Legislature(2021 - 2022)BUTROVICH 205

03/03/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 192 BOARD OF LICENSED MIDWIVES TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+= SB 175 HEALTH CARE SERVICES BY TELEHEALTH TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 3, 2022                                                                                          
                           1:31 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello                                                                                                            
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
Representative Ivy Spohnholz                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 175                                                                                                             
"An Act relating to telehealth; relating to the practice of                                                                     
medicine; relating to medical assistance coverage for services                                                                  
provided by telehealth; and providing for an effective date."                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 192                                                                                                             
"An  Act relating  to  midwives and  the  practice of  midwifery;                                                               
relating  to apprentice  midwives; relating  to the  licensing of                                                               
midwives; relating to insurance  requirements for the practice of                                                               
midwifery; and providing for an effective date."                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 175                                                                                                                  
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH                                                                                 
SPONSOR(s): SENATOR(s) WILSON                                                                                                   
                                                                                                                                
02/01/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/01/22       (S)       HSS, L&C                                                                                               
02/24/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/24/22       (S)       -- Invited & Public Testimony --                                                                       
03/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 192                                                                                                                  
SHORT TITLE: BOARD OF LICENSED MIDWIVES                                                                                         
SPONSOR(s): SENATOR(s) KAWASAKI                                                                                                 
                                                                                                                                
02/15/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/15/22       (S)       HSS, L&C, FIN                                                                                          
03/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JASMIN MARTIN, Staff                                                                                                            
Senator David Wilson                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis for SB 175                                                               
on behalf of the sponsor.                                                                                                       
                                                                                                                                
RENEE GAYHART, Director                                                                                                         
Healthcare Services                                                                                                             
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions during the discussion of                                                               
SB 175.                                                                                                                         
                                                                                                                                
GENNIFER MOREAU, Director                                                                                                       
Division of Behavioral Health                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered questions during the discussion of                                                               
SB 175.                                                                                                                         
                                                                                                                                
SARAH CHAMBERS, Director                                                                                                        
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions during the discussion of                                                               
SB 175.                                                                                                                         
                                                                                                                                
NANCY MERRIMAN, Executive Director                                                                                              
Alaska Primary Care Association                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Provided invited testimony on SB 175.                                                                     
                                                                                                                                
JOHN SOLOMON, Director                                                                                                          
Behavior Health                                                                                                                 
Maniilaq Association                                                                                                            
Kotzebue, Alaska                                                                                                                
POSITION STATEMENT: Provided invited testimony on SB 175.                                                                     
                                                                                                                                
SUZANNE ISHII-REGAN, representing self                                                                                          
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 175.                                                                           
                                                                                                                                
SARAH ELIASEEN, representing self                                                                                               
Eagle River, Alaska                                                                                                             
POSITION STATEMENT: Testified in support of SB 175.                                                                           
                                                                                                                                
CODY CHIPP, Director                                                                                                            
Alaska Native Tribal Health Consortium (ANPHC)                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 175.                                                                           
                                                                                                                                
JOE HAYS, Staff                                                                                                                 
Senator Scott Kawasaki                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented SB 192 on behalf of the sponsor.                                                                
                                                                                                                                
CHERIE BOWMAN, Intern                                                                                                           
Senator Scott Kawasaki                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis for SB 192                                                               
on behalf of the sponsor.                                                                                                       
                                                                                                                                
RACHEL PUGH, Member                                                                                                             
Board of Certified Direct-Entry Midwives                                                                                        
Department of Commerce, Community and Economic Development                                                                      
Eagle River, Alaska                                                                                                             
POSITION STATEMENT: Provided invited testimony on SB 192.                                                                     
                                                                                                                                
BETHEL BELISLE, Chair                                                                                                           
Board of Certified Direct-Entry Midwives                                                                                        
Department of Commerce, Community and Economic Development                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Provided invited testimony on SB 192.                                                                     
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:31:59 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call  to  order  were  Senators  Costello,  Reinbold,  and  Chair                                                               
Wilson. Senator Begich and Hughes arrived shortly thereafter.                                                                   
                                                                                                                                
           SB 175-HEALTH CARE SERVICES BY TELEHEALTH                                                                        
                                                                                                                              
1:32:19 PM                                                                                                                    
CHAIR WILSON announced  the consideration of SENATE  BILL NO. 175                                                               
"An  Act relating  to  telehealth; relating  to  the practice  of                                                               
medicine; relating  to medical  assistance coverage  for services                                                               
provided by telehealth; and providing for an effective date."                                                                   
                                                                                                                                
1:32:38 PM                                                                                                                    
SENATOR  COSTELLO moved  to adopt  the committee  substitute (CS)                                                               
for  SB 175,  work order  32-LS1421\I Version  I, as  the working                                                               
document.                                                                                                                       
                                                                                                                                
1:32:50 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
1:33:40 PM                                                                                                                    
CHAIR  WILSON   removed  his  objection;  he   found  no  further                                                               
objection, and Version I was adopted as the working document.                                                                   
                                                                                                                                
1:33:49 PM                                                                                                                    
SENATOR HUGHES and SENATOR BEGICH joined the meeting.                                                                           
                                                                                                                                
1:34:04 PM                                                                                                                    
CHAIR  WILSON, speaking  as  sponsor,  paraphrased the  following                                                               
sponsor statement for SB 175:                                                                                                   
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     The  COVID pandemic  brought many  hardships, but  also                                                                    
     inspired  innovation. The  committee has  had extensive                                                                    
     conversations  on   telehealth,  through  both   SB  56                                                                    
     (Disaster   Bill)  and   SB   78  (Senator   Costello's                                                                    
     Telehealth   Bill).  SB   175   capitalizes  on   these                                                                    
     innovations  and  conversations. Access  to  telehealth                                                                    
     services were  broadened temporarily during  the COVID-                                                                    
     19  pandemic.  We  want to  continue  these  telehealth                                                                    
     flexibilities and  make them  permanent in  statute. SB
     175:                                                                                                                       
     •  Improves access to behavioral  health and helps to                                                                      
          address opioid use disorder.                                                                                          
     •  Reduces bureaucracy.                                                                                                    
     •  Makes  health  care  possible  when  an  in-person                                                                      
          visit doesn't make sense, or just isn't an                                                                            
          option.                                                                                                               
                                                                                                                                
1:35:04 PM                                                                                                                    
     There is an  extensive packet of letters  of support to                                                                    
     this   legislation.  Some   of   the  supporters   are:                                                                    
     Southcentral Foundation, ASHNHA,  Alaska Association on                                                                    
     Developmental  Disabilities,  Alaska Behavioral  Health                                                                    
     Association,  AARP,  Alaska  Primary  Care  Association                                                                    
     Alaska  Regional  Coalition  (TCC,  Kawerak,  Maniilaq,                                                                    
     Chugachmuit, Central  Council Tlingit &  Haida), Alaska                                                                    
     Native  Health  Board,   Family  Centered  Services  of                                                                    
     Alaska, Set Free Alaska, and U.S. Renal Care.                                                                              
                                                                                                                                
     SB 175:                                                                                                                    
   1) Creates a new section on telehealth for health care                                                                       
     providers  licensed  with  the  State  of  Alaska  that                                                                    
     removes  the requirement  for  an  in-person visit  and                                                                    
     ensures payment parity for telehealth visit.                                                                               
                                                                                                                                
   2) Allows physicians licensed in another state to deliver                                                                    
     telehealth services within their scope of practice if:                                                                     
        a. There  is    an   established   physician-patient                                                                    
          relationship,                                                                                                         
        b. The non-resident physician has given the patient                                                                     
          an in-person physical exam,                                                                                           
        c. And the services are related to ongoing treatment                                                                    
          or follow-up care related to past treatment.                                                                          
                                                                                                                                
   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 and ensures payment                                                                    
     parity   and  Medicaid   coverage  for   virtually  any                                                                    
     telehealth modality.                                                                                                       
                                                                                                                                
     SB 175  does not require  anyone to deliver  or receive                                                                    
     services through telehealth. Both  the provider and the                                                                    
     patient  may choose  to limit  or decline  a telehealth                                                                    
     encounter.                                                                                                                 
                                                                                                                                
1:36:40 PM                                                                                                                    
CHAIR WILSON noted that Representative Spohnholz sponsored a                                                                    
companion bill.                                                                                                                 
                                                                                                                                
1:37:02 PM                                                                                                                    
JASMIN MARTIN, Staff, Senator David Wilson, Juneau, Alaska,                                                                     
paraphrased the following sectional analysis on behalf of the                                                                   
sponsor:                                                                                                                        
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Section 1: Adds a new section (.085 Telehealth) to AS                                                                  
         08 (Business and Professions) .01 (Centralized                                                                     
     Licensing).                                                                                                            
          (a) Allows a healthcare provider (other than                                                                          
               physician licensed in in another state) to                                                                       
               provide health  care services  via telehealth                                                                    
               without first conducting an in-person visit.                                                                     
           (b) Allows an out-of-state physician to provide                                                                      
               health care services via telehealth if:                                                                          
                (1) The physician and patient have pre-                                                                         
                   established relationship.                                                                                    
                (2) There    has     been    an    in-person                                                                    
                    examination.                                                                                                
                (3) The telehealth visits are a follow-up to                                                                    
                   previously     provided    health    care                                                                    
                   services.                                                                                                    
          (c) Creates limits for a telehealth appointment.                                                                      
              If  a telehealth  appointment falls  outside a                                                                    
              provider's  authorized scope of practice, they                                                                    
              may  refer   the  patient  to  an  appropriate                                                                    
              clinician.  Prohibits  a  healthcare  provider                                                                    
              from  charging for  any portion  of the  visit                                                                    
              that was beyond their scope of practice.                                                                          
          (d) Requires fees charged for telehealth to be no                                                                     
              more than fees charged for in person visits.                                                                      
          (e) Allows a physician, podiatrist, osteopath, or                                                                     
              physician assistant licensed with the State of                                                                    
              Alaska to prescribe  controlled substances via                                                                    
              telehealth if they comply  with Alaska Statute                                                                    
              regarding  prescribing  controlled  substances                                                                    
              without a physical examination.                                                                                   
          (f) Allows an advanced practice registered nurse                                                                      
              licensed   with   the  State   of  Alaska   to                                                                    
              prescribe     controlled    substances     via                                                                    
              telehealth.                                                                                                       
          (g) Prohibits    a   provider   from   prescribing                                                                    
              controlled substances via telehealth other                                                                        
              than as provided in (e) and (f).                                                                                  
                                                                                                                                
