Legislature(2021 - 2022)BUTROVICH 205
02/02/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB56 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 56 | TELECONFERENCED | |
SB 56-EXTENDING COVID 19 DISASTER EMERGENCY
1:33:21 PM
CHAIR WILSON announced the consideration of SB 56, Senate Bill
NO. 56 "An Act extending the January 15, 2021, governor's
declaration of a public health disaster emergency in response to
the novel coronavirus disease (COVID-19) pandemic; providing for
a financing plan; making temporary changes to state law in
response to the COVID-19 outbreak in the following areas:
occupational and professional licensing, practice, and billing;
telehealth; fingerprinting requirements for health care
providers; charitable gaming and online ticket sales; access to
federal stabilization funds; wills; unfair or deceptive trade
practices; and meetings of shareholders; and providing for an
effective date."
CHAIR WILSON pointed out that the committee has new material,
including a new, indeterminate fiscal note from the Department
of Revenue. He called Commissioner Adam Crum to the table.
1:34:42 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services (DHSS), Anchorage, Alaska, noted that Heidi Hedberg,
Director of the Division of Public Health, Bryan Fisher,
incident commander for the state with the Department of Military
and Veterans Affairs, and Dr. Zink, DHSS Chief Medical Officer,
would be available online for questions. The commissioner
planned to do a high-level sectional analysis of SB 56 while Mr.
Fisher would provide an overview of AS 26.23, the Alaska
Disaster Act. Then the commissioner planned to do a high-level
walkthrough of the public health emergency, the disaster
declaration timeline, and major components of the Alaska
response. Heidi Hedberg will discuss the authority under AS
26.23.020 and how the authorities were used in the state
response and why these authorities are needed for an extended
disaster declaration as proposed by SB 56. The commissioner
added that representatives from the Department of Commerce,
Community and Economic Development, the Office of Management and
Budget, Department of Public Safety, the Department of Revenue,
and the Department of Law were online to answer questions about
particular sections of the bill that impact their respective
departments and programs.
COMMISSIONER CRUM stated that Section 1, the Findings Sections,
establishes the chronology of SARS-CoV-2, the virus that lead to
COVID-19, and the state of Alaska's response to the imminent
threat and the outbreak of COVID-19 in Alaska. It includes a
description of federal agency actions in approving emergency use
authorizations (EUA) for the immediate nationwide distribution
of a COVID-19 vaccination, which occurred on December 11, 2020,
and the need for statewide response under AS 18.15.390 to
address the public health disaster emergency and aid in vaccine
distribution across the state.
COMMISSIONER CRUM said that Section 2, Extension of the January
14 Disaster Declaration to September 30, 2021, provides that the
commissioner of DHSS may certify to the governor that there is
no longer an outbreak of COVID-19 or credible threat. The
commissioner shall submit a proclamation to the legislature that
indicates that the public health disaster emergency no longer
exists.
1:37:10 PM
SENATOR BEGICH stated that he objected to the governor's claimed
extension of these orders as unconstitutional. Senator Begich
says that none of his caucus objects to the idea of public
safety being paramount. They do object to the governor asserting
his authority in an inappropriate manner in this regard. Senator
Begich said he is going to question this legislation on two
counts. One is the whereas clauses that specifically speak to
the extension of those orders, which are unconstitutional.
Secondly, the extension to September 30 will be a relatively
illegal extension of this order. He also wanted the commissioner
to know that he supports the efforts of the department and
public health and backs the medical decisions the department has
made because they have ensured that Alaska is in the position it
is in today, the state with the highest level of vaccinations
and one of the lowest mortality rates per capita. He commends
the commissioner for that, but there are constitutional issues
to be considered. That will make the commissioner's job more
difficult. He wants to work with him to do this in the smoothest
way possible, but the constitutional issues must be addressed.
CHAIR WILSON stated that the committee will not spend time on
the constitutionality of the past. That is not the purview of
this hearing. The committee is hearing the extension before
them, not addressing the ones in November or December. The
committee is only addressing the extension before the committee.
SENATOR BEGICH responded that as point of record, they are
referred to in the legislation.
CHAIR WILSON said he understands that, but he is stating that is
not the purview of the hearing today. The committee will address
the extension going forth, not the ones in the past.
1:39:35 PM
SENATOR REINBOLD shared that she appreciated her colleagues'
comments. She wanted to have the opportunity to discuss the
constitutionality of this and of past [events]. This is the
first hearing, the first opportunity the legislature has had to
weigh in on one of the biggest events in the history of Alaska
and Health and Social Services has been at the helm. She asked
Commissioner Crum if he could define "credible threat,"
"disaster," and the data he is using. She thought in her
committee [Judiciary] that he was using the UAA (University of
Alaska Anchorage) data. The premise of what he is basing a
disaster declaration on is important. She has found four
important, powerful research documents that show that the data
Commissioner Crum used, the Imperial College data, is
significantly flawed.
COMMISSIONER CRUM replied that a credible threat has to do with
the mission of DHSS, which is to protect and promote the health
and wellbeing of all Alaskans. DHSS works and partners with the
federal agencies the CDC (Centers for Disease Control and
Prevention) and the FDA (U.S. Food and Drug Administration).
DHSS follows their lead and does any specific Alaskan tweaks to
policy and actions as necessary. DHSS looks at what is happening
in other states and considers whether anything about Alaska's
geographic position can be used to its advantage. Initial
modeling did come out with outrageous numbers about where things
were going and about deaths. These sources were COVID Act Now,
the University of Washington, King's College in London, all
across the board the data was in a similar vein. It is not just
one single study at a time. DHSS looked across the board at what
was happening and the context of the situation as it was
occurring, both around the world and in the United States.
Admittedly, those projections ended up being fatally flawed, but
quite a few states actually reached their breaking points.
Hospitals had issues about capacity and with Alaska having acute
care beds for less than two percent of the population, DHSS
wanted to make sure that it took care of that. During the
response in this very long year, Alaska has had hurricanes in
Southwest and Western Alaska that has delayed people getting
care and being transported out and delayed the delivery of goods
for the response. Those are some of the data points that they at
DHSS used when they made decisions for Alaska.
