Legislature(2019 - 2020)BUTROVICH 205
03/23/2020 11:15 AM Senate RULES
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| Audio | Topic |
|---|---|
| Start | |
| SCR14 | |
| SB241 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SCR 14 | TELECONFERENCED | |
| *+ | SB 241 | TELECONFERENCED | |
SB 241-EXTENDING COVID 19 DISASTER EMERGENCY
4:24:31 PM
CHAIR COGHILL announced the consideration of SENATE BILL NO.
241, "An Act extending the March 11, 2020, governor's
declaration of a public health disaster emergency in response to
the COVID-19 pandemic; relating to the powers of the director of
insurance; relating to standing orders issued by the chief
medical officer; relating to professional licensing; relating to
telemedicine and telehealth; relating to board of nursing
fingerprint requirements; relating to the 2020 primary and
general elections; relating to permanent fund dividend
applications; relating to automatic voter registration; relating
to tax; relating to shareholder meetings; and providing for an
effective date."
He noted that this was the first hearing and there was a
proposed committee substitute (CS).
4:24:54 PM
SENATOR GIESSEL moved to adopt the Senate Rules committee
substitute (CS) for SB 241, work order 31-GS2260\U, as the
working document.
CHAIR COGHILL objected for an explanation of the changes.
CHAIR COGHILL recognized that Senators Stedman, Hughes, Stevens,
Revak and Bishop were in the audience. He also listed the
individuals who were available online to answer questions.
4:25:19 PM
RENA MILLER, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, directed attention to the Summary
of Changes document for SB 241 between version A and version U.
She noted that Legislative Legal Services made technical changes
throughout version U to conform to legislative drafting
conventions. [Original punctuation provided.]
Throughout:
- Adds 'novel coronavirus disease' before 'COVID-
19' in first reference in each section
- Adds 'in the Department of Health and Social
Services' after 'chief medical officer'
st
- Removes '31Alaska State' before references to
'legislature'
- Adds 'calendar year' before '2020'
- Adds 'of Health and Social Services' after
'department'
- Technical restructuring of some sentences to
conform to Legislative Legal drafting standards
Page 1, lines 1-8 Conforms title; removes reference
to Division of Insurance and to
general election and adds
reference to financing plan.
Page 2, lines 1-2 Adds 'severe acute respiratory
syndrome coronavirus 2' before
'SARS- CoV-2)
Page 2, line 3 Changes 'causing' to 'leading to'
Page 2, line 6 Removes reference to sec. 319 in
relation to the Public Health
Service Act
Page 3, lines 2-3 Removes 'the department's'
before 'personnel' and adds
'of the Department of Health and
Social Services' to qualify both
personnel and resources
Page 3, line 8 Changes the date 'March 12, 2021'
to 'September 1, 2020' as the end
date of the disaster declaration
extension
Page 3, line 9 Removes former section 2 related
to the Division of Insurance
Page 3, line 13 Changes the date 'March 12, 2021'
to 'September 1, 2020' as the end
date of the disaster declaration
extension
Page 3, line 14 Adds 'The extension under this
subsection' in legal drafters'
restructuring of provision order
Page 3, line 19 Removes reference to 'based on a
reliable source'
Page 3, lines 23-25 Adds 'determined by the governor'
and adds provision that the
certification must be based on
specific information received from
a state or federal agency or
another source determined by the
commissioner to be reliable
Page 3, line 29 Adds a new section related to a
financing plan
Page 5, lines 1-2 Adds that if the chief medical
officer is incapacitated, the
chief medical officer's designee
may issue standing orders
Page 5, lines 10-18 Restructures subsection per legal
drafters
4:30:49 PM
SENATOR BEGICH asked for confirmation that the restructured
subsection does not change the intent.
MS. MILLER replied that is correct. It clarifies that the chief
medical doctor, not the standing order, needs to provide the
education and training.