1:39:00 PM                                                                                                                    
          (h) Removes the burden to document barriers to an                                                                     
              in-person  visit and clarifies that  the board                                                                    
              or   department  cannot  require  health  care                                                                    
              services   to  be  provided  from   a  certain                                                                    
              location.                                                                                                         
          (i) Clarifies that nothing in this section re-                                                                        
              quires a provider to provide telehealth                                                                           
              services or a patient to use telehealth                                                                           
              services.                                                                                                         
          (j) Defines: "health care provider," "licensed,"                                                                      
               and "telehealth."                                                                                                
                                                                                                                                
     Section 2: Amends AS 08  (Business and Professions) .64                                                                  
     (Medicine)  .364  (Prescription   of  drugs  without  a                                                                  
     physical examination).                                                                                                   
     Removes  the in-person  requirement in  AS 08.64.364(b)                                                                    
     for  an appropriate  health care  provider to  assist a                                                                    
     patient   during  a   telehealth  appointment   with  a                                                                    
     physician or  physician assistant  regarding controlled                                                                    
     substances.                                                                                                                
                                                                                                                                
1:39:45 PM                                                                                                                    
     Section 3: Adds  a new section (.100  Telehealth) to AS                                                                  
     18 (Health,  Safety, Housing, Human Rights,  and Public                                                                  
     Defenders) .08 (Emergency Medical Services).                                                                             
         (a) Allows an individual certified or licensed to                                                                      
             provide    emergency   services    to   provide                                                                    
             emergency services through telehealth.                                                                             
         (b) Requires a certified or licensed individual to                                                                     
             stay within  their scope  of practice  during a                                                                    
             telehealth visit. Prohibits them  from charging                                                                    
             for any portion  of the  visit that  was beyond                                                                    
             their scope of practice.                                                                                           
         (c) Requires fees charged for telehealth to be no                                                                      
             more than fees charged for in person visits.                                                                       
         (d) Removes the burden to document attempts at an                                                                      
             in person visit and clarifies  that the council                                                                    
             or  department   cannot  require   health  care                                                                    
             services  to   be  provided   from  a   certain                                                                    
             location.                                                                                                          
         (e) Clarifies that nothing in this section requires                                                                    
             a provider to provide telehealth services or a                                                                     
             patient to use telehealth services.                                                                                
         (f) Defines "telehealth" as defined in section 1.                                                                      
                                                                                                                                
                                                                                                                              
1:40:46 PM                                                                                                                    
     Section  4:  Adds  a new  section  (.069.  Payment  for                                                                  
     Telehealth)  to AS  47 (Welfare,  Social Services,  and                                                                  
     Institutions)   .07  (Medical   Assistance  for   Needy                                                                  
     Persons).                                                                                                                
         (a) Requires Medicaid to pay for services by                                                                           
              telehealth at the same rate  they would if the                                                                    
              services were provided in person.                                                                                 
         (b) Requires the department to adopt regulations                                                                       
              for  services  provided   through  telehealth.                                                                    
              Requires these  regulations to  treat services                                                                    
              provided  through   telehealth  in   the  same                                                                    
              manners as services provided in person. Allows                                                                    
              the department to  limit modes,  coverage, and                                                                    
              reimbursement of telehealth only if:                                                                              
              (1) The  department  specifically excludes  or                                                                    
                   limits services from telehealth coverage                                                                     
                   through regulation.                                                                                          
              (2)  Determines, through  substantial  medical                                                                    
                   evidence, that a service cannot be safely                                                                    
                   provided via telehealth.                                                                                     
              (3)  Providing a  service  through  telehealth                                                                    
                   would violate federal law or render a                                                                        
                   service ineligible for reimbursement                                                                         
                   under federal law.                                                                                           
          (c) Requires all telehealth services comply with                                                                      
              HIPAA.                                                                                                            
          (d) Defines "federally qualified health center,"                                                                      
              "rural health clinic," "state plan," and                                                                          
              "telehealth."                                                                                                     
                                                                                                                                
1:41:23 PM                                                                                                                    
     Section 5: Adds  a new section (.585  Telehealth) to AS                                                                  
     47  (Welfare, Social  Services,  and Institutions)  .30                                                                  
     (Mental Health).                                                                                                         
     Identical to  section 3 but  applies to  entities which                                                                    
     are   approved  to   receive  grant   funding  by   the                                                                    
     Department  of Health  and Social  Services to  deliver                                                                    
     community health services.                                                                                                 
                                                                                                                                
     Section 6: Adds  a new section (.145  Telehealth) to AS                                                                  
     47  (Welfare, Social  Services,  and Institutions)  .37                                                                  
     (Uniform Alcoholism and Intoxication Act).                                                                               
     Identical  to  section  3  but  applies  to  public  or                                                                    
     private   treatment   facilities    approved   by   the                                                                    
     Department  of   Health  and  Social  Services   in  AS                                                                    
     47.37.140  to  deliver  services  designated  under  AS                                                                    
     47.37.40     AS   47.37.270  addressing  substance  use                                                                    
     disorders.                                                                                                                 
                                                                                                                                
     Section 7-10                                                                                                             
     Amends the  uncodified law  to instruct  the Department                                                                    
     of Health  and Social  Services to submit  an amendment                                                                    
     to  the state  plan  and seek  approval  from the  U.S.                                                                    
     Department of  Health and Human Services  if needed and                                                                    
     provides immediate  effective dates for other  areas of                                                                    
     this bill.                                                                                                                 
                                                                                                                                
1:42:25 PM                                                                                                                    
MS. MARTIN presented the changes to SB 175:                                                                                     
                                                                                                                                
[Original punctuation provided.]                                                                                                
     Section 1                                                                                                                
     Replaces any  reference to "examination"  with "visit,"                                                                    
     and  updates  corresponding   language  throughout  the                                                                    
     bill, except for providers licensed in another state.                                                                      
                                                                                                                                
     Removes  language  in  subsection   (a)  of  version  A                                                                    
     related  to  the   telehealth  authority  of  providers                                                                    
     licensed in  another state.  This language  is replaced                                                                    
     with  subsection (b),  which creates  an exemption  for                                                                    
     physicians licensed in another  state to deliver health                                                                    
     care services  within their scope of  practice if there                                                                    
     is an  established physician-patient  relationship, the                                                                    
     non-resident  physician has  given the  patient an  in-                                                                    
     person physical  exam, and the services  are related to                                                                    
     ongoing  treatment or  follow-up care  related to  past                                                                    
     treatment.                                                                                                                 
                                                                                                                                
     Cleans up the  provisions regarding medication assisted                                                                    
     treatment  by removing  subsection  (d)  in version  A,                                                                    
     which  pertained  to  services  addressing  opioid  use                                                                    
     disorder.  This  language  was  deemed  unnecessary  to                                                                    
     ensure the  telehealth delivery of  medication assisted                                                                    
     treatment   to  treat   opioid   use  disorder   (i.e.,                                                                    
     medication,    counseling,   and    behavioral   health                                                                    
     therapies).                                                                                                                
                                                                                                                                
     Revises   the   prescribing  authority   provision   by                                                                    
     separating  physicians,  podiatrists,  osteopaths,  and                                                                    
     physician  assistants in  subsection (e)  from advanced                                                                    
     practice registered nurses (APRNs) in subsection (f).                                                                      
                                                                                                                                
     Amends the  APRN language in  subsection (f)  to remove                                                                    
     the  in-person  requirement of  prescribing  controlled                                                                    
     substances  (including  buprenorphine) via  telehealth.                                                                    
     This does  not change  the prescribing scope  for these                                                                    
     providers.                                                                                                                 
                                                                                                                                
     Creates  subsection  (h)   to  remove  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.                                                                                                                
                                                                                                                                
     Clarifying  language   is  inserted   under  subsection                                                                    
     (j)(2)  defining  all  providers  in  this  section  as                                                                    
     licensed in good standing.                                                                                                 
                                                                                                                                
1:43:36 PM                                                                                                                    
     Section  3 Creates  subsection (h)  under  Title 18  to                                                                  
     remove  requirements to  document all  attempts for  an                                                                    
     in-person  visit.  This  section  replicates  the  same                                                                    
     provisions  on documentation  and physical  setting for                                                                    
     emergency medical services as Section 1.                                                                                   
                                                                                                                                
     Section 4                                                                                                                
     Amends telehealth services  included in Alaska Medicaid                                                                    
     by  explicitly   including  home   and  community-based                                                                    
     waiver  services   in  subsection  (a)(2)   and  adding                                                                    
     services  provided under  a  state  plan option  (e.g.,                                                                    
     1915(k) services)  in subsection (a)(3).  Adds language                                                                    
     in  subsection (b),  line 13  to ensure  the department                                                                    
     must revise  regulatory language to  include telehealth                                                                    
     in the definition of a "visit."                                                                                            
                                                                                                                                
