Legislature(2023 - 2024)BUTROVICH 205
04/11/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB106 | |
| SB24 | |
| SB91 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 106 | TELECONFERENCED | |
| += | SB 24 | TELECONFERENCED | |
| += | SB 91 | TELECONFERENCED | |
SB 91-TELEHEALTH: MULTIDISCIPLINARY CARE TEAM
4:20:36 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 91 "An Act relating to
telehealth; relating to multidisciplinary care teams; and
relating to the practice of medicine."
He noted that this was the second hearing and there were two
amendments for the committee to consider.
4:21:17 PM
CHAIR WILSON moved to adopt Amendment A.6 ("Amendment 1"), work
order 33-LS0193\A.6.
33-LS0193\A.6
Bergerud
4/5/23
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR WILSON
Page 6, following line 29:
Insert new bill sections to read:
"* Sec. 4. AS 44.33.381(b) is amended to read:
(b) The department shall maintain the registry
of businesses performing telemedicine services in the
state. The registry must include the name, address,
and contact information of businesses performing
telemedicine services in the state. The department may
renew every three years the registration of a business
that meets all renewal requirements established by
regulation and pays a renewal fee every three years.
* Sec. 5. AS 44.33.381 is amended by adding a new
subsection to read:
(d) The department shall charge the following
fees for businesses performing telemedicine services
in the state:
(1) initial registration fee, $100;
(2) renewal fee, $100;
(3) fee to report changes in the business's
registration information, $50."
4:21:31 PM
SENATOR KAUFMAN objected for purposes of discussion.
4:21:35 PM
CHAIR WILSON explained that Amendment 1 changes the registration
fee for the telehealth registry to $100 and adds a $100 renewal
fee every three years. The existing $50 fee for a business to
change its registration information remains the same.
4:22:18 PM
SENATOR TOBIN referenced paragraph (3) in Section 5 of the
amendment and commented that charging $50 to update a business's
registration information might keep some businesses from making
updates. She asked for more information.
CHAIR WILSON suggested that Sylvan Robb speak to question
because the provision was existing language.
4:23:28 PM
SYLVAN ROBB, Director, Division of Corporations, Business &
Professional Licensing, Department of Commerce, Community, and
Economic Development (DCCED), Juneau, Alaska, stated that the
current fee to register with the telemedicine registry is $50.
SENATOR TOBIN said she'd like to look at the statute.
4:24:00 PM
At ease.
4:26:45 PM
CHAIR WILSON reconvened the meeting.
4:26:51 PM
SENATOR TOBIN read subsection (a) of AS 44.33.381 relating to
the telemedicine business registry which did not mention fees.
She articulated her reservations about placing a fee in statute
rather than regulation, and noted that many businesses update
their information every two years and the amendment calls for a
three-year renewal. She asked the Chair if he would entertain a
conceptual amendment to change "every three years" to "every two
years" on lines 7 and 9 and allow the fees to be set in
regulation.
CHAIR WILSON suggested breaking the items into two conceptual
amendments. He added that his hesitation is that the department
might not get around to updating the fees timely.
4:28:35 PM
SENATOR TOBIN agreed to make two motions. She moved to adopt
Conceptual Amendment 1 to Amendment 1.
CONCEPTUAL AMENDMENT 1 TO AMENDMENT 1
Page 1, lines 7 and 9 replace 3 years with 2 years.
4:29:02 PM
CHAIR WILSON asked if there was any objection; he found none and
Conceptual Amendment 1 to Amendment 1 was adopted.
4:29:12 PM
At ease.
4:29:56 PM
CHAIR WILSON reconvened the meeting.
4:30:00 PM
SENATOR TOBIN moved Conceptual Amendment 2 to Amendment 1.
CONCEPTUAL AMENDMENT 2 TO AMENDMENT 1
Page 1, line 13, following: "initial registration fee,
$100;"
Insert: "adjusted for inflation set by the
department;"
4:30:28 PM
CHAIR WILSON objected for purposes of discussion.
4:30:38 PM
SENATOR KAUFMAN asked how the fee would be determined.
CHAIR WILSON opined that it would be done through the regulatory
process. He asked Ms. Robb to speak to that process.
