Legislature(2021 - 2022)DAVIS 106
02/17/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB265 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 308 | TELECONFERENCED | |
| *+ | HB 265 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
HB 265-HEALTH CARE SERVICES BY TELEHEALTH
3:06:08 PM
CO-CHAIR SNYDER announced that the only order of business would
be HOUSE BILL NO. 265, "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."
3:07:57 PM
REPRESENTATIVE SPOHNHOLZ, as prime sponsor, presented HB 265 via
a PowerPoint [hard copy included in the committee packet]. She
said that HB 265 would expand the telehealth flexibilities
created during the COVID-19 pandemic, as they have allowed
health care to be more accessible and affordable. She mentioned
prior bills which have addressed telehealth. Slide 3 listed the
payment barriers to telehealth, as follows: no telehealth parity
laws; some telehealth services not covered under Medicaid; and a
higher burden for audio-only visits. The slide listed the
regulation barriers as the in-person requirement for selecting
health care providers and the requirement to document barriers
before billing. As shown on slide 4, she pointed out that the
state public health emergency expired in April 2021. She stated
that the proposed legislation would restore the best of the
telehealth flexibilities adopted during the COVID-19 pandemic,
and this would ensure high-quality health care standards in
Alaska.
3:12:49 PM
REPRESENTATIVE SPOHNHOLZ proceeded to slides 6-9 and listed the
three provisions of HB 265: removes the in-person barrier in
the licensing statute for telehealth; enhances telehealth
treatment for substance abuse disorders; and expands Medicaid
coverage for telehealth services and modalities. She said the
removal of barriers would apply to all health care providers
licensed in the state and allow each licensing board to
determine what is appropriate. Regarding the enhancement of
telehealth delivery, HB 265 would allow physicians, osteopaths,
and physician assistants to write prescriptions for controlled
substances without an in-person visit. It would allow
practitioners waived by the Drug Enforcement Administration to
deliver medication-assisted treatment via telehealth without an
in-person requirement. Regarding Medicaid, the proposed
legislation would ensure reimbursements for behavioral health
services. She said that in order to achieve the right balance
while drafting the legislation a variety of stakeholders have
been involved, including health care providers, behavioral
health providers, tribal health, and others.
3:15:49 PM
GENEVIEVE MINA, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, on behalf of Representative Spohnholz, prime
sponsor, offered the sectional analysis of HB 265 [included in
the committee packet], which read as follows [original
punctuation provided]:
Section 1
Adds a new section on telehealth under Title 8 for all
health care providers licensed with the State of
Alaska. This section removes the requirement for an
in-person examination prior to a telehealth appoint.
Health care providers licensed in a different state
may also conduct telehealth if referred by a health
care provider licensed in Alaska or with a federal or
tribal health care program.
Subsections (b) and (c) create limits for a telehealth
appointment. If a telehealth appointment falls outside
of a provider's authorized scope of practice, they may
refer a patient to an appropriate clinician. The cost
of a service delivered through telehealth must be the
same if it was delivered in person.
Subsections (d) and (e) ensures that physicians,
osteopaths, physician assistants can deliver services
related to opioid use disorder (e.g., medically
assisted treatment) and controlled substances via
telehealth without conducting an in-person examination
for. For advanced practice registered nurses, these
same provisions apply, with the addition of an in-
person requirement for controlled substances (other
than buprenorphine).
Subsection (f) gives patient or provider the choice to
decline service through telehealth in favor of an in-
person service.
Section 2 Removes the in-person requirement in AS
08.64.364(b) for an appropriate health care provider
to assist a patient during a telehealth appointment
with a physician or physician assistant regarding
controlled substances. This section replicates the
same provisions on cost, scope of services, and
patient protections as Section 1.
Section 3 Adds a new section on telehealth under Title
18 for emergency medical services. This section
removes the requirement for an in-person examination
prior to a telehealth encounter. This section
replicates the same provisions on cost, scope of
services, and patient protections as Section 1.
Section 4 Adds a new section on telehealth payment
under Title 47 for Alaska Medicaid. This section
requires the Department of Health and Social Services
to pay for telehealth services in the same manner as
an in person service for the following: behavioral
health services, Medicaid waiver and demonstration
services; services provided by a community health aide
or community health practitioner, behavioral health
aide or behavioral health practitioner, dental health
aide therapist, chemical dependency counselor; other
services provided by an individual or entity eligible
for department certification and Medicaid
reimbursement; and services provided at rural clinics
and federally qualified health centers. This
subsection also allows for a telehealth visit to be
conducted through any means which could be useful in a
patient-provider relationship, including through
email, text, and phone call. Subsection (b) allows for
the department to restrict the provision of telehealth
services if the telehealth services, according to
substantial medical evidence, cannot be safely
delivered via telehealth, or if the federal government
will not reimburse the delivery of certain services
provided via telehealth.