     Section 5-6                                                                                                              
     These are new sections  adding telehealth provisions to                                                                    
     entities   in  Title   47.  These   entities  represent                                                                    
     grantees   which   deliver  community   mental   health                                                                    
     services, or  facilities approved by the  department to                                                                    
     deliver   substance  use   disorder  treatment.   Their                                                                    
     authority   to   deliver  telehealth   was   previously                                                                    
     unaddressed  in   version  W   because  they   are  not                                                                    
     applicable to the  provisions in Title 8  or the Alaska                                                                    
     Medicaid   provisions  in   Title  47.   Both  sections                                                                    
     replicate  the  same  telehealth  provisions  on  cost,                                                                    
     scope of services,  patient protections, documentation,                                                                    
     and physical setting as Section 1.                                                                                         
                                                                                                                                
1:44:23 PM                                                                                                                    
     Section  5 creates  AS  47.30.585  to include  entities                                                                    
     designated  under AS  47.30.520    AS 47.30.620,  which                                                                    
     are   approved  to   receive  grant   funding  by   the                                                                    
     Department  of Health  and Social  Services to  deliver                                                                    
     community mental health services.                                                                                          
                                                                                                                                
     Section  6 creates  AS 47.37.145  to include  public or                                                                    
     private   treatment   facilities    approved   by   the                                                                    
     Department  of   Health  and  Social  Services   in  AS                                                                    
     47.37.140  to  deliver  services  designated  under  AS                                                                    
     47.37.40     AS   47.37.270  addressing  substance  use                                                                    
     disorders.                                                                                                                 
                                                                                                                                
1:45:07 PM                                                                                                                    
SENATOR  REINBOLD  stated  that  when  the  telehealth  bill  was                                                               
introduced  by former  Representative Vasquez,  Alaska physicians                                                               
were adamant about the requirement  for an in-person visit before                                                               
online visits could  occur. She asked for an  explanation of what                                                               
SB 175 does in that regard that wasn't in that House bill.                                                                      
                                                                                                                                
MS.  MARTIN  responded  that  the  bill  removes  the  burden  of                                                               
documenting  an   attempted  in-person   visit.  It   would  also                                                               
establish payment parity for telehealth and in-person visits.                                                                   
                                                                                                                                
1:46:03 PM                                                                                                                    
SENATOR  REINBOLD  asked  if SB  175  would  address  prescribing                                                               
related to telehealth.                                                                                                          
                                                                                                                                
1:46:21 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:48:52 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
1:48:57 PM                                                                                                                    
SENATOR REINBOLD asked  whether HB 275 and SB  175 were identical                                                               
because the fiscal notes talked about two different bills.                                                                      
                                                                                                                                
1:49:12 PM                                                                                                                    
CHAIR WILSON  replied that the  bills were the same.  He deferred                                                               
to the Division of Healthcare  Services, Department of Health and                                                               
Social  Services  (DHSS) to  address  the  fiscal notes  and  the                                                               
reason an  additional person  is needed  to provide  services the                                                               
division is already providing to the public.                                                                                    
                                                                                                                                
1:49:57 PM                                                                                                                    
RENEE  GAYHART,  Director,  Healthcare  Services,  Department  of                                                               
Health and  Social Services (DHSS), Juneau,  Alaska, related that                                                               
the department would retain some  flexibilities for public health                                                               
emergency care.  It would require regulatory  changes and quality                                                               
assurance  reviews of  payments, which  would require  additional                                                               
staff  time.   The  additional  staff   was  to   ensure  quality                                                               
assurance. She noted  that the Division of  Behavioral Health and                                                               
Senior and Disability Services staff were online.                                                                               
                                                                                                                                
1:51:34 PM                                                                                                                    
CHAIR WILSON asked if the  department should wait to determine if                                                               
there  are additional  costs to  the  administration. The  fiscal                                                               
note does not say how many  more patients would use telehealth as                                                               
a modality versus in-patient care.  According to the fiscal note,                                                               
it appears  the department  adds this as  a cost  into perpetuity                                                               
and not  just as a one-time  charge. He asked why  the department                                                               
would  not  just  request temporary  funds  in  the  supplemental                                                               
budget.                                                                                                                         
                                                                                                                                
MS. GAYHART responded  that the department has  been working with                                                               
Representative  Spohnholz  and  others  on what  could  be  added                                                               
through SB 175  and the companion bill. Due to  the pandemic, the                                                               
flexibilities put  in place added many  recipients to telehealth.                                                               
She  indicated that  if the  changes in  the bill  are permanent,                                                               
they  require additional  regulations,  system  edits, and  post-                                                               
payment claims review.  She stated that the  Centers for Medicare                                                               
and Medicaid  Services (CMS) temporarily waived  the requirements                                                               
because  of   the  pandemic,  noting  that   CMS  reimburses  the                                                               
department  for  services  it   provides  to  recipients  through                                                               
providers. However, making those  changes permanent would require                                                               
additional staff.                                                                                                               
                                                                                                                                
1:53:40 PM                                                                                                                    
CHAIR WILSON expressed his concern  about the ongoing costs in SB
175. He  offered his view  that the regulation changes  would not                                                               
happen until FY 2027 and FY 2028.                                                                                               
                                                                                                                                
1:54:05 PM                                                                                                                    
GENNIFER   MOREAU-JOHNSON,  Director,   Division  of   Behavioral                                                               
Health,  Department   of  Health  and  Social   Services  (DHSS),                                                               
Anchorage, Alaska, stated that the  Division of Behavioral Health                                                               
was   very  interested   in  supporting   access  to   care.  She                                                               
highlighted that  part of  their mission  is to  ensure effective                                                               
care and  assurance of quality  outcomes. The  full-time position                                                               
in  the   division's  fiscal  note   would  provide   review  and                                                               
monitoring  to   assure  the  clinical  appropriateness   of  the                                                               
services  and   for  ongoing  review  to   ensure  national  best                                                               
practices related  to telehealth. She envisioned  that telehealth                                                               
would  be a  method of  delivery that  would continue  to develop                                                               
over time. Thus,  the division believes the position  should be a                                                               
full-time  permanent position  to stay  abreast of  national best                                                               
practices and ensure quality.                                                                                                   
                                                                                                                                
1:55:19 PM                                                                                                                    
CHAIR WILSON wondered if the division was currently doing so.                                                                   
                                                                                                                                
MS.  MOREAU-JOHNSON answered  yes.  However,  this bill  proposes                                                               
language   that  would   require  regulatory   changes  for   the                                                               
administration  of  telehealth,  which would  require  additional                                                               
staff support.                                                                                                                  
                                                                                                                                
1:55:46 PM                                                                                                                    
SENATOR BEGICH asked  what additional work the  bill required. He                                                               
related that the  division would need to  develop new regulations                                                               
for one year, but she  indicated the department currently reviews                                                               
and monitors  telehealth activities. Thus,  he was unsure  of the                                                               
additional work that SB 175 would require.                                                                                      
                                                                                                                                
MS. MOREAU-JOHNSON  answered that language  in SB 175  relates to                                                               
substantial  medical  evidence,  and  because  telehealth  is  an                                                               
emerging platform, the division  wants to ensure patients receive                                                               
quality telehealth care.  She said the bill  focuses on providing                                                               
behavioral   services  through   telehealth,  and   the  division                                                               
supports that  access but wants  to ensure adequate  services are                                                               
provided.  She highlighted  that the  division is  small and  has                                                               
taken  on substantial  work to  implement the  [Medicaid Section]                                                               
1115 waiver.                                                                                                                    
                                                                                                                                
1:57:02 PM                                                                                                                    
SENATOR  BEGICH stated  he  could understand  up  to a  five-year                                                               
follow-up;  however,  SB  175 should  reduce  documentation  once                                                               
enacted,  so he  was not  comfortable  with the  fiscal note.  He                                                               
offered  his view  that the  fiscal note  is inflated  by half  a                                                               
million dollars. He surmised that it  would likely take a year or                                                               
18  months at  most. He  said  he did  not  see the  need for  an                                                               
ongoing  full-time  position over  time  and  suggested that  the                                                               
division clearly  assess the time  required to  determine quality                                                               
telehealth delivery.                                                                                                            
                                                                                                                                
1:58:08 PM                                                                                                                    
SENATOR HUGHES  expressed concern  about the cost  of SB  175 for                                                               
Alaskans because  it allows  fees for a  telehealth visit  at the                                                               
same rate as  an in-person visit. She  recalled stipulating years                                                               
ago that telehealth would reduce  health care costs in the state,                                                               
especially  for villages.  She stated  that the  costs associated                                                               
with  telehealth are  less than  for  a clinic.  For example,  no                                                               
medical  assistant   takes  the  patient's  blood   pressure  and                                                               
performs  other   duties,  resulting   in  lower   overhead.  She                                                               
highlighted  that Alaska  has  a problem  with  high health  care                                                               
costs, so she questioned why  the medical fees for telehealth and                                                               
in-person visits would be the same.                                                                                             
                                                                                                                                
