Legislature(2021 - 2022)BUTROVICH 205
03/31/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB175 | |
| HB184 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 175 | TELECONFERENCED | |
| *+ | HB 184 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 175-HEALTH CARE SERVICES BY TELEHEALTH
1:36:03 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 175
"An Act relating to telehealth; relating to the practice of
medicine; relating to medical assistance coverage for services
provided by telehealth; and providing for an effective date."
1:36:33 PM
At ease
1:37:30 PM
CHAIR WILSON reconvened the meeting and solicited a motion.
1:37:34 PM
SENATOR COSTELLO moved to adopt the committee substitute (CS)
for SB 175, work order 32-LS1421\G, Version G, as the working
document.
1:37:47 PM
CHAIR WILSON objected for discussion purposes.
1:38:33 PM
CHAIR WILSON stated that, as sponsor, he would present the
summary of changes for SB 175 from Version I to Version G. It
read as follows:
[Original punctuation provided.]
Version 32-LS1421\G (Senate Health and Social Services
Committee Substitute)
6 distinct changes from first 32-LS1421\I to 32-
LS1421\G
1) The ability to prescribe, dispense, or administer
botulinum toxin (Botox) via telehealth is removed.
a. Page 2, Line 21: Removed "botulism toxins".
1:38:54 PM
CHAIR WILSON continued to review the changes in SB 175 from
Version I to Version G.
2) Language regarding Alaska Medicaid services in
Section 4 is cleaned up.
a. Page 5, Lines 24 and 25: Removed facsimile to
remove fax as a modality for Alaska Medicaid.
b. Page 5, Lines 5 and 6: Removed "and other federal
waivers or demonstrations" and added a separate line
for "services covered under federal waivers and
demonstrations other than home and community-based
services.
c. Page 5, line 17: Deleted "the Community Health Aide
Program Certification Board" and replaced it with "a
certifying entity for behavioral health professionals
in the state specified by the department in
regulations"
3) Language regarding prescribing via telehealth for
APRNs is tightened and clarified. Does not expand the
prescribing powers of APRNs.
a. Page 2, Lines 25: Added "if the advanced practice
registered nurse complies with AS 08.68.710."
1:40:18 PM
b. New section 3 (does not exist in version I):
Creates a new section under Title 8, Chapter 68
(Nursing) defining the telehealth prescriptive
authority of APRNs in statute. This section aligns the
regulatory authority of the Board of Nursing with the
State Medical Board regarding the prescription of
controlled substances via telehealth.
4) Language was added to require applicable licensing
boards and DHSS to adopt regulations necessary to
implement sections 3-6 of the Act (including the
Medicaid provisions) no later than June 30, 2023.
1:41:04 PM
CHAIR WILSON continued to review the changes in SB 175 from
Version I to Version G.
a. New section 11 (does not exist in version I): Adds
language to detail when each entity must adopt
regulations.
b. Adds a new effective date for section 11. New
section 11 takes effect immediately
5) Added 7-year sunset on Medicaid pay parity. a. New
Section 6 and 7 with effective date of June 30th,
2030: Sunset's language relating to Medicaid pay
parity for telehealth.
6) Changed language throughout to refer to Department
of Health.
1:42:17 PM
SENATOR BEGICH asked whether these changes were made in
collaboration with the department and the sponsor.
CHAIR WILSON noted that the department staff present was nodding
in agreement, and he sponsored SB 175 and agrees with the
changes.
1:42:48 PM
SENATOR HUGHES asked for clarification on Medicaid pay parity
and the sunset date.
CHAIR WILSON stated that pay parity would allow telehealth to
receive the same payment for services as in-person practitioners
for seven years and then sunset. This was based on best
practices for pay parity and would allow the stakeholders time
to work on this issue.
SENATOR HUGHES suggested a shorter time for non-Medicaid
telehealth patients. She wondered whether pay parity should be
three or four years rather than seven.
CHAIR WILSON answered that he envisioned it would take two years
for the department to develop regulations to set rates. He noted
that the department staff was nodding in agreement.
1:44:26 PM
SENATOR HUGHES related her understanding that Medicaid sets the
tone for other insurers. She expressed concern about high health
care costs, so the sooner savings were seen, the better for the
state. She asked whether private medical practice and insurance
could provide savings earlier than seven years.
1:46:00 PM
CHAIR WILSON directed attention to an article in members'
packets from the National Council of State Legislatures (NCSL)
on best practices regarding pay parity. He offered to resend the
information if need be. He noted that a floor amendment removed
pay parity from SB 56, the bill extending the COVID-19 disaster
emergency. He stated that research had shown that many entities
do not wish to engage in telehealth because it was more
profitable to continue to practice in person.