Sections 5-8 Amends the uncodified law to instruct the
Department of Health and Social Services to submit an
amendment to the state plan and seek approval from the
U.S. Department of Health and Human Services if needed
and provides immediate effective dates for other areas
of this bill.
3:19:40 PM
REPRESENTATIVE SPOHNHOLZ, in reference to stakeholders, stated
that in the following week she would present to the committee
some modest changes to the proposed legislation.
3:21:54 PM
APRIL KYLE, President and CEO, Southcentral Foundation (SCF),
expressed hope that the health care system would be able to
incorporate what had been learned during the COVID-19 pandemic.
She described HB 265 as "a step toward that." She stated that
prior to the pandemic, the tribal health system had been
delivering health care across Alaska for decades, but not
without barriers, such as reliance on video services for
reimbursement, which is not feasible in many places in the
state. As a result, there were some telehealth deliveries, but
many times health care relied on transporting [patients] to hub
communities or Anchorage. She stated that at the start of the
pandemic, SCF had changed its service delivery model "overnight"
to create safe, in-person care, clinically sound video care, and
good audio care. Care teams from the areas of mental health,
addiction services, and primary care partnered with people and
families to determine the best type of care needed. She said
this resulted in "good clinical outcomes and cost savings." She
emphasized the importance of bringing people the type of care
needed "in real time" so their health would not spiral downward.
3:25:17 PM
NANCY MERRIMAN, Executive Director, Alaska Primary Care
Association, testified in support of HB 265. She stated that
the proposed legislation would expand telehealth in Alaska by
increasing access to primary care and behavioral health
services. She listed the following benefits: a range of
telehealth modalities; the option for patients and providers to
engage outside a clinical setting; and reimbursements for
telehealth visits. She stated that in 2020 health centers
served 105,000 patients through 450,000 visits. She noted that
substance abuse disorder treatment is one of the fastest growing
areas of telehealth. She added that the temporary telehealth
policy changes benefited health centers, as now they are
recognized as telehealth treatment providers. She spoke about
the challenges of accessing health care centers and the number
of patients who live in underserved rural communities. She said
in 2021 a cohort of health centers reported that 59 percent of
telehealth services occurred by phone and 41 percent by audio
and video. She reported that telehealth for behavioral health
now represents 35 percent of all telehealth usage. She further
reported that the use of telehealth visits has resulted in fewer
dropped visits and less delayed care. She urged the committee
to support HB 265.
3:29:42 PM
PRESTON SIMMONS, CEO, Providence Alaska Medical Center
("Providence"), testified in support of HB 265. He reported
that in 2020 Providence served more than 12,000 Alaskans via
telehealth. He said behavioral health represented 31 percent of
this, with the other areas being internal medicine, family
medicine, pediatrics, and maternal and fetal medicine. He spoke
about health care transformation to improve overall economics
and health outcomes. He advised that the state has the
opportunity to use what it learned during the pandemic to
modernize the health care system, while also taking advantage of
the federal advancements in broadband infrastructure.
MR. SIMMONS urged the state to stop incentivizing the most
expensive forms of health care, giving the example of using
emergency rooms for primary care. He talked about Providence's
initiative to modernize how it serves communities in Alaska. He
stated that the top 10 percent of health care users account for
"a vast majority of costs." He shared that individuals have
explained that they use the emergency room for primary care
because emergency rooms are on public transportation routes,
while other facilities often are not. Telehealth removes the
barriers related to transportation, improves health equity, and
strengthens patient relationships, while "incentivizing the most
appropriate care settings." He talked about the benefits of
telehealth, not only in Anchorage, but in other areas of the
state. He mentioned helping patients near their support
network, including helping COVID-19 patients via telehealth. He
talked about scheduling telehealth appointments by phone and
empowering Alaskans to make informed health care decisions. He
said Providence averaged 120 virtual visits per day during the
height of the pandemic. He indicated that there has been
improved health outcomes because of telehealth, and he said HB
265 would allow the good work being done to continue.
3:35:03 PM
TOM CHARD, Executive Director, Alaska Behavioral Health
Association (ABHA), testified in support of HB 265. He stated
that the proposed legislation would improve access to care,
patient satisfaction, provider satisfaction, and the efficiency
and outcomes of the care received. He said that during the
federal and state public health emergencies, ABHA set aside some
regulations and removed regulatory barriers, which resulted in
the exponential expansion of behavioral health in telehealth.
He noted that the annual Medicaid report published in November
[2021] highlighted that the top diagnoses were in the category
of behavioral health. He stated that the option of telehealth
had removed barriers, such as transportation issues, child care
issues, or [scheduling issues related to] jobs or school
attendance. He emphasized that the federal public health
emergency would expire on 4/15/22, and on the next day benefits
gained over the last couple years could be lost. He stated that
HB 265 would extend those benefits by extending the flexibility
around modality, removing the in-person requirements, and
ensuring payment parity. He said within the past two years at
Providence no-show rates have dropped and more people have
received care, with patients and providers being more satisfied.
