04/11/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB106 | |
| SB24 | |
| SB91 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 106 | TELECONFERENCED | |
| += | SB 24 | TELECONFERENCED | |
| += | SB 91 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 11, 2023
3:31 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator James Kaufman, Vice Chair
Senator Löki Tobin
Senator Forrest Dunbar
Senator Cathy Giessel
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
State Medical Board
David Barnes - Wasilla
- CONFIRMATION ADVANCED
SENATE BILL NO. 106
"An Act relating to home- and community-based services under the
medical assistance program; and providing for an effective
date."
- MOVED SB 106 OUT OF COMMITTEE
SENATE BILL NO. 24
"An Act relating to mental health education; and providing for
an effective date."
- HEARD & HELD
SENATE BILL NO. 91
"An Act relating to telehealth; relating to multidisciplinary
care teams; and relating to the practice of medicine."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 106
SHORT TITLE: HOME AND COMMUNITY-BASED WAIVER SERVICES
SPONSOR(s): SENATOR(s) GIESSEL
03/17/23 (S) READ THE FIRST TIME - REFERRALS
03/17/23 (S) HSS
04/04/23 (S) HSS AT 3:30 PM BUTROVICH 205
04/04/23 (S) Heard & Held
04/04/23 (S) MINUTE(HSS)
04/11/23 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 24
SHORT TITLE: PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION
SPONSOR(s): SENATOR(s) GRAY-JACKSON
01/18/23 (S) PREFILE RELEASED 1/9/23
01/18/23 (S) READ THE FIRST TIME - REFERRALS
01/18/23 (S) EDC, HSS, FIN
02/22/23 (S) EDC AT 3:30 PM BELTZ 105 (TSBldg)
02/22/23 (S) Heard & Held
02/22/23 (S) MINUTE(EDC)
03/06/23 (S) EDC AT 3:30 PM BELTZ 105 (TSBldg)
03/06/23 (S) Moved SB 24 Out of Committee
03/06/23 (S) MINUTE(EDC)
03/08/23 (S) EDC RPT 4DP 1NR
03/08/23 (S) DP: TOBIN, GRAY-JACKSON, STEVENS, KIEHL
03/08/23 (S) NR: BJORKMAN
03/23/23 (S) HSS AT 3:30 PM BUTROVICH 205
03/23/23 (S) Heard & Held
03/23/23 (S) MINUTE(HSS)
04/11/23 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 91
SHORT TITLE: TELEHEALTH: MULTIDISCIPLINARY CARE TEAM
SPONSOR(s): SENATOR(s) CLAMAN
03/06/23 (S) READ THE FIRST TIME - REFERRALS
03/06/23 (S) HSS, FIN
03/21/23 (S) HSS AT 3:30 PM BUTROVICH 205
03/21/23 (S) Heard & Held
03/21/23 (S) MINUTE(HSS)
04/11/23 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
DR. DAVID BARNES, Governor Appointee
State Medical Board
Department of Commerce, Community, and Economic Development
Wasilla, Alaska
POSITION STATEMENT: Testified as a governor appointee to the
State Medical Board.
SHARON FISHEL, Education Specialist II
Innovation and Excellence in Education
Department of Education and Early Development (DEED)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
24.
KELLY MANNING, Deputy Director
Innovation and Education Excellence
Department of Education and Early Development (DEED)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
24.
SYLVAN ROBB, Director
Division of Corporations, Business & Professional Licensing
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
91.
ACTION NARRATIVE
3:31:08 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:31 p.m. Present at the
call to order were Senators Tobin, Kaufman, Dunbar, Giessel, and
Chair Wilson.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
STATE MEDICAL BOARD
3:32:06 PM
CHAIR WILSON announced the consideration of the confirmation
hearing for David Barnes to the State Medical Board. He asked
Dr. Barnes to tell the committee about himself and his reason
for wanting to serve on the State Medical Board.
3:32:24 PM
DR. DAVID BARNES, Governor Appointee, State Medical Board,
Department of Commerce, Community and Economic Development
(DCCED), Wasilla, Alaska, testified as a governor appointee to
the State Medical Board. He gave a brief history of his
personal, educational and work experience. He graduated from
medical school in 1999 and moved to Alaska in 2003 to work in
hospitals and clinics in the Wasilla area. He stated his
understanding that his primary role on the board would be to
participate in the regulation of the practice of medicine in the
state of Alaska. He hopes to contribute to the professionalism
of the medical industry and protect the public and healthcare
providers by reviewing cases. He described Alaska as a unique
environment because much of the population lives in remote
locations that do not have ready access to healthcare providers.
