especially a  benefit during the                                                               
pandemic.  Telehealth   offers  important  alternative   to  some                                                               
services. Alaska will gain from having it.                                                                                      
                                                                                                                                
3:01:16 PM                                                                                                                    
CHAIR  WILSON  closed   public  testimony  and  held   SB  78  in                                                               
committee.