Legislature(2013 - 2014)SENATE FINANCE 532
03/18/2014 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB108 | |
| SB80 | |
| SCR16 | |
| HB23 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SCR 16 | TELECONFERENCED | |
| += | HB 23 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | SB 80 | ||
| = | SB 108 | ||
SENATE BILL NO. 80
"An Act relating to the practice of telemedicine and
relating to licenses for out-of-state physicians or
podiatrists to practice telemedicine in this state
under certain circumstances."
9:14:16 AM
Senator Dyson explained that SB 80 introduced into Alaska's
Medical Practice Act the practice of telemedicine, sets
parameters for prescription of controlled substances
without an in-person contact between physician and patient,
establishes a definition for telemedicine, and provides
that health care insurers may not require in-person contact
between a health care provider and patient before payment
is made for services. With Alaska's large rural and remote
areas, the need for telemedicine is especially acute with
much of the state designated as medically underserved by
the federal Health Resources and Services Administration.
The legislation will provide expanded opportunity for
health care delivery for individuals and businesses
throughout Alaska. Currently, the only delivery of
telehealth in Alaska is via the Alaska Federal Health Care
Access Network (AFHCAN), established in 1998 to provide
telehealth services for federal beneficiaries in Alaska,
including Alaska Natives. The Alaska Native Tribal Health
Care Consortium (ANTHC) manages the telehealth program and
provided statewide health and information technology
services to Alaska Natives and American Indians, in
additions to supporting the local tribal health
organizations. The bill will allow the cost-saving and
efficiencies of telehealth to be delivered to the many
other constituencies in Alaska that do not qualify to
participate in the ANTHC telehealth program. In Alaska and
nationwide, the ongoing discussion of how to provide
greater access to health care at a reasonable cost is
becoming ever more relevant. Telemedicine is emerging as a
key element in the delivery of health services to children,
seniors, and other vulnerable populations through the
integration of technology and provider car. The Patient
Protection and Affordable Care Act is leading to increased
demand that physicians interact with more patients.
Telemedicine allows physicians to consult with more
patients, and enables patients to meet with their
physicians in a shorter time period. In terms of economic
advantages, telemedicine saves travel time and expense for
patients who otherwise have to leave home and work to see a
health care provider, provides for more timely diagnosis of
ailments, and reduces unnecessary ER visits.
9:19:24 AM
Mr. Kopp stated that the build out recipient of the state's
broadband network in Southwest and Western Alaska the
ANTHC, which created the Alaska Federal Health Care Network
expanding telemedicine statewide. He announced that GCI had
employees in very remote locations, and were using
telemedicine. The physicians were given a Cease and Desist
order, because, under state regulations, prescription of
medication or diagnosis of a patient must not be done based
solely on a patient-supplied history. In order for a
physician to prescribe medication, there must be an in-
person visit. He stressed that the regulations were old
fashioned, and enacted before telehealth was advanced.
Alaska Natives and federal entities had access to the
current telehealth network, but others would not be allowed
access. The legislation sought to allow those people to
take part in the telehealth network. He stressed that the
cost of a trip to a medical clinic for some Alaskans was
extremely expensive. He pointed out that the ANTHC
announced that telehealth had saved over $10 million in
travel costs for the clientele that were served. The
legislation introduced into statute the practice of
telemedicine. The sponsor met twice with the State Medical
Board, and had conversations to conclude on the current
language in the bill. He stated that the Department of
Corrections (DOC) requested an exception to continue
prescribe controlled substances electronically, due to the
DOC diversity that were going through withdrawals or have
behavioral disorders while incarcerated.
9:22:57 AM
Mr. Kopp stated that the bill was in line with other
states' that allowed for physical examinations to take
place electronically: California, Kansas, Maryland, New
Mexico, Ohio, Texas, Vermont, Hawaii, Louisiana, Nevada,
North Carolina, South Dakota, and Virginia. He presented
the sectional analysis (copy on file):
Section 1 - Adds a new section in the Medical Practice
Act (AS 08.64) establishing the practice of
telemedicine. Remains unchanged.
Section 2 - Clarifies how prescription of drugs
without a physical examination is to occur by setting
three requirements: 1) the prescription drug is not to
be a controlled substance, 2) the physician is located
in the state and able to provide follow-up care, and
3) the person consents to sending a copy of records of
the encounter to their primary care provider if the
prescribing physician is not their primary care
provider and the physician sends the records to the
primary care provider. It deletes the license for out
of state physician or podiatrist to practice
telemedicine.
Section 3 - Creates a definition for the practice of
telemedicine by adding a new paragraph to the Medical
Practice Act's definition section AS 08.64.380. It
deletes the langrage pertaining to personal interview
requirements for physician licensure for out-of-state
telemedicine license.
