Legislature(2023 - 2024)ADAMS 519
05/08/2024 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB91 | |
| SB95 | |
| SB99 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 74 | TELECONFERENCED | |
| += | SB 75 | TELECONFERENCED | |
| + | HB 275 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 91 | TELECONFERENCED | |
| += | SB 95 | TELECONFERENCED | |
| += | SB 99 | TELECONFERENCED | |
| += | SB 228 | TELECONFERENCED | |
CS FOR SENATE BILL NO. 91(FIN)
"An Act relating to telehealth; relating to
multidisciplinary care teams; and relating to the
practice of medicine."
4:06:57 PM
SENATOR MATT CLAMAN, SPONSOR, read from prepared remarks:
Good afternoon, Co-Chairs and members of the House
Finance Committee. For the record, this is Matt
Claman, Senator for District H in West Anchorage.
Our office began work on Senate Bill 91 in the summer
of 2022 after we were contacted by a constituent who
had recently been diagnosed with ALS, a rare
degenerative disease that leads to paralysis and death
within 2 to 5 years. There is no cure for ALS.
Upon receiving her diagnosis, Sheila Swanson flew to
Seattle to receive specialty treatment at an ALS
multidisciplinary care clinic, where multiple types of
healthcare professionals work together to treat her
complex illness. The multidisciplinary care team model
of healthcare has become the standard of care for
people with ALS because it's proven to extend their
quality of life. When Sheila was ready to return home
after treatment, she was told that she could continue
to receive telehealth care from her physician, but she
would need to fly to Seattle to receive in-person care
from the other seven members of her multidisciplinary
care team, including a respiratory therapist, speech
language pathologist, a physical therapist, and other
health care providers.
Sheila travels each quarter to receive care from her
multidisciplinary care team, but there will come a day
that she is unable to do so. Sheila's written
testimony is included in your bill packet, and I
encourage you to read her letter to learn about her
experience.
Receiving the kind of care Sheila needs is not
possible in Alaska. There are about 30 Alaskans with
ALS diagnoses and no clinics that specialize in this
area of care. I would prefer for this healthcare to be
available in Alaska, but as a practical matter,
specialized care for rare diseases is available in
large cities with major medical centers and a higher
volume of patients.
In 2022, the legislature passed House Bill 265, which
created a framework in statute for various in-state
healthcare professions to practice telehealth and
ensured Alaskans' access to critical health care. SB
91 only amends House Bill 265 for out-of-state
providers by adding members of out-of-state
"multidisciplinary care teams" as an option for
telehealth when an Alaskan is suffering from a life-
threatening condition and the multidisciplinary care
is not reasonably available in-state.
To address patient protection, SB 91 ensures that all
out-of-state members of multidisciplinary care teams
are subject to Alaska's regulatory authority. SB 91
also aligns multidisciplinary care teams with the
current registration process for Alaska's telemedicine
business registry.
Senate Bill 91 will expand telehealth options so that
Alaskans with life-threatening health conditions can
receive the specialized care they need while remaining
at home and in their local support network whenever
possible.
Thank you for hearing this legislation today. If the
Committee would like, my staff, Claire Lubke, will
take you through a sectional analysis of the bill.
I'll be happy to answer any questions you may have.
4:10:53 PM
Co-Chair Foster moved to invited testimony.
GAIL BRATEN, SELF, ANCHORAGE (via teleconference), and TIM
JENNINGS, SELF, ANCHORAGE (via teleconference), testified
at the same time. Mr. And Ms. Braten were both long-time
residents of Alaska. Mr. Braten shared that he has
Amyotrophic Lateral Sclerosis (ALS). Ms. Braten stated that
healthcare for ALS was a challenge and SB 91 would allow
the Braten's to remain in Alaska for part of the treatment
via telehealth. The disease was tremendously difficult, and
the disease progresses rapidly with the loss of bodily
functions. She stressed that there was no known cure, but
research was advancing at a fast pace. She shared that they
were informed that a multidisciplinary collaborative
approach among a multiple disciplined healthcare team
provided that best care. Alaska lacked specialized,
multidisciplinary care teams for ALS and other rare, life-
threatening diseases. She delineated that they travelled to
the Mayo Clinic in Rochester, Minnesota in February 2024 to
attend an ALS Multidisciplinary Clinic. They met with a
neurologist, physical rehabilitation specialist, speech
pathologist, registered dietician, occupational therapist,
respiratory therapist, research coordinator for clinical
trials, and a social worker. It was recommended that we
attend the clinic every 3 months. Travel was time
consuming, expensive, and eventually, it would become more
and more difficult to travel. However, Mr. Braten would
still need the expertise and developing therapies found at
the Mayo Clinic. Telemedicine with the healthcare team will
be key to managing his disease, but unless SB 91 passes,
that will not be an option. She emphasized that time was
critical for Mr. Braten to continue his multidisciplinary
care. She urged the committee to adopt the legislation. Ms.