CHAIR  WILSON  commented  that   his  office  worked  with  other                                                               
telehealth  providers during  a  Medicaid  Policy conference  and                                                               
found that  there were two  reasons for including  payment parity                                                               
in SB  175. One reason was  that it helps incentivize  the use of                                                               
telehealth since  most doctors prefer  in-patient visits  for the                                                               
profitability  of  their  practice.   He  offered  to  distribute                                                               
information from  the National Conference of  Legislatures (NCSL)                                                               
on this. NCSL  researched the issue and found it  also related to                                                               
the  initial  cost  for  some   of  the  rural  community  health                                                               
providers  in the  nation to  provide  telehealth. Thus,  payment                                                               
parity allows  providers to recoup  the initial costs  of setting                                                               
up private  and secure telehealth communications  equipment. This                                                               
is  particularly important  for  small  practices in  underserved                                                               
communities  because they  may not  have the  financial means  to                                                               
offer  telehealth if  the reimbursement  rates are  substantially                                                               
lower. He  noted that  he was working  with stakeholders  and the                                                               
sponsor  of the  companion bill  to consider  an amendment  for a                                                               
sunset date for payment parity.                                                                                                 
                                                                                                                                
2:01:52 PM                                                                                                                    
SENATOR HUGHES  opined that  telehealth costs  affect individuals                                                               
and will  also be  reflected in savings  to the  Medicaid budget.                                                               
She  referred to  page 6,  line  9 of  Version I,  that says  the                                                               
Department  of   Health  and  Social  Services   (DHSS)  has  the                                                               
responsibility  to   decide  what  will  be   covered,  excluded,                                                               
limited, or  reimbursed for services provided  by telehealth. She                                                               
offered her  belief that the  medical board decides  what doctors                                                               
can do,  and the nursing  board decides what  nurse practitioners                                                               
can  do.   She  wondered  how   DHSS  would  determine   what  is                                                               
appropriate for telehealth. She  suggested that the medical board                                                               
would want to determine what is suitable for telehealth.                                                                        
                                                                                                                                
CHAIR   WILSON  replied   that   this   section  was   addressing                                                               
reimbursable  services. It  allows  the  department to  determine                                                               
which provided services will be  reimbursed. For example, certain                                                               
case  management providers  may not  be covered  through Medicaid                                                               
for  in-patient visits,  but  the visit  may  be covered  through                                                               
another  private insurance.  This provision  would allow  them to                                                               
say which service  modalities will be reimbursed.  It would allow                                                               
the  state  to  set  the   regulations  accordingly  for  current                                                               
procedural  terminology  (CPT)  codes and  determine  which  ones                                                               
would be set for reimbursable services in Alaska.                                                                               
                                                                                                                                
2:04:29 PM                                                                                                                    
MS. MOREAU-JOHNSON  agreed that the  language in SB  175 provides                                                               
the  department  the  authority   to  establish  regulations  for                                                               
reimbursement  and  to  maintain   like  reimbursement  for  like                                                               
services to the extent possible.                                                                                                
                                                                                                                                
2:04:51 PM                                                                                                                    
SENATOR HUGHES referred to Section  1, which states that in-state                                                               
providers  may  use  telehealth without  conducting  a  patient's                                                               
physical exam.  In contrast, out-of-state providers  must have an                                                               
in-person medical  exam before providing service.  She questioned                                                               
the    constitutionality   of    having   different    telehealth                                                               
requirements for using non-Alaskan licensed physicians.                                                                         
                                                                                                                                
CHAIR  WILSON replied  that  he  did not  believe  it caused  any                                                               
constitutional  issues. He  explained that  Section 1  relates to                                                               
licensing requirements  for doctors,  creating parity  for Alaska                                                               
and out-of-state physicians.                                                                                                    
                                                                                                                                
2:05:55 PM                                                                                                                    
SARAH  CHAMBERS, Director,  Division  of Corporations,  Business,                                                               
and  Professional Licensing,  Department  of Commerce,  Community                                                               
and  Economic Development  (DCCED), Juneau,  Alaska, related  her                                                               
understanding that Section  1 of SB 175  eliminates licensure for                                                               
out-of-state providers.  Out-of-state providers must  be licensed                                                               
in Alaska to  provide care in the state. SB  175 would allow out-                                                               
of-state physicians licensed in  another jurisdiction to practice                                                               
in Alaska  via telehealth,  but they  must follow  Alaska's laws.                                                               
She  related  that  during  the pandemic,  some  Alaskans  had  a                                                               
Seattle  doctor for  specialty care  but had  health restrictions                                                               
and  could not  travel  to Seattle.  Their  provider had  limited                                                               
access to in-patient services, or it was cost prohibitive.                                                                      
                                                                                                                                
2:07:32 PM                                                                                                                    
SENATOR HUGHES  stated the explanation makes  sense. She wondered                                                               
if this was opening the  door to allow out-of-state physicians to                                                               
live in  the state and  provide telehealth  services indefinitely                                                               
without obtaining an Alaska license.                                                                                            
                                                                                                                                
CHAIR  WILSON  opined  that  the  requirements  would  make  that                                                               
difficult and deferred to Ms. Chambers.                                                                                         
                                                                                                                                
MS.  CHAMBERS replied  that the  intent is  to have  a bifurcated                                                               
system  where  a physician  practicing  in  Alaska must  have  an                                                               
Alaska  license.  She  offered   to  research  when  out-of-state                                                               
physicians would  need an  Alaska license  to clarify  the bill's                                                               
intent for the future.                                                                                                          
                                                                                                                                
2:09:19 PM                                                                                                                    
CHAIR WILSON  stated he would add  the suggestion to his  list of                                                               
potential amendments.                                                                                                           
                                                                                                                                
2:09:38 PM                                                                                                                    
NANCY   MERRIMAN,  Executive   Director,   Alaska  Primary   Care                                                               
Association,   Anchorage,   Alaska,   paraphrased   her   invited                                                               
testimony as follows:                                                                                                           
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     The  Alaska Primary  Care  Association (APCA)  supports                                                                    
     the operations  and development of Alaska  29 federally                                                                    
     qualified  health  centers,  also  known  as  community                                                                    
     health  centers,   or  FQHC.  Health   centers  provide                                                                    
     comprehensive   whole   person  care   which   includes                                                                    
     medical,   dental,   behavioral,  pharmacy   and   care                                                                    
     coordination  services.  A   PCA  and  Alaska's  health                                                                    
     centers support  SB 175 because it  increases access to                                                                    
     primary  care and  behavioral health  services, and  it                                                                    
     expands  telehealth  in  this space.  This  legislation                                                                    
     does  several   things  that  are  important   to  help                                                                    
     centers.  First,  it  includes a  range  of  telehealth                                                                    
     modalities,  including audio  only, both  now and  into                                                                    
     the future.  Second, it  allows patients  and providers                                                                    
     to  engage in  telehealth  services  outside of  clinic                                                                    
     setting  if  they so  choose.  And  third, it  provides                                                                    
     adequate    reimbursement   for    telehealth   visits,                                                                    
     providing new  points of access  to whole  person care,                                                                    
     including behavioral health  and substance use disorder                                                                    
     treatment.                                                                                                                 
                                                                                                                                
     In  2020,   health  centers  served   105,000  patients                                                                    
     through  450,000 visits.  Telehealth and  substance use                                                                    
     disorder  services  are  our fastest  growing  area  of                                                                    
     service,   and  of   those  visits   40  percent   were                                                                    
     accommodated via  telehealth. In the  subspecialty area                                                                    
     of  substance  use  disorder services,  45  percent  of                                                                    
     visits  were via  telehealth. The  temporary telehealth                                                                    
     policy  changes have  benefited health  centers because                                                                    
     they have  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                                                                    
     bundled payment reimbursement model.                                                                                       
                                                                                                                                
2:11:47 PM                                                                                                                    
MS. MERRIMAN continued her testimony:                                                                                           
                                                                                                                                
     Health  centers  serve  hard to  reach  community.  The                                                                    
     majority   of   health  center   patients   experienced                                                                    
     challenges in  accessing health care that  include long                                                                    
     distances  to  reach  local providers,  cost  of  care,                                                                    
     transportation,  language,  and cultural  barriers.  In                                                                    
     Alaska, over  half of our  patients are from  racial or                                                                    
     ethnic minorities, a majority  are low income, and most                                                                    
     patients  live  in  rural communities.  Health  centers                                                                    
     best serve  their patient populations if  they have the                                                                    
     ability to use technology  to meet their patients where                                                                    
     they   are  at.   Additionally,  workforce   shortages,                                                                    
     particularly  in  behavioral health  providers,  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  40 percent  by audio  or 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 a                                                                    
     stronger  continuity  of  care  for  patients,  reduced                                                                    
     travel  costs,  and  has   resulted  in  fewer  dropped                                                                    
     visits, and less  delayed and more costly  care. And we                                                                    
     understand  that delivering  quality whole  person care                                                                    
     ultimately  leads  to  better  health  outcomes,  saves                                                                    
     lives,  and in  the  long  run saves  on  cost. So,  on                                                                    
     behalf  of  the  Alaska Primary  Care  Association  and                                                                    
     health centers across the state, I urge you to support                                                                     
     SB 175. And we appreciate your support.                                                                                    
                                                                                                                                
2:13:39 PM                                                                                                                    
SENATOR REINBOLD stated she made  a commitment when she supported                                                               
telehealth  six years  ago to  support  Alaska's physicians.  She                                                               
said she  is pleased that SB  175 requires physicians to  have an                                                               
established  patient  relationship   before  offering  telehealth                                                               
services.  She expressed  concern  that SB  175  might mean  more                                                               
patients would  seek medical  care from  physicians in  the Lower                                                               
48, which could be difficult  for local providers who established                                                               
small clinics. She  wants to ensure that patients do  not turn to                                                               
out-of-area   telemedicine  and   leave  local   doctors  without                                                               
patients.                                                                                                                       
                                                                                                                                
CHAIR WILSON  asked Ms. Merriman whether  Alaskan providers would                                                               
have that concern.                                                                                                              
                                                                                                                                