Page 5, line 18 Adds 'of implementing the standing
order' after 'means' Page 5, line
28 Removes end date for
reporting of 'until March 2021'
Page 5, lines 30-31 Adds that the reporting must
include the expenditures related
to the emergency
Page 6, line 4 Adds 'made' before 'without'
Page 6, lines 5-6 Changes 'because of' to 'to
contain the spread of'
Page 6, lines 6-9 Requires a final report on Nov. 1,
2020, or 60 days after the
emergency ends if it ends before
Sept. 1, 2020. Requires the
monthly reports to include
cumulative information
Page 6, line 12 Adds 'and occupational' to the
section heading
Page 6, line 18 Adds n good standing' after
'certificate'
Page 6, lines 19-23 Adds new provision that licenses
expedited under this section
expire Sept. 1, 2020, or when the
emergency is over, whichever comes
first
Page 7, lines 6-10 Adds new provision that expedited
licensees traveling to Alaska must
comply with CDC travel guidelines
Page 7, lines 11-13 Adds definition of 'director' as
the DCCED division director for
professional licensing
4:33:27 PM
Page 8, lines 10-11 Adds that fees charged for
telemedicine and telehealth may
not be more than 5% above the
typical fees charged
Page 8, line 17 Removed provision allowing waiver
of privacy requirements [in
conjunction with telehealth]
Page 8, lines 22-27 Expands expedited fingerprinting
requirement to multiple public
health professions requiring
fingerprinting in conjunction with
licensure
Page 9, line 1 Removes reference to general
election; adds a statewide special
election
Page 9, line 9 Changes date of June [30], 2020 to
April 30, 2020 as extended
deadline to apply for a 2020
permanent fund dividend [This
section also corrects an erroneous
reference to a 2019 to a 2020
dividend received this calendar
year]
Page 10, lines 4-8 Adds provision repealing sections
1-4 and 6-12 on Sept. 1, 2020, or
when the emergency ends, whichever
comes first
Page 10, line 9 Adds that section 5, reporting
requirement, is repealed Nov. 2,
2020
4:35:26 PM
SENATOR BEGICH observed that all the repealer clauses but
the last one end with the phrase "no longer exists." The
last is a straight repeal on November 2, 2020. He asked what
happens if the disaster has been extended beyond that date.
MS. MILLER replied a decision to extend the disaster beyond
November 1, 2020 presumably would require another piece of
legislation. Any other provisions, including reporting
requirements, could be extended at the same time.
4:36:18 PM
CHAIR COGHILL removed his objection; finding no further
objection, version U was adopted.
4:36:43 PM
SENATOR BEGICH moved Amendment 1.
31-GS2260\U.1
Wallace/Marx
3/23/20
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: CSSB 241(RLS), Draft Version "U"
Page 8, line 31, through page 9, line 2:
Delete "the lieutenant governor may, after
consultation with the commissioner of health and
social services, direct that a primary or statewide
special election to be held in the state in calendar
year 2020 be held"
Insert "for the duration of the public health
disaster emergency declaration issued by the governor
on March 11, 2020, the director of the division of
elections shall conduct all elections"
CHAIR COGHILL objected for discussion purposes.
SENATOR BEGICH explained that Amendment 1 signals the
lieutenant governor that if the legislature extends the
declaration, a vote by mail provision for the general
election should not be precluded. He said his caucus
suggested the proposed language to give clear direction to
the lieutenant governor.
4:39:03 PM
CHAIR COGHILL said he would maintain his objection because
he did not want to experiment with the general election.
SENATOR GIESSEL said she understands the intent but the
legislature will have to readdress the declaration should
the emergency continue past September 1. That would give the
Division of Elections some days more than two months to
transition [the general election] to vote by mail.
Therefore, she would not support Amendment 1.
SENATOR BEGICH responded that his caucus wanted him to call
this to the committee's attention, but it is the will of the
committee.
CHAIR COGHILL remarked that there is agreement that things
will get tough and everyone is looking for good solutions.
