Legislature(2021 - 2022)BELTZ 105 (TSBldg)

05/02/2022 01:30 PM Senate LABOR & COMMERCE

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01:30:20 PM Start
01:30:33 PM Confirmation Hearing(s)
01:40:13 PM HB265
02:46:30 PM HB306
03:10:35 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Consideration of Governor’s Appointees: TELECONFERENCED
Board of Nursing - Jody Miller
Board of Certified Direct-Entry Midwives -
Hannah St. George
-- Invited & Public Testimony --
*+ HB 265 HEALTH CARE SERVICES BY TELEHEALTH TELECONFERENCED
Moved CSHB 265(FIN) Out of Committee
-- Invited & Public Testimony --
*+ HB 306 EXTEND BOARD OF PHARMACY TELECONFERENCED
Moved HB 306 Out of Committee
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
           HB 265-HEALTH CARE SERVICES BY TELEHEALTH                                                                        
                                                                                                                                
1:40:13 PM                                                                                                                    
CHAIR COSTELLO announced  the consideration of CS  FOR HOUSE BILL                                                               
NO.  265(FIN) "An  Act relating  to telehealth;  relating to  the                                                               
practice of  medicine and  the practice  of nursing;  relating to                                                               
medical assistance coverage for  services provided by telehealth;                                                               
and providing for an effective date."                                                                                           
                                                                                                                                
She advised the public that  the committee was very familiar with                                                               
this issue.                                                                                                                     
                                                                                                                                
1:41:15 PM                                                                                                                    
REPRESENTATIVE IVY  SPOHNHOLZ, Alaska State  Legislature, Juneau,                                                               
Alaska, sponsor  of HB 265, stated  that in the interest  of time                                                               
she would bypass the presentation.  She presented the legislation                                                               
paraphrasing the following sponsor statement for CSHB 265(FIN):                                                                 
                                                                                                                                
     The COVID-19 pandemic  relaxed Alaska's telehealth laws                                                                    
     and  enabled broader  access to  behavioral health  and                                                                    
     specialty  care,  created   cost-savings  from  reduced                                                                    
     travel, and  increased the convenience  of high-quality                                                                    
     health  care to  patients  across  the state.  However,                                                                    
     Alaskans    have   faced    barriers   to    telehealth                                                                    
     appointments   due   to   regulatory   hurdles   across                                                                    
     professions  and  inconsistent  Medicaid  coverage  for                                                                    
     services delivered via  telehealth. Furthermore, COVID-                                                                    
     19  related flexibilities  were regulatory  suspensions                                                                    
     and not permanent.                                                                                                         
                                                                                                                                
     HB  265  maintains  these  pandemic-related  telehealth                                                                    
     flexibilities and  expands Alaska Medicaid  coverage of                                                                    
     telehealth services in statute as follows.                                                                                 
                                                                                                                                
     1) Creates a  new section on telehealth  for all health                                                                    
        care providers  licensed with  the  State of  Alaska                                                                    
        that removes the requirement for  an in-person visit                                                                    
        and documentation of a barrier to an in-person visit                                                                    
        prior to the delivery of telehealth.                                                                                    
     2) Allows  telehealth follow-up visits  from physicians                                                                    
        licensed in  another state  who  have established  a                                                                    
        physician-patient relationship and conducted an in-                                                                     
        person physical examination with an Alaska patient.                                                                     
     3)   Ensures  telehealth   availability  for   services                                                                    
        related  to  opioid  use   disorder  and  controlled                                                                    
        substances for certain providers.                                                                                       
     4)  Increases  telehealth  access for  Alaska  Medicaid                                                                    
        beneficiaries by ensuring coverage  for services for                                                                    
        behavioral   health,   home    and   community-based                                                                    
        services, rural health clinics,  federally qualified                                                                    
        health centers,  and  other  programs  eligible  for                                                                    
        Alaska  Medicaid   reimbursement.  Ensures   payment                                                                    
        parity  and   Medicaid   coverage   for   telehealth                                                                    
        modalities (e.g.,  appointments  over the  Internet,                                                                    
        phone, etc.).                                                                                                           
     5) There is no requirement to deliver services through                                                                     
       telehealth, and both the provider and the patient may                                                                    
       choose to limit or decline a telehealth encounter.                                                                       
                                                                                                                                
     Comprehensive  telehealth  delivery has  revolutionized                                                                    
     health  care in  Alaska  by creating  another tool  for                                                                    
     providers  to  care  for   patients  when  they  cannot                                                                    
     physically  be  together.  HB   265  will  continue  to                                                                    
     modernize  the  state's  health   care  system  to  the                                                                    
     benefit of all Alaskans.                                                                                                   
                                                                                                                                
1:44:13 PM                                                                                                                    
REPRESENTATIVE  IVY  SPOHNHOLZ  stated  that HB  265  aligns  the                                                               
statute regarding  controlled substances via telehealth  with the                                                               
federal  Drug  Enforcement  Agency (DEA)  regulations  so  Alaska                                                               
providers have  to comply with  just one set of  regulations. DEA                                                               
regulations   require   an   in-person   examination   prior   to                                                               
prescribing  a controlled  substance, and  the bill  ensures that                                                               
people have  access via telehealth to  controlled substances once                                                               
they have  established a relationship  with a provider.  The bill                                                               
supports  the marketplace  for telehealth  by ensuring  equal pay                                                               
for equal work, but allows  lower Medicaid payments when services                                                               
are not  comparable. This supports reduced  health care spending.                                                               
She noted  that between  FY 2020  and FY2021,  Medicaid increased                                                               
telehealth  spending  and  reduced  Medicaid  travel  for  a  net                                                               
savings of 38 percent or $46 million.                                                                                           
                                                                                                                                