4:31:00 PM
MS. ROBB confirmed that most fees are in regulation and adjusted
periodically, to ensure that the fee is roughly equal to the
cost to administer the program. She advised that the
telemedicine business registry was not administratively
burdensome and confirmed that if the registration is renewed
every two years, the fee would be reviewed on that schedule as
well.
4:32:09 PM
SENATOR KAUFMAN warned about making incremental changes that
cost more than the revenue that's realized.
4:32:24 PM
SENATOR GIESSEL suggested a further amendment to add the
inflation adjustment to the renewal fee on line 14 of Amendment
1. She moved to adopt Conceptual Amendment 3 to Amendment 1.
CONCEPTUAL AMENDMENT 3 TO AMENDMENT 1
Page 1, line 14, following: "renewal fee, $100;"
Insert: "adjusted for inflation set by the
department;"
4:32:36 PM
CHAIR WILSON found no objection and Conceptual Amendment 3 to
Amendment 1 was adopted.
4:32:52 PM
CHAIR WILSON removed his objection to the two conceptual
amendments Senator Tobin offered. He found no further objection
and Amendment 1, as amended, was before the committee.
4:33:13 PM
SENATOR DUNBAR commented that changing the renewal from every
three years to every two years results in a 50 percent increase
in the renewal fee and he hopes that is enough for the
department to recoup its costs. He referenced the fee for
changing the business's registration information in subsection
(d)(3) and suggested the committee consider eliminating it
because providing updated information is behavior that should be
encouraged.
CHAIR WILSON deferred to Ms. Robb since the provision was
already in regulation.
4:34:19 PM
MS. ROBB opined that since the change fee was in the current
regulations, it was difficult to say whether eliminating it
would change behavior.
SENATOR DUNBAR asked how often the $100 renewal fee is charged
currently.
MS. ROBB replied that the telemedicine business registry is
perpetual. The registration does not expire so there is no
renewal fee. Responding to an additional question, she confirmed
that Amendment 1 adds the renewal fee.
SENATOR DUNBAR asked if she agreed that, should the amendment
pass and the registration is renewed every two years, the
department will get updated information about the businesses
every two years.
4:35:23 PM
MS. ROBB agreed.
SENATOR DUNBAR asked if she believes that the renewal process
will be sufficient to collect the data that's needed or if the
provision in paragraph (3) to report changes in the registration
information is also needed.
4:35:51 PM
MS. ROBB responded that she views it as a policy call. She added
that the data on the telemedicine business registry isn't used
very much, but if that were to change it would be beneficial to
have up-to-date data.
4:36:25 PM
SENATOR DUNBAR suggested the committee remove paragraph (3) from
Amendment 1.
4:36:45 PM
SENATOR GIESSEL said a reason for keeping paragraph (3) and
collecting a $50 to update a healthcare business's registration
information is that email addresses and names sometimes change
and it's helpful to licensees and the division to have that
information recorded somewhere.
CHAIR WILSON opined that the $50 change fee would be
insignificant for most healthcare businesses.
SENATOR DUNBAR asked the bill sponsor for his view of subsection
(d)(3) of Amendment 1 which imposes a $50 fee for a business to
report changes in their business registration information.
4:38:24 PM
SENATOR CLAMAN responded that in light of all the proposed
changes, he views the $50 change fee as a disincentive for
businesses to provide the information. He added that he was
always hesitant to legislate things that are usually done by
regulation. Thus he would support an amendment to remove
paragraph (3) on lines 15 and 16 of Amendment 1.
4:39:53 PM
SENATOR DUNBAR asked for confirmation that the department could
impose a similar change fee through regulation.
CHAIR WILSON said that's correct.
4:40:09 PM
SENATOR DUNBAR moved to adopt Conceptual Amendment 4 to
Amendment 1.
CONCEPTUAL AMENDMENT 4 TO AMENDMENT 1
Page 1, lines 15-16:
Delete: "(3) fee to report changes in the
business's registration information, $50."