MS. MERRIMAN  opined that SB  175 seeks to establish  and protect                                                               
the patient-provider relationship.                                                                                              
                                                                                                                                
2:15:17 PM                                                                                                                    
SENATOR REINBOLD stated  she supports SB 175  because it prevents                                                               
providers  from  requiring  patients   to  be  vaccinated  before                                                               
receiving treatment. She is concerned  about the opioid crisis in                                                               
Alaska and  whether SB  175 would increase  access to  opioids in                                                               
Alaska.                                                                                                                         
                                                                                                                                
CHAIR  WILSON responded  no.  He  stated that  SB  175 would  not                                                               
increase access because there are  still state statutes that out-                                                               
of-state providers  must follow.  He said he  would follow  up to                                                               
ensure  that  all  entities  are   required  to  follow  Alaska's                                                               
prescribing rules.                                                                                                              
                                                                                                                                
SENATOR REINBOLD recalled that  opioid prescriptions were limited                                                               
to a 7-day maximum prescription.                                                                                                
                                                                                                                                
2:16:22 PM                                                                                                                    
SENATOR REINBOLD  asked if SB  175 mirrors or complements  HB 172                                                               
related  to  psychotropic  medication use  in  sub-acute  medical                                                               
facilities.                                                                                                                     
                                                                                                                                
CHAIR WILSON answered no.                                                                                                       
                                                                                                                                
2:17:09 PM                                                                                                                    
SENATOR  REINBOLD  related  her   understanding  that  the  local                                                               
physicians, physician's assistants,  and nurse practitioners were                                                               
represented  by APCA.  She acknowledged  that  APCA testified  in                                                               
support  of SB  175,  but  she would  like  to  know if  Alaska's                                                               
healthcare providers support SB 175.                                                                                            
                                                                                                                                
CHAIR WILSON replied that other  invited testimony would speak to                                                               
her concern.                                                                                                                    
                                                                                                                                
2:17:37 PM                                                                                                                    
JOHN  SOLOMON, Director,  Behavior Health,  Maniilaq Association,                                                               
Kotzebue, Alaska,  stated that Maniilaq  is the  only association                                                               
serving the  Northwest Arctic area  villages on the  North Slope.                                                               
Before becoming an administrator, he  was a counselor who flew to                                                               
villages  to see  patients, carrying  his  backpack and  sleeping                                                               
bag. He  emphasized the importance  of telehealth to  his region,                                                               
which he hopes was happening in other rural Alaska areas.                                                                       
                                                                                                                                
MR. SOLOMON  explained that  previously many  logistical barriers                                                               
prevented   patients  from   obtaining  treatment.   Still,  once                                                               
restrictions were removed,  the flexibilities allowed telehealth,                                                               
which brought about an explosion  in the number of clients asking                                                               
for  and receiving  care. Telehealth  for substance  abuse groups                                                               
went up  800 percent in six  months. People had been  waiting and                                                               
wanting care but lacked access  to providers. The substance abuse                                                               
program grew from  five to 70 ongoing clients.  He emphasized the                                                               
importance  of  the telephonic  provision  in  SB 175  for  rural                                                               
Alaskans.  The Northwest  Arctic  has clinics  that  do not  have                                                               
behavioral  health aides  (BHAs) and  organizations with  clinics                                                               
that are  not staffed. The  telephonic option provides  access to                                                               
obtain care. In  rural Alaska, telehealth is not  about better or                                                               
best practices but about care or no care for rural Alaskans.                                                                    
                                                                                                                                
MR. SOLOMON highlighted  that Maniilaq has worked  to develop the                                                               
local workforce  in villages, so  village BHA's can  provide care                                                               
to  other  villages.  The  hope  is to  fill  the  remaining  BHA                                                               
positions. In  closing, he stated  that the  Maniilaq Association                                                               
is a strong advocate for SB 175.                                                                                                
                                                                                                                                
2:20:23 PM                                                                                                                    
CHAIR WILSON related that BHA stands for behavior health aide.                                                                  
                                                                                                                                
MR.  SOLOMON agreed  and  elaborated that  in  the tribal  health                                                               
organizations, a  behavior health  aide works as  a village-based                                                               
counselor.                                                                                                                      
                                                                                                                                
2:20:43 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 175.                                                                                 
                                                                                                                                
2:21:09 PM                                                                                                                    
SUZANNE ISHII-REGAN,  representing self, Anchorage,  Alaska, said                                                               
she is  a member of a  family who has benefited  from telehealth.                                                               
She  thanked  the  state  for   a  quick  pivot  to  provide  the                                                               
flexibility  of  telehealth  during the  pandemic,  which  helped                                                               
protect many vulnerable citizens. She  said she has a male family                                                               
member  who   uses  a  ventilator   and  has  a   primary  immune                                                               
deficiency.  She noted  that telehealth  helped  the family  stay                                                               
connected  to  doctors  and  avoid   exposure  to  illnesses  and                                                               
infection, so they  did not bring them  home. Telehealth provided                                                               
an opportunity for  first-time access to services  when he needed                                                               
to transition  to a new  provider. It also reduced  barriers that                                                               
allowed him  to continue receiving  medical care.  Telehealth was                                                               
beneficial  during extreme  cold and  icy weather,  which further                                                               
complicate   mobility  issues.   She  said   it  was   easier  to                                                               
communicate  since masks  did  not  have to  be  worn during  the                                                               
telehealth appointments.                                                                                                        
                                                                                                                                
2:23:40 PM                                                                                                                    
SARAH ELIASEEN,  representing self,  Eagle River,  Alaska, stated                                                               
she is a 96-year-old retired  schoolteacher who appreciated being                                                               
able  to  stay  home  and  receive medical  care.  She  has  been                                                               
declared legally blind  and must use a walker. She  can no longer                                                               
use   public  transportation   but  would   like  to   remain  as                                                               
independent as  possible. She surmised  that she is not  the only                                                               
person  who  finds  transportation to  Anchorage  difficult.  She                                                               
mentioned  that  while  visiting   with  her  doctor  online,  an                                                               
assistant kept  records and facilitated  the call. She  asked the                                                               
committee to make telehealth a  permanent option for the elderly,                                                               
disabled, those  in rural  areas, and anyone  else who  needs it.                                                               
She thanked members and urged them to pass SB 175.                                                                              
                                                                                                                                
2:27:30 PM                                                                                                                    
CODY  CHIPP, Director,  Alaska  Native  Tribal Health  Consortium                                                               
(ANPHC),   Anchorage,   Alaska,   stated  that   the   telehealth                                                               
flexibility  that  came about  through  COVID  created a  greater                                                               
ability  to provide  greater  access to  care.  ANPHC launched  a                                                               
telehealth  behavioral  health  clinic to  address  COVID-related                                                               
distress. He stated  that ANTHC uses OQ 45, the  gold standard of                                                               
patient-reported outcome measures,  to measure clinical outcomes.                                                               
Telehealth was found  to be accessible, safe,  and effective. The                                                               
clinical  outcomes were  equal to  or greater  than the  national                                                               
averages.  Client surveys  expressed patient  gratitude for  easy                                                               
access  to services  previously  not  available. Alaska's  fiscal                                                               
analysis  has shown  that telehealth  could also  save the  state                                                               
money, as noted  in the Medicaid Reform report in  response to SB
74. Telehealth also  saves individuals time and  money because it                                                               
eliminates driving time.                                                                                                        
                                                                                                                                
CHAIR WILSON kept public testimony open on SB 175.                                                                              
                                                                                                                                
2:29:32 PM                                                                                                                    
CHAIR WILSON held SB 175 in committee.                                                                                          
                                                                                                                                
2:30:17 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
                                                                                                                                
               SB 192-BOARD OF LICENSED MIDWIVES                                                                            
                                                                                                                                
2:31:16 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration  of  SENATE  BILL  NO.  192  "An  Act  relating  to                                                               
midwives and  the practice of  midwifery; relating  to apprentice                                                               
midwives;  relating to  the licensing  of  midwives; relating  to                                                               
insurance  requirements  for  the   practice  of  midwifery;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
2:31:49 PM                                                                                                                    
JOE   HAYS,  Staff,   Senator   Scott   Kawasaki,  Alaska   State                                                               
Legislature,  Juneau, Alaska,  paraphrased the  sponsor statement                                                               
for SB 192:                                                                                                                     
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Senate Bill 192 would  establish licensing of certified                                                                    
     professional midwives in Alaska  and create a governing                                                                    
     board  to  develop   licensing  procedures  and  review                                                                    
     licensing applications and renewals.                                                                                       
                                                                                                                                
     Currently  Alaska only  has  legislation regarding  the                                                                    
     certification  of  direct-entry   midwives.  This  bill                                                                    
     would institute licensing  requirements and regulations                                                                    
     for  certified professional  midwives to  be formed  in                                                                    
     conjunction  with   a  nationally   recognized  midwife                                                                    
     organization.  The  bill  also requires  that  licensed                                                                    
     midwives  have  basic  life support  certification  for                                                                    
     health  care providers  and  certification in  neonatal                                                                    
     resuscitation,  and knowledge  of  and experience  with                                                                    
     non-hospital-based births. These  requirements would be                                                                    
     in  addition  to a  required  background  in a  health-                                                                    
     related field other than nursing  and graduation from a                                                                    
     master's level midwifery education program.                                                                                
                                                                                                                                