He said he also sees that Alaska has a general deficit of
healthcare providers. He opined that he was qualified to help
the board, based on his more than 20 years of experience in both
in-patient and out-patient health care in urban and rural areas.
He thanked the legislature for passing the telehealth bill and
said he looks forward to serving if he is confirmed.
CHAIR WILSON asked if there were questions for Dr. Barnes.
3:38:35 PM
SENATOR GIESSEL asked when he came to Alaska.
DR. BARNES replied it was in June 2003.
SENATOR GIESSEL asked for his view of the purpose of the State
Medical Board.
DR. BARNES replied that it's to provide oversight and help with
the resolution of complaints from a regulatory and statutory
perspective.
3:39:47 PM
SENATOR GIESSEL said that is a good summary of the mechanisms,
but the purpose of the State Medical Board is to protect the
public through the regulation of the safe practice of medicine.
She thanked Dr. Barnes for being willing to serve.
3:41:34 PM
SENATOR TOBIN expressed concern that even though the authorizing
statute for the State Medical Board identifies five licensed
physicians residing in as many separate judicial locations as
possible, the current members are predominantly from Anchorage
and the Mat-Su Valley, and Dr. Barnes is from Palmer. The
representative from Sitka is the only one who is not on the road
system. She said she appreciates that Dr. Barnes put his name
forward but it is very important to have representation from
people who know what it's like to live and work in rural Alaska.
It's a concern that there isn't enough diverse representation
from other parts of the state.
3:43:38 PM
CHAIR WILSON opened public testimony on the governor appointee,
David Barnes, to the State Medical Board; finding none, he
closed public testimony.
3:43:56 PM
SENATOR KAUFMAN moved to forward the following name to a joint
session for consideration:
State Medical Board
David Barnes - Wasilla
Signing the reports regarding appointments to boards and
commissions in no way reflects individual members' approval or
disapproval of the appointees; the nominations are merely
forwarded to the full legislature for confirmation or rejection.
3:44:13 PM
CHAIR WILSON found no objection and the name was forwarded.
3:44:21 PM
At ease.
SB 106-HOME AND COMMUNITY-BASED WAIVER SERVICES
3:45:40 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 106 "An Act relating to home-
and community-based services under the medical assistance
program; and providing for an effective date."
He noted that the committee heard the introduction and took
invited and public testimony during the first hearing. He asked
Senator Giessel to update the committee on the status of the
department's application for a waiver.
3:46:20 PM
SENATOR CATHY GIESSEL, District E, Alaska State Legislature,
Juneau, Alaska, speaking as the sponsor of SB 106, stated that
on April 4 the federal government declined the request to extend
the waiver that temporarily allows legally responsible
individuals (LRI) to be paid for rendering personal care
services to family members who are Medicaid eligible. The
current waiver ends on May 11, 2023, which makes the bill even
more important. She cautioned that even if SB 106 were to pass,
it would take time to write regulations so there would be a gap
in payments to people supplying this care.
3:47:23 PM
CHAIR WILSON discerned there were no questions or comments and
solicited a motion.
3:47:27 PM
SENATOR KAUFMAN moved to report SB 106, work order 33-LS0476\B,
from committee with individual recommendations and attached zero
fiscal note(s).
3:47:45 PM
CHAIR WILSON found no objection and SB 106 was reported from the
Senate Health and Social Services Standing Committee.
3:47:55 PM
At ease.
SB 24-PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION
3:50:25 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 24 "An Act relating to mental
health education; and providing for an effective date."
He noted that the committee heard the introduction and took
invited and public testimony during the first hearing. He
further noted that there was an amendment for the committee to
consider.
3:50:55 PM
At ease.
3:57:04 PM
CHAIR WILSON reconvened the meeting and moved to adopt Amendment
A.1 ("Amendment 1"), work order 33-LS0232\A.1.