4:40:23 PM
CHAIR WILSON objected for purposes of discussion. He said wanted
the business registry to remain viable and he thought it was
reasonable for a business to pay a fee for the department to
process changes in its registry information. He added that he
was hesitant to rely on the department imposing a fee through
regulation because that process is so slow.
4:42:11 PM
SENATOR GIESSEL agreed with his thoughts; the cost of state
government is increasing and the Division of Corporations,
Business & Professional Licensing is shorthanded, so the $50 fee
could make a difference in funding the activities related to the
bill.
4:42:45 PM
CHAIR WILSON asked for further discussion; he found none and
asked for roll call vote on Conceptual Amendment 4 to Amendment
1.
4:43:01 PM
A roll call vote was taken. Senators Dunbar and Tobin voted in
favor of Conceptual Amendment 4 to Amendment 1 and Senators
Giessel, Kaufman, and Wilson voted against it. The vote was 2:3.
4:43:23 PM
CHAIR WILSON announced that on a vote of 2 yeas and 3 nays,
Conceptual Amendment 4 to Amendment 1 failed.
CHAIR WILSON asked for further discussion on Amendment 1 as
amended; he found none.
4:43:44 PM
SENATOR KAUFMAN removed his objection.
4:43:44 PM
CHAIR WILSON found no further objection and Amendment 1 as
amended, was adopted.
4:43:49 PM
CHAIR WILSON solicited a motion for Amendment A.8 (Amendment
2") by Senator Giessel.
4:43:54 PM
SENATOR GIESSEL moved to adopt Amendment A.8 ("Amendment 2"),
work order 33-LS0193\A.8, to SB 91.
33-LS0193\A.8
Bergerud
4/6/23
AMENDMENT 2
OFFERED IN THE SENATE
Page 1, line 8, following "AS 08.01.087.":
Insert "A member of a physician's
multidisciplinary care team may provide a health care
service through telehealth to a patient located in
this state only if the health care service is not
otherwise available in the state."
Page 3, lines 3 - 5:
Delete "that includes a physician licensed in
another state who meets the requirements of (b)(1) of
this section"
Page 3, following line 5:
Insert new bill sections to read:
"* Sec. 3. AS 08.02.130(j) is amended by adding a
new paragraph to read:
(5) "member of a multidisciplinary care
team" means an audiologist, speech-language
pathologist, behavior analyst, professional counselor,
dietitian, nutritionist, naturopath, marital and
family therapist, podiatrist, osteopath, physician
assistant, nurse, pharmacist, psychologist or
psychological associate, or a social worker who is a
member of a team that includes a physician licensed in
another state who meets the requirements of (b)(1) of
this section.
* Sec. 4. AS 08.02.130 is amended by adding a new
subsection to read:
(k) A member of a multidisciplinary care team
shall register with the department before providing
telehealth services to a patient located in the state.
To register with the department, a member of a
multidisciplinary care team shall submit
(1) the name of the physician leading the
multidisciplinary care team;
(2) the area of health care in which the
member of the multidisciplinary care team will be
practicing and proof of licensure in a state or
territory of the United States in that area;
(3) any applicable fees, as determined by
the department."
Renumber the following bill section accordingly.
4:43:57 PM
CHAIR WILSON objected for purposes of discussion.
4:44:01 PM
SENATOR GIESSEL stated that her goal is to ensure that to every
extent possible, Alaskans are providing the telehealth services
that are offered in Alaska. The provision on page 1, lines 2-4
clarifies that the members of a physician's multidisciplinary
care team may provide health care through telehealth to a
patient in Alaska only if the service is not available in
Alaska. The language on page 1, line 12 through page 2, line 4
identifies the professions that logically would be part of a
multidisciplinary care team that provides telehealth services.
She said not all of the professions initially identified in the
bill were logical for telehealth services. Section 4 defines the
requirements for the members of a multidisciplinary care team
which includes registering with the department. The amendment
also removes the provision on page 3, lines 3-5 of the bill
because it's redundant.
CHAIR WILSON asked if there were any questions
4:46:44 PM
SENATOR DUNBAR asked which professions were removed from the
list of telehealth providers.
4:46:57 PM
SENATOR GIESSEL directed attention to the health care providers
identified on page 2 line 20 through page 3, line 1 of the bill.