4:41:04 PM
A roll call vote was taken. Senator Begich voted in favor
of Amendment 1 and Senators von Imhof, Giessel, and Coghill
voted against it. Therefore, Amendment 1 failed by a 1:3
vote.
4:41:11 PM
SENATOR BEGICH moved Amendment 2.
31-GS2260\U.3
Wallace/Marx
3/23/20
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: CSSB 241(RLS), Draft Version "U"
Page 9, lines 9-11:
Delete "An application received after March 31,
2020, is exempt from automatic voter registration
under AS 15.07.070(i)-(m)."
CHAIR COGHILL objected for discussion purposes.
SENATOR BEGICH said the automatic voter registration law
was passed by initiative and he would argue that since the
application period for the 2020 dividend is being moved to
April 30, the automatic voter registration on the dividend
application, that voters passed by a substantial margin,
should not be arbitrarily abrogated.
4:42:43 PM
CHAIR COGHILL restated his objection.
4:42:55 PM
SENATOR HOFFMAN joined the committee.
CHAIR COGHILL summarized Amendment 2 for Senator Hoffman
and said his objection is that there would be a cost, a
timing issue, and a logistical challenge if elections are
transitioned to vote by mail.
CHAIR COGHILL maintained his objection.
4:43:38 PM
SENATOR BEGICH restated that this would extend the
requirement for automatic voter registration that passed by
a substantial margin. He said he understands the opposing
argument, but he supports sticking with the system.
4:44:37 PM
A roll call vote was taken. Senator Begich voted in favor
of Amendment 2 and Senators Hoffman, von Imhof, Giessel,
and Coghill voted against it. Therefore, Amendment 2 failed
by a 1:4 vote.
4:45:13 PM
SENATOR BEGICH stated that minority staff have been working
to identify areas in statute that hopefully will be
addressed in this or other legislation. He listed the
following technical amendments that are being considered:
temporary relief for the cost of living allowance
requirements if it is not possible to timely return to the
state safely; temporary assistance program; physical
presence of witnessing requirements; intent language to ask
the University of Alaska to engage students as a means of
getting younger poll workers; and provisions related to
sanitizing stores, price gouging, vehicle repossessions,
student loan forbearance, deliberate infecting, and
telemedicine providers. He relayed his intent to share the
amendments liberally with members of the body and not
submit any that are not relevant. In this crisis we don't
want to miss the opportunity to ensure against unintended
mistakes when protecting finances, economics, and the
health and safety of Alaskans, he said. He reiterated that
the amendments are temporary and only intended to cover the
crisis.
4:48:41 PM
SENATOR GIESSEL asked him to elaborate on the telemedicine
comment because it may be based on the letters from [The
Alaska Hospitalist Group, LLC and the Alaska State Hospital
& Nursing Home Association ASHNHA)] which appear to
misinterpret the provision.
SENATOR BEGICH confirmed that in response to those letters,
his staff was looking into an amendment to AS 44.33.381 to
temporarily waive limitations on telemedicine providers
relating to the insurance coverage requirement in AS
21.42.422.
SENATOR GIESSEL said she didn't believe that either the
hospitalist group or ASHNHA clearly understood what is
written in the bill relating to telemedicine providers. She
asked her staff to comment.
4:49:58 PM
MS. MILLER said the provisions Senator Begich mentioned in
[AS 21.42] relating to insurance may not have been
addressed in those letters. The provisions in the bill
don't go into AS 21 in relation to telemedicine and
telehealth but she believes in the bill apply equally to
in- or out-of-state doctors and nurses who are licensed to
practice.
SENATOR BEGICH responded that his staff would coordinate
with Senator Giessel's staff to ensure there are no
duplication.
CHAIR COGHILL suggested they also talk to the finance
people.
SENATOR BEGICH responded that the minority staff have been
engaging with majority staff to every extent possible so
this is a coordinated rather than arbitrary process.