Braten thanked the committee.
4:15:33 PM
Co-Chair Foster OPENED public testimony.
EMILY NENON, ALASKA GOVERNMENT RELATIONS DIRECTOR, AMERICAN
CANCER SOCIETY AND CANCER ACTION NETWORK, favored the
legislation. She voiced that telehealth created more
options in healthcare. She reported that 85 percent of all
cancer care was available locally. However, for a small
number of patients outside access to care was critical. She
exemplified a follow up appointment after treatment or
surgery as a reason for telehealth. A telehealth
appointment would allow the patient to continue care
relieving the burden of travel.
Representative Hannan recounted that the bill had been
described to be related to terminal diagnoses. She asked if
all individuals with a cancer diagnosis would be able to
receive services via telehealth. Ms. Nenon answered that
when the original telehealth bill was adopted the
definition of life threatening was included and currently
in statute. She delineated that the definition was based on
federal law that applied to any condition that without
intervention a person's life would be shortened. Therefore,
without intervention the condition would progress, and it
applied to stage 1 cancer and other conditions. She
concluded that it applied to timely intervention.
4:19:23 PM
Representative Galvin asked about deep depression and
anything along the lines of mental health. She asked
whether telehealth applied if one could not get the care in
Alaska. Ms. Nenon replied that she was not a healthcare
provider. She thought that there were many mental health
conditions that could be life threatening without proper
intervention.
4:20:28 PM
BEVERLY WOOLEY, SELF, BIG LAKE (via teleconference), spoke
in support of the legislation. She elaborated that HB 265
(Health Care Services by Telehealth, Chapter 38 SLA 22,
07/13/2022) created a statutory framework for telehealth
provided by out-of-state physicians offering greater access
to care. The bill went further allowing multidisciplinary
care teams to also participate in telehealth. She shared
that she was a 20 year cancer survivor and often needed to
travel out-of-state for care related to earlier treatment.
She delineated that treating cancer was complex and often
required a multi-disciplinary team; the standard of care at
cancer center throughout the world. Currently, telehealth
with out-of-state providers were only allowed between the
patient and the physician. However, much of her care and
the care of other cancer patients was provided by other
members of the physician's team like a nurse or physical
therapist, etc. She emphasized that it would be a great
benefit to her and other Alaskans to receive care via
telehealth without having to fly out of state for a brief
or follow up appointment. The bill would alleviate much of
the issues regarding travelling for follow up appointments
with members of a physician's multidisciplinary care team.
She urged the committee to pass the bill.
4:24:22 PM
BROOKE LAVENDER, ALS CARE SERVICES MANAGER, ALS
ASSOCIATION, GIRDWOOD (via teleconference), spoke in
support of SB 91. She shared that the organization's
mission was to serve individuals with ALS and ensure they
have support and access to care. Alaska was one of two
states that did not have an ALS multidisciplinary care
team. She elucidated that traveling for care was a
financial burden and added a physical and emotional toll on
patients and families. She had awarded several quality of
life grants in the current year so patients could travel
out-of-state to see their multidisciplinary care team. The
bill would reduce the current burden. The goal was to make
multidisciplinary care more available to community members
and improve quality of life. Alaska had an above average
prevalence of ALS and the fewest resources. The bill would
offer the access to care. She thanked the committee.
Co-Chair Foster CLOSED Public Testimony.
Co-Chair Foster CLOSED Public Testimony for SB 34, which
was left open during the morning meeting.