2:33:18 PM                                                                                                                    
     This  bill  would  also  create  a  Board  of  Licensed                                                                    
     Midwives from  the current  Board of  Certified Direct-                                                                    
     Entry Midwives. The new Board  will adopt standards and                                                                    
     regulations  for  licensed  midwives that  are  in  the                                                                    
     public   interest   and    in   compliance   with   the                                                                    
     Administrative  Procedure Act.  The  Board will  review                                                                    
     license applications  and renewals for midwives  in the                                                                    
     State  of Alaska  and  establish insurance  provisions.                                                                    
     The  Board  will  help to  develop  future  legislation                                                                    
     specific to  licensed midwives that will  clarify these                                                                    
     standards and regulations.                                                                                                 
                                                                                                                                
     SB 192  is important for ensuring  safer at-home births                                                                    
     and  improving   prepartum  and  postpartum   care  for                                                                    
     mothers and infants.                                                                                                       
                                                                                                                                
     I  ask for  your  consideration and  support of  Senate                                                                    
     Bill  192 to  allow  the State  licensing of  certified                                                                    
     professional midwives and the  formation of a governing                                                                    
     board  to oversee  the  standards  and regulations  for                                                                    
     licensed midwives.                                                                                                         
                                                                                                                                
2:34:15 PM                                                                                                                    
CHERIE BOWMAN, Intern, Senator Scott Kawasaki, Alaska State                                                                     
Legislature, Juneau, Alaska, read the sectional analysis for SB
192:                                                                                                                            
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Section 1. Uncodified  law providing legislative Intent                                                                    
     to preserve right of women  to deliver children at home                                                                    
     with licensed midwives.                                                                                                    
                                                                                                                                
     Section  2. Amends  AS  08.01.017(17)  to change  board                                                                    
     name  form  (certified  direct  -  entry)  to  licensed                                                                    
     midwives.                                                                                                                  
                                                                                                                                
     Section 3.  Amends AS 08.02.010(a)  to explain  who can                                                                    
     practice  and  what  type of  professional  letters  or                                                                    
     title shall appear on.                                                                                                     
                                                                                                                                
     Section  4. Amends  AS  08.03.010(c)(8)  to change  the                                                                    
     name certified direct   entry  to licensed midwives and                                                                    
     adds an effective date of June 30, 2023.                                                                                   
                                                                                                                                
2:35:20 PM                                                                                                                    
     Section 5. Amends AS 08.64.370  to explain how licensed                                                                    
     midwives  are recognized  with or  without compensation                                                                    
     and how licensed midwives are defined in AS 08.65.190                                                                      
                                                                                                                                
     Section  6. Amends  AS  08.65.010(a)  to establish  the                                                                    
     board of licensed midwives.                                                                                                
                                                                                                                                
     Section 7. Amends AS 08.65.010(b)  to define who can be                                                                    
     members of the licensed midwife board.                                                                                     
                                                                                                                                
     Section 8.  Amends AS 08.065.030 to  address the powers                                                                    
     and duties of the board of midwives                                                                                        
                                                                                                                                
     Section  9.   Amends  AS  08.065.040   to  add   a  new                                                                    
     subsection  on activities  the  board  cannot adopt  by                                                                    
     regulations  to  include:  (b) and  (c).  Subsection  B                                                                    
     includes                                                                                                                   
                                                                                                                                
       1. Requires a person to have a nursing degree or                                                                         
           diploma to be licensed under this chapter                                                                            
                                                                                                                                
        2. Requires a licensed midwife to practice midwifery                                                                    
        under  the  supervision  of  or  collaboration  with                                                                    
        another  health  care  provider  or  a  health  care                                                                    
        facility                                                                                                                
                                                                                                                                
        3. Requires  a  licensed midwife  to  enter into  an                                                                    
        agreement, whether  written,  oral,  or  in  another                                                                    
        form, with another health care provider  or a health                                                                    
        care facility.                                                                                                          
                                                                                                                                
        4. Limits the location where a  licensed midwife may                                                                    
        practice midwifery.                                                                                                     
                                                                                                                                
2:36:43 PM                                                                                                                    
     Subsection C. adds definitions  of health care facility                                                                    
     and health care provider  as identified in AS 18.35.399                                                                    
     and AS 09.65.300 respectively.                                                                                             
                                                                                                                                
     Section  10.   Amends  AS  08.65.050  to   address  the                                                                    
     qualifications  needed  to  be a  licensed  midwife  in                                                                    
     Alaska.                                                                                                                    
                                                                                                                                
        1.   Line   1  reads   "holds   a  valid   certified                                                                    
        professional    midwife    certificate,    if    the                                                                    
        certificate  is issued  by  a nationally  recognized                                                                    
        midwife  organization recognized  by  the board  and                                                                    
        the requirements for  the certificate are consistent                                                                    
        with this chapter."                                                                                                     
                                                                                                                                
        2.  Line 2  is added  and reads  "applies on  a form                                                                    
        provided by the board".                                                                                                 
                                                                                                                                
        3. Lines 2 and 3 are renumbered as 3 and 4.                                                                             
                                                                                                                                
        4. Line  4 is  renumbered as line  5 and adds  "is a                                                                    
        certified  in  basic life  support  for health  care                                                                    
        provider" and adds the word "and".                                                                                      
                                                                                                                                
        5.  Line 5  is renumbered  as  line 6  and adds  "is                                                                    
        certified in  the interventions used at  the time of                                                                    
        birth to support  the establishment of breathing and                                                                    
        circulation of the newborn."                                                                                            
                                                                                                                                
        Section   11.  Amends   AS   08.65.080  to   explain                                                                    
        procedures for renewal of midwifery license.                                                                            
                                                                                                                                
2:38:08 PM                                                                                                                    
     Section  12.  Amends  AS   08.65.090(a)  to  allow  the                                                                    
     midwifery   board   to   issue   permits   to   midwife                                                                    
     apprentices who have  satisfied the education, training                                                                    
     and apprenticeship  that is deemed  by the board  to be                                                                    
     in the  public interest and recognized  by a nationally                                                                    
     commissioner  to  adopt  regulations to  implement  and                                                                    
     interpret the Act.                                                                                                         
                                                                                                                                
     Section 13.  Amends AS 08.65.110 to  address grounds of                                                                    
     discipline, suspension  or revocation  of certification                                                                    
     for licensed midwives.                                                                                                     
                                                                                                                                
     Section 14.  Amends AS 08.65.120(a)  to give  the board                                                                    
     the   authority  to   impose   discipline  to   include                                                                    
     revocation  or  suspension  of midwives'  licenses  for                                                                    
     those who broke any code of conduct.                                                                                       
                                                                                                                                
     Section 15.  Amends AS 08.65.120(d)  to give  the board                                                                    
     the ability to  reinstate a licensed after  appeal if a                                                                    
     person  proves  to  able to  practice  with  reasonable                                                                    
     skill and safety.                                                                                                          
                                                                                                                                
     Section 16. Amends  AS 08.65.140 to allow  the board to                                                                    
     adopt   regulations   to    licensed   midwives   after                                                                    
     consultation  with  a   nationally  recognized  midwife                                                                    
     organization. The regulations would  have to conform to                                                                    
     the public interest.                                                                                                       
                                                                                                                                
     Section  17.  Amends  AS  08.08.65.150  to  add  a  new                                                                    
     subsection to read:                                                                                                        
                                                                                                                                
     (b) A  licensed midwife may practice  midwifery without                                                                    
     being under the supervision  of, or collaborating with,                                                                    
     another  health   care  provider   or  a   health  care                                                                    
     facility.                                                                                                                  
                                                                                                                                
2:39:50 PM                                                                                                                    
     (c) A  licensed midwife may practice  midwifery without                                                                    
     entering  into a  written or  other  form of  agreement                                                                    
     with  another health  care provider  or  a health  care                                                                    
     facility.                                                                                                                  
                                                                                                                                
     (d)  A  licensed  midwife may  provide  services  using                                                                    
     audio,  video,  or  other   electronic  media  for  the                                                                    
     purpose of diagnosis, consultation or treatment.                                                                           
                                                                                                                                
     Section 18:  Amends AS 08.65.150 to  give specification                                                                    
     that  a   non-licensed  midwife  recognized   under  AS                                                                    
     08.65.150 cannot receive compensation.                                                                                     
                                                                                                                                
     Section 19: Amends  AS 08.65.160 to address  who can be                                                                    
     called   a   licensed   midwife   and   the   penalties                                                                    
     established for a person who uses the title illegally.                                                                     
                                                                                                                                
     Section  20: Amends  AS 08.65.170  to exclude  licensed                                                                    
     physicians and advanced practiced registered nurses.                                                                       
                                                                                                                                
     Section  21:   Amends  AS  08.65.180  to   explain  the                                                                    
     responsibility  of  care  is  not  transferred  from  a                                                                    
     licensed  midwife to  a  licensed  physician until  the                                                                    
     patient is physically within the physician's care.                                                                         
                                                                                                                                
     Section  22: Amends  AS  08.65.190(1)  to explain  what                                                                    
     board is being discussed licensed midwives.                                                                                
                                                                                                                                
     Section  23:  Amends  AS  08.65.190(3)  to  define  the                                                                    
     practice   of   midwifery  to   include   preconception                                                                    
     pregnancy,  the  first  postpartum year  and  well-baby                                                                    
     care for the infant through the age of six weeks.                                                                          
                                                                                                                                
2:41:41 PM                                                                                                                    
     Section  24:  Amends  AS  08.65.190  by  adding  a  new                                                                    
     paragraph to read:                                                                                                         
                                                                                                                                
     1. "licensed  midwife" means a midwife  who is licensed                                                                    
     under this chapter to practice midwifery.                                                                                  
     2. "midwife" means a person who practices midwifery.                                                                       
                                                                                                                                