4:51:35 PM
SENATOR GIESSEL suggested it was worth the time to address
the concerns articulated in the letters from ASHNHA and the
hospitalist group. She said ASHNA wishes to have controlled
substances included in the telemedicine component whereas
she supports the governor's approach that excludes
controlled substances. She noted that ASHNHA also expressed
concern with paragraph (3) in Section 7 that reads:
(3) unless the health care provider has a preexisting
provider-patient relationship with a patient that is
unrelated to novel coronavirus disease (COVID-19), the
health care services provided are limited to services
related to screening for, diagnosing, or treating
COVID-19;
She said this loophole for telemedicine is intentionally
wide open to allow treatment of COVID-19, but not to treat
a new patient with something like diabetes. She said she
supports what the governor put in the original bill and it
is sustained in this committee substitute.
SENATOR BEGICH indicated there was no need for an amendment
on that provision.
CHAIR COGHILL asked Ms. Carpenter to provide her testimony.
4:53:57 PM
HEATHER CARPENTER, Health Care Policy Advisor, Department
of Health and Social Services (DHSS), Juneau, Alaska,
stated that DHSS is concerned that the extension is just
six months because the World Health Organization, the
Centers for Disease Control (CDC), and other countries
anticipate that the COVID-19 pandemic to continue, with
waves and peaks, for one or two years. She expressed
appreciation for the work the committee had done and
committed to continue to work with the committee if another
extension became necessary.
CHAIR COGHILL thanked Ms. Carpenter and asked Ms. Monk to
provide her testimony.
4:55:06 PM
JEANNIE MONK, Senior Vice President, Alaska State Hospital
& Nursing Home Association, Juneau, Alaska, provided
context to her comments with the explanation that she is
leading a statewide telehealth strategy work group for the
DHSS emergency operations command, looking at better ways
to use telehealth to take care of people during this
crisis. She said she is bringing the group's perspective on
what is needed in Alaska to respond to this crisis.
She said the ASHNHA letter raised concerns with the two
provisions that Senator Giessel highlighted, but she would
primarily speak to the provision in Section 7 that requires
a preexisting provider-patient relationship. She said this
is important because a major disruption to Alaska's health
care system can be expected. She pointed out that an
existing medical provider might be out sick or have had to
relocate to see patients in an alternative care site. For
this reason, ASHNHA and the work group feel that the health
care system needs flexibility to care for as many people as
possible using telehealth. This keeps both providers and
patients safe.
MS. MONK said it's already the situation that some
physicians are in self-quarantine and have been redirected
to provide care by telemedicine. It is also possible that a
patient who needs care can't be seen by their regular
provider or one with whom they have an existing
relationship. For example, it is critical that a diabetic
receives the care they need and this may be more important
in this crisis than that they see the provider with whom
they have a relationship. She said the point of using
telehealth is to increase and maintain capacity throughout
the system so it is important that it is not limited to
just COVID-19.
MS. MONK said ASHNHA is also asking for a specific
exemption for controlled substances where the patient is
already in a hospital, long-term acute care hospital, a
long-term care facility, a regular hospital, or an
alternative delivery site that is established to take care
of COVID-19 patients. She said there may come a time when
doctors should not be expected to physically enter a
facility to see patients unless absolutely necessary.
ASHNHA does not support taking the tool of controlled
substances away from providers during a crisis. She
emphasized that the exemption is specifically for patients
in a facility. She noted that the hospitalist group has
also mentioned this concern.
4:59:45 PM
SENATOR GIESSEL responded that the governor had those two
elements in the original bill and they are sustained at
this time. This emergency declaration will expire on
September 1, 2020 and the legislature will be able to
review it again and make an adjustment if it becomes
necessary, she said.
5:00:30 PM
SENATOR GIESSEL moved to report the Senate Rules CS for SB
241, work order 31-GS2260\U, from committee with individual
recommendations and attached fiscal note(s).
5:00:59 PM
CHAIR COGHILL found no objection and CSSB 241(RLS) was
reported from the Senate Rules Standing Committee.