1:45:34 PM                                                                                                                    
REPRESENTATIVE   SPOHNHOLZ  highlighted   the  narrow   exception                                                               
crafted in  HB 265  to allow Alaskans  to receive  follow-up care                                                               
with doctors they  have seen from out of state.  The Alaska State                                                               
Medical  Association  supports  this  change  to  help  eliminate                                                               
unnecessary travel.  The Division of Corporations,  Business, and                                                               
Professional Licensing  has oversight  and the ability  to recoup                                                               
costs  in the  event there  is a  bad actor  licensed in  another                                                               
state.  The bill  also allows  more  flexibility in  the mode  of                                                               
delivery  of  telehealth  and it  protects  the  patient/provider                                                               
relationship.  Nothing  in  the  bill requires  the  provider  to                                                               
deliver care  via telehealth or  the patient to receive  care via                                                               
telehealth.                                                                                                                     
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  underscored that HB 265  does not allow                                                               
non-Alaskan  providers  to  practice   in  Alaska  without  state                                                               
licensure.   This  was   important  to   stakeholders,  and   the                                                               
telemedicine business  registry for Alaska shows  that 84 percent                                                               
of registrants are  Alaskan providers and the 16  percent of non-                                                               
Alaskan providers  are licensed  in Alaskan.  The bill  also does                                                               
not increase  access to controlled substances.  Both prescription                                                               
drug limits  and the Prescription Drug  Monitoring Program (PDMP)                                                               
remain  in place,  and DEA  regulations  still require  in-person                                                               
examinations  before an  opioid  is  prescribed. She  highlighted                                                               
that providers throughout the state  report being able to provide                                                               
high-quality care to  Alaskan patients. She said  the invited and                                                               
public  testimony will  talk about  how telehealth  has increased                                                               
access to care without a reduction in quality.                                                                                  
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  extended  her thanks  to  the  diverse                                                               
group of stakeholders  her office had been working  with over the                                                               
last 18  months to get HB  265 passed. She added  that the robust                                                               
expansion  the bill  proposes could  not  have been  accomplished                                                               
without the partnership with both DCCED and DHSS.                                                                               
                                                                                                                                
1:49:16 PM                                                                                                                    
CHAIR  COSTELLO turned  to invited  testimony and  recognized Dr.                                                               
Melinda  Rathkopf,  the  director  of the  Allergy,  Asthma,  and                                                               
Immunology Center of Alaska.                                                                                                    
                                                                                                                                
1:49:37 PM                                                                                                                    
DR. MELINDA  RATHKOPF, Director, Allergy, Asthma,  and Immunology                                                               
Center of Alaska (AAICA), Anchorage,  Alaska, stated that she has                                                               
been practicing medicine at AAICA for  16 years and she wanted to                                                               
share how telehealth  has made it easier for the  clinic to serve                                                               
the entire  state. She  explained that  the clinic  has satellite                                                               
clinics and  had already started  looking into  telehealth before                                                               
the  pandemic.  They  had  purchased some  of  the  software  and                                                               
hardware, which made the transition easier.                                                                                     
                                                                                                                                
DR. RATHKOPF said  she wanted to speak to the  bill to stress the                                                               
importance of pay  parity for telehealth. Her  clinic accepts all                                                               
payment options and it's challenging  to continue to provide care                                                               
as   the   cost   of  everything   continues   to   rise   except                                                               
reimbursements. It wouldn't be sustainable if they go down.                                                                     
                                                                                                                                
She explained that  by paying in parity she can  block a half day                                                               
and see patients  in outlying areas via telehealth  and still pay                                                               
the  ongoing costs  to maintain  the brick  and mortar  office in                                                               
Anchorage.  Doing telehealth  doesn't eliminate  the need  to pay                                                               
her receptionist and  other staff or order  supplies. These costs                                                               
are ongoing regardless of the mode  of delivery of care. She said                                                               
allowing parity in  pay will continue to be key  in continuing to                                                               
be  able to  provide annual  and  follow up  service for  instate                                                               
physicians.                                                                                                                     
                                                                                                                                
DR.  RATHKOPF  stated  that allowing  out-of-state  providers  to                                                               
provide follow-up care works well  for her business. For example,                                                               
she sees some  rare immune deficiency patients some  of whom have                                                               
to utilize services  through Seattle. It's been  very helpful for                                                               
these high risk patients to  get follow-up care without having to                                                               
take  time to  fly down  and risking  potential exposures  during                                                               
that flight. She described HB 265  as a very good compromise that                                                               
allows  Alaska  physicians to  provide  care  for their  patients                                                               
while also allowing  those patients to receive care  from an out-                                                               
of-state provider when it's appropriate.                                                                                        
                                                                                                                                
