Legislature(2019 - 2020)ADAMS ROOM 519
05/09/2019 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB44 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 44 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
May 9, 2019
1:30 p.m.
1:30:07 PM
CALL TO ORDER
Co-Chair Wilson called the House Finance Committee meeting
to order at 1:30 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Tammie Wilson, Co-Chair
Representative Jennifer Johnston, Vice-Chair
Representative Dan Ortiz, Vice-Chair
Representative Ben Carpenter
Representative Andy Josephson
Representative Gary Knopp
Representative Bart LeBon
Representative Kelly Merrick
Representative Colleen Sullivan-Leonard
Representative Cathy Tilton
MEMBERS ABSENT
None
ALSO PRESENT
Senator Cathy Giessel, Sponsor; Heather Carpenter, Deputy
Director, Department of Health and Social Services; Sara
Chambers, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community
and Economic Development; Emily Ricci, Health Care Policy
Administrator, Division of Retirement and Benefits,
Department of Administration.
PRESENT VIA TELECONFERENCE
Wendy Smith, President, Alaska Academy of Physicians
Assistants, Juneau.
SUMMARY
CSSB 44(FIN)
TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS
CSSB 44(FIN) was HEARD and HELD in committee for
further consideration.
CS FOR SENATE BILL NO. 44(FIN)
"An Act relating to the prescription of drugs by a
physician assistant without physical examination; and
providing for an effective date."
1:30:42 PM
SENATOR CATHY GIESSEL, SPONSOR, described the bill. She
explained that SB 44 addressed telehealth authorization for
physician assistants (PAs). She detailed that the bill was
a cleanup of a bill that passed the legislature in 2016.
The Medicaid reform bill, known as SB 74-Medicaid Reform;
Telemedicine; Drug Databas [CHAPTER 25 SLA 16, 06/21/2016]
authorized Alaskas physicians to render care via
telemedicine that included providing treatment, or
prescribing, dispensing, or administering a prescription
drug without conducting a physical examination. However, SB
74 only addressed physicians, and the Alaska State Medical
Board interpreted that the bill's provisions should not
apply to (PAs). The state medical board had determined on
its own that physicians' assistants could not provide
telemedicine services. She relayed the history of the PA
profession. She informed the committee that during the
Vietnam War medics performed critical lifesaving and
complex medical services in the field. Subsequently, the
medics gained significant medical skills and physicians
began to employ them under their supervision. Eventually,
the PA profession was created. She cited a document from
the American Academy of Physicians Assistants that outlined
the education and duties of PAs that included taking
medical histories, performing physical exams and lab
testing, diagnosis, prescribing, and assisting in surgery.
Typically, the required education was 27 months culminating
in graduating with a master's degree. The training included
rotations through the usual clinical specialties; totaling
approximately 2000 hours of supervised clinical practice.
She furthered that the Alaska State Medical Board issued
guidelines that were included in the bill packet ["Alaska
State Medical Board-Board Issued Guidelines] (copy on
file) requiring a PA to maintain a collaborative agreement
with a physician. The PA was required to maintain monthly
contact with the physician and the physician authorized
where the PA could practice and the medications she could
prescribe. She elaborated that PAs often obtained Drug
Enforcement Administration (DEA) authorization to prescribe
controlled substances. She concluded that the bill would
close the gap created in SB 74 and reestablish the ability
for PAs to provide telehealth services. She revealed that
PAs previously had the authorization to provide
telemedicine prior to passage of SB 74.
1:34:35 PM
Senator Giessel addressed who would benefit from the
legislation. She emphasized that patients especially from
underserved and rural areas would benefit most. She pointed
to a map from the Health Professional and Services
Administration that depicted Health Professional Shortage
Areas (HPSA) for primary care (copy on file) in Alaska. She
noted that most of the state was included in shortage
areas. Allowing PAs to provide telemedicine expanded access
to care. She pointed to the letters of support (copy on
file) from PAs who practice in rural areas. The state
medical board had taken a neutral position on the bill. She
reported that the Department of Health and Social Services
(DHSS) would offer an amendment to the bill.
Representative Knopp asked if she had received letters of
opposition. Senator Giessel replied in the negative.
Representative Knopp inquired whether any physicians
expressed opposition to the bill. Senator Giessel answered
in the negative.
1:36:37 PM
Representative Josephson remarked on the sponsors
testimony that the department had an amendment. He thought
that was unusual.
Co-Chair Wilson replied that the committee could draft a
committee substitute , which was the typical process. She
asked DHSS to speak to the forthcoming amendment.
HEATHER CARPENTER, DEPUTY DIRECTOR, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES, answered that the governor had
introduced a Medicaid bill; SB 112/HB 135-Medicaid
Expansion; Drug Cost Containment. She reported that the
department asked the sponsor if two provisions from the
bill could be added to SB 44 to expedite passage in the
current session. The provisions related to the state's
preferred drug list. She explained that DHSS updated the
drug list once each year and the amendment would allow the
department to update by reference through regulations.
Currently, it took 6 to 9 months before the preferred drug
list was fully adopted. The department published the list
of proposed changes once each year but discussed the
changes four times each year.
1:38:52 PM
Co-Chair Wilson remained uncertain what the amendment did.
Ms. Carpenter answered that two sections of the governors
bill - Section 1 and Section 7 would be amended into SB 44.
She explained that Medicaid had a preferred drug list and a
prior authorization medication list. The first section of
SB 44 would authorize the lists to be updated via
regulations; resulting in reducing the process to 60 days.
Representative LeBon shared that he had previously been a
board member of the Interior Community Health Center for 20
years that had a health clinic in Healy managed by a PA and
the supervision was provided from the Fairbanks clinic. He
asked how the bill would change the arrangement. He asked
if it was necessary for the PA to be located near the
physician. Senator Giessel answered that SB 44 only
required contact - via telephone or email with the
supervising physician. Occasionally, they might consult
with each other on a complicated case or other issues. She
furthered that the amendment was tangential to the bill.
The preferred drug list was part of how Medicaid controlled
costs for prescription drugs. The drug list typically
advocated for the use of generic drugs first and allowed
bulk buying of prescription drugs. She noted that the list
was a major cost savings for the Medicaid system.
1:41:39 PM
Co-Chair Wilson reported that the amendment would be
brought to the committee for discussion in a later meeting.
Co-Chair Wilson OPENED public testimony.
Representative LeBon inquired whether it was most likely
the case that the PA would be in the same building as the
supervisory physician.
WENDY SMITH, PRESIDENT, ALASKA ACADEMY OF PHYSICIANS
ASSISTANTS, JUNEAU (via teleconference), responded that was
not the case for most of the PAs in the state of Alaska.
She added that most PAs were supervised via telephone or
email.
1:44:03 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, relayed that the state
medical board updated its disposition of SB 44 and was in
support of the bill.
Co-Chair Wilson CLOSED public testimony.
Co-Chair Wilson asked Ms. Chambers to review the fiscal
note.
Ms. Chambers complied. She reviewed the fiscal impact note
(FN1 CED) from the Department of Commerce, Community and
Economic Development in the amount of $5.3 thousand. She
delineated that the appropriation request was the cost to
update regulations. The appropriation would specifically
cover legal costs to amend regulations, printing, and
postage in the first year. Co-Chair Wilson asked whether
the costs would be paid by the medical board. Ms. Chambers
replied in the affirmative and added that the cost was
covered by receipt supported services paid for by licensing
fees.
Representative LeBon asked whether telehealth was expanded
to include nurse practitioners. Ms. Chambers informed the
committee that nurses, and advanced nurse practitioners had
been able to perform telehealth services for decades. She
added that the Board of Nursing was currently adopting
regulations to clarify the practice.
1:46:20 PM
EMILY RICCI, HEALTH CARE POLICY ADMINISTRATOR, DIVISION OF
RETIREMENT AND BENEFITS, DEPARTMENT OF ADMINISTRATION,
reviewed the Department of Administration zero fiscal note
(FN 2 ADM). She indicated that the bill would not impact
the current telehealth benefit structure provided under the
AlaskaCare plans.
Co-Chair Wilson asked whether the department anticipated
any savings from the bill. Ms. Ricci replied that
conceptually, in time it could save money. However, not
within the timeframe of the fiscal note. She reported that
currently, telehealth was very infrequently utilized. Out
of two million claims process each year, fewer than 40
claims were being processed annually for telemedicine. She
did not anticipate the bill having a financial impact, but
she did believe it had the potential to increase access in
the future.
Representative Josephson expressed surprise that only 40
out of 2 million claims from the pool of state employees
were for telehealth services. He asked for confirmation.
Ms. Ricci answered that when the division checked the data
it discovered that fewer than 40 were being billed under a
specific Current Procedural Terminology (CPT) code and the
associated modifier for the types of services. She
elaborated that the division found that some of the
services might had been billed without the correct code
modifier for telehealth. She deduced that there may be
slightly higher utilization of telemedicine but she was
unable to pull the data at present. She qualified that
regardless, out of 2 million annually processed claims the
department did not anticipate an immediate fiscal impact.
1:49:08 PM
Representative Carpenter asked if there was a telemedicine
issue for rural Alaska related to bandwidth issues. Ms.
Ricci replied that she was not the best person to answer
the question, but she guessed that there were some related
issues.
Co-Chair Wilson noted that she would attempt to find the
answer.
SB 44 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
1:50:49 PM
The meeting was adjourned at 1:50 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CS for SB44 (FIN) Sectional Summary vsn E.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Letter of Support AK Policy Forum 3-2019.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Letter of Support ACoA 3-21-19.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Sponsor Statement revised 4-2-19.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document AK State Medical Bd PA scope of practice.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document HRSA -HPSA Underserved Primary Care Areas (1).pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document DEA Drug Schedules.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Letter of Support ANHB 3-26-19.pdf |
HFIN 5/9/2019 1:30:00 PM |
HB 3 SB 44 |
| SB44 Letter of Support Aikey 3-13-19.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document PA guidelines AK State Medical Bd.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document Prescribing Authority PA.pdf |
HFIN 5/9/2019 1:30:00 PM |
SB 44 |