33-LS0232\A.1
Wallace/Marx
4/3/23
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR WILSON
Page 1, following line 9:
Insert a new bill section to read:
"* Sec. 2. AS 14.03.016(a) is amended to read:
(a) A local school board shall, in consultation
with parents, teachers, and school administrators,
adopt policies to promote the involvement of parents
in the school district's education program. The
policies must include procedures
(1) recognizing the authority of a parent
and allowing a parent to object to and withdraw the
child from a standards-based assessment or test
required by the state;
(2) recognizing the authority of a parent
and allowing a parent to object to and withdraw the
child from an activity, class, or program;
(3) providing for parent notification not
less than two weeks before any activity, class, or
program that includes content involving human
reproduction, [OR] sexual matters, or mental health is
provided to a child;
(4) recognizing the authority of a parent
and allowing a parent to withdraw the child from an
activity, class, program, or standards-based
assessment or test required by the state for a
religious holiday, as defined by the parent;
(5) providing a parent with an opportunity
to review the content of an activity, class,
performance standard, or program;
(6) ensuring that, when a child is absent
from an activity, class, program, or standards-based
assessment or test required by the state under this
section, the absence is not considered an unlawful
absence under AS 14.30.020 if the child's parent
withdrew the child from the activity, class, program,
or standards-based assessment or test or gave
permission for the child's absence."
Renumber the following bill sections accordingly.
Page 2, line 29:
Delete "sec. 3"
Insert "sec. 4"
Page 3, line 4:
Delete "sec. 3"
Insert "sec. 4"
3:57:17 PM
SENATOR KAUFMAN objected for purposes of discussion.
3:57:21 PM
CHAIR WILSON explained that the amendment adds "mental health"
to AS 14.03.016(a)(3), which is the education statute pertaining
to parents' rights to notification and their child's education.
He read paragraph (3) with the proposed addition. The subsequent
bill sections are renumbered accordingly.
CHAIR WILSON asked if there were questions or comments.
3:58:28 PM
SENATOR DUNBAR asked if parent notification was already in
statute.
CHAIR WILSON answered that parental notification is in existing
statute but it's not in the education statutes. His reason for
adding mental health to this piece of statute is to help ensure
that parents are aware and can be prepared for any reaction
their child might have as a result of discussions about mental
health situations.
3:59:43 PM
SENATOR DUNBAR observed that mental health is a broader category
than human reproduction and sexual matters, which are
specifically mentioned in paragraph (3), and that other parts of
the bill call for specific instruction in mental health. He
asked the Chair if he envisioned that only specific courses
would require notification or if it would be required for any
lesson that touches on mental health.
CHAIR WILSON responded that he wasn't sure that the bill had a
definition for "mental health."
CHAIR WILSON asked Sharon Fishel or Kelly Manning whether there
was a definition in statute for "mental health."
KELLY MANNING, Deputy Director, Innovation and Education
Excellence, Department of Education and Early Development
(DEED), Juneau, Alaska deferred the question to Ms. Fishel.
SHARON FISHEL, Education Specialist II, Innovation and
Excellence in Education, Department of Education and Early
Development (DEED), Juneau, Alaska, stated that she would follow
up with an answer.
4:01:54 PM
CHAIR WILSON responded to Senator Dunbar's question with the
explanation that mental health is used broadly and is intended
to provide guidelines for instruction, similar to programs about
domestic violence and sexual assault and Brie's Law for dating
violence. Mental health is added to paragraph (3) to ensure that
the department develops guidelines for programs relating to
mental health and that parents receive notification about those
programs.
SENATOR DUNBAR asked whether Brie's Law had a parental
notification component.
CHAIR WILSON answered yes; it falls under domestic violence and
sexual assault.
4:03:08 PM
At ease.
4:04:05 PM
CHAIR WILSON reconvened the meeting.
4:04:08 PM
SENATOR DUNBAR wondered whether there was a way to narrow the
amendment so the notification requirement is specific to the
instructional units about mental health. He explained that he
didn't want a teacher to be disciplined if a class discussion
strayed into mental health matters. He cited the hypothetical
example of a literature class discussing a poet who died by
suicide and that topic is raised in the course of the class
discussion.
CHAIR WILSON articulated his intent to ensure that a parent or
guardian is notified if a topic such as suicide is brought up in
class so they're able to support their child if the need arises
as a result of the class discussion.