He urged the passage of HB 265.
3:39:18 PM
CO-CHAIR SNYDER opened public testimony on HB 265.
3:39:40 PM
JOHN SOLOMON, Director, Behavioral Health, Maniilaq Association,
shared that before the pandemic he had flown into villages to
provide in-person counseling services. He emphasized that "up
here" telehealth is not about getting better health care; it is
about getting any care at all. He indicated there was an 800
percent increase in those seeking care when telehealth was an
option, and he said those were people who had been waiting for
care. He expressed support for telehealth.
3:41:08 PM
SHANNON DAVENPORT, RN, Alaska Nurses Association (ANA),
testified that ANA supports HB 265 because it would provide
"continuity of care," as nurses would be able to follow-up with
patients at home via telehealth. Furthermore, as a hospice
nurse, she said telehealth has made it easier for families to
say goodbye to their loved ones. She stated that telehealth
services have opened avenues for those who were unable to be
seen by a provider in person. She reiterated ANA's support of
HB 265.
3:43:06 PM
CO-CHAIR SNYDER closed public testimony on HB 265.
3:43:16 PM
REPRESENTATIVE FIELDS said he supports many of the provisions in
the proposed legislation; however, he would like to ensure
Alaskans are choosing available doctors in the state as opposed
to paying doctors in the Lower 48. To clarify, he pointed to
language which would amend AS 08.01, on page 1 of the proposed
legislation, line 9-12, which read:
If a health care provider is licensed in another
state, the health care provider may provide services
under this section only to a patient who is referred
by a health care provider licensed under this title or
a federal or tribal health care program.
REPRESENTATIVE FIELDS explained that he does not want the
proposed legislation to undermine Alaska's limited and necessary
health care workforce.
3:44:11 PM
REPRESENTATIVE SPOHNHOLZ responded that this is important, and
it will be addressed in the upcoming committee substitute. She
explained that this would allow for follow-up visits with
specialists via telehealth after an in-person visit to a doctor
in the Lower 48.
3:45:28 PM
REPRESENTATIVE FIELDS opined that one of the more disturbing
developments has been the growing investment in health care by
Wall Street, and he advised that a loophole should not be
created which "outsiders could exploit to the detriment of
Alaska."
3:46:04 PM
REPRESENTATIVE MCCARTY expressed concern regarding the
requirement that in-state providers be licensed while out-of-
state providers are not required to be licensed. He said "do no
harm" does not extend to unlicensed providers unless an
interstate compact exists.
3:47:34 PM
REPRESENTATIVE SPOHNHOLZ responded that the upcoming committee
substitute would address this issue. She clarified that
Alaskans would be allowed to have follow-up visits via
telehealth with providers in the Lower 48 in regard to "very
unique specialty care" not available in the state. She offered
some examples of this.
3:50:28 PM
REPRESENTATIVE MCCARTY offered his understanding that there were
some [providers] licensed in Alaska who were "rogue." He said
that the state investigated the individuals; however, once they
leave the state, they are no longer licensed. He opined that it
was great to offer telehealth during an emergency period. He
related that he has heard, "when it ended," providers do not
want to pay the licensing fees in Alaska. He expressed the
opinion that this is offensive.
3:51:57 PM
CO-CHAIR SNYDER noted that this issue had been addressed in a
past session, and she asked if there were any significant
changes in the proposed legislation.
3:52:48 PM
MS. MINA responded that the main differences would be the focus
on health care providers licensed in Alaska and the expansion of
Medicaid services. She said the language in HB 265 is narrower
than previous legislation.
3:53:28 PM
REPRESENTATIVE FIELDS asked if it would be possible to charge
non-licensed providers to practice in Alaska. He then inquired
about equitable payment for telehealth and what other states are
doing.
3:54:14 PM
REPRESENTATIVE SPOHNHOLZ, to the first question, answered that
the solution would be to have a registration fee, which could be
equivalent to a license fee. She said that the committee
substitute would affect a very narrow class of people. To
Representative Fields' second question, she said historically
telehealth is done at a lower rate, and sometimes there is an
associated telehealth service fee. The problem, she explained,
is "that hasn't supported the marketplace in developing
telehealth." She indicated that telehealth may not have brick
and mortar costs, but it has technology-related costs.
[HB 265 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 265 Sponsor Statement 01.26.22.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 Letters of Support - U.S. Renal Care 01.21.22.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 - Version W.PDF |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 Sectional Analysis - Version W 01.26.22.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 v W Fiscal Note - DCCED Licensing.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 v W Fiscal Note - DOH DBH Behavioral Health Administration.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 v W Fiscal Note - DOH DMS Medicaid Services.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 v W Fiscal Note - DOH HCS Medical Assistance Administration.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 Presentation 02.16.22.pptx |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 2.16.2022.pdf |
HHSS 2/17/2022 3:00:00 PM |
HB 265 |