SYLVAN ROBB, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS,
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, reviewed the new
Department of Commerce, Community and Economic Development
(DCCED) fiscal impact note dated May 5, 2024. She indicated
that the fiscal note showed a first year cost of $159.3
thousand that would continue into the out years in
Designated General Funds (DGF) and the fund source was
Receipt Services where the costs were paid for by the
licensees' fees. The additional cost reflected the need for
an additional investigator.
4:29:01 PM
Co-Chair Foster noted the committee could hear the
sectional analysis if desired.
Representative Hannan was a strong supporter of the bill.
She looked at lines 11-12 on page 1 of the bill and read:
"service, as provided by the multidisciplinary care team,
that is not reasonably available in the state." She
wondered if the language was in the original bill. She was
concerned by the language "not reasonably available in the
state." She offered that there were areas of the state
lacking certain specialists but existed in other parts of
the state. She wondered if it precluded someone if their
preferred medical team was out-of-state. Senator Claman
responded that the language was modified during the bill
moving through the committee process. The section was
specific to a multidisciplinary care team. Therefore if one
type of specialist was available in the state but was not
part of the multidisciplinary care team the language did
not place any limitations on a person seeking telehealth
for a specialist on their multidisciplinary care team out-
of- state. He emphasized that the phrase only applied to
multidisciplinary care teams. Representative Hannan wanted
to know if the phrase could be eliminated, and the same
goal could be achieved. She was concerned over how
insurance companies would interpret the language and
restrict coverage. She wondered if the language was
critical, or whether the language was the only way to reach
a compromise for the bill.
4:32:08 PM
Senator Claman answered that the language had been worked
out with a number of interested parties and the language
not reasonably available" was familiar to the courts and
there was flexibility in the standard. He reiterated that
it was not a strict standard. He stated that the language
was worked on in a number of iterations. Currently, the
state lacked any multidisciplinary healthcare anywhere in
Alaska that treat the conditions discussed in the bill.
Representative Coulombe understood that the service could
not currently be provided in Alaska because the team was
not registered in Alaska and would need to register with
the state in order to provide telehealth. She wondered
where the medical board fit in the process. Senator Claman
answered that HB 265 required a business registry and not a
registry for the individual physician. He exemplified that
the University of Washington Medical Centers registered in
the state and all of the physicians licensed there were
able to provide telehealth to Alaskans. He referenced
Sheila Swanson who had been going to Seattle for ALS care
and was able to receive services via telehealth in Alaska.
A multidisciplinary care team could have members in
different medical businesses. In that case, all the
businesses were required to register in the state to allow
the team members to participate in telehealth in Alaska. In
addition, once registered, the business would become
subject to investigations regarding the care provided.
4:35:23 PM
Representative Coulombe surmised that the state medical
board still had some disciplinary power over the team. She
wondered how the board intersected in the process. Senator
Claman responded affirmatively and affirmed the boards
oversight jurisdiction due to the registration.
Senator Claman appreciated the bill hearing.
Co-Chair Foster asked for members to inform him if they
did not anticipate submitting amendments and wanted to move
bills faster.
Representative Josephson supported moving the bill.
4:37:07 PM
AT EASE
4:40:48 PM
RECONVENED
Co-Chair Foster noted they had to be back on the floor at
5:00 p.m.
Representative Stapp MOVED to REPORT CSSB 91(FIN) out of
committee with individual recommendations and the
accompanying fiscal note.
There being NO OBJECTION, it was so ordered.
CSSB 91(FIN) was REPORTED out of committee with seven "do
pass" recommendations and one "no recommendation"
recommendation and with one new fiscal impact note from the
Department of Commerce, Community and Economic Development.
Co-Chair Foster thanked Senator Claman.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 275 DPS Follow-Up-1 NIJ Best Practices.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |
| HB 275 DPS Follow-Up-1.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |
| HB 275 DPS Follow-Up-2.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |
| HB 275 Transmittal Letter.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |
| HB275 Letters of Support and Letter of Opposition.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |
| SB 75 & SB 74 Public Testimony Rec'd by 050624 2.pdf |
HFIN 5/8/2024 1:30:00 PM |
SB 74 SB 75 |
| HB275 Sectional Analysis Version B 3.22.24.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |
| HB275 Summary of Changes Version A to B 3.22.24.pdf |
HFIN 5/8/2024 1:30:00 PM |
HB 275 |