1:47:21 PM
HEATHER CARPENTER, Healthcare Policy Advisor, Office of the
Commissioner, Department of Health and Social Services (DHSS),
Juneau, Alaska, stated that the department held several
conversations with Chair Wilson and the sponsor of the companion
House bill. The department had expressed some concern but had
not focused on the number of years. She said the department
understood the desire to develop the infrastructure for
telehealth. She explained that Medicaid currently pays the same
for in-person and telehealth services. She indicated that it
would modernize the Medicaid program by moving away from fee-
for-service to value-based and bundled payments for managed
care. The department felt it would be helpful if the limitation
for paying the same for in-person versus telehealth does not
exist into perpetuity. She related her understanding that Chair
Wilson came up with a reasonable compromise for the department.
1:48:27 PM
SENATOR HUGHES maintained her concern about the length of time
because telehealth was initiated in many places at least ten
years ago. She expressed concern that seven years was too long
to allow for infrastructure and adjustments. She wondered if the
sponsor would consider shortening that timeframe but indicated
that she would not stop the bill because of it. She emphasized
that health care costs are one of the state's major problems.
CHAIR WILSON indicated that he was working with the sponsor of
the companion bill on that issue. He said he hoped to marry the
bills in the next committee of referral, the Senate Labor &
Commerce Committee.
1:49:54 PM
CHAIR WILSON [removed his objection]; he found no further
objection; and the committee substitute (CS) for SB 175, Version
G was adopted as the working document.
1:50:17 PM
SENATOR REINBOLD moved to adopt Amendment 1, work order 32-
LS1421\G.1.
32-LS1421\G.1
Foote
3/22/22
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 175(HSS), Draft Version "G"
Page 1, line 9:
Delete "without"
Insert "only after"
1:50:19 PM
CHAIR WILSON objected for discussion purposes.
1:50:22 PM
SENATOR REINBOLD explained that Amendment 1 would require an in-
person visit before providing telehealth services. She offered
her view that this protects physicians in Alaska.
1:50:47 PM
CHAIR WILSON stated that the purpose of previous versions of the
bill was to allow those physicians who have established network
care to practice, allowing the expansion of telehealth for
Alaskans. He said the language in Version G requires the
physician to be an Alaskan provider who practices in Alaska.
1:51:39 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development, Juneau, Alaska, stated that Version G made
many changes that are not in the House version of the bill. She
explained that Amendment 1 would remove "without." However, the
language "without" reinforces the statutes regarding health care
providers in AS 08. The boards have adopted regulations allowing
telehealth care without requiring an in-person visit. She noted
that Chair Wilson indicated this also allows Teladoc physicians
who are licensed in Alaska but may not physically be in Alaska
to provide health care to Alaskans, which is currently allowed.
She related that Teladoc is a large health care provider part of
the state employee health network that uses Alaska-licensed
physicians. She explained that removing "without" and inserting
"after" would mean they could no longer practice in Alaska.
Instead, these physicians would need to be physically present in
Alaska to provide health care for Alaskans.
1:53:51 PM
CHAIR WILSON noted that these physicians must be licensed in the
State of Alaska to practice medicine using telehealth.
1:54:04 PM
MS. CHAMBERS answered yes; these physicians must be licensed in
the state unless they practice medicine through the Indian
Health Service (IHS) or the military.
1:54:20 PM
SENATOR HUGHES raised the issue of health care costs. She asked
the record to reflect her support for Alaskan physicians and
providers. However, she said it is a concern that Alaska
physicians charge from 100 to 300 percent more for services than
out-of-state providers. She highlighted her desire to create
competition. She said she would oppose Amendment 1 because a
telehealth provider might be helpful to Alaskans. She noted that
a telehealth provider might provide a specialty not provided in
Alaska. She highlighted that the state should not stop Alaskans
from seeking more affordable care.
1:55:41 PM
SENATOR REINBOLD stated that she would never undercut Alaska
physicians. She read Section 1 (a):
A health care provider other than a physician licensed
in another state may provide health care services
within the health care provider's authorized scope of
practice to a patient in this state through telehealth
without first conducting an in-person visit.
SENATOR REINBOLD offered her view that it was easy to miss many
things in telehealth and that medical personnel learn much more
with in-person patient care.
1:57:13 PM
SENATOR COSTELLO referred to page 3, lines 2-5, subsection (i),
which does not force health care providers or patients to use
telehealth but leaves it up to the patient to decide.
1:57:43 PM
SENATOR REINBOLD stated that it is expensive to move to Alaska
and set up a practice only to have people make phone calls to
the Lower 48. She maintained her support for Amendment 1.
1:58:06 PM
A roll call vote was taken. Senators Reinbold voted in favor of
the motion to adopt Amendment 1, and Senators Hughes, Begich,
Costello and Wilson voted against it. Therefore, Amendment 1
failed on a 1:4 vote.
CHAIR WILSON announced that Amendment 1 failed on a vote of 1
yea and 4 nays.