     Section 25:  Amends AS 09.65.300(c)(1) to  add licensed                                                                    
     midwives as a health care provider.                                                                                        
                                                                                                                                
     Section  26:  Amends  AS11.42.470(1)  to  add  licensed                                                                    
     midwives as a health care worker.                                                                                          
                                                                                                                                
     Section 27:  Amends AS 18.20.095(e)(2) to  add licensed                                                                    
     midwives as a licensed staff member under AS 08.64.                                                                        
                                                                                                                                
     Section  28: Amends  AS  18.50.165(b)  to add  licensed                                                                    
     midwives to  the responsibilities  of the  registrar to                                                                    
     distribute information to.                                                                                                 
                                                                                                                                
     Section  29: Amends  AS  21.36.090(d)  to add  licensed                                                                    
     midwives  as a  person  who cannot  practice or  permit                                                                    
     unfair  discrimination against  a  person who  provides                                                                    
     services covered  under a  group health  insurance that                                                                    
     extends coverage on an expense incurred basis.                                                                             
                                                                                                                                
2:43:12 PM                                                                                                                    
     Section  30:  Amends  AS  21.42.355  by  adding  a  new                                                                    
     subsection that reads:                                                                                                     
                                                                                                                                
     (c)  If a  health care  insurance plan  or an  excepted                                                                    
     benefits policy or contract  provides indemnity for the                                                                    
     cost  of  services of  a  physician  provided to  women                                                                    
     during  preconception,  pregnancy, childbirth  and  the                                                                    
     period after childbirth up to  one year, indemnity in a                                                                    
     reasonable amount  shall also be provided  for the cost                                                                    
     of  a midwife  licensed in  AS 08.65  who provides  the                                                                    
     same  services. Indemnity  may be  provided under  this                                                                    
     subsection only  if the licensed midwife  is practicing                                                                    
     as a licensed midwife within the scope of the license.                                                                     
                                                                                                                                
     (d)  If a  health care  insurance plan  or an  excepted                                                                    
     benefits  policy or  contract  provides for  furnishing                                                                    
     those services required  of a physician in  the care of                                                                    
     women  during preconception,  pregnancy childbirth  and                                                                    
     the  period  after  childbirth, and  the  period  after                                                                    
     childbirth  up to  one year,  the  contract shall  also                                                                    
     provide  that a  midwife  licensed under  AS 08.65  may                                                                    
     furnish  those same  services instead  of a  physician.                                                                    
     Services may be provided  under this subsection only if                                                                    
     the  licensed  midwife  is  practicing  as  a  licensed                                                                    
     midwife as  a licensed  midwife in accordance  with the                                                                    
     regulations adopted  under AS 08.65.030(a)(7),  and the                                                                    
     services provided  within the scope of  practice of the                                                                    
     license.                                                                                                                   
                                                                                                                                
2:44:57 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:45:50 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
2:45:52 PM                                                                                                                    
MS. BOWMAN continued reading the sectional analysis for SB
192:                                                                                                                            
                                                                                                                                
     Section  31:  Amends  AS  21.84.335(b)(15)  to  add  AS                                                                    
     21.42.355(a) and (b).                                                                                                      
                                                                                                                                
     Section  32: Amends  AS  25.20.055(a)  to add  licensed                                                                    
     midwives to the protocol  that hospitals must follow to                                                                    
     assist a  single parent  and coupled  parents regarding                                                                    
     their  rights and  responsibilities and  the forms  and                                                                    
     statements that must be filled out.                                                                                        
                                                                                                                                
     Section  33: Amends  AS  25.20.055(b)  to add  licensed                                                                    
     midwives to the list  of medical professionals who must                                                                    
     adhere to the  same duties described in  (a)(2)  (6) of                                                                    
     this  section or  ensure that  an agent  performs those                                                                    
     duties.                                                                                                                    
                                                                                                                                
     Section 34: Amends AS  44.62.330(a)(36) to rename board                                                                    
     of certified direct entry to licensed midwives.                                                                            
                                                                                                                                
     Section  35:  Amends  AS   47.07.900  to  explain  what                                                                    
     midwife services are for a licensed midwife.                                                                               
                                                                                                                                
     Section  36: Amends  AS  47.20.320(d)  to add  licensed                                                                    
     midwives in  this section explaining  who shall  not be                                                                    
     criminally or civilly liable for providing information                                                                     
     in good faith to the department or its designee.                                                                           
                                                                                                                                
        Section 37: Repeals AS 08.65.060, 08.65.070 and                                                                         
     08.65.090(b).                                                                                                              
                                                                                                                                
2:47:36 PM                                                                                                                    
       Section 38: Amends uncodified law by adding a new                                                                        
     section that reads:                                                                                                        
                                                                                                                                
        Transition:    Continuation     of    Board.     (a)                                                                    
              Notwithstanding AS  08.65.030,  as amended  by                                                                    
              sec 8 of this Act, the members of the Board of                                                                    
              Certified Direct-Entry Midwives, as that board                                                                    
              is  constituted  under AS  08.65.030  as  that                                                                    
              section  reads on  December  31,  2022,  shall                                                                    
              operate as the Board of Licensed Midwives from                                                                    
              January 1, 2023, until the  new members of the                                                                    
              Board of the  Licensed Midwives  are appointed                                                                    
              by  the governor  un  sec  39of this  Act  and                                                                    
              confirmed   by  the   legislature   under   AS                                                                    
              08.65.010, as amended by secs. 6 and 7 of this                                                                    
              Act.                                                                                                              
                                                                                                                                
        (b) in  this section,  "Board of  Licensed Midwives"                                                                    
             means   the   Board    of   Licensed   Midwives                                                                    
             established by AS 08.65.010 as amended by secs                                                                     
             6 and 7 of this Act.                                                                                               
                                                                                                                                
       Section 39: Amends uncodified law by adding a new                                                                        
     section that reads:                                                                                                        
                                                                                                                                
    Transition:   Current   Direct   Entry   Midwives   and                                                                     
        Apprentice   Midwives.   (a)    Notwithstanding   AS                                                                    
        08.65.050, as  amended  by sec  10  of  this Act,  a                                                                    
        person who holds on December 31,  2022, an unexpired                                                                    
        certificate  to   practice  direct-entry   midwifery                                                                    
        issued under AS 08.65.050, as that  section reads on                                                                    
        December 31, 2022, is licensed on the effective date                                                                    
        of secs. 1    40 of  this Act to  practice midwifery                                                                    
        under AS 08.65, as amended  by secs. 6    24 of this                                                                    
        Act, for a two - year period.                                                                                           
                                                                                                                                
     (b) Notwithstanding AS 08.65.090, as amended by sec 12                                                                     
        of this  Act, a  person  who holds  on December  31,                                                                    
        2022,  an  unexpired   permit  to  practice   as  an                                                                    
        apprentice  direct-entry  midwife  issued  under  AS                                                                    
        08.65.090, as  that section  reads  on December  31,                                                                    
        2022, is permitted on the effective  date of secs. 1                                                                    
          40  of  this  Act  to  practice as  an  apprentice                                                                    
        midwife under AS 08.65.090, as amended by sec. 12 of                                                                    
        this Act, for a two-year period.                                                                                        
                                                                                                                                
2:50:21 PM                                                                                                                    
     Section 40. The  uncodified law of the  State of Alaska                                                                    
     is amended by adding a new section that reads:                                                                             
                                                                                                                                
     TRANSITION:  NEW  BOARD  MEMBERS. (a)  Within  60  days                                                                    
        after the effective  date of  secs. 1    40  of this                                                                    
        Act, the governor shall appoint an advanced practice                                                                    
        registered nurse  licensed under  AS 08.68  to be  a                                                                    
        member of the board to replace  the physician member                                                                    
        of the board  for the remainder  of the term  of the                                                                    
        physician member.                                                                                                       
                                                                                                                                
2:50:53 PM                                                                                                                    
     (b) Within 60 days after  the effective date of secs. 1                                                                    
          40  of this  Act,  the governor  shall appoint  an                                                                    
        advanced practice registered nurse licensed under AS                                                                    
        08.68 to be  a member  of the  board to  replace the                                                                    
        certified nurse midwife member of the  board for the                                                                    
        remainder of the term of the certified nurse midwife                                                                    
        member.                                                                                                                 
                                                                                                                                
     (c)  The board,  as constituted  under (a)  and (b)  of                                                                    
        this section,  shall begin  operating  as the  board                                                                    
        when  the  legislature  has  confirmed  the  members                                                                    
        appointed under (a) and (b) of this section.                                                                            
                                                                                                                                
     (d)  In  this  section,  "board"  means  the  Board  of                                                                    
        Licensed Midwives  established by  AS 08.65.010,  as                                                                    
        amended by secs. 6 and 7 of this Act.                                                                                   
                                                                                                                                
2:51:49 PM                                                                                                                    
     Section 41. The  uncodified law of the  State of Alaska                                                                    
     is amended by adding a new section to read:                                                                                
                                                                                                                                
     TRANSITION:  REGULATIONS.  The  Board  of  Direct-Entry                                                                    
        Midwives  established  by  AS   08.65.010,  as  that                                                                    
        section reads  on December  31,  2022, shall  adopt,                                                                    
        repeal,  or  amend   regulations  as   necessary  to                                                                    
        implement the changes made  by secs. 1    40 of this                                                                    
        Act. The  regulations  take  effect under  AS  44.62                                                                    
        (Administrative Procedure Act), but not before                                                                          
        January 1, 2023.                                                                                                        
                                                                                                                                
     Section 42. Reads "Section 41 of this Act takes effect                                                                     
     immediately under AS 01.10.070(c)."                                                                                        
                                                                                                                                