CHAIR WILSON asked Ms. Fishel if the parental notification
requirement in the existing statute relating to programs or
classes about human reproduction and sexual matters extended to
discussions in other classes that touch on those topics.
4:06:48 PM
MS. FISHEL reminded the committee that SB 24 is about developing
guidelines for teachers to develop standards for programs about
mental health and not a curriculum. She pointed out that
teachers need to have some leeway to have conversations with
students when topics relating to mental health and suicide come
up organically in a classroom.
CHAIR WILSON indicated that his question wasn't really answered.
4:07:50 PM
SENATOR GIESSEL countered that Ms. Fishel's response did answer
the question. She said Ms. Fishel used the example of suicide,
but she was thinking about everyday situations such as a child
who is distraught because of domestic violence in their family
or their best friend's family and they bring that up in a
classroom. The teacher or a counselor in that situation has to
help those students process, and that is mental health. She
commented that it was odd to add mental health to the subjects
that require two weeks advance notice because it would tie
teachers' hands and prevent them from addressing everyday topics
or conversations that might arise in any given school day.
4:09:45 PM
CHAIR WILSON said he was willing to rework the amendment and
address mental health in a separate curriculum.
4:09:55 PM
SENATOR GRAY-JACKSON suggested the committee consider removing
the word "activity."
CHAIR WILSON opined that removing the word "activity" would
affect the other items in the paragraph.
SENATOR KAUFMAN commented that it would be worthwhile to take
the time to make it right.
4:10:53 PM
CHAIR WILSON withdrew Amendment 1, work order 33-LS0232\A.1, and
committed to work with the sponsor.
4:11:02 PM
SENATOR GRAY-JACKSON requested permission for the committee to
hear DEED's reasoning and explanation for the large fiscal note.
When the bill was introduced in the previous legislature, the
fiscal note was $71 thousand; this year the fiscal note had
increased to $256 thousand. She questioned the reason for
increasing the size of the committee from 20 to 30 members
CHAIR WILSON agreed to hear the explanation.
4:12:45 PM
KELLY MANNING, Deputy Director, Innovation and Education
Excellence, Department of Education and Early Development
(DEED), Juneau, Alaska, stated that the department met with the
sponsor and then met separately to consider how to reduce the
fiscal note. The conclusion was that the fiscal note is
reflective of the current cost of the work. She recounted the
following factors that DEED evaluated:
• The size of the committee increased from 20 to 30 members
because DEED determined that was appropriate for the type of
work that SB 24 considers. It will include subject matter
experts in mental health as well as district representatives
throughout the state to reflect different size and geographic
locations.
• The work requires a facilitator who understands the national
and Alaska landscape and is able to negotiate challenging
conversations in groups that have different perspectives.
• The fiscal note for SB 24 is higher than it was for the
original bill because the cost for this work has increased
significantly since COVID.
• In the past DEED was able to attract educators with lower
stipends, but higher stipends recognize the extra-duty work of
educators as an important component of teacher engagement.
CHAIR WILSON commented on the general increase in fiscal notes
from last year to this year and stressed that Senate Finance was
taking a hard look at the increases.
4:17:58 PM
CHAIR WILSON held SB 24 in committee.
4:18:06 PM
At ease.
SB 91-TELEHEALTH: MULTIDISCIPLINARY CARE TEAM
4:20:36 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 91 "An Act relating to
telehealth; relating to multidisciplinary care teams; and
relating to the practice of medicine."
He noted that this was the second hearing and there were two
amendments for the committee to consider.
4:21:17 PM
CHAIR WILSON moved to adopt Amendment A.6 ("Amendment 1"), work
order 33-LS0193\A.6.
33-LS0193\A.6
Bergerud
4/5/23
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR WILSON
Page 6, following line 29:
Insert new bill sections to read:
"* Sec. 4. AS 44.33.381(b) is amended to read:
(b) The department shall maintain the registry
of businesses performing telemedicine services in the
state. The registry must include the name, address,
and contact information of businesses performing
telemedicine services in the state. The department may
renew every three years the registration of a business
that meets all renewal requirements established by
regulation and pays a renewal fee every three years.
* Sec. 5. AS 44.33.381 is amended by adding a new
subsection to read:
(d) The department shall charge the following
fees for businesses performing telemedicine services
in the state:
(1) initial registration fee, $100;
(2) renewal fee, $100;
(3) fee to report changes in the business's
registration information, $50."