SENATOR REINBOLD pointed out that the commissioner said that the
data used was fatally flawed. That is important because it
agrees with her research. She noted that she had emailed that to
the chair and wanted that to be part of the official hearing
because as Senator Begich said, it is part of the bill. She
would like part of the hearing to be about the UAA model. The
first thing that must be done is to talk about why the disaster
was declared in the first place. There were 18 mandates and if
the declaration was based on a faulty model, it throws
everything out the window. It is important to get the premise on
record. She asked the chair to include the research as a
courtesy.
CHAIR WILSON recognized that the senate president, Senator
Micciche, was in the room.
SENATOR REINBOLD said that the commissioner had not defined
"credible threat," which is important. He said DHSS is to
promote the health of all Alaskans. Lots of Alaskans are
suffering at an unprecedented number because of the mandates and
this ongoing disaster declaration. That causes her tremendous
pause. One in four children are suffering because of the
lockdowns and schools being shut down. Her heart goes out to
them and the parents who are suffering. If he is looking out for
the health of Alaskans, this is not the way to do it. The health
and wellbeing economically must be looked at holistically. She
still needs "credible threat" defined. In terms of geography,
which he just mentioned, London is dense and Alaska is
widespread, which is another reason why the models were flawed.
She wanted to see that data about acute hospital beds. She asked
the chair whether they could see the data the disaster
declaration extensions were based upon. She has been requesting
that information for quite some time.
CHAIR WILSON answered that some of that will be in the
presentation.
1:45:33 PM
SENATOR COSTELLO stated that she cannot support extending the
disaster declaration until the end of September. It sends the
wrong message to suffering Alaskans that things will not change
and the state will be in a lockdown. She asked why the
administration did not consider just extending every 30 days.
She is anticipating that his answer will align with what she
read in the [committee] material, that the administration wants
the disaster declaration to align with the federal budget cycle.
The state's budget cycle has never been aligned with the federal
budget cycle. It has never prevented Alaska from receiving
federal funds. The state is interested in receiving federal
funds to help suffering Alaska families; however, she cannot
support an extension well until September of this year. She
asked the commissioner why the administration did not consider
extending the declaration for 30 days.
COMMISSIONER CRUM asked whether Senator Costello meant an
extension by the legislature or the governor.
SENATOR COSTELLO replied that he could answer to both.
1:47:02 PM
COMMISSIONER CRUM explained that if the legislature is in
session or meeting, it is up to the legislature to make the
extension. The date of September 30 is because the federal
public health emergency comes from the Department of Health and
Human Services in 90-day sections at a time. If an extension
enters into a quarter of the year, the benefits of that public
health emergency go to the end of the quarter. For example, the
prior enhanced FMAP (Federal Medical Assistance Percentage) of
6.2 percent to the Medicaid program was supposed to end January
20, but because it went into January, the state would receive
the benefits until the end of this quarter. That is one reason
why. Secretary Azar put forth an extension on January 24 for 90
days. They look to President Biden to not allow the public
health emergency to expire in his first 100 days. Knowing that
there will be at least one more extension from President
Biden's-appointed Health and Human Services Secretary, September
30 was chosen because much of the flexibility from Health and
Human Services has a lot to do with the delivery of healthcare
systems. That flexibility is tied to the federal public health
emergency. The date was not necessarily about federal funding.
It about the flexibility to respond and how the state can use
that flexibility through waiver and suspension of regulation and
statute.
SENATOR COSTELLO responded that she understood the desire to be
flexible and malleable, but to take an entire legislative
branch, the people's branch, and to essentially take the
legislature out of the equation is problematic. The legislature
is planning on being responsive to the needs of Alaskans and the
federal funding, and she doesn't see that there would be any
problem with getting the legislature to extend if that were
needed. Again, the date of September 30, 2021, is highly
problematic for her and her constituents. She would like to work
with the committee and DHSS on finding something that is more
palatable.
COMMISSIONER CRUM added that one more item is that after
submitting the bill, DHSS did receive a letter from the Acting
Health and Human Services Secretary who said that it is the
intention of the Biden administration to continue the public
health emergency at least through the end of calendar year 2021.
1:49:47 PM
SENATOR HUGHES shared that she appreciates and shares the
concerns of the committee expressed so far. She is interested in
hearing the case the administration will present. She
appreciated Commissioner Crum willingness to be in the hot seat.
She is concerned about the legislative branch having the ability
to end a disaster declaration. She does not think that is in the
bill. If it is the will of the committee to move the bill out,
if it is the will of the senate to pass this on the floor, they
should consider adding the ability of the legislature to end the
emergency declaration at any point. She asked whether, in order
for a state to receive the FMAP of 6.2 percent related to the
pandemic if President Biden extends the public emergency, the
state has to have an existing emergency declaration in place to
receive enhancement.
COMMISSIONER CRUM answered no.
SENATOR REINBOLD said that she had not heard "credible threat"
or "disaster" defined. The legislature has the power of the
purse. She wants to know how much the department has been
redistributing but first she wants the definitions because a lot
of people think the disaster was declared based on faulty
information. Some of the mandates that have the names of the
commissioner, the governor, and Dr. Zink all over them are
creating a catastrophe, economically and constitutionally. She
felt completely sidelined by the administration. The DHSS budget
is huge and she wants to know how much additional funding it has
received.
COMMISSIONER CRUM replied that Incident Commander Bryan Fisher
will go over the entire Alaska Disaster Act and what that means
in Alaska.
SENATOR REINBOLD said she was asking for the definitions of
"credible threat" and "disaster." She asked for a yes or a no
about whether she could get complete information that the
disaster was declared on based on hospital capacity.
CHAIR WILSON responded that Commissioner Crum is saying that the
incident commander can give that information and define that for
the committee. The committee needed to move on because the
administration needed to present and then allow time for
questions.
COMMISSIONER CRUM explained that the next section will have an
entire overview of the Disaster Act, which gives the definition
of "disaster" in Alaska. As far as "credible threat," that goes
with the information and context available at the time. He would
be happy to put a response in writing for the committee on that.
1:54:07 PM
COMMISSIONER CRUM said Section 3, Finance Plan, establishes the
finance plan for the disaster declaration. The components are
the same appropriations that were made in 2020 in support of the
March 11 disaster declaration that was extended to November 15,
the expenditure of CARES (Coronavirus Aid, Relief, and Economic
Security) Act receipts ratified by the legislature, and any future
appropriations that may be made for FY 21 or FY 22. In addition,
the governor may not expend more than $10 million from the
disaster relief fund for the emergency declared on January 15
and extended to September 30, 2021.