1:54:13 PM                                                                                                                    
CHAIR  COSTELLO  commented  that  it seems  that  her  particular                                                               
specialty  lends itself  to in-person  visits. She  asked her  to                                                               
talk about  what happens differently  for her patients  when they                                                               
have a telehealth appointment versus an in-person appointment.                                                                  
                                                                                                                                
DR.  RATHKOPF responded  that she  was initially  concerned about                                                               
not being able to lay her hands  on her patients, but quite a bit                                                               
of  an exam  can  be done  over  video and  her  patients have  a                                                               
primary   physician  who   has  done   an  in-person   exam.  She                                                               
acknowledged  that certain  procedures  like  skin and  pulmonary                                                               
testing  require  an  in-person   visit,  but  pointed  out  that                                                               
allergists  treat a  lot  of  diseases that  do  not require  any                                                               
testing.  She   advised  that  one  reason   her  clinic  started                                                               
telehealth pre-pandemic  was to  screen out those  who had  to be                                                               
seen in person versus via  telehealth. Sometimes she determines a                                                               
patient  really  needs  an in-person  visit  but  the  telehealth                                                               
option  cuts down  up  to  75 percent  of  the  people that  will                                                               
require travel or need to be put  on a waitlist so she can travel                                                               
to meet  them. Telehealth  makes her more  efficient both  at her                                                               
satellite clinics and her office.                                                                                               
                                                                                                                                
1:56:22 PM                                                                                                                    
SENATOR STEVENS referenced a book  he'd been reading on longevity                                                               
that  offers  statistical  evidence  that  patients  who  have  a                                                               
personal relationship  with their  doctor live longer  than those                                                               
who do  not have that type  of relationship. He asked  if she had                                                               
any  further   reflection  on  the   importance  of   a  personal                                                               
relationship with a doctor.                                                                                                     
                                                                                                                                
DR.  RATHKOPF   said  her   experience  is   that  doctor/patient                                                               
relationships  that   were  established  in  person   can  easily                                                               
continue online. What she believes  would be very difficult is to                                                               
establish  a  relationship  in the  telehealth  model  where  the                                                               
patient calls a national line  and gets a different provider each                                                               
call. She  assured the  committee that  most providers  in Alaska                                                               
that  are participating  in telehealth  are using  it to  support                                                               
established patients.                                                                                                           
                                                                                                                                
1:58:53 PM                                                                                                                    
SENATOR  MICCICHE  stated  that  when   he  worked  on  an  early                                                               
telehealth bill  he was led  to believe that telehealth  would be                                                               
at  a lower  cost  because  there wouldn't  be  the facility  and                                                               
materials costs  and the visits  would be shorter  than in-person                                                               
visits. He asked  for her logic on why pay  parity is the correct                                                               
path.                                                                                                                           
                                                                                                                                
2:00:11 PM                                                                                                                    
DR. RATHKOPF said it would  be difficult to justify blocking half                                                               
or  a  whole day  clinic  to  treat  telehealth patients  if  she                                                               
weren't paid  the equivalent  because she  could easily  fill the                                                               
clinic with  in-person patients. She said  most providers squeeze                                                               
telehealth into  blocks during  the day,  but the  overhead costs                                                               
still exist  and the telehealth  appointments generally  take the                                                               
same amount of  time as the in-person visits.  She explained that                                                               
when she sees  patients in person she can have  three patients in                                                               
separate  exam rooms  at the  same time  whereas with  telehealth                                                               
it's a one-on-one  appointment. Telehealth is not  a cost savings                                                               
for the provider and without pay  parity it would be too easy for                                                               
providers to say they didn't want to do telehealth.                                                                             
                                                                                                                                
2:02:50 PM                                                                                                                    
SENATOR MICCICHE said  the argument was very  convincing and he'd                                                               
like her to send the chair that explanation in writing.                                                                         
                                                                                                                                
DR. RATHKOPF agreed to do so.                                                                                                   
                                                                                                                                
CHAIR COSTELLO asked the sponsor if she had anything to add.                                                                    
                                                                                                                                
2:03:18 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ said  she had two things  to add. First,                                                               
she clarified  that the  cost savings  between FY2020  and FY2021                                                               
was 23  percent, not 38 percent  but the $48 million  savings was                                                               
correct.                                                                                                                        
                                                                                                                                
Second, she  said the  testimony and  questions about  pay parity                                                               
target the  underlying issue of  ensuring that  patients continue                                                               
to receive  treatment from their  established providers  and that                                                               
Alaskan providers  continue to be  able to provide the  care. She                                                               
shared  her personal  experience  using telehealth  when she  had                                                               
COVID-19  last month  and  was  able to  see  both her  long-time                                                               
physician  and  a  specialist. She  agreed  with  Dr.  Rathkopf's                                                               
explanation  of  the need  for  pay  parity and  highlighted  her                                                               
earlier testimony  that 84 percent  of telehealth care  in Alaska                                                               
is provided by Alaska-based organizations and providers.                                                                        
                                                                                                                                
CHAIR  COSTELLO asked  Genevieve  Mina to  present the  sectional                                                               
analysis for HB 265.                                                                                                            
                                                                                                                                
2:05:19 PM                                                                                                                    
GENEVIEVE  MINA,  Staff,  Representative  Ivy  Spohnholz,  Alaska                                                               
State Legislature,  Juneau, Alaska,  read the  sectional analysis                                                               
for CSHB 265(FIN), version E:                                                                                                   
                                                                                                                                