      Section 43. Reads "Except as provided in sec. 42 of                                                                       
     this Act, this Act takes effect January 1, 2023."                                                                          
                                                                                                                                
2:52:53 PM                                                                                                                    
CHAIR WILSON opened  invited testimony on SB 192.  He stated that                                                               
public testimony would be heard at a later date.                                                                                
                                                                                                                                
2:53:45 PM                                                                                                                    
RACHEL PUGH,  Member, Board  of Certified  Direct-Entry Midwives,                                                               
Department  of  Commerce,  Community  and  Economic  Development,                                                               
Eagle River,  Alaska, stated  she strongly  supports SB  192. She                                                               
said she  was directly involved  in writing the  proposed statute                                                               
changes  for over  a year.  The changes  are necessary  to comply                                                               
with  state audit  recommendations  and  eliminate many  outdated                                                               
statutes that  make it  challenging to  access midwifery  care in                                                               
Alaska.                                                                                                                         
                                                                                                                                
MS. PUGH  related one  issue: the lack  of legal  recognition and                                                               
insurance  coverage for  certified  direct-entry midwives  (CDMs)                                                               
and  certified professional  midwives  (CPMs),  based on  current                                                               
statutes,  is  creating  insurmountable  financial  barriers  for                                                               
many.                                                                                                                           
                                                                                                                                
MS. PUGH reported that a  nationwide study revealed that only 3.4                                                               
percent of hospital births were  paid out of pocket. In contrast,                                                               
67.9 percent  of planned out-of-hospital births  and 32.3 percent                                                               
of  birth  center births  were  self-pay.  Seven and  nine-tenths                                                               
percent  of all  births in  Alaska  are planned  out of  hospital                                                               
births, whereas the national average is 1.6 percent.                                                                            
                                                                                                                                
MS.  PUGH stated  that SB  192  would provide  greater access  to                                                               
midwifery.  It  would allow  midwives  to  practice to  the  full                                                               
extent  of  their  competencies and  education  and  ensure  that                                                               
Alaska  midwives  have  nationally recognized  credentials.  They                                                               
would  be paid  the same  rate  as certified  nurse midwives  and                                                               
physicians  for identical  procedures. She  said studies  provide                                                               
clear evidence that midwifery care,  birth center, and home birth                                                               
settings  provide   improved  birth   outcomes  and   are  highly                                                               
effective at improving maternal and infant health.                                                                              
                                                                                                                                
MS.  PUGH said  not  passing  SB 192  limits  freedom of  medical                                                               
choice and available medical options  to families in more than 35                                                               
states.                                                                                                                         
                                                                                                                                
2:55:42 PM                                                                                                                    
MS.  PUGH offered  her view  that the  changes in  SB 192  do not                                                               
endanger the  health and safety of  a single woman in  Alaska. SB
192 would  not affect  how a midwife  currently practices  or the                                                               
type of care  they provide. It would not limit  or restrict women                                                               
from choosing their providers or where to give birth.                                                                           
                                                                                                                                
MS.  PUGH emphasized  that she  was  fighting for  the rights  of                                                               
women  and families  in Alaska  to have  more options  and better                                                               
access  to the  type of  maternity  care that  they deserve,  not                                                               
less.  She  stated that  witnessing  women  being denied  medical                                                               
coverage for home births was  frustrating. She said she was tired                                                               
of explaining  to women that  bureaucracy dictates  their limited                                                               
maternity  care  in Alaska,  but  if  they  lived in  many  other                                                               
states, they would have more freedom in their medical choices.                                                                  
                                                                                                                                
2:56:36 PM                                                                                                                    
MS. PUGH  said she was also  tired of providing medical  care for                                                               
free,  such as  postpartum care  beyond six  weeks, which  she is                                                               
trained  and  licensed to  provide.  She  highlighted that  other                                                               
medical providers  are reimbursed when providing  these services.                                                               
However, due to the current statute, she cannot do so.                                                                          
                                                                                                                                
MS. PUGH highlighted  another issue in Alaska:  some women choose                                                               
to  have an  unassisted birth  because Alaska's  current statutes                                                               
and  regulations prevent  them  from hiring  a licensed  midwife,                                                               
most often due to insurance  coverage and financial barriers. She                                                               
stated SB 192  addresses a human rights issue.  She urged members                                                               
to pass the bill as written.                                                                                                    
                                                                                                                                
2:57:56 PM                                                                                                                    
BETHEL BELISLE,  Chair, Board  of Certified  Midwives, Department                                                               
of  Commerce,  Community  and  Economic  Development,  Anchorage,                                                               
Alaska, stated  that she is  a certified direct-entry  midwife in                                                               
Alaska  and  a  professional  midwife,  a  nationally  recognized                                                               
designation. She has  been a midwife since 1999, with  a home and                                                               
birth center  practice. She  related that she  has served  on the                                                               
board since 2020.                                                                                                               
                                                                                                                                
MS. BELISLE thanked Senator Kawasaki  for introducing the bill to                                                               
preserve the rights of Alaska women  to have access to safe, out-                                                               
of-hospital   providers,   high-quality  care,   and   guaranteed                                                               
insurance coverage.                                                                                                             
                                                                                                                                
MS. BELISLE  indicated that  SB 192  resulted from  a legislative                                                               
audit that  began in 2016.  The audit recommended that  the Board                                                               
of Certified Direct-Entry Midwives  pursue statutory changes that                                                               
benefit  the  public.  However,  due  to  a  perceived  financial                                                               
concern,  the  previous  board   did  not  make  the  recommended                                                               
changes. She said  the 2020 audit noted, "The  board identified a                                                               
need  to   change  certification   statutes  to   align  Alaska's                                                               
midwifery laws with national standards."                                                                                        
                                                                                                                                
2:59:24 PM                                                                                                                    
MS.   BELISLE   stated   that   the   first   legislative   audit                                                               
recommendation  indicated that  the  board identified  a need  to                                                               
change certification  statutes to  align Alaska's  midwifery laws                                                               
with  national  standards.  However,   due  to  the  legal  costs                                                               
involved with the project, the  board did not recommend statutory                                                               
changes.                                                                                                                        
                                                                                                                                
MS.  BELISLE stated  she joined  the  board and  became chair  in                                                               
2020,  and the  board worked  on that  recommendation. The  board                                                               
also reviewed the peer review  process and fiscal responsibility.                                                               
The legislature passed a peer review  bill in 2021. The board now                                                               
operates "in the black."                                                                                                        
                                                                                                                                
MS.  BELISLE stated  that  SB  192 provides  the  final piece  to                                                               
complete the  2020 audit recommendations  because the  bill would                                                               
align Alaska's  law with national standards,  which are currently                                                               
the  Certified  Professional  Midwife  Standards.  SB  192  would                                                               
increase  fiscal responsibility  by  requiring  applicants to  be                                                               
vetted  by  a  national organization,  thereby  streamlining  the                                                               
licensure process in Alaska.                                                                                                    
                                                                                                                                
MS. BELISLE  listed numerous  ways SB  192 will  benefit midwives                                                               
and patient  health. It would  extend well-baby visits  from four                                                               
weeks to  six weeks, thus  helping to reduce  neonatal morbidity.                                                               
It would  extend postpartum care  to one year,  reducing maternal                                                               
morbidity  and mortality  by having  a  trusted provider  helping                                                               
with maternal  mental health concerns and  providing referrals as                                                               
needed. It would allow for  preconception counseling, which could                                                               
increase  the health  of  the next  generation  of Alaskans.  She                                                               
offered her  view that this  bill would stand for  women's rights                                                               
to  choose  where  and  with  whom  they  feel  most  comfortable                                                               
birthing, knowing  that their midwifery providers  are trained to                                                               
national standards. She related that  the bill would complete the                                                               
legislative  audit  and  provide   lower  costs,  including  that                                                               
midwifery births  have a  40 percent  lower cesarean  rate, fewer                                                               
low birthweight  babies, and babies  were 26 percent  less likely                                                               
to  be born  prematurely. At  a recent  board meeting,  the board                                                               
gave unanimous approval  for SB 192. The  board acknowledges that                                                               
change  is  hard  but emphasizes  the  importance  of  protecting                                                               
public safety  and abiding  by the  legislative audit.  She urged                                                               
members to support SB 192.                                                                                                      
                                                                                                                                
3:01:27 PM                                                                                                                    
CHAIR WILSON held SB 192 in committee.                                                                                          
                                                                                                                                
3:02:29 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Standing Committee meeting at 3:02 p.m.                                                                                         

Document Name Date/Time Subjects
SB 192 Sponsor Statement 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Supporting Doc Why We Need CPM 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Audit Recommendations DLA 6.19.2020.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 FN DCCED CBPL 2.25.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 FN DCCED IO 2.25.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Leg Legal Memo 1.18.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Leg Legal Memo 2.11.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Letters 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 NARM letter of Support 3.23.21.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 175 Sectional Analysis v. I 3.1.2022.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 Sponsor Statement v. I 3.1.2022.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 Explanation of Changes v. A-I 3.2.2022.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 v.I Work Draft 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 FN DOH MS 2.18.22.pdf SHSS 3/3/2022 1:30:00 PM
SB 175
SB 175 FN DOH BH 2.18.22.pdf SHSS 3/3/2022 1:30:00 PM
SB 175
SB 175 FN DOH HCS 2.18.22.pdf SHSS 3/3/2022 1:30:00 PM
SB 175
SB 175 FN DCCED 2.18.22.pdf SHSS 3/3/2022 1:30:00 PM
SB 175
SB 175 (HB 265) Letters 03.02.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HB 265
SB 175
SB 192 Sectional Analysis 3.3.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192