Section 4 - Adds a new section to the state insurance
code and provides that an insurance company that
offers a health care insurance plan that provides
coverage for telemedicine may not require that prior
in person contact occur between doctor and patient
before payment is made for covered services. It
deletes the language amending the license fee statute
and add an out-of-state license fee.
Section 5 - Provides an effective date for
applicability of new section AS 21.54.102 dealing with
health care insurance plans.
9:26:28 AM
Senator Olson queried the reason the physician should be
located within the state. Mr. Kopp responded that the
provision was included, because the physician must be
available for follow-up care.
Senator Olson wondered if he could treat patients while on
vacation. Mr. Kopp responded that medical regulation
already provided exception for existing physician-patient
relationships.
Senator Olson felt that Section 2 allowed for prescribing
medication without a physical examination. Mr. Kopp replied
that there an exception already outlined in regulation.
Senator Dyson furthered that the Medical Board was fairly
conservative, and there was some concern regarding some
large national firms that were currently practicing
telemedicine nationwide. He remarked that the medical board
wanted to preserve the traditional doctor/patient
relationship.
Senator Olson wondered if the Alaska Medical Association
was supportive of the legislation. Mr. Kopp replied that
the board may be neutral, and may be supportive. The
Association did not support the out-of-state licensing of
physicians.
Senator Olson asked if the Alaska State Medical Board
supported the bill. Mr. Kopp replied that the Board asked
for the removal of out-of-state licensing. He furthered
that the sponsor had been working with the association, and
he believed that the association was in support of the
legislation.
Senator Olson queried the position of the Alaska Medical
Association. Mr. Kopp responded that they were supportive
of the legislation.
Senator Olson asked for the position of the Alaska State
Medical Board. Mr. Kopp replied that they were either
neutral or in support, but not in opposition to the
legislation.
9:31:17 AM
Senator Olson wondered if there were conversations with the
rural providers to see how they view the legislation.
Senator Dyson replied that he believed there was enthusiasm
from the rural communities and rural medical centers.
Senator Olson stressed that there were some private
physicians that were treating patients. He queried the
position of these private providers. Mr. Kopp replied that
the sponsor had not received a position statement from
those providers.
Co-Chair Meyer remarked that the file did not contain many
position letters, so it was assumed that most people were
neutral on the legislation.
Co-Chair Meyer wondered if the Labor and Commerce
subcommittee's concerns had been addressed. Senator
Dunleavy replied in the affirmative.
Co-Chair Meyer wondered if there was a new fiscal note
forthcoming. Mr. Kopp replied that there was a new fiscal
note forthcoming.
Co-Chair Meyer stressed that DOC had some concerns, and
would perhaps comment on the fiscal note.
9:35:27 AM
LAURA BROOKS, HEATH CARE ADMINISTRATOR, DEPARTMENT OF
CORRECTIONS, introduced herself.
ROBERT LAWRENCE, DOCTOR, CHIEF MEDICAL OFFICER, DEPARTMENT
OF CORRECTIONS, introduced himself.
Ms. Brooks stated that DOC had worked with the sponsor on
some of the language of the bill. She stated that DOC was
one of the first agencies to use telemedicine in order
provide improved medical services to inmates across the
state. Psychiatrists began using telemedicine in 1998.
Telemedicine had allowed DOC to defer some significant
costs that would have been incurred, if the facilities were
staffed. Telemedicine was an integral part of the DOC's
operations. The wording in the bill related to controlled
substances could impact DOC in the area of psychiatry, for
the new inmates that had mental health crisis. The tele-
psychiatry allowed for safe and immediate intervention for
inmates experiencing a mental health crisis. She stated
that DOC was a 24-hour provider, so there was a 24-hour on-
call system, so a physician was always available.
Prescribing controlled substances was common for those on-
call providers, because the vast majority of the highly
intoxicated arrestees come in after hours, and were at a
high risk for alcohol withdrawal that could be life-
threatening. She estimated that approximately 3000 of those
controlled substance prescriptions were written annually,
just for that segment of the inmate population. She
remarked that DOC did not have policy concerns with the
legislation, but was concerned with the language in order
to continue to provide the services to inmates.
Dr. Lawrence stressed that there were different types of
telemedicine in the state. He explained that one type of
telemedicine was provider to provider communication, and
direct patient to provider communication. Both of the forms
of telemedicine were approved by the State Medical Board.
The legislation addressed a third type of telemedicine
where a patient was able to contact a medical provider
directly, without the existence of a prior doctor/patient
relationship. He stressed that DOC wanted to ensure that
there was no negative impact on the history of
telemedicine.
9:40:54 AM
Co-Chair Meyer wondered if the legislation included the
amended language. Dr. Lawrence replied that DOC was
currently working with the bill sponsor to draft language
that accommodates the forms of telemedicine that were
currently in practice.