[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.                                                                                                                    
        Subsection (a) removes the requirement for an in-                                                                       
        person visit prior to a telehealth appointment.                                                                         
      Subsection (b) narrowly exempts physicians licensed                                                                       
        in another state to deliver health care services via                                                                    
        telehealth if  there  is  an established  physician-                                                                    
        patient relationship,  an  in-person physical  exam,                                                                    
        and the services are related to ongoing treatment or                                                                    
        follow-up  care  related  to   past  treatment.  The                                                                    
        language also references new enforcement language in                                                                    
        Section 2.                                                                                                              
          Subsections (c) and (d) 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 as  if it were delivered                                                                    
        in person.                                                                                                              
        ? Subsections (e), (f), and (g) ensure that only                                                                        
        authorized providers  licensed  with  the  State  of                                                                    
        Alaska can  prescribe  controlled substances  (e.g.,                                                                    
        buprenorphine,  Adderall,   etc.)   via   telehealth                                                                    
        without  conducting   an   in-person  visit.   These                                                                    
        providers must  comply with  the  state and  federal                                                                    
        laws  regarding   the  prescription   of  controlled                                                                    
        substances via telehealth.                                                                                              
          o Subsection  (e) pertains  to providers  in Title                                                                    
             8, Chapter 64 (Medicine) (i.e., physicians,                                                                        
             podiatrists,    osteopaths     and    physician                                                                    
             assistants).                                                                                                       
          o  Subsection (f)  pertains  to Advanced  Practice                                                                    
             Registered Nurses (APRNs) in Title 8, Chapter                                                                      
             68 (Nursing).                                                                                                      
      Subsection (h) removes requirements to document all                                                                       
        attempts for  an in-person  visit  and prevents  the                                                                    
        department  or  board  from  limiting  the  physical                                                                    
        setting  of  a   health  care   provider  delivering                                                                    
        telehealth.                                                                                                             
      ? Subsection (i) confirms that health care providers                                                                      
        under this  section  are  not  required  to  deliver                                                                    
        telehealth services.                                                                                                    
      ? Subsection (j) provides definitions for all health                                                                      
        care providers applicable to this section, specifies                                                                    
        that the provider must be licensed in good standing,                                                                    
        and defines telehealth.                                                                                                 
                                                                                                                                
     Section  2  Creates  AS  08.64.33  defining  the  State                                                                
     Medical Board's  authority to enforce  against exempted                                                                    
     physicians  in Section  1 and  ensures these  providers                                                                    
     must comply with Alaska laws for licensed physicians.                                                                      
                                                                                                                                
        o Subsection (a) describes the grounds for the board                                                                    
          to sanction a physician  licensed in another state                                                                    
          providing  telehealth services  in  Section 1:  if                                                                    
          they  violate  Alaska   laws  for  Alaska-licensed                                                                    
          physicians;   exceed   the    defined   scope   of                                                                    
          telehealth  services in  Section 1;  or prescribe,                                                                    
          administer, or dispense  a controlled substance to                                                                    
          an Alaska patient located in the state.                                                                               
        o Subsection (b) and (c) ensures  that the board can                                                                    
          enforce exempted physicians in  the same manner as                                                                    
          Alaska-licensed  physicians. In  addition to  this                                                                    
                                                                                                                                
          authority,  they  can   issue  a  ceaseand-desist                                                                     
          order and notify the  licensing authority for each                                                                    
          state the physician is licensed.                                                                                      
        o Subsection  (d),  (e), (g),  and  (h) details  the                                                                    
          board's   disciplinary    actions   for   exempted                                                                    
          physicians,  mirroring similar  language regarding                                                                    
          sanctions for Alaska-licensed physicians.                                                                             
        o Subsection (f) ensures that the  board can recover                                                                    
          costs    related    to   the    proceedings    and                                                                    
          investigation directly from  an exempted physician                                                                    
          in Section 1.                                                                                                         
                                                                                                                                
2:09:21 PM                                                                                                                    
     Section 3  Amends language related to  the prescription                                                                
     of  controlled  substances  via  telehealth  under  the                                                                    
     State  Medical Board.  This deletes  language requiring                                                                    
     an additional health care provider  to assist a patient                                                                    
     during  a telehealth  appointment with  a physician  or                                                                    
     physician   assistant   regarding   the   prescription,                                                                    
     dispensing,    and    administration   of    controlled                                                                    
     substances.                                                                                                                
                                                                                                                                
2:09:45 PM                                                                                                                    
     Section 4-5  Adds sections related to  the prescription                                                                
     of  controlled  substances  via  telehealth  under  the                                                                    
     Board of  Nursing. This  does not  change the  Board of                                                                    
     Nursing's authority or the scope  of practice for APRNs                                                                    
     ensures regulatory equity between  the Board of Nursing                                                                    
     and the State Medical  Board regarding the prescription                                                                    
     of controlled  substances via  telehealth for  all DEA-                                                                    
     registered practitioners.                                                                                                  
                                                                                                                                