COMMISSIONER CRUM explained that Section 4, Report to the
Legislature, requires that the Office of Management and Budget
(OMB) submit a monthly report to the Legislative Finance
Division that lists the total expenditures incurred by the state
in its response to the public health emergency disaster,
including expenditures aimed at mitigating, preventing, and
controlling COVID-19. The report will include cumulative
expenses incurred since March 11, 2020, the date the governor
issued an initial declaration of a public health disaster. This
section further provides for a final report due to the
Legislative Finance Division no later than November 30, 2021, or
60 days after the governor determines the public health disaster
emergency no longer exists, whichever is earlier.
SENATOR REINBOLD said, "First of all, it sounds like any of us
can read the Disaster Act. I mean, we understand that. But it
sounds like a lot of people do not believe there is an emergency
right now. And it sounds like, one, you cannot define the
emergency. It sounds like you cannot define the disaster, so are
going to have fill in the blanks in there and you cannot define
imminent threat, so, what my question to you is, in regard to
the disaster, it's coming up on a year, one full year, when the
statutes say 30 days. How can you justify extending this? If
you're to look out for the health and wellbeing of all Alaskans,
and this is causing tremendous harm, as you know, I just want
straight up, how can you justify extending this, knowing how
many people, how many businesses are suffering, how many
children are suffering? How many rights are being violated? How
can you justify this?"
CHAIR WILSON said there is going to be a section in the
presentation to explain to the general public some of the
differences in Title 21 vs. the gubernatorial mandate from the
administration vs. local mandates. There is huge confusion that
one does not need to happen without the other.
1:57:02 PM
SENATOR REINBOLD asked the commissioner if he is clearly able to
define "credible threat," clearly define the disaster, clearly
justify the extension of the disaster, and can she, yes or no,
get all the data of the disaster based on hospital beds.
CHAIR WILSON suggested that data is broad term, so that could be
narrowed and put to the department in writing.
SENATOR REINBOLD replied that it had been given multiple times.
CHAIR WILSON pointed out that hospital capacity is on the data
dashboard. He believed the commissioner answered the other
questions on the disaster and credible threat.
SENATOR REINBOLD asked if the answer is she cannot get the
hospital data. She has been asking and emailing [to get
information].
CHAIR WILSON repeated that the hospital capacity is on the DHSS
dashboard and the department is indicating that it can provide
that information to the committee.
SENATOR REINBOLD said, "They changed some of the parameters and
I've been trying to drill down and get the information." She has
been trying to get the information for months and this may be
her only opportunity. "The people deserve to know why this
disaster was declared in December based on hospital beds and
their whole lives are being transformed," she said.
CHAIR WILSON replied that the committee is not going into the
premise of the disaster declaration. The committee is going to
address the bill that is in front of them. He had said earlier
that the committee is not going into the past. The committee
will address the bill in front of them. "It was stated earlier
that the legislature had the ability to meet and the legislature
did not. We failed to act positively. We failed to act
negatively, to vote this up or down. My intent is to get this in
front of the legislative body so they can make a decision to
vote in the affirmative or to vote in the negative. That is the
intent the chair has. My intent is trying to get this through so
we can make a decision one way or the other as a legislative
body."
1:59:54 PM
SENATOR HUGHES said she knows the committee is not revisiting
the past, it is looking forward as far as what SB 56 means for
Alaska now and in the coming year. She said she spoke to the
commissioner about wanting to know the data that would be the
basis for ending the disaster declaration. That should not be a
feeling that things have settled down. The legislators should
know what would be the point at which the declaration would be
repealed or stopped. And in reference to that, they would need
to know where the state is now. She asked what the state's
targets are. Perhaps the administration would present that to
the committee, but she wants that on the record. Although they
are not revisiting the past, they need that information for
their decision-making going forward.
CHAIR WILSON replied that is germane as Section 4 is about the
end date of the disaster.
SENATOR REINBOLD said to echo Senator Begich and Senator Hughes,
if they are not looking back, they can't look at this bill
because it contains dates from the past.
CHAIR WILSON responded that in terms of the bill's finance plan,
that is referenced as it was simpler and saves on paper. Those
items could be printed to give to committee members. He thought
this was a simpler method of documenting that instead of
increasing the size of the bill.
SENATOR REINBOLD replied that the bill talks about the diagnoses
on March 12. It has nothing to do with the financial plan. Line
23 on page 2 talks about the number of cases. This is all
germane and they are talking about the past. This has nothing to
do with the fiscal notes or the financial plan. It is in the
bill itself.
CHAIR WILSON said the committee had to allow the commissioner
and staff the opportunity to present and other people were
available for testimony to add to the conversation.
COMMISSIONER CRUM said that with Section 5, professional
licensing is administered by the director of the Division of
Corporations, Business, and Professional Licensing. The items in
this section are the state cannot increase licensing fees during
the public health disaster emergency declaration, and licenses,
permits, and certificates can be granted on an expedited basis
if an individual holds a corresponding license or permit in good
standing in another jurisdiction. This is an expedited means of
getting healthcare workers to the state in the event of a surge.
The state may temporarily modify or waive continuing education
requirements for licensees who need to renew. The state can
require individuals who receive a license, permit, or
certificate to arrange and agree to supervision by an individual
who holds one. This was an item the legislature put forward to
allow students, such as nursing students, to start providing
healthcare. This section also provides that a licensed
professional seeking or holding an expedited license, permit, or
certificate under this section who travels to Alaska from
outside of Alaska must comply with the travel restrictions
orders or guidelines recommended by the CDC.
2:04:22 PM
SENATOR BEGICH asked if the number of people receiving temporary
licenses will be part of the report.
COMMISSIONER CRUM answered yes.
SENATOR BEGICH continued that his only question with this
section is whether DHSS has examined the implications of the
temporary certification. For example, if a nurse practitioner
has an emergency license that is not based on the normal
training, postdisaster declaration, will that person be
qualified based on the emergency license. He asked if that
person gets to leap over those taking the normal coursework. He
wants to know the unintended consequences. He also asked if any
analysis has been done to know whether this has impacted the
Alaska healthcare workforce.
COMMISSIONER CRUM replied that for the second half of the
question, it will be a supplement. Those individuals will still
have to operate under their professional boards. He will direct
the first half of the question to Sara Chambers, who is online.
SENATOR BEGICH clarified that he was concerned about
professional qualifications necessary for for a field being
missed because of this extended disaster declaration that could
create a false sense of experience that may not be relevant to
the educational experience a person would normally need for
certification.
2:07:15 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, explained that the
greatest need for the emergency courtesy licensing is for
unusual circumstances that have arisen because of COVID. When
rural areas have been hit hard, particularly in areas where
commercial activity such as mining or commercial fishing is
taking place and there is not a strong workforce to meet the
needs of all COVID patients and mitigation efforts, the division
has been able to use courtesy licensing to bring people up who
would otherwise not be going to work in an Anchorage hospital,
for example. The division has seen a few unusual circumstances
like that where the Alaska workforce could not meet the need.
These are board decisions, and the division has worked with
various boards to set up siderails so that the courtesy licenses
do not supplant a regular license. Someone who works in a
hospital performing regular duties needs a regular license.
There is an end date to those licenses. It depends on the
particular board, but the boards are conscientious about putting
up siderails to make sure this did not create property rights
for someone to "leap over" someone else who might need to meet
higher standards in order to permanently practice under a full
license.
SENATOR BEGICH responded that that answers his question. Another
point regarding the chair's statement about the legislature
coming together as a body is that it is not just the
legislators' responsibility. The governor also has the power to
bring the legislature together, should he desire to do so.
SENATOR REINBOLD asked the Ms. Chambers if licensing with
special accommodations during this challenging time could be
done through another bill without extending the disaster
declaration. Senator Kawasaki took the lead with bills for the
military and military wives. It sounds like the department wants
federal funds, and there are alternatives for that. She asked if
the division has to have the disaster extended.
MS. CHAMBERS answered that most boards lean on the declaration
of a disaster or a public emergency to be able to issue those
courtesy licenses. That is one of the siderails. It depends on
the license type, but there needs to be a finding of an
emergency in order for the boards to authorize those courtesy
licensing.
SENATOR REINBOLD summarized that Ms. Chambers is saying that she
has to have a disaster declaration and an emergency in place, to
do this. It cannot be done with other legislation.
MS. CHAMBERS replied that it could be done with other means, and
this is the vehicle in front of the legislature now. Other ways
could be looked at for an emergency to be declared. She'd be
happy to explore that, but the vehicle in front of them now is
an opportunity to continue what the legislature did last year
that helps economic development and delivers healthcare services
to people in a short amount of time.
2:12:11 PM
SENATOR REINBOLD reiterated that Ms. Chambers is telling the
committee that she has to have an emergency to make special
accommodations. Regarding economic development, a lot of people
are in economic crisis now. Businesses are going out. The
situation must be looked at holistically. Senator Reinbold has
never seen so many people and businesses suffering. She was
raised in Anchorage and it is almost unrecognizable. When Ms.
Chambers is talking about economic growth, declaring an
emergency is not the best way to do it. Senator Reinbold will
hold Ms. Chambers to her word that she cannot do this unless she
is in an emergency.
SENATOR HUGHES pointed out that ordinances at the municipal
level are separate from what the committee is dealing with. She
does feel for those in the municipality of Anchorage. Part of
her district is in the municipality. Part of it is in Mat-Su,
and Mat-Su has not suffered in the same way. Some of the things
at the home rule level has made it worse for Alaskans. The
legislature could pass a bill that has nothing to do with an
emergency disaster that would have the same provisions. The
legislature could do it for telehealth, for fingerprinting, for
shareholder meetings, for charitable gaming. Any of these
changes could be made by the legislature. Her understanding is,
and the Department of Law could correct her, is that the
legislature could make any of these changes without the
declaration. Senator Costello brought up her discomfort about
going as late as September. If the legislature is not at the
level of worrying about hospital capacity but wants people to
readily access health care services, the legislature could
provide the telehealth provisions suggested in this bill even if
a disaster declaration is not in place. If she is wrong about
that, she asked the commissioner to let her know.
MS. CHAMBERS said that to address Senator Reinbold's comments,
there are other vehicles to accomplish the particular carveouts
relating to licensing. There are different ways for the
legislature to accomplish those goals. The governor did propose
some of those goals last year preCOVID in some of his bills. The
legislature may see some similar types of legislature coming
forward. The division would be interested in speaking to members
of the legislature about some of those goals, which did predate
COVID. She wanted to clarify that there are other means for
licensing to be taken up by the legislature if it is will of the
legislature to move those forward this session. She can't speak
to other areas that would require a particular type of emergency
declaration that, as Senator Reinbold pointed out, may speak to
federal funding opportunities. That is separate from licensing.
Altogether, this vehicle is a useful tool to serve Alaska during
this time, but she wanted to be clear that the licensing aspects
could be utilized outside of this legislation, as the governor
suggested preCOVID last year.
2:16:42 PM
COMMISSIONER CRUM described Section Six, Telehealth, as allowing
for the healthcare provider licensed, permitted, certified in
another jurisdiction to practice telehealth in Alaska without
first conducting an in-person physical examination or being
licensed in Alaska. The telehealth services provided must be
within a provider's authorized scope of practice. If the
providers determines that the encounter will extend beyond the
scope of practice or services, providers must notify their
patients and recommend the patients contact a healthcare
provider licensed in Alaska. The healthcare provider cannot
charge unreasonable fees and the fees must be consistent with
the ordinary fees charged for that service and may not be more
than five percent above the ordinary fees typically charged.
SENATOR COSTELLO shared that in the material provided, this
would allow the commissioner to waive any state law or
regulation related to telehealth or telemedicine if compliance
would substantially prevent or impede healthcare services. It
goes on to say that the department anticipates that there could
be additional costs incurred due to the unknowns of COVID if the
federal and state disaster declarations do not terminate at the
same time, which the commissioner has established as September
30. Her office contacted Legislative Research and received
information that says that research has been reviewing executive
orders from states to determine if any have extended disaster
declarations related to COVID-19 through September 30, 2021, in
the manner of SB 56. Legislative Research has not located any
instances of such an extension having been affirmed by a state
legislature. It goes on to say that in many other states
governors have the authority to extend the declaration by 30,
45, or 60 days, which Alaska does. She asked if the commissioner
could give an example of a telehealth law or regulation that
actually impedes healthcare services because when she voted on
that legislation, it was her understanding that the state was
expanding options for Alaska via telehealth and telemedicine.
She is confused about how telehealth could prevent or impede
healthcare services.
COMMISSIONER CRUM replied that this specifically addresses,
under this disaster declaration extension, healthcare providers
licensed outside of the jurisdiction of Alaska. Typical rules
and regulations inside of Alaska state that providers must be
licensed inside the state and if not, the provider must first
have an in-person visit. That has been waived throughout this.
This is the flexibility that CMS, the Centers for Medicare and
Medicaid Services, has allowed through the federal public health
emergency. In order to meet that flexibility, Alaska has to
waive this provision.
2:19:43 PM
SENATOR COSTELLO asked the commissioner whether, when the
legislature had exhaustive hearings on telemedicine, the
legislature missed the mark because they didn't allow that for
that flexibility at that time.
COMMISSIONER CRUM responded no, these are exigent circumstances,
the inability of travel, of the disaster. Also, unnecessary in-
person visits are not wanted for individuals who can take
advantage of telehealth. The state does not want to lose the
ability to have out-of-state providers. Typically, in the past,
they would rotate up to Alaska, have in-person clinics, and then
have a patient. Normally the department wants to protect the
Alaska-licensed providers. This is not something the legislature
could have contemplated at the time.
CHAIR WILSON asked Ms. Chambers to also provide some
information. She was in front of the committee last year for the
nurse-compacting agreement and explained that providers must be
licensed in the states they are practicing in, so a telemedicine
provider in Texas must be licensed in Alaska to take a phone
call in Texas.
SENATOR COSTELLO noted that the commissioner is stating that an
extension of the disaster is needed in order to address this
issue.
COMMISSIONER CRUM agreed and said the department put this
forward to meet those federal flexibilities.
SENATOR COSTELLO asked if it had to be in this legislation.
COMMISSIONER CRUM responded that it is up to the legislature.
For the timeline to meet the one that expires on February 14,
this is the most expedited vehicle to do so.
2:21:16 PM
SENATOR HUGHES asked whether, with telehealth, just like with
professional licensing, fingerprinting, shareholder meetings,
charitable gaming, the legislature could make decisions, either
temporarily or permanently, whether or not there is a disaster
declaration.
COMMISSIONER CRUM answered that he will not speak as to what the
legislature can or cannot do, but he would believe so.
CHAIR WILSON added that he understands that some of the
professional licensing boards have the regulatory process. He
asked if the legislature would supersede the regulatory process
by creating statute or if the best means is having the emergency
disaster declaration so those regulations could be waived
without the need for the regulatory process.
MS. CHAMBERS replied that the section on telehealth and
telemedicine in the bill has allowed, as it was previously
iterated in SB 231 and is reiterated here, boards and the
division the opportunity to allow telehealth to happen, which
would not otherwise happen because of existing state statutes.
Boards and many of the nonboarded programs do not have the
authority to allow people to practice telehealth on an Alaskan
in the state of Alaska because state law does not permit it. It
would require a statutory change or a suspension of those
statutes as proposed in the bill to enable this telehealth
provision.
CHAIR WILSON said another professional licensing question is
whether it would be better suited to change that through statute
or would the regulatory process need to be changed as well.
Obviously, that goes through the Department of Law and the
lieutenant governor's office.
MS. CHAMBERS explained that the licensing provisions that are
being requested in the bill are because they require statutory
changes. The boards have done all that they can through the
regulatory process. These are some of the remaining areas that
require legislative action in order to provide the flexibility
that healthcare facilities and patients in Alaska have needed
during the pandemic. These require changes in state law.
2:24:28 PM
SENATOR BEGICH said as a point of clarification, with SB 241,
the legislature adjusted it and added a number of provisions.
The legislature has the ability to change this bill in any way
it wishes. If the legislature wanted to make a permanent change
with an item in the bill, it can through a separate, standalone
piece of legislation. In fact, his objection to the nursing
compact last year was because it appeared to weaken the
standards for nursing qualifications. To Senator Hughes through
the chair, the answer to her question is yes, the legislature
has the power to do all those things and yes, the legislature is
going to adjust this bill. The comments of Senator Reinbold and
Senator Costello speak to that. The legislature will adjust this
bill through the process and do it collaboratively. The
legislature has the power at any given to make these changes
permanent, if they so wish.
SENATOR REINBOLD shared that she wanted to refer to SB 241. She
talked to Legislative Research yesterday and they told her it
was only referred to Rules. She thought the hearing where she
heard it for the first time was roughly between midnight and 2
a.m. That was the first time she heard it because it was only
referred to Rules. She said to correct her if she was wrong.
SENATOR BEGICH responded that it was extensively debated in the
Finance Committees in both bodies. It was debated in Finance and
Rules. It was extensively debated in Rules because the minority
had a number of provisions they hoped to add. It was in more
than one committee. He was only able to comment on it because he
sat on the Rules Committee.
SENATOR REINBOLD stated that she potentially received
misinformation yesterday. She remembered watching it around
midnight to 2 a.m. and then it went directly to the floor. It
caught a lot of legislators who were not in Finance or Rules off
guard.
SENATOR BEGICH clarified that it was the Conference Committee.
SENATOR REINBOLD said correct, the Free Conference Committee. It
came in roughly between midnight and 2 a.m. and went directly to
the floor. The legislature didn't know what COVID was, the
governor was throwing all these travel mandates down.
Legislators didn't know if they would be stuck in [Juneau].
After a tremendous number of amendments, it was thrown out. It
was not a well-vetted bill. Many people have serious remorse
about that. She asked about just reading an email that all
amendments [for SB 56] are due tomorrow. This is the first
hearing, the first time hearing the bill, all amendments are due
tomorrow, and the committee is just getting a basic grasp of the
bill. She asked the chair if 5 p.m. tomorrow is the cutoff date
for submitting amendments.
CHAIR WILSON answered that his office still working through
that. Obviously the committee is not through the presentation so
that deadline will probably be extended. His intent was to get
through the first presentation of the sectional today, so the
deadline will probably be moved. "Let's see what we can do to
get through and then we'll have a new date and time," he said.
2:28:34 PM
SENATOR REINBOLD said that Section 6 is a concern for her
because she worked on the telehealth bill. Sidelines were put in
that bill to protect Alaskan physicians because it is so
valuable to see someone person-to-person, get to know them,
rather than just an informal meeting online. The quality of
healthcare often goes much higher when someone is able to meet
with a physician face-to-face. She asked how this bill is
changed from the telehealth bill and asked the commissioner to
describe Section 6 in layman's terms.
COMMISSIONER CRUM answered that this section allows individuals
to get telehealth without first having an in-person visit
because of how the virus spreads. This allows the vulnerable
population who want to stay to home protect themselves to get
access to medical care without an in-person appointment.
SENATOR REINBOLD said that is exactly what she was hoping the
commissioner would say about page 7, line 22. She understands
social distancing, but she loved that the bill required the
first visit be in-person. Having worked in a medical clinic and
office, she knows how valuable that is. That raises a red flag.
That causes her pause with herd immunity possibly being reached,
along with mitigation measures, and American doctors having
dealt with so many patients and having such remarkable outcomes.
This bill does talk about diagnosing, prescribing, dispensing,
and administering prescriptions, excluding controlled
substances. She asked if ivermectin, hydroxychloroquine, zinc,
vitamin D were part of the disaster plan and have they been
completely and readily available for physicians or were there
any restrictions on those agents, including with supply chains
in Alaska.
COMMISSIONER CRUM replied DHSS talks weekly about available
treatments and therapeutics. As therapeutics get approved by the
FDA, they come into the state or directly to hospitals. DHSS
works to make sure they know how to administer them. As far as
other items, if they are commercially available and doctors
wants to give that to their patients, as long as it is in the
scope of their license, the state does not restrict that.
SENATOR REINBOLD asked if ivermectin and hydroxychloroquine have
been available and have they been part of the DHSS disaster.
People have been asking her to make sure she gets this on the
record.
COMMISSIONER CRUM replied that doctors can prescribe all
available commercial items to patients. DHSS does not get in the
way of that. DHSS has spoken frequently about the beauty of
prevention using zinc and vitamin D. Articles on the DHSS
website speak of the importance of vitamin D for respiratory
illnesses. The state does not restrict the use of commercially
available items. If a pharmacist wants to have a conversation
with a provider, that is between them. The state does not get in
the way of that. DHSS deals with treatments that come from the
FDA emergency use authorization process for therapeutics.
2:32:58 PM
SENATOR REINBOLD asked if the commissioner could tell her about
the availability of ivermectin and hydroxychloroquine and have
there been any restrictions about their use. They genuinely save
lives.
COMMISSIONER CRUM replied that those are not items that came
through the FDA emergency use authorization process, so his
department has nothing to do with that. He does not know if they
are commercially available. He is not a provider. If a provider
wishes to find those and prescribe those to patients, the
provider can.
SENATOR REINBOLD said it sounds like ivermectin or
hydroxychloroquine has not been part of the disaster plan.
COMMISSIONER CRUM said that Section 7, Fingerprinting, provides
that DCCED shall coordinate with DHSS and Public Safety to
expedite the process for submitting fingerprints for certain
license applicants. This coincides with professional licensing
in Section 5.
SENATOR COSTELLO pointed out that the bill mandates coordination
among three departments to expedite the fingerprinting. She
asked if that needed to be in legislation.
COMMISSIONER CRUM noted that a representative from Public Safety
was online.
SENATOR COSTELLO clarified that the bill mandates coordination
among three departments. She understood the value of expediting
fingerprinting but asked why it has to be mandated in state
statute, couldn't it just be made more efficient.
2:35:57 PM
LISA PURINTON, Bureau Chief, Department of Public Safety,
Anchorage, Alaska, replied that her understanding is that there
is an allowance for processing name-based background checks and
to delay the submission of fingerprints when there is an
emergency situation at the state level. The Department of Public
Safety has requested to allow these exigent circumstances to
permit processing of name-based checks without the submission of
fingerprints right away with the understanding that those
fingerprints will become available within 180 days of the end of
the emergency declaration. The agency can submit the
fingerprints sooner than the 180 day mark if they become
available to meet the federal requirement for submitting
fingerprints for noncriminal justice purposes. That would be one
of the reasons for the requirement.
SENATOR COSTELLO responded that prior to Ms. Purinton's answer
she assumed the protections for Alaskans and the standards would
remain the same and just the processing would be expedited, but
Ms. Purinton is saying there will be a different process that is
simply name based and the rest of the process would happen
within 180 days. She asked if there are any detrimental impacts
to the safety of Alaskans with name-based checks.
MS. PURINTON answered that she could not speak to that. The
department does not have statistics on it. The criminal history
records would be searched based on a person's demographic
information. It would be just absent the fingerprint
submissions, which would be submitted later. The Department of
Public Safety would still do the fingerprint-based checks; it
just wouldn't happen immediately. The Department of Public
Safety does process fingerprint cards for various applicant
purposes as expeditiously as possible. The regular timeframe for
running records for DCCED licenses in 2020 was 4.8 days.
2:39:09 PM
SENATOR HUGHES clarified that the name-based check is not
allowable under current statute. Public Safety must have Section
7 for name-based checks to move forward.
MS. PURINTON answered that she did not know if the exigent
circumstances were necessarily based in statute. The request was
made to the compact council, the governing body that oversees
all noncriminal applicant background check processes through
various state and national databases. The exigent circumstances
were permitted due to the emergency disaster declaration from
the state.
COMMISSIONER CRUM said that Section 8, Meeting of Shareholders;
Notice of Shareholder Meetings, is another section under
Commerce. It allows for meetings shareholders, shareholders of
Native corporations, and members of a nonprofit corporation, to
be held by electronic communication, in compliance with
guidelines adopted by the each of the type of entities board of
directors
COMMISSIONER CRUM said that Section 9, Charitable Gaming Online
Ticket Sales, has to do with the Department of Revenue. It
allows certain charitable gaming activities to be conducted
online during the public health disaster emergency declared by
the governor on January 15, 2021, and extended by this act.
Permitees and operators may sell tickets and draw the winning
ticket online for a raffle or lottery, dog mushers' contest,
derby, or type of classic. The seller must verify that the
purchaser is of legal age to purchase, physically in Alaska, and
not within an area where charitable gaming is prohibited. The
Department of Revenue is responsible for establishing the
standards for the online ticket sales.
SENATOR BEGICH expressed his gratitude for this section as it
did impact charitable organizations and allowed them to continue
their efforts.
SENATOR REINBOLD stated that with this section, an emergency
declaration was not needed. The legislature could deal with it
in another bill. Senator Bishop has some great gaming ideas and
he did one bill for education. She is trying to embolden the
power of the legislative branch in a rightful and due place. All
federal funds should come through the legislature and
legislation should be coming through the legislature. She asked
if it is correct that this could be dealt with very easily
through another piece of legislation.
CHAIR WILSON replied that the answer is yes. Everything can be
done by legislation. He has a bill on Section 8.
COMMISSIONER CRUM said that Section 10-12, Repeal of certain
sections of SB 241 (SLA 2020) and sections of SB 56 on certain
dates, amends Section 37, Chapter 10, SLA 2020, a technical
cleaning up: repeal Section 29 of SB 241, purchase of seafood
for distribution, effective March 11, 2021; repeals Section 31
of SB 241, tolling of Office of Administrative Hearings,
effective March 11, 2021; and SB 241, providing a sunset date
for these sections.
SENATOR HUGHES asked what is left in SB 241 that is not being
repealed. There was a rent moratorium and different things like
that.
COMMISSIONER CRUM deferred to the Department of Law.
CHAIR WILSON added that a later slide talks about the initial
health mandates and what has expired.
2:44:32 PM
SUSAN POLLARD, Chief Assistant Attorney General, Department of
Law, Juneau, Alaska, said the question is what is left of SB 241
and why is it referenced in SB 56.
SENATOR HUGHES asked if Sections 10-12 were passed, what would
remain of SB 241.
MS. POLLARD answered that most of the provisions in SB 241,
which was also Chapter 10, SLA, Session Law of Alaska, 2020,
have already expired. However, in Section 37 of SB 241, five
different provisions do not repeal until March 11, 202[1]. SB
56, through Sections 10 and 11, amends SB 241 to retain
particular provisions that would have repealed March 11, 202[1].
Those are Sections 25, relating to videoconferencing for will
signatures, Section 26, relating to unfair and deceptive trade
practices, and Section 28, relating to access to federal
education state funds.
SENATOR HUGHES asked Ms. Pollard to repeat the last statement.
MS. POLLARD said that three sections from SB 241 have been moved
to SB 56, Section 11, page 10, line 9. Section 28 of Chapter 10,
SLA, 2020, SB 241, says state access to federal Education
Stabilization Funds under the Coronavirus Aid, Relief, and
Economic Security (CARES) Act. That section can be found in SB
241 in Section 28 on page 22.
SENATOR HUGHES asked if there are education unused funds and
that is one of the reasons it needs to extend beyond March.
MS. POLLARD answered that she did not know. A representative
from the Office of Management and Budget may know.
SENATOR HUGHES observed that these are things the legislature
could decide to keep in place on a temporary or permanent basis,
regardless of whether the disaster declaration is extended.
CHAIR WILSON called Neil Steininger, Director of the Office of
Management and Budget, to clarify the reference to education
funding in SB 241. He asked whether the bill would need to go
forth to continue to receive education funding through the CARES
Act or future acts.
2:48:56 PM
NEIL STEININGER, Director, Office of Management and Budget,
Juneau, Alaska, answered that in order to receive the education
funding that the state received from the prior two relief
packages which goes to school districts, the state needed
appropriations for federal receipts. The state has used the RPL
(Revised Program Legislative) process in the past. That would be
available to receive additional funding in the future. It can be
used for funding for any purpose and is not necessarily reliant
on the disaster declaration.
SENATOR BEGICH clarified that Mr. Steininger is saying that the
state doesn't need Section 28. It can be done through the RPL
process.
MR. STEININGER asked for additional clarification of the
question.
SENATOR BEGICH explained that in Section 11 of the current bill,
line 9, page 10, Sections 25, 26, and 28, Chapter 10, SLA, the
former SB 241, are repealed and give the date of the repeal. It
is because the state does not need them. The state has the power
to do that through the RPL process. That is what he thought he
heard Mr. Steininger say.
MR. STEININGER replied yes, that is correct.
COMMISSIONER CRUM said that Section 13, Effective Date, state
that if Sections 1-10 and Section 12 take effect after February
14, 2021, the sections are retroactive to February 14, 2021.
Section 14 is another effective date saying that the underlying
bill has an immediate effective date clause if passed.
CHAIR WILSON clarified that if the legislature decided to pass
some version of SB 56, the date would be retroactive to February
14 so that there would be no gap.
COMMISSIONER CRUM answered yes.
SENATOR BEGICH asked what the governor will do if the
legislature does not pass this bill and the declaration expires
February 14.
COMMISSIONER CRUM responded that he cannot speak for governor's
office directly. The legislation is in session and meeting, so
it is up to the legislature to extend this. If that does not
happen, the commissioner does not believe that another disaster
declaration will occur.
2:52:16 PM
SENATOR BEGICH said that he wanted to clarify an earlier
statement. He said the bill had gone to Finance first. SB 242
went to Finance first and sections of SB 242, after extensive
debate, rolled into SB 241 in the Rules Committee. Legislative
Research gave Senator Reinbold the correct information. The
Rules Committee then had only seen SB 241. The discussion that
occurred on SB 242 was rolled into SB 241. It went to the floor
and was extensively debated and amended. Then it went to the
house. The house extensively amended the bill as well and sent
it back to the senate. It went to Free Conference Committee and
then the late night Free Conference Committee meeting occurred.
He wanted to clarify that for the record. Senator Reinbold was
correct and he was incorrect about the single referral.
SENATOR REINBOLD thanked Senator Begich for the clarification.
She recalled it was confusing between SB 241 and SB 242.
SENATOR HUGHES said that she has two big, high-level,
overarching questions. Based on what the committee learned
today, extending the emergency declaration could be removed. It
could just end. The legislature could put in statute that it is
ending it. All the other things could be done independently. SB
56 could be the vehicle for some of those. She wants to know
what the specific advantage is to the administration to
extending the declaration. It is not the FMAP enhancement. The
commissioner said the state could get that anyway. The
telehealth, professional licensing, fingerprinting, shareholder
meetings, charitable gaming could all be done regardless of the
extension of the declaration. She asked what the advantage is to
extending the declaration and why did the commissioner feel he
needed it.
2:54:59 PM
COMMISSIONER CRUM replied that is the bulk of the rest of the
presentation. First he had to introduce the bill and go over the
sectional analysis. The key thing to the disaster declaration is
the powers under AS 26.23 to continue the response. It has to do
with rapid procurement, along with justifications, in order to
do things like mass vaccination clinics. The dispensing clinics
that have occurred around the state and have been so successful
in keeping Alaska number one per capita in vaccinations have
occurred because of the ability of DHSS to do rapid contracting
with local providers and groups and for items like procurement
of space. The typical government procurement process takes about
three months. Without the ability to do that, the state would
fall to the back of the pack in terms of vaccinations. The state
wouldn't be able to distribute and use testing as rapidly in
order to keep staff on with letters of agreement with unions.
The whole situation with the response, all of the safety metrics
in which Alaska leads, would fall. That is primarily why.
COMMISSIONER CRUM added that Senator Hughes had alluded to the
system of local government in Alaska as set forth in the state
constitution. Article 10, Section 1, of the Alaska Constitution
requires a liberal construction be given to the powers of local
government. The constitutional provision confers on local
governments a broad grant of authority. Most local governments
in Alaska do not necessarily need an expressed grant of
authority from the state in order to act. For example, the
municipality of Anchorage can issue emergency declarations and
take emergency measures because neither state law nor its
charter prevents such action. A disaster act does not prohibit
local governments from taking actions necessary to manage
disasters within their affected communities. Accordingly,
because the legislature has granted many local governments those
powers "not otherwise permitted by law," these local governments
have legal authority to take actions they deem necessary to
address the public health disaster, provided that those actions
are not prohibited as a matter of law.
SENATOR HUGHES clarified that she was hearing that the primary
reason for the extension was vaccination distribution and
testing. She asked if the legislature could grant DHSS the
ability to expedite that absent a disaster declaration.
COMMISSIONER CRUM answered that he was not sure. It was also for
the processes for the governor to waive or suspend regulations
and statutes and to allocate scarce resources. Under a disaster
declaration, the governor has the authority to allocate scarce
resources such as food, water, and medicine. This would include
therapeutics and vaccines. At this point in time the state has
eligibility criteria set up to protect the most vulnerable.
Without the ability to allocate that, the state couldn't do
that. Anyone could get the available vaccines.
CHAIR WILSON explained that the certificate of need has to be
waived to have the ability to set up alternative care sites or
clinics.
2:58:27 PM
SENATOR HUGHES said that an important question that she raised
earlier is, if the disaster is extended, what will be the
criteria, the metrics, to end it.
COMMISSIONER CRUM replied that there are a number of metrics
involved. It depends on what is going one. A primary decider is
if there is enough vaccine available and distributed in the
state for those willing to take it. At that point in time, when
vaccine hesitancy takes over with people who don't want to take
it, the tools will be there, local communities and individuals
can make that choice. That is one metric that has been discussed
internally. That depends on federal allocations and production
schedules. The state doesn't have a particular timeframe on what
that looks like. That is a very big metric.
SENATOR HUGHES asked if DHSS would provide the information on
how many vaccines it wants distributed and when the state hits
that point. She asked if the commissioner would present that to
legislators.
COMMISSIONER CRUM answered that he can do that.
CHAIR WILSON reminded the committee that the meeting room had to
be vacated soon to allow time for sanitizing because of COVID
and asked for questions that would take less than 30 seconds to
answer.
SENATOR COSTELLO shared that she was reading from the state
constitution at that moment about the powers of the legislative
branch and the governor. It says that the legislature may
terminate a disaster emergency at any time by law.
SENATOR REINBOLD said that she has several questions for the
commissioner, but because vaccines are such a huge issue, she
would like Chair Wilson to dedicate time for that. She wants to
know things like who has liability for adverse reactions, is it
the state because the state is pushing vaccines, or is it the
person who administers the vaccines. This is a new type of
vaccine developed in seven months when the average is about
seven years. These are not FDA approved. They are only
authorized for emergency use.
3:01:25 PM
CHAIR WILSON responded that the committee will have a vaccine
hearing later. This bill and another have time restraints. After
that, the committee will have a hearing about vaccines.
SENATOR REINBOLD said that she wanted to get these questions on
record at next committee hearing. "Yes or no, do they have to
sign informed consent," she asked Commissioner Crum.
CHAIR WILSON restated not on vaccine-related questions. If she
wanted to submit questions about vaccines, the committee could
try to get answers ahead of time.
SENATOR REINBOLD said this is huge issue. People could be dying
or paralyzed. She just needs to know, yes or no, do they have to
sign informed consent, and where does liability lie if there is
an adverse event. That is a fair question.
CHAIR WILSON responded that it is a fair question. If she wanted
to get her questions to the committee, the committee would get
that to the commissioner's office, and hopefully answers could
be provided in writing to the entire committee.
SENATOR REINBOLD said that it seemed that the answer was yes to
having a committee on vaccines and she asked if the chair could
give her a yes or no in regard to providing the model and the
problems with the model, if she could officially ask that that
be part [of that hearing].
CHAIR WILSON replied yes.
SENATOR REINBOLD said that at a future time she would like to
ask the commissioner how much money he has in his budget or
perhaps she could ask that now. She believed the total budget is
around $4 billion. She asked how much extra money DHSS has
gotten since COVID.
CHAIR WILSON said that the committee will finish the
conversation. This hearing will not be the end of the discussion
of the emergency declaration bill. The commissioner and his
office will be available for the next three weeks to present to
the committee. The committee will have time to ask all those
questions.
3:03:34 PM
SENATOR BEGICH pointed out that the emergency order does have an
impact on legal liability for restaurants. Restaurants have done
new plans for extended service. If the emergency order expires,
those plans go away. There is that issue to be discussed. It is
not the purview of this committee but it does relate to the
question about the emergency orders.
CHAIR WILSON replied that there is a whole section in the
presentation about the why that the committee did not get to.
The commissioner will be ready to dive into that at the next
meeting.
[Chair Wilson held SB 56 in committee.]