Co-Chair Meyer wondered if there would be a fiscal impact
to DOC in the forthcoming fiscal note. Ms. Brooks did not
anticipate any change to the fiscal note.
Senator Olson expressed concern regarding the issue of
licensing medical practitioners. He wanted to ensure that
the medical providers were clearly following the law. Dr.
Lawrence replied that the language was included in order to
ensure that the allowance was not maliciously used, without
the relationship already established. The FDA gave
different levels of the prescription of controlled
substances, which restricted the prescription through
telemedicine regardless of state law allowance. The other
scheduled medicines were just as equally problematic in the
small communities, because of the potential for abuse.
Those restrictions must be in place without a prior
doctor/patient relationship, to ensure that both parties
understand the use of the medication.
Senator Olson noted that a person agrees to send a copy of
medical records to their primary care provider, but
stressed that many rural residents did not have a primary
care provider. He wondered if that was taken into
consideration. Dr. Lawrence replied that DOC never faced
that issue. He could not speak to how other physicians in
the state would respond to that.
Senator Olson stressed that those people who did not have
any health care coverage or protection should not be at
risk of losing their licenses. Dr. Lawrence recognized
that there was a fear of telemedicine hampering the
business side of medicine in the state.
Co-Chair Meyer stated that the new language would be
incorporated into a forthcoming committee substitute.
9:48:41 AM
DAVE POWERS, DOCTOR, BRISTOL BAY HEALTH, DILLINGHAM (via
teleconference), addressed some concerns regarding the
legislation. When he moved to Alaska in 1984, he worked in
Anchorage. At the time, he was told that each small village
had a medical provider. He found that to be true when he
worked in each village. He felt that there was better
medical care in rural Alaska than there was in rural
Colorado and Idaho. He worked to get telemedicine, as it
currently stands, in 1998, which rapidly became relied
upon. He felt that virtually no one was restricted from the
telemedicine use. He stressed that the interaction with
health aides was essential for telemedicine, so there were
no laws broken with regard to a patient's history and vital
signs. He remarked that the legislation made it seem like
the practices were not already occurring. He felt that it
made the common practices illegal.
9:55:30 AM
Co-Chair Meyer wondered if the State Medical Board was in
support of the bill. Dr. Powers responded that the
legislation was intended for those in rural Alaska with no
access to health care. He stated that the current system
was in almost every village in Alaska, and there were no
restrictions for the Natives to use that system.
Senator Olson wondered if the legislation defined the
boundaries more clearly. Dr. Powers replied that the bill
did not clarify telemedicine, and only raised concerns.
Senator Olson asked that Dr. Powers examine the forthcoming
committee substitute.
Co-Chair Meyer felt that some concerns would be address in
the forth-coming committee substitute.
HENRY PHILLIPS, DOCTOR, TELADOC, NASHVILLE (via
teleconference), addressed some concerns regarding the
legislation. He pointed out that the Medical Board took
action against some physicians in his program to pull some
licenses. The board had announced that they were against
telehealth, at least in certain circumstances. There were
approximately 15 million Americans that were in telehealth
programs, and would probably double in the next year.
Telehealth helped to solve a rural access issue. The
legislation allowed for someone to stay in their location,
and contact a physician that they do not have a previous
relationship with and not travel to that location. He
stated that 50 percent of telehealth occurred in rural
areas and the other 50 percent occurred in urban settings.
He stated that it was still difficult access your provider
in a timely manner. The legislation allowed for access to
telehealth to all Alaskans.
10:02:33 AM
SHEELA TALLMAN, PREMERA BLUE CROSS BLUE SHIELD, SEATTLE
(via teleconference), stated that she was available for
questions.
Vice-Chair Fairclough wondered how the insurance would be
handled for a person who did not have a physical
appointment with a physician. Ms. Tallman replied that
telemedicine services were provided, and she was only aware
of it if a provider used a modifier with a claim submitted.
Vice-Chair Fairclough asked if insurance companies covered
telemedicine. Ms. Tallman responded that Premera covered
telemedicine services, as long as the service is covered
under the policy.
RON HALE, HOSPITAL ADMINISTRATION, ALASKA PSYCHIATRIC
INSTITUTE, ANCHORAGE (via teleconference), introduced
himself.
Co-Chair Meyer CLOSED public testimony.
Senator Olson queried Mr. Hale's position on the
legislation. Mr. Hale replied that he could not provide an
opinion, because he was a state employee. He wanted to work
with the sponsor to enhance the language of the bill.
Senator Olson wondered if Mr. Hale had the language of the
new committee substitute. Mr. Hale replied that he had not
seen the new committee substitute.
SB 80 was HEARD and HELD in committee for further
consideration.
10:07:12 AM
AT EASE
10:08:53 AM
RECONVENED