        ? Section 4 amends the Board of Nursing's regulatory                                                                    
          authority  to  include controlled  substances  via                                                                    
          telehealth  in  Section   5,  mirroring  statutory                                                                    
          language for the State Medical Board.                                                                                 
        ? Section 5 creates a new section AS 08.68.710                                                                          
          defining the telehealth  prescriptive authority of                                                                    
          APRNs  in   statute.  This  section   removes  the                                                                    
          regulatory in-person  requirement for  APRNs under                                                                    
          12  AAC  44.925(c),   mirroring  the  deletion  of                                                                    
          language for  the State  Medical Board  in Section                                                                    
          3.                                                                                                                    
                                                                                                                                
2:10:50 PM                                                                                                                    
     Section 6 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, documentation, physical  setting, and patient                                                                    
     protections as Section 1.                                                                                                  
                                                                                                                                
     Section  7 Adds  a  new section  on telehealth  payment                                                                
     under Title 47 for Alaska Medicaid.                                                                                        
                                                                                                                                
        ? Subsection (a) requires the Department of Health                                                                      
          to pay for telehealth  services in the same manner                                                                    
          as  an  in  person   service  for  the  following:                                                                    
          behavioral  health  services, home  and  community                                                                    
          based  services  (HCBS),  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,                                                                    
          non-HCBS services  covered under a  federal waiver                                                                    
          or  demonstration, 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.                                                                                             
                                                                                                                                
2:11:59 PM                                                                                                                    
          This  subsection  also  allows  for  a  telehealth                                                                    
          visit  to be  conducted  through  any means  which                                                                    
          could    be   useful    in   a    patient-provider                                                                    
          relationship,   including  an   audio-only  (i.e.,                                                                    
          phone call) appointment.                                                                                              
        ? Subsection (b) requires the department to adopt                                                                       
          regulations   regarding   payment  of   telehealth                                                                    
          services.   This   provision   also   allows   the                                                                    
          department to limit  or restrict Medicaid coverage                                                                    
          under  this section  if  a  service delivered  via                                                                    
          telehealth  cannot be  safely delivered  according                                                                    
          to  substantial   medical  evidence,  or   if  the                                                                    
          federal   government   will  not   reimburse   the                                                                    
          delivery of the service via telehealth.                                                                               
        ? Subsection (c) specifies that the coverage of                                                                         
          services   in  Alaska   Medicaid  must   be  HIPAA                                                                    
          compliant.                                                                                                            
                                                                                                                                
     Section 8-9 Adds sections on  telehealth under Title 47                                                                
     for  grantees  that  deliver  community  mental  health                                                                    
     services, or  facilities approved by the  department to                                                                    
     deliver   substance   use  disorder   treatment.   Both                                                                    
     sections  replicate the  same telehealth  provisions on                                                                    
     cost,   scope   of   services,   patient   protections,                                                                    
     documentation, and physical setting as Section 1.                                                                          
                                                                                                                                
        ? Section 8 creates AS 47.30.585 to include entities                                                                    
          approved   to  receive   grant   funding  by   the                                                                    
          Department of  Health to deliver  community mental                                                                    
          health services.                                                                                                      
                                                                                                                                
        ? Section 9 creates AS 47.37.145 to include public                                                                      
          or private treatment facilities approved by the                                                                       
          Department   of   Health   to   deliver   services                                                                    
          addressing substance use disorders.                                                                                   
                                                                                                                                
     Section 10 Provides an immediate effective date.                                                                       
                                                                                                                                
2:13:32 PM                                                                                                                    
CHAIR   COSTELLO   referenced   Section   1(d)   and   shared   a                                                               
constituent's  experience  of  flying  to Seattle  and  having  a                                                               
telemedicine appointment while  in the Board Room  at the airport                                                               
because the physician  was not licensed in  Alaska. Following the                                                               
appointment, her  constituent got  back on a  plane to  return to                                                               
Alaska. She  said she  brought it up  because there  are Alaskans                                                               
who have  established relationships with physicians  that are not                                                               
licensed  in Alaska  and when  COVID-19  happened those  Alaskans                                                               
weren't able  to travel  to get care  from those  physicians. She                                                               
asked the sponsor  to talk about the balance the  bill strikes in                                                               
that regard  and whether it  also allows  telemedicine counseling                                                               
and mental  health appointments to  be conducted by  an attending                                                               
physician who is not licensed in Alaska.                                                                                        
                                                                                                                                
2:15:02 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ replied  that constituent's  experience                                                               
is the  reason for the  provision in Section  1 of the  bill. She                                                               
described the  work to get  stakeholders to agree to  this narrow                                                               
exception and  shared that  her focus  was to  reduce unnecessary                                                               
travel  while ensuring  that Alaska  licensees wouldn't  bear the                                                               
cost  of investigations  into potential  bad actors  from out-of-                                                               
state. The bill authorizes the  State Medical Board to recoup the                                                               
costs of those investigations.                                                                                                  
                                                                                                                                
She clarified  that the  bill does not  provide an  exception for                                                               
counseling and  behavioral health care via  telemedicine when the                                                               
provider   is  not   licensed  in   Alaska.  Licensing   for  the                                                               
professionals  that  typically  provide  this  type  of  care  is                                                               
simpler  and  less  time  consuming  than  for  medical  doctors.                                                               
According to  the chair of  the Psychology Board, it  takes about                                                               
six weeks  to get  an Alaska license  as a  psychologist, whereas                                                               
the  barrier is  higher  and  it takes  a  lot  longer to  become                                                               
licensed as a physician in Alaska.                                                                                              
                                                                                                                                