The professions removed from that list include chiropractor,
dental hygienist, dentist, direct-entry midwife, dispensing
optician, physical therapist, and occupational therapist.
4:47:34 PM
SENATOR DUNBAR said the list makes sense with the exception of
physical therapist and perhaps occupational therapist. He asked
if she could think of any circumstances where those services
could be provided through telehealth. He cited his personal
experience with physical therapy that only initially was in-
person; thereafter he was given pictures to use as a guide.
4:48:28 PM
SENATOR GIESSEL said it's a good point but physical therapists
also have to assess the patient's progress, and that's generally
hands-on. The same applies to occupational therapy assessments.
CHAIR WILSON asked her to clarify that an in-state physical
therapist could offer telehealth services.
SENATOR GIESSEL answered yes.
4:49:31 PM
SENATOR KAUFMAN offered his understanding that smart phone
technology is capable of measuring one's eyes, so optometry
services could be delivered via telehealth. He was aware of
statutes in Texas that addresses optometry services via
telehealth.
SENATOR GIESSEL described the differences between an optician,
an optometrist, and an ophthalmologist.
4:50:57 PM
SENATOR KAUFMAN asked how businesses that provide glasses by
mail would fit.
CHAIR WILSON responded that the purpose is to allow out-of-state
providers to provide services for life-threatening conditions.
He didn't consider ordering glasses through the mail in that
category.
4:51:41 PM
SENATOR DUNBAR asked the bill sponsor whether any of the
professions that the amendment excludes would have affected the
multidisciplinary care team for his constituent who has ALS and
others in similar circumstances that prompted the bill.
4:52:29 PM
SENATOR CLAMAN stated that his constituent who has ALS has both
a physical therapist and an occupational therapist on her
multidisciplinary care team and she sometimes uses telehealth
for those services. In addition, the ALS group in Alaska and the
American Cancer Society raised questions about the first
provision in the amendment regarding a member of the
multidisciplinary care team only providing health care services
through telehealth to an Alaskan if the health care services are
not otherwise available in the state. Both organizations asked
whether it was the insurance company or the patient who would
have the burden of showing that the service was not otherwise
available. To Senator Kaufman's question about telehealth
services for optometry and the possibility of using an iPhone
app, he said significant brain cancer can affect brain function
and it's reasonable to think that somebody in that circumstance
would want to see the optician who saw them last. He articulated
concern with Section 3 of the amendment, pointing out that
making a list of the professions that can be part of a
multidisciplinary care team could unintentionally be either
over-inclusive or under-inclusive. He argued that the best way
to strike a balance between providing care for the patient who
wants the care and maximizing the use of providers in Alaska
wherever possible was through Section 4 of Amendment 2.
4:58:29 PM
SENATOR GIESSEL noted that she had neglected to mention that
optometrist was not on the list in Section 3.
4:59:00 PM
SENATOR DUNBAR asked Senator Claman if his concern could be
alleviated by amending the language on page 1, lines 2-4 of the
amendment.
4:59:31 PM
SENATOR CLAMAN said his initial thought was to change the
language on page 1, line 4 from "not otherwise available in the
state." to "not reasonably available in the state." However, he
would like to hear from the American Cancer Society and the ALS
group in Alaska first, because those organizations have first-
hand experience working with highly specialized
multidisciplinary care teams and the people who leave the state
to receive very specialized care.
5:00:26 PM
At ease.
5:00:58 PM
CHAIR WILSON reconvened the meeting and advised that the
committee's time had run out for the day.
5:01:08 PM
CHAIR WILSON held SB 91 in committee with Amendment 2 pending.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 91 Supporting Testimony - MS Society Letter of Support 4.4.23.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |
| 3.23.23 David Barnes Medical App_Redacted.pdf |
SHSS 4/11/2023 3:30:00 PM |
Consideration of Governor's Appointees - David Barnes - State Medical Board |
| SB 106 DOH Medicaid Svcs.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 106 |
| SB 24 Amendment A.1.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 24 |
| SB 91 Amendment A.6.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |
| SB 91 amendment A.8.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |
| SB 91 Amendment A.6 am 4.11.23.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |