04/06/2016 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB372 | |
| HB234 | |
| SB148 | |
| SB142 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 234 | TELECONFERENCED | |
| + | SB 148 | TELECONFERENCED | |
| + | SB 142 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 372 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
April 6, 2016
3:32 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Shelley Hughes, Vice Chair
Representative Jim Colver
Representative Gabrielle LeDoux
Representative Cathy Tilton
Representative Andy Josephson
Representative Sam Kito
MEMBERS ABSENT
Representative Mike Chenault (alternate)
OTHER LEGISLATORS PRESENT
Representative Lora Reinbold
Representative Louise Stutes
COMMITTEE CALENDAR
HOUSE BILL NO. 372
"An Act relating to insurance; relating to expenses for
insurance examinations; relating to regulations for insurance
utilization review, benefits determination, health care
insurance grievance resolution procedures, independent review of
adverse determinations or final adverse determinations,
independent review organizations, and continuing education
providers; relating to required provisions for health care
insurance contracts and policies, including health care provider
choice; establishing civil penalties for insurers for failure to
provide requested records; amending the definition of 'wet
marine and transportation' insurance; amending provisions on
limited licenses to include crop insurance; relating to third-
party administrator notification requirements; relating to
certification filing by reinsurance intermediary brokers;
relating to rate filings, delivery of insurance policies or
endorsements; relating to refunds of variable life insurance
policies and variable annuities; establishing limitations on
issuance of long- term care insurance; relating to requirements
for group health insurance policies; amending the definition of
'group health insurance'; relating to motor vehicle service
contracts; relating to notice requirements for meetings of
stockholders or members of a domestic insurer; establishing a
definition of 'bona fide association'; relating to requirements
and penalties for committing a fraudulent or criminal insurance
act; updating criteria for examinations; relating to rate filing
deviations; establishing civil penalties for certain wilful
violations; and providing for an effective date."
- MOVED CSHB 372(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 234
"An Act relating to insurance coverage for mental health
benefits provided through telemedicine."
- HEARD & HELD
SENATE BILL NO. 148
"An Act relating to reporting of workplace injuries to the
division of labor standards and safety."
- MOVED CSSB 148(L&C) OUT OF COMMITTEE
SENATE BILL NO. 142
"An Act relating to insurance coverage for anti-cancer
medications."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 372
SHORT TITLE: OMNIBUS INSURANCE
SPONSOR(s): LABOR & COMMERCE
03/21/16 (H) READ THE FIRST TIME - REFERRALS
03/21/16 (H) L&C
03/28/16 (H) L&C AT 3:15 PM BARNES 124
03/28/16 (H) Heard & Held
03/28/16 (H) MINUTE (L&C)
03/30/16 (H) L&C AT 3:15 PM BARNES 124
03/30/16 (H) Heard & Held
03/30/16 (H) MINUTE (L&C)
04/04/16 (H) L&C AT 3:15 PM BARNES 124
04/04/16 (H) Heard & Held
04/04/16 (H) MINUTE (L&C)
04/06/16 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 234
SHORT TITLE: INSURANCE COVERAGE FOR TELEMEDICINE
SPONSOR(s): REPRESENTATIVE(s) VAZQUEZ
01/19/16 (H) PREFILE RELEASED 1/8/16
01/19/16 (H) READ THE FIRST TIME - REFERRALS
01/19/16 (H) HSS, L&C
03/15/16 (H) HSS AT 3:00 PM CAPITOL 106
03/15/16 (H) Heard & Held
03/15/16 (H) MINUTE (HSS)
03/17/16 (H) HSS AT 3:00 PM CAPITOL 106
03/17/16 (H) Moved HB 234 Out of Committee
03/17/16 (H) MINUTE (HSS)
03/18/16 (H) HSS RPT 3DP 1NR 1AM
03/18/16 (H) DP: TARR, VAZQUEZ, WOOL
03/18/16 (H) NR: TALERICO
03/18/16 (H) AM: SEATON
04/06/16 (H) L&C AT 3:15 PM BARNES 124
BILL: SB 148
SHORT TITLE: EMPLOYER REPORT OF WORKPLACE INJURY/DEATH
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/19/16 (S) READ THE FIRST TIME - REFERRALS
01/19/16 (S) L&C
02/02/16 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/02/16 (S) Heard & Held
02/02/16 (S) MINUTE (L&C)
02/04/16 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/04/16 (S) Moved CSSB 148(L&C) Out of Committee
02/04/16 (S) MINUTE (L&C)
02/08/16 (S) L&C RPT CS 4DP NEW TITLE
02/08/16 (S) DP: COSTELLO, GIESSEL, MEYER, STEVENS
02/24/16 (S) TRANSMITTED TO (H)
02/24/16 (S) VERSION: CSSB 148(L&C)
02/26/16 (H) READ THE FIRST TIME - REFERRALS
02/26/16 (H) L&C
04/06/16 (H) L&C AT 3:15 PM BARNES 124
BILL: SB 142
SHORT TITLE: INSURANCE FOR ANTI-CANCER MEDICATION
SPONSOR(s): SENATOR(s) GIESSEL
01/19/16 (S) READ THE FIRST TIME - REFERRALS
01/19/16 (S) L&C
02/04/16 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/04/16 (S) Heard & Held
02/04/16 (S) MINUTE (L&C)
02/16/16 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/16/16 (S) Moved CSSB 142(L&C) Out of Committee
02/16/16 (S) MINUTE (L&C)
02/17/16 (S) L&C RPT CS 4DP SAME TITLE
02/17/16 (S) DP: COSTELLO, GIESSEL, MEYER, STEVENS
03/02/16 (S) TRANSMITTED TO (H)
03/02/16 (S) VERSION: CSSB 142(L&C) AM
03/04/16 (H) READ THE FIRST TIME - REFERRALS
03/04/16 (H) L&C
04/06/16 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
KONRAD JACKSON, Staff
Representative Kurt Olson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented Amendment 1, to the committee
substitute (CS) for HB 372, on behalf of Representative Olson,
Chair of the House Labor and Commerce Standing Committee,
sponsor,
MEGAN WALLACE, Attorney
Legislative Legal and Research Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
372.
DONALD HALE, Insurance Specialist
Division of Insurance
Department of Commerce, Community & Economic Development (DCCED)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
372.
FRED PARADY, Deputy Commissioner
Department of Commerce, Community & Economic Development (DCCED)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
372.
REPRESENTATIVE LIZ VAZQUEZ
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 234, as sponsor.
ANITA HALTERMAN, Staff
Representative Liz Vazquez
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 234, on behalf of
Representative Vazquez, sponsor.
AROM EVANS M.D., Medical Director
Orion Behavioral Health Network
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 234.
JOE THOMAS, Deputy Commissioner
Department of Labor & Workforce Development (DLWD)
Anchorage, Alaska
POSITION STATEMENT: Presented CSSB 148, on behalf of the Senate
Rules Committee by request of the governor.
KARI NORE, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented Amendment 1 to CSSB 142, on
behalf of Senator Giessel, prime sponsor.
EMILY NENON, Alaska Government Relations Director
American Cancer Society/Cancer Action Network
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 142.
ERIC HANSEN, Spokesperson
International Myeloma Foundation
Unknown Location
POSITION STATEMENT: Testified in support of SB 142.
KIMBERLY THEIS, Advocacy Manager
Leukemia & Lymphoma Society
San Francisco, California
POSITION STATEMENT: Testified in support of SB 142.
ACTION NARRATIVE
3:32:50 PM
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:32 p.m. Representatives Tilton,
Kito, Josephson, Hughes, and Olson were present at the call to
order. Representatives Colver and LeDoux arrived as the meeting
was in progress.
HB 372-OMNIBUS INSURANCE
3:33:05 PM
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 372, "An Act relating to insurance; relating to
expenses for insurance examinations; relating to regulations for
insurance utilization review, benefits determination, health
care insurance grievance resolution procedures, independent
review of adverse determinations or final adverse
determinations, independent review organizations, and continuing
education providers; relating to required provisions for health
care insurance contracts and policies, including health care
provider choice; establishing civil penalties for insurers for
failure to provide requested records; amending the definition of
'wet marine and transportation' insurance; amending provisions
on limited licenses to include crop insurance; relating to
third-party administrator notification requirements; relating to
certification filing by reinsurance intermediary brokers;
relating to rate filings, delivery of insurance policies or
endorsements; relating to refunds of variable life insurance
policies and variable annuities; establishing limitations on
issuance of long- term care insurance; relating to requirements
for group health insurance policies; amending the definition of
'group health insurance'; relating to motor vehicle service
contracts; relating to notice requirements for meetings of
stockholders or members of a domestic insurer; establishing a
definition of 'bona fide association'; relating to requirements
and penalties for committing a fraudulent or criminal insurance
act; updating criteria for examinations; relating to rate filing
deviations; establishing civil penalties for certain wilful
violations; and providing for an effective date."
[Although not stated on the record of the House Labor and
Commerce Standing Committee meeting of 4/4/16, the committee
treated HB 372, Version H, as adopted and before the committee.]
3:33:28 PM
REPRESENTATIVE HUGHES moved to adopt Amendment 1 labeled 29-
LS1379\H.1, Wallace, 4/5/16, which read:
Page 8, lines 16 - 22:
Delete all material and insert:
"(15) "emergency medical condition" means a
medical condition manifesting itself by acute symptoms
of sufficient severity, including severe pain, that a
prudent person who possesses an average knowledge of
health and medicine could reasonably expect that the
absence of immediate medical attention would result in
serious impairment of bodily functions, serious
dysfunction of a bodily organ or part, or would place
the person's health or, with respect to a pregnant
woman, the health of the woman or her unborn child, in
serious jeopardy."
CHAIR OLSON objected for discussion purposes.
3:33:57 PM
KONRAD JACKSON, staff to Representative Kurt Olson, Alaska State
Legislature, informed the committee that Amendment 1 addresses
concerns expressed regarding page 8, Section 11, which is the
definition of an emergency medical condition. Amendment 1
changes the definition to more closely mirror what exists in the
Patient Protection and Affordable Care Act of 2010 (PPACA). He
pointed out that the word "layperson" was not included in the
requested change in order to conform to the Manual of
Legislative Drafting.
REPRESENTATIVE LEDOUX asked if there is a difference between a
"reasonable person" standard and a "prudent person" standard.
3:35:31 PM
MEGAN WALLACE, Attorney, Legislative Legal Counsel, Legislative
Legal Services, Legislative Affairs Agency, asked Representative
LeDoux to repeat the question.
REPRESENTATIVE LEDOUX asked for the difference between the
standards applied to define a reasonable person versus a prudent
person. Usually, she commented, the term prudent person is used
with regard to investment decisions; whereas, a person who has
committed a wrong and, as a layperson, should have known better
is characterized as a reasonable person.
MS. WALLACE replied that, in this case, the prudent person is
modified by "a prudent person that possesses an average
knowledge of health and medicine" and opined the term is not out
of place. She deferred to the Division of Insurance for
specialized knowledge as to which term is preferred; further,
neither prudent person nor reasonable person is defined in
statute.
3:38:05 PM
DONALD HALE, Insurance Specialist, Division of Insurance,
Department of Commerce, Community & Economic Development,
deferred to an attorney.
REPRESENTATIVE LEDOUX noted that her question could be resolved
in the next committee of referral.
CHAIR OLSON suggested that the intent of the change was also to
achieve compliance with PPACA.
REPRESENTATIVE JOSEPHSON directed attention to page 8, Section
11: AS 21.07, Patient protections under the health care
insurance policies. He noted that generally, there is a desire
to keep people out of emergency rooms unless necessary. He then
observed that the definitions of emergency medical condition in
the proposed legislation and in the amendment as written set a
high standard, and remarked:
You have to find that ... you could suffer serious
dysfunction, impairment, or serious jeopardy. ... Are
we saying that, that an insurance company could deny
coverage at an emergency room, unless it's plausible
that the visitor or the patient was reasonably going
to expect some of those types of egregious or serious
conditions? ... So, I'm just wondering, where this
definition gets applied.
MR. HALE expressed his understanding that the purpose is to
protect someone who seeks emergency care "and [their problem] is
not what they thought it was."
REPRESENTATIVE JOSEPHSON repeated Mr. Hale's statement that
"it's not what they thought it was or it could be precisely what
they thought it was."
MR. HALE agreed.
CHAIR OLSON opined that there are enough safeguards built in and
the emergency room would err on the side of caution.
REPRESENTATIVE KITO said that, from personal experience, even
medical professionals will recommend an emergency room visit out
of caution. He said he hoped the definition would protect those
individuals who believe they are in danger, or who are advised
by medical professionals to go to an emergency room.
REPRESENTATIVE LEDOUX, noting that the bill does not have
another committee referral, requested a definition of reasonable
person versus prudent person from the Division of Insurance.
Prudent person appears to be a stricter standard in that the
person must be smarter than a reasonable person, she said.
MS. WALLACE said a quick search reveals that "a reasonably
prudent person" and a "reasonable person" have been used in
similar context. She opined that a "prudent person" does not
represent a higher standard than a "reasonable person," but
merely is a minor differentiation.
3:46:30 PM
FRED PARADY, Deputy Commissioner, Office of the Commissioner,
Department of Commerce, Community & Economic Development
(DCCED), advised that Amendment 1 is useful in that the section
relates to patient protections under health care insurance
policies, and the Department of Commerce, Community & Economic
Development (DCCED) seeks to bring Alaska's insurance statutes
up to code with models based on PPACA. He offered to provide
additional guidance from the director of the Division of
Insurance.
REPRESENTATIVE HUGHES expressed interest in the context of the
definition; for example, some residents use an emergency room
for nonemergency care, and she asked whether the [bill]
establishes in statute that an insurance company might not have
to cover a charge for a condition not described.
MR. PARADY reiterated that he would like to speak with his
director in this regard. He stated that statute holds the
requirements for contract provisions for health care insurance,
one of which is that there be a utilization review process, and
the language in the statute defines the review. He opined the
definition is patient protection.
REPRESENTATIVE HUGHES said one reason health care costs are high
is because emergency room care is used for nonemergency medical
conditions. She asked whether there is an attempt here to not
cover something when a person goes to the emergency room for a
nonemergency medical condition.
CHAIR OLSON opined there is more coverage under PPACA, not less.
3:50:28 PM
CHAIR OLSON removed his objection to Amendment 1. There being
no objection, Amendment 1 was adopted.
3:51:21 PM
REPRESENTATIVE HUGHES moved to report the committee substitute
for HB 372, Version 29-LS1379\H, Wallace, 3/30/16, as amended,
out of committee with individual recommendations and the
accompanying fiscal notes. There being no objection, CSHB
372(L&C) was reported out of the House Labor and Commerce
Standing Committee.
3:51:51 PM
The committee took an at ease from 3:51 p.m. to 3:53 p.m.
HB 234-INSURANCE COVERAGE FOR TELEMEDICINE
3:53:59 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 234, "An Act relating to insurance coverage for
mental health benefits provided through telemedicine."
3:54:42 PM
REPRESENTATIVE LIZ VAZQUEZ, Alaska State Legislature, introduced
HB 234, to be presented by Anita Halterman.
3:55:10 PM
ANITA HALTERMAN, staff to Representative Liz Vazquez, Alaska
State Legislature, speaking on behalf of Representative Vazquez,
advised that HB 234 is a mental health parity bill. The bill
requires that the health insurance industry provide
reimbursement for mental health coverage through the delivery
mode of telemedicine. Alaska Medicaid has paid for mental
health and substance abuse telemedicine for many years; however,
only one insurer in Alaska has been providing reimbursement.
The bill requires that insurers reimburse for telemedicine care
without requiring a face-to-face visit, which could improve
access to mental health services for 15 percent of the
population in Alaska. This bill does not provide new coverage,
but it provides a new means of reimbursement for a coverage
option currently available through the health insurance
industry.
3:56:21 PM
MS. HALTERMAN said one concern related to HB 234 is the
prohibition of face-to-face visits. She directed attention to a
document entitled, "The American Telemedicine Association, 50
State Telemedicine Gaps Analysis" from the National Conference
of State Legislators, which described the national status
regarding telemedicine. The analysis indicated that 22 states
have laws giving them the highest possible "grade" and Alaska
received an A+ for telemedicine Medicaid reimbursement.
However, Alaska received an F grade as to the private sector,
and this bill is an effort to correct that issue. Most private
insurers cover reimbursement for telemedicine without a face-to-
face visit; the states of Texas and Arkansas appear to be the
only states with a face-to-face requirement, and the state of
Arizona is the only state requiring a face-to-face encounter
before mental health services can be delivered. She pointed out
that HB 234 does not prohibit a health care professional from
requiring a face-to-face visit, but leaves the decision up to
the medical professional, not the insurer. Further, she
stressed that this is an insurance bill, not a medical bill.
3:59:02 PM
MS. HALTERMAN advised that the second concern raised pertained
to licensing within Alaska, and she clarified that the bill
requires a provider be licensed in Alaska in order to practice
within the state. The third concern was a request to add
substance abuse to the bill; however, the Alaska Statutes that
originally required that substance abuse be provided were
repealed in 1997. She said she has received input from
stakeholders within the industry about what definitions might be
useable, but Alaska has no clear definition of substance abuse
in statute, so the issue of including substance abuse has been
tabled. Ms. Halterman reiterated that this is a parity bill
requiring the health insurance industry to do what Medicaid has
been doing for many years.
CHAIR OLSON cautioned that the substance abuse issue would
complicate the bill.
MS. HALTERMAN agreed. Returning attention to the first concern,
she referred to a code of ethics and other guidance documents
with regard to face-to-face requirements, and other issues that
may affect this particular industry.
REPRESENTATIVE VAZQUEZ pointed out that she does not want to
attempt to micromanage the medical profession and that it is up
to them to require face-to-face visits.
REPRESENTATIVE COLVER asked for clarification that substance
abuse telemedicine is not included in the bill.
MS. HALTERMAN advised that the sponsor had been asked to
consider introducing a definition for substance abuse, but after
consulting with Legislative Legal and Research Services, and
individuals within the insurance industry, discovered there is
no clean definition available currently in Alaska that has been
vetted by stakeholders in this industry.
4:03:05 PM
REPRESENTATIVE COLVER expressed concern that this legislation
not "opt out" smoking cessation, which is generally handled over
the telephone. He also expressed concern regarding someone who
just needs counseling as to where to go for treatment services
for substance abuse. Representative Colver restated smoking
cessation can be provided over the telephone, and urged that the
proposed legislation not opt out smoking cessation services.
MS. HALTERMAN expressed her understanding that ICD-10 medical
codes are uniformly used primarily for substance abuse and
mental health. She explained that many individuals require
services that are mental health in nature, may directly be
substance abuse related, and which may be covered by this bill.
Insurers such as AETNA have indicated that much of what would be
included in a definition of substance abuse may already be
covered because of the uniform use of ICD-10 codes for
behavioral health. She advised stakeholder input is needed to
determine what is necessary to ensure that whatever additional
coverage might not be provided by this bill is considered next
session.
REPRESENTATIVE HUGHES observed that a mental health care
provider must be licensed in Alaska, and asked whether a
telemedicine, mental health care provider could be located out-
of-state. She asked whether this legislation would broaden the
scope of access for Alaskans.
MS. HALTERMAN deferred the question to an invited witness.
REPRESENTATIVE HUGHES spoke in support of consistency in
providers and questioned whether it is advisable to provide a
person's mental health services totally by telemedicine, or
whether there should be face-to-face contact. If so, out-of-
state providers could not provide that service. She stressed
the importance of knowing if the bill allows for out-of-state
providers.
4:07:27 PM
REPRESENTATIVE COLVER read from the end of the second paragraph
of an email from John DeRuytern, Hope Counseling Center,
addressed to Representative Vazquez, 1/16/16, available in the
committee packet, which read as follows [original punctuation
provided]:
However, I am very concerned that the bill's language
specifically prohibits a requirement that face-to-face
evaluation occur prior to telehealth services being
reimbursed. This prohibition is a SIGNIFICANT end run
around Best Practices and the safe delivery of mental
health services using telehealth technologies.
REPRESENTATIVE COLVER asked Ms. Halterman to address the
foregoing issue.
MS. HALTERMAN reminded the committee that the bill is an
insurance bill and does not influence medical professionals.
Therefore, the mandate of a face-to-face requirement is a
mandate on the insurance industry and not on the medical
professionals. There is no intent to change the best practices
of the medical professionals, and they retain the right to
require a face-to-face visit. This bill directs that insurers
not impose a face-to-face requirement and that the decision is
left to medical professionals.
4:09:19 PM
REPRESENTATIVE JOSEPHSON assumed that some face-to-face contact
improves the efficacy of counseling. He asked whether a Juneau
citizen could hire someone in Anchorage rather than hiring a
Juneau practitioner.
MS. HALTERMAN confirmed that the bill allows some flexibility
for the medical professional, and it will be up to that
professional to determine whether or not it is appropriate to
deliver mental health services without a face-to-face
requirement. The risk assumed for not requiring a face-to-face
visit would rest with the medical professional, who retains the
right to establish practice rules allowing them to have a face-
to-face requirement. In fact, it would be their liability if
they didn't require a face-to-face visit. She said:
... this bill is not to influence the medical
practice, but rather is trying to influence
restrictions on the insurance industry that they not
impose additional obligations. This bill is strictly
restricting them from imposing a face-to-face
requirement. It in no way restricts the medical
professional from making a decision based on risk with
their patients to require a face-to-face ...
4:11:37 PM
CHAIR OLSON asked whether using Skype would be considered face-
to-face contact.
MS. HALTERMAN referred to the previous analysis document and
opined Skype may be an option. She noted that Texas has a face-
to-face requirement, but does not clearly define whether it is a
physical face-to-face meeting. Neither Texas nor Arizona
describe "what that face-to-face obligation actually is."
CHAIR OLSON noted that a telemedicine program has been
operational in Kotzebue and around the North Slope using Skype
or something similar.
MS. HALTERMAN reiterated that Medicaid has been reimbursing for
telemedicine in Alaska since 1999-2005, when Alaska introduced
the first telemedicine regulations in the nation. She noted
Medicaid has not had any concerns with regard to mental health
or substance abuse services delivered via telemedicine in
Alaska. For instance, [Alaska Native health services] and the
[U.S. Department of Veterans Affairs] have a lot of exceptions,
and Medicaid has been openly reimbursing. Previous testimony
from Director Margaret Brodie, Health Care Services, Department
of Health and Social Services, related that the bill will
benefit Alaska Medicaid because currently, Medicaid is
reimbursing for mental health services through telemedicine, but
is unable to process a third party recovery for those
reimbursements since the private sector may not. This bill, she
said, would allow Medicaid to possibly recoup some monies from
the private sector.
CHAIR OLSON opined that Medicaid pays air travel expenses.
MS. HALTERMAN agreed that transportation from a remote area in
order for a patient to receive a face-to-face visit can be
costly in Alaska, and noted that mental health services have
been delivered and reimbursed by Medicaid in at least 36
Medicaid states, with few problems.
CHAIR OLSON opened public testimony.
4:15:40 PM
AROM EVANS M.D., Medical Director, Orion Behavioral Health
Network, advised that Orion Behavioral Health delivers
telemedicine throughout the state. Dr. Evans explained that in
the past private insurance primarily paid for services, but the
funding has been cut in the last three years, which has reduced
care to many Alaskans who subsequently lost their insurance
benefits when coverage changed to a third-party administrator.
The population served by Orion Behavioral Health Network would
not receive care without telemedicine; for example, patients who
are homebound or who live in small communities that cannot
provide direct psychiatric care. He said the bill allows
services to reach individuals, even those who do not qualify for
Medicaid, such as adolescents and developmentally delayed
adults, and may prevent an emergency situation from developing.
Dr. Evans clarified that the bill affects insurance and does not
seek to change licensing board practices and current rules
regarding face-to-face contact, which are fairly strict. At
this time the [State Medical Board, Department of Commerce,
Community & Economic Development] does not allow out-of-state
providers to practice telemedicine, except under certain,
limited circumstances.
DR. EVANS cautioned that, in some cases, if a person is unable
to receive services without a face-to-face visit, the result
will be that the patient doesn't receive services due to the
aging of Alaska's population and the limited care in rural
communities.
REPRESENTATIVE HUGHES understood that the bill would increase
access to care and asked what the best practices are for the
standard of care for treatment without ever having a face-to-
face visit. She referred to related proposed legislation.
DR. EVANS advised that proposed SB 74 requires the medical board
to adopt standards regarding out-of-state providers. Currently,
practice by out-of-state providers is allowed only in certain
circumstances. As for the standard of care, he said that most
states allow for care via telehealth without an in-person
examination, as do the ethical guidelines for the American
Telemedicine Association. In his practice, Dr. Evans said,
every effort is made to do a face-to-face visit. Face-to-face
visits are provided whenever possible, although there are
certainly times when it is just not possible, and best care
practices dictate administering service via telemedicine.
4:22:16 PM
CHAIR OLSON announced that public testimony would remain open.
[HB 234 was held over.]
4:22:41 PM
The committee took an at ease from 4:22 p.m. to 4:23 p.m.
SB 148-REPORTING WORKPLACE INJURIES
4:23:24 PM
CHAIR OLSON announced that the next order of business would be
CS FOR SENATE BILL NO. 148(L&C), "An Act relating to the
reporting of workplace injuries to the division of labor
standards and safety; and providing for an effective date."
4:23:54 PM
JOE THOMAS, Deputy Commissioner, Office of the Commissioner,
Department of Labor & Workforce Development (DLWD), advised that
proposed SB 148 amends current workplace accident reporting
requirements to include reporting of incidents involving the
loss of an eye or an amputation. These amendments are necessary
to comport with the federal workplace accident reporting
standards effective January 1, 2015. Alaska operates an
approved state plan under the Federal Occupational Safety and
Health Act of 1970, which requires that states maintain
standards that meet the federal standards at a minimum, and AS
18.60.030 established that Alaska maintain requirements that are
at least as effective as those adopted by the U. S. Department
of Labor. The Occupational Safety and Health Administration
(OSHA) made changes to the accident reporting requirements under
federal regulation 29 CFR 1904 related to the reporting of
industrial accidents resulting in an amputation or the loss of
an eye, and notified the state that failure to maintain
equivalency could jeopardize federal funding as well as the
state's jurisdiction over occupational safety and health.
Alaska seeks to maintain said jurisdiction and the associated
funding. Mr. Thomas restated that SB 148 brings Alaska's
workplace accident reporting standards up to the federal
standard, and urged for the committee's support.
REPRESENTATIVE HUGHES asked whether the definition of amputation
includes digits, an ear, or another body part.
MR. THOMAS opined that amputation is any loss of any body part.
4:26:38 PM
REPRESENTATIVE LEDOUX referred to page 2, lines 7-9, Section 1,
which read as follows:
The subsection does not apply to an employer that
first receives information of a fatality, [OR] in-
patient hospitalization, loss of an eye, or amputation
more than 30 days after the accident.
REPRESENTATIVE LEDOUX questioned how an employer would not be
aware of an accident or fatality for more than 30 days
afterward.
MR. THOMAS agreed and said any employee/employer could provide
notice to DLWD.
REPRESENTATIVE LEDOUX asked whether it is an excuse if the
president of a company denies knowledge but the job foreman knew
about it.
MR. THOMAS said his assumption is that, as long as there were
people on the job who knew of an accident, the employer is
expected to know, depending upon the severity of the situation.
4:28:42 PM
REPRESENTATIVE LEDOUX asked for an example of circumstances
under which an employer would not know about an accident for 30
days.
MR. THOMAS suggested an employer, or the owner of a company, may
be on vacation in a locale where they are unable to be contacted
by a superintendent. In further response to Representative
LeDoux, Mr. Thomas explained that the term employer is used to
indicate that anyone on the job can report an incident.
Generally, the owner of a company would be made aware of an
accident during some period of time, but the supervisor on the
job would call an ambulance and report a workplace accident to
DLWD.
REPRESENTATIVE LEDOUX asked what happens if a supervisor doesn't
report it.
MR. THOMAS opined the law would hold the employer responsible
for not reporting.
CHAIR OLSON advised that in the case of an amputation or loss of
an eye, the hospital would call the employer and the insurance
company to confirm the person is an employee, and that there is
insurance coverage by workers compensation insurance.
REPRESENTATIVE LEDOUX restated her interest in knowing the
purpose of the exception for an employer who does not receive
notice within 30 days after an accident, which seems
unreasonable.
MR. THOMAS said, although that situation may never arise, the
wording is based upon federal language and was used to ensure
compliance.
REPRESENTATIVE HUGHES asked whether the word employer includes
the superintendent.
MR. THOMAS said yes, that is the interpretation by DLWD.
REPRESENTATIVE HUGHES surmised that it would include anyone at
the company or the next person down from the top of the list of
job titles.
MR. THOMAS answered yes.
4:32:28 PM
REPRESENTATIVE LEDOUX suggested an employer may not be aware of
a situation at a remote site.
REPRESENTATIVE COLVER asked for statistics on this type of
accident in Alaska.
MR. THOMAS said he was unsure of the variety of accidents to
this degree. However, this calendar year there have been three
fatalities, and he offered to provide further information to the
committee.
REPRESENTATIVE COLVER recalled an incident that occurred in a
trench in Anchorage last summer, and asked for clarification
that there have been only three [job related] fatalities in
2016.
MR. THOMAS stated last calendar year included the aforementioned
fatality and two others. In further response to Representative
Colver, he said the other two fatalities were an accident at
CMI's shop in Anchorage, and the death of a health care worker
in a long-term care home. At the CMI shop a jack failed and a
worker was crushed.
4:34:45 PM
CHAIR OLSON opened public testimony. After ascertaining no one
wished to testify, closed public testimony.
4:35:28 PM
REPRESENTATIVE HUGHES moved to report CSSB 148(L&C), Version 29-
GS2801\W, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, CSSB
148(L&C) was reported from the House Labor and Commerce Standing
Committee.
4:35:49 PM
The committee took an at ease from 4:35 p.m. to 4:36 p.m.
SB 142-INSURANCE FOR ANTI-CANCER MEDICATION
4:36:36 PM
CHAIR OLSON announced that the final order of business would be
CS FOR SENATE BILL NO. 142(L&C) am, "An Act relating to
insurance coverage for anti-cancer medications."
4:37:09 PM
REPRESENTATIVE HUGHES moved to adopt Amendment 1, labeled 29-
LS1133\W.A.1, Wallace, 4/5/16, which read:
Page 1, line 1, following "medications":
Insert "; and providing for an effective date"
Page 2, following line 14:
Insert a new bill section to read:
"* Sec. 3. This Act takes effect January 1, 2017."
CHAIR OLSON objected for discussion purposes.
4:37:21 PM
KARI NORE, Staff, Senator Cathy Giessel, Alaska State
Legislature, advised that Amendment 1 changes the effective date
of the bill, as requested by the PREMERA health insurance
company, in order to ensure it can completely implement this
change and not affect premiums or accrue additional costs.
4:38:02 PM
CHAIR OLSON removed his objection to Amendment 1.
4:38:18 PM
REPRESENTATIVE LEDOUX objected to Amendment 1 for discussion
purposes. She said she was aware there are certain times a
cancer patient is prescribed medication, which is paid for, but
then receives it in another form and it is not paid for. She
expressed her preference for the legislation to be effective
immediately instead of January 1, 2017.
MS. NORE advised that PREMERA's fiscal year 2016 filing must be
submitted by May 6, 2015. There is concern that the proposed
legislation, as written, would cause PREMERA to amend its
filings, causing a fiscal impact to consumers.
CHAIR OLSON commented that initially all of the contracts come
up on January 1; therefore, there are already contracts in place
that are good until December 31.
MS. NORE added that the bill only applies to new and renewed
plans, and would not affect plans currently in place.
REPRESENTATIVE LEDOUX surmised that if the bill were passed in
April [2016], PREMERA would have three weeks to respond.
MS. NORE pointed out that the sponsor wishes to avoid putting
any additional burden on consumers, especially since the bill
only applies to renewed plans. Ms. Nore further explained that
SB 142 seeks to ensure that both intravenously and orally
administered cancer treatments are treated fairly and are
equally available to consumers. She said currently, there is a
disparity between what patients pay for intravenous cancer
treatments versus oral, because oral treatments are billed as
prescriptions, and there is no deductible to meet. However,
intravenous treatments are often billed as medical benefits, of
which there is a deductible to reach, and after which the
consumer no longer pays. Thus, although oral cancer treatment
is much cheaper for administration costs, it ends up being more
expensive. Also, certain cancer treatments are only available
in the oral option; therefore, patients should not be forced to
pay higher premiums simply because treatment is only available
in the oral form. In addition, the bill also prevents the re-
classification of benefits or increasing costs, with respect to
both intravenous and oral cancer treatments.
4:43:05 PM
REPRESENTATIVE LEDOUX relayed her personal experience with
typhoid oral and inoculation vaccines: inoculations are
reimbursed by insurance and oral vaccines are not. She
questioned why the bill is limited to cancer treatments as there
are probably many drugs that can be taken orally or
intravenously.
MS. NORE answered that the sponsor chose to focus on cancer
medications, and deferred to the director of the Division of
Insurance at DCCED.
CHAIR OLSON opened public testimony.
4:44:56 PM
EMILY NENON, Alaska Government Relations Director, American
Cancer Society/Cancer Action Network, advised that 40 states
have adopted this measure. She described it as a modernization
of Alaska's insurance statutes due to the tremendous changes in
cancer research making many options available in an oral form as
opposed to infusion. Ms. Nenon stated that the issue is not
just about whether a physician prescribed chemo in the pill or
the infusion form, but that some chemo treatments are only
available in the oral form; in fact, approximately 25 percent of
the new treatments in the research pipeline for cancer are oral.
She pointed out that oral medications often have fewer side
effects and the ease of administration is a huge issue,
particularly with the geographic challenges of Alaska. Ms.
Nenon expressed her organization's support for the bill.
4:46:39 PM
ERIC HANSEN, International Myeloma Foundation, advised he is an
advocate for patients - and is also a patient - as four years
ago he was diagnosed with Multiple Myeloma caused by exposure to
Agent Orange. Multiple Myeloma is incurable, but treatable by
chemo, and he noted that research breakthroughs have made some
insurance procedures obsolete; for example, the pharmacy benefit
for many conditions is insufficient, when applied to cancer
medications. He opined that the issue for most patients is not
so much the needles and the toxicity of chemo, but rather
[medical] access, especially in Alaska. For example, in Juneau
there is only one nurse who can administer chemo, as it is a
highly specialized procedure. There are few places in the
entire state where a person can be infused with chemo and some
patients need to be infused twice per week. The pills that are
now available target cancers, unlike chemo fluids, which "just
kill everything." Mr. Hansen characterized cancer treatment
pills as "a godsend," because patients do not have to adhere to
the administrator's availability or spend four hours to receive
an infusion. Further, a patient's veins can collapse. Mr.
Hansen said he has been taking one pill per day for three years
to treat his cancer, although he may have to eventually return
to infusion chemo pending further research. He noted the
difficulties for those who live far from infusion treatment
facilities and urged for this "insurance glitch" to be resolved,
and restated his support for the bill.
REPRESENTATIVE LEDOUX asked Mr. Hansen's view of changing the
effective date from immediately to January 1.
MR. HANSEN, speaking as a patient, said he would like to make
the effective date tomorrow because someone who cannot afford
the copay will have to go somewhere for treatment. He
acknowledged that the insurance companies have to establish
paperwork, but sooner is better for patients.
REPRESENTATIVE COLVER described Mr. Hansen's testimony as
compelling, and inquired about the cost for Mr. Hansen's copay.
MR. HANSEN replied that he qualifies for Medicare; however, if
he were younger, his copay would be $2,000 per month. He said
he would have had to go back to the hospital and the chemo
fluids, although now all cancer medications cost about the same
because they are all unique and targeted.
4:54:33 PM
KIMBERLY THEIS, Advocacy Manager, Leukemia & Lymphoma Society,
echoed the sentiments that have been shared, and said that the
Leukemia & Lymphoma Society believes this is a vital solution
intended to ensure that patients can reliably and consistently
expect fair coverage for cancer treatments even when the
treatments come in the form of a pill. She said the society is
hopeful that the lawmakers in Alaska will embrace this bill
because it helps to offer meaningful improvements in access to
care.
CHAIR OLSON announced public testimony would remain open.
[SB 142 was held over.]
4:55:32 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:55 p.m.