CHAIR  COSTELLO  asked  Pam  Ventgen  whether  the  Alaska  State                                                               
Medical Association supports the current version of HB 265.                                                                     
                                                                                                                                
2:18:19 PM                                                                                                                    
PAM   VENTGEN,   Executive   Director,   Alaska   State   Medical                                                               
Association (ASMA),  Anchorage, Alaska, answered yes;  ASMA fully                                                               
supports the current version of  HB 265. ASMA worked closely with                                                               
the many stakeholders to craft  the narrow language to allow out-                                                               
of-state  specialists  to  continue  to  care  for  their  Alaska                                                               
patients via telemedicine.                                                                                                      
                                                                                                                                
2:19:52 PM                                                                                                                    
CHAIR COSTELLO  asked the sponsor  to talk about the  urgency and                                                               
timeliness  of this  legislation,  and thus  the  reason for  the                                                               
immediate effective date.                                                                                                       
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  explained  that both  DCCED  and  DHSS                                                               
indicated they would be able  to implement the legislation within                                                               
the  90-day window  of  an immediate  effective  date. This  will                                                               
ensure that  Alaskans continue  to have access  to the  care they                                                               
have  been receiving  after the  federal public  health emergency                                                               
expires on July 22, 2022.                                                                                                       
                                                                                                                                
SENATOR MICCICHE noted  that a constituent who  is an optometrist                                                               
contacted his  office to articulate  the concern that  the [Board                                                               
of Examiners  in Optometry]  did not  feel that  all examinations                                                               
can take place  online via video. He asked how  the bill proposes                                                               
to address those limited situations.                                                                                            
                                                                                                                                
2:21:38 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ agreed  that not  all examinations  are                                                               
appropriate for online.  The decision in HB 265 was  to provide a                                                               
framework for telehealth  and leave the regulations  for the many                                                               
individual license  types to the  appropriate board  because they                                                               
have the  expertise and understand  the scope of  practice better                                                               
than legislators.                                                                                                               
                                                                                                                                
SENATOR  MICCICHE summarized  that  certain  procedures could  be                                                               
excluded from telehealth through regulation.                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ   confirmed  that  was   the  intention                                                               
because it would  be too onerous to define every  license type by                                                               
statute.                                                                                                                        
                                                                                                                                
CHAIR  COSTELLO  recognized  Christopher  Dietrich  as  the  next                                                               
person invited to testify.                                                                                                      
                                                                                                                                
2:24:40 PM                                                                                                                    
CHRISTOPHER DIETRICH,  Medical Director, Orion  Behavioral Health                                                               
(OBH), Palmer, Alaska,  testified by invitation in  support of HB
265. He  stated that he  is a member  of the American  Academy of                                                               
Physician  Assistants  and  on  the  board  for  PAs  in  Virtual                                                               
Medicine  and  Telemedicine. He  opined  that  from a  behavioral                                                               
health perspective,  HB 265 will  break down barriers  to patient                                                               
care,  particularly  with  controlled substances.  OBH  has  many                                                               
patients from  rural areas  who currently have  to travel  to the                                                               
clinic to meet with a nurse  and get medication to maintain their                                                               
behavioral health even when they  have been taking the medication                                                               
for years.  The bill  will eliminate  the need  for much  of this                                                               
travel,  make  it  more  likely   that  patients  stay  on  their                                                               
medication, and  reduce behavioral  health crises. He  also spoke                                                               
in   support   of  payment   parity   for   care  delivered   via                                                               
telemedicine.                                                                                                                   
                                                                                                                                
2:27:55 PM                                                                                                                    
PHILIP LICHT, President and CEO,  Set Free Alaska (SFA), Wasilla,                                                               
Alaska, testified by  invitation in support of HB  265. He stated                                                               
that SFA  offers substance  abuse and  mental health  services in                                                               
both  MatSu and  Homer.  It provides  residential and  outpatient                                                               
care for adults  and behavioral health services  for children. In                                                               
2016,  SFA  began  exploring  telehealth   as  a  way  to  remove                                                               
barriers,  such  as  lack  of transportation,  in  an  effort  to                                                               
improve  access  to  care. Individuals  who  need  treatment  for                                                               
substance abuse often  don't have a driver's  license, so getting                                                               
to  an intensive  outpatient treatment  program  several times  a                                                               
week   is  extremely   challenging.   He  cited   a  study   from                                                               
Massachusetts that found that living  more than a mile from their                                                               
intensive outpatient treatment center  made it significantly less                                                               
likely that  the client would complete  their treatment. Clearly,                                                               
not many  Alaskans who need  treatment live within  that critical                                                               
radius.  When SFA  started offering  telehealth care  they saw  a                                                               
significant  increase  in show  rates  both  pre and  during  the                                                               
pandemic. The  point is that telehealth  increases the likelihood                                                               
of successful  outcomes for individuals who  need substance abuse                                                               
and mental health services.                                                                                                     
                                                                                                                                
MR.  LICHT mentioned  payment parity  and highlighted  that SFA's                                                               
experience has  been that telehealth  is a little  more expensive                                                               
to provide.  Personnel costs  and overhead  remain the  same, but                                                               
there has been an increase in  costs due to the Zoom subscription                                                               
and the technology and hardware  that's needed. Internet speed is                                                               
critical and it's more practical  for each clinician to have dual                                                               
monitors so  they can have clinical  notes on one screen  and the                                                               
clients  on  the  other.  For  SFA  it  is  very  important  that                                                               
telehealth appointments  are reimbursed at  the same rate  as in-                                                               
person visits.                                                                                                                  
                                                                                                                                
2:31:55 PM                                                                                                                    
NANCY MERRIMAN, Executive Director, Alaska Primary Care                                                                         
Association (APCA), Anchorage, Alaska, provided the following                                                                   
testimony in support of HB 265:                                                                                                 
                                                                                                                                
     The  Alaska Primary  Care  Association (APCA)  supports                                                                    
     the operations  and development  of Alaska's  29 Health                                                                    
     Centers (also commonly referred  to as Community Health                                                                    
     Centers or Federally  Qualified Health Centers). Health                                                                    
     Centers provide comprehensive  whole person care, which                                                                    
     includes  medical,  dental,  behavioral,  pharmacy  and                                                                    
     care coordination services.                                                                                                
                                                                                                                                
     APCA and Alaska's Health  Centers support HB265 because                                                                    
     it  increases access  to  primary  care and  behavioral                                                                    
     health services and expands  telehealth in Alaska. This                                                                    
     legislation:                                                                                                               
                                                                                                                                
     ? Includes a range  of telehealth modalities, including                                                                    
     audio-only, now & into the future                                                                                          
     ?   Allows  patients   and  providers   to  engage   in                                                                    
     telehealth services  outside a  clinic setting  if they                                                                    
     so choose                                                                                                                  
     ?  Provides   adequate  reimbursement   for  telehealth                                                                    
     visits, providing new points  of access to whole person                                                                    
     care,  including behavioral  health  and substance  use                                                                    
     disorder treatment.                                                                                                        
                                                                                                                                
     In  the  most  recent  year of  full  reporting,  2020,                                                                    
     Alaska's   Health  Centers   served  105,000   patients                                                                    
     through  450,000  visits  delivering  medical,  dental,                                                                    
     behavioral  health,  substance use  disorder  treatment                                                                    
     and  other care.  Behavioral health  and substance  use                                                                    
     disorder services  are Health Centers'  fastest growing                                                                    
     area of service. 40% of  these visits were accommodated                                                                    
     via telehealth.  In the  subspecialty of  substance use                                                                    
     disorder services, 45% of visits were via telehealth.                                                                      
                                                                                                                                
     Alaska's  Health Centers  have weathered  many emerging                                                                    
     challenges  brought   on  by  the  pandemic   and  APCA                                                                    
     appreciates  the actions  taken  by  the Department  of                                                                    
     Health  Social  Services,  which  have  allowed  Health                                                                    
     Centers to reach their patients via telehealth.                                                                            
                                                                                                                                
     The temporary telehealth  policy changes allowed Health                                                                    
     Centers  to   be  recognized  as   telehealth  treating                                                                    
     providers; to  furnish some behavioral  health services                                                                    
     via  audio-only   technology;  and   to  be   paid  for                                                                    
     telehealth     services    furnished     to    Medicaid                                                                    
     beneficiaries under the  Health Centers' unique payment                                                                    
     system, called the prospective payment system (PPS).                                                                       
                                                                                                                                
     APCA  supports HB265  as  this  key legislation  allows                                                                    
     these   temporary  telehealth   provisions  to   become                                                                    
     permanent for patients and providers in Alaska.                                                                            
                                                                                                                                
     Health  Centers,  by  definition,  serve  hard-to-reach                                                                    
     communities.  The majority  of  Health Center  patients                                                                    
     experience a  range of  challenges in  accessing health                                                                    
     care that include facing long  distances to reach local                                                                    
     providers, cost of  care, transportation, language, and                                                                    
     cultural  barriers.  In  Alaska, over  half  of  Health                                                                    
     Center   patients  are   racial/ethnic  minorities,   a                                                                    
     majority  are low-income,  and  most  patients live  in                                                                    
     rural communities.                                                                                                         
                                                                                                                                
     Health   Centers   can   best   serve   their   patient                                                                    
     populations if they have the  ability to use technology                                                                    
     to   better  support   their  patients.   Additionally,                                                                    
     workforce  shortages,  particularly in  the  behavioral                                                                    
     health  sector,  impact   Health  Centers  uniquely  as                                                                    
     nonprofit safety-net  providers, and  telehealth allows                                                                    
     Health  Centers to  use their  clinical workforce  most                                                                    
     nimbly.                                                                                                                    
                                                                                                                                
     In 2021, a cohort of  health centers reported that [of]                                                                    
     their telehealth  interactions, 59 percent  occurred by                                                                    
     phone and  41 percent by  audio and video.  Through the                                                                    
     pandemic,   demand  for   tele-behavioral  health   now                                                                    
     represents 35 percent of all telehealth usage.                                                                             
                                                                                                                                
     Health  Centers  have   witnessed  how  telehealth  has                                                                    
     provided  stronger  continuity  of care  for  patients,                                                                    
     reduced  travel costs,  has resulted  in fewer  dropped                                                                    
     visits  and a  reduction in  delayed (and  more costly)                                                                    
     care.  We  understand  that  delivering  quality  whole                                                                    
     person   care  ultimately   leads   to  better   health                                                                    
     outcomes, saves lives and in  the long run, it saves on                                                                    
     cost.                                                                                                                      
                                                                                                                                
MS. MERRIMAN urged the committee to support HB 265.                                                                             
                                                                                                                                
2:35:51 PM                                                                                                                    
CHAIR COSTELLO opened public testimony on HB 265.                                                                               
                                                                                                                                
2:36:10 PM                                                                                                                    
JAYNE  ANDREEN,  President,   Alaska  Public  Health  Association                                                               
(APHA), Douglas,  Alaska, stated that  she was testifying  from a                                                               
personal perspective as  well as on behalf of APHA  in support of                                                               
HB 265.  She shared  that she  and her husband  had to  make four                                                               
trips to  Seattle for care in  2021. This was difficult  and time                                                               
consuming  despite having  a good  relationship with  the out-of-                                                               
state provider. On  the last trip they spent 10  minutes with the                                                               
specialist who  said they were  following the treatment  plan and                                                               
that it  was too bad the  appointment couldn't have been  done on                                                               
the phone.  They left Juneau  at 5:30  a.m. that morning  and got                                                               
back to Juneau that evening at 9:30 p.m.                                                                                        
                                                                                                                                
MS. ANDREEN emphasized that it was  critical for Alaska to have a                                                               
good  telehealth system  that maintains  Alaska's standards.  For                                                               
this reason, she wholeheartedly supported HB 265.                                                                               
                                                                                                                                
2:37:57 PM                                                                                                                    
LARRY  JOHANSEN,  representing  self, Ketchikan,  Alaska,  stated                                                               
that he was testifying in support  of HB 265 because it will save                                                               
him money and  allow him to receive the health  care he needs. He                                                               
shared that he was diagnosed  with Parkinson Disease 14 years ago                                                               
and has been able to keep  the symptoms under control with expert                                                               
specialty care that  is not available in Alaska. Early  on he was                                                               
told he should  move to Seattle, but he loves  Alaska and doesn't                                                               
want to leave.  He was living in Haines late  last winter when he                                                               
got sick and had to go  to Seattle to get the specialty treatment                                                               
he needed.  He advocated for  Alaskans to  be able to  access the                                                               
specialty care  they need  via telehealth  using audio  and video                                                               
and  online  computer-aided  treatment. He  restated  his  strong                                                               
support for HB 265.                                                                                                             
                                                                                                                                
2:44:19 PM                                                                                                                    
CHAIR COSTELLO closed public testimony on HB 265.                                                                               
                                                                                                                                
2:44:35 PM                                                                                                                    
SENATOR STEVENS moved  to report HB 265,  work order 32-LS0754\E,                                                               
from  committee  with  individual  recommendations  and  attached                                                               
fiscal note(s).                                                                                                                 
                                                                                                                                
CHAIR COSTELLO found no objection  and CSHB 265(FIN) was reported                                                               
from the Senate Labor and Commerce Standing Committee.                                                                          
                                                                                                                                
She thanked  the sponsor  and her staff  for the  background work                                                               
that was  done on the  bill and  voiced her personal  support for                                                               
telemedicine for Alaskans.                                                                                                      
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ thanked  the  chair  and committee  for                                                               
supporting  the  bill  and  offered   to  answer  any  additional                                                               
questions.                                                                                                                      
                                                                                                                                
CHAIR COSTELLO noted that Senator  Micciche asked Dr. Rathkopt to                                                               
follow up  in writing about  the cost  for her office  to provide                                                               
telemedicine  compared  to  in-person  visits.  That  information                                                               
would be forwarded to the next committee of referral.                                                                           
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  said  she'd make  sure  the  committee                                                               
received the information.                                                                                                       

Document Name Date/Time Subjects
Jody Miller Application_Redacted.pdf SL&C 5/2/2022 1:30:00 PM
GOVERNOR'S APPOINTEES
Hannah St. George Application_Redacted.pdf SL&C 5/2/2022 1:30:00 PM
GOVERNOR'S APPOINTEES
HB 265 v. E.PDF SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Sponsor Statement v. E.pdf SFIN 5/12/2022 1:00:00 PM
SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Sectional Analysis v. E.pdf SFIN 5/12/2022 1:00:00 PM
SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Explanation of Changes v. W to v. E.pdf SFIN 5/12/2022 1:00:00 PM
SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Presentation 04.28.22.pdf SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Testimony Received as of 04.28.22.pdf SL&C 5/2/2022 1:30:00 PM
HB 265
HB 306 v. A.pdf SL&C 5/2/2022 1:30:00 PM
HB 306
HB 306 Sponsor Statement.pdf SL&C 5/2/2022 1:30:00 PM
HB 306
HB 306 Sectional Analysis v. A.pdf SL&C 5/2/2022 1:30:00 PM
HB 306
HB 306 Legislative Audit Division Sunset Review BOP 7.15.21.pdf SL&C 5/2/2022 1:30:00 PM
HB 306
HB 306 Letters of Support received as of 2.25.22.pdf SL&C 5/2/2022 1:30:00 PM
HB 306
HB 306 Fiscal Note 2360 - DCCED.PDF SL&C 5/2/2022 1:30:00 PM
HB 306