4:21:31 PM
SENATOR KAUFMAN objected for purposes of discussion.
4:21:35 PM
CHAIR WILSON explained that Amendment 1 changes the registration
fee for the telehealth registry to $100 and adds a $100 renewal
fee every three years. The existing $50 fee for a business to
change its registration information remains the same.
4:22:18 PM
SENATOR TOBIN referenced paragraph (3) in Section 5 of the
amendment and commented that charging $50 to update a business's
registration information might keep some businesses from making
updates. She asked for more information.
CHAIR WILSON suggested that Sylvan Robb speak to question
because the provision was existing language.
4:23:28 PM
SYLVAN ROBB, Director, Division of Corporations, Business &
Professional Licensing, Department of Commerce, Community, and
Economic Development (DCCED), Juneau, Alaska, stated that the
current fee to register with the telemedicine registry is $50.
SENATOR TOBIN said she'd like to look at the statute.
4:24:00 PM
At ease.
4:26:45 PM
CHAIR WILSON reconvened the meeting.
4:26:51 PM
SENATOR TOBIN read subsection (a) of AS 44.33.381 relating to
the telemedicine business registry which did not mention fees.
She articulated her reservations about placing a fee in statute
rather than regulation, and noted that many businesses update
their information every two years and the amendment calls for a
three-year renewal. She asked the Chair if he would entertain a
conceptual amendment to change "every three years" to "every two
years" on lines 7 and 9 and allow the fees to be set in
regulation.
CHAIR WILSON suggested breaking the items into two conceptual
amendments. He added that his hesitation is that the department
might not get around to updating the fees timely.
4:28:35 PM
SENATOR TOBIN agreed to make two motions. She moved to adopt
Conceptual Amendment 1 to Amendment 1.
CONCEPTUAL AMENDMENT 1 TO AMENDMENT 1
Page 1, lines 7 and 9 replace 3 years with 2 years.
4:29:02 PM
CHAIR WILSON asked if there was any objection; he found none and
Conceptual Amendment 1 to Amendment 1 was adopted.
4:29:12 PM
At ease.
4:29:56 PM
CHAIR WILSON reconvened the meeting.
4:30:00 PM
SENATOR TOBIN moved Conceptual Amendment 2 to Amendment 1.
CONCEPTUAL AMENDMENT 2 TO AMENDMENT 1
Page 1, line 13, following: "initial registration fee,
$100;"
Insert: "adjusted for inflation set by the
department;"
4:30:28 PM
CHAIR WILSON objected for purposes of discussion.
4:30:38 PM
SENATOR KAUFMAN asked how the fee would be determined.
CHAIR WILSON opined that it would be done through the regulatory
process. He asked Ms. Robb to speak to that process.
4:31:00 PM
MS. ROBB confirmed that most fees are in regulation and adjusted
periodically, to ensure that the fee is roughly equal to the
cost to administer the program. She advised that the
telemedicine business registry was not administratively
burdensome and confirmed that if the registration is renewed
every two years, the fee would be reviewed on that schedule as
well.
4:32:09 PM
SENATOR KAUFMAN warned about making incremental changes that
cost more than the revenue that's realized.
4:32:24 PM
SENATOR GIESSEL suggested a further amendment to add the
inflation adjustment to the renewal fee on line 14 of Amendment
1. She moved to adopt Conceptual Amendment 3 to Amendment 1.
CONCEPTUAL AMENDMENT 3 TO AMENDMENT 1
Page 1, line 14, following: "renewal fee, $100;"
Insert: "adjusted for inflation set by the
department;"
4:32:36 PM
CHAIR WILSON found no objection and Conceptual Amendment 3 to
Amendment 1 was adopted.
4:32:52 PM
CHAIR WILSON removed his objection to the two conceptual
amendments Senator Tobin offered. He found no further objection
and Amendment 1, as amended, was before the committee.
4:33:13 PM
SENATOR DUNBAR commented that changing the renewal from every
three years to every two years results in a 50 percent increase
in the renewal fee and he hopes that is enough for the
department to recoup its costs. He referenced the fee for
changing the business's registration information in subsection
(d)(3) and suggested the committee