1:58:46 PM
SENATOR COSTELLO emphasized that an out-of-state medical doctor
who provides telehealth to a patient in the state must have an
established relationship and have previously conducted a
physical examination. She related her understanding that a
physician must have a connection to the patient or an Alaskan
physician. She asked if that was correct.
CHAIR WILSON answered no. He indicated that it was similar to
the Alaska Care plan, Teladoc, so all the members under Alaska
Care could call Teladoc and reach health care providers licensed
in Alaska.
2:00:00 PM
SENATOR COSTELLO clarified that she was referring to medical
professionals who are licensed outside the state. She
interpreted the bill to mean that the physician must have an
established physician-patient relationship and have previously
conducted a physical examination in person.
MS. CHAMBERS explained that subsection (b) creates a carve-out
that does not currently exist that would allow physicians not
licensed in Alaska to deliver telehealth services. Currently,
out-of-state physicians can be physically in another state, but
the physician must be licensed in Alaska.
2:01:02 PM
SENATOR REINBOLD read subsection (a) "A health care provider
other than a physician licensed in another state may provide
health care services within the health care provider's
authorized scope of practice to a patient located in the state
through telehealth without first conducting an in-person visit."
She asked whether this could apply to international health care
providers.
2:01:57 PM
MS. CHAMBERS referred to page 3, line 7, to the definition of
health care provider, which applies to those licensed in the
state. She stated that the health care provider referenced in
Section 1, on page 1, line 6, related to a person practicing any
listed profession who holds a license in Alaska. A person
traveling internationally could provide telehealth so long as
they are in good standing in Alaska.
2:02:54 PM
At ease
2:03:32 PM
CHAIR WILSON reconvened the meeting.
2:03:38 PM
SENATOR REINBOLD moved to adopt Amendment 2, work order 32-
LS1421\G.3.
32-LS1421\G.3
Foote
3/30/22
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 175(HSS), Draft Version "G"
Page 10, following line 17:
Insert a new subsection to read:
"(f) Nothing in this section authorizes an
individual employed by an entity permitted to provide
telehealth under this section to prescribe, dispense,
or administer through telehealth a controlled
substance listed in AS 11.71.140 - 11.71.190."
Reletter the following subsection accordingly.
Page 11, following line 12:
Insert a new subsection to read:
"(f) Nothing in this section authorizes an
individual employed by a facility permitted to provide
telehealth under this section to prescribe, dispense,
or administer through telehealth a controlled
substance listed in AS 11.71.140 - 11.71.190."
Reletter the following subsection accordingly.
2:03:41 PM
CHAIR WILSON objected for discussion purposes.
2:03:44 PM
SENATOR REINBOLD explained that Amendment 1 would insert a new
subsection (f), which she read.
2:04:19 PM
SENATOR HUGHES emphasized the importance of being careful with
controlled substances. She said her daughter, a physician, just
prescribed a controlled substance via telehealth. She said it
would have been unethical for her not to provide the needed
treatment for her patient in a rural setting. She stated that
she would oppose Amendment 2.
2:05:10 PM
SENATOR BEGICH agreed with Senator Hughes that allowing a
telehealth provider to prescribe means the patient only needs to
meet with one in-person provider, but that the second provider
could be via telehealth. He offered his view that Amendment 2
would place an undue burden on people who might not be able to
access an in-person provider. He highlighted the importance of
being cautious about opioids but would oppose Amendment 2 based
on the provider's ethical duty.
2:06:02 PM
SENATOR REINBOLD maintained that given the opioid crisis, it was
important to get a handle on controlled substances. She said
allowing someone to prescribe controlled substances from out-of-
state via telehealth was alarming. She offered her view that it
should require an in-person visit.
2:06:55 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 2, and Senators Hughes, Begich,
Costello, and Wilson voted against it. Therefore, Amendment 2
failed on a 1:4 vote.
CHAIR WILSON announced that Amendment 2 failed on a vote of 1
yea and 4 nays.
2:07:19 PM
CHAIR WILSON asked Ms. Chambers to provide the committee with
information on how the Prescription Drug Monitoring Program
(PDMP) would work with telehealth prescriptions for controlled
substances.
CHAIR WILSON held SB 175 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 184 Sectional Analysis version A.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 Sponsor Statement version A.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 LOS_Maniilaq.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 LOS_Alaska Childrens Trust.pdf |
HHSS 4/27/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 LOS_Alaska Regional Coalition.pdf |
HHSS 4/27/2021 3:00:00 PM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 Work Draft v.G.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Testimony 3.21.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Letters 3.30.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Exp of Changes V.I to V.G.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| HB 184 Letter 3.16.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 A 1.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| HB 184 Powerpoint 3-31-2022.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 A 2.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| HB 184 Powerpoint #2 3.31.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 Supporting Doc Pay Parity 4.4.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Ammendments Considered.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 FN BH UPDATED 2.18.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SHSS SB175 Follow-Up Information from CBPL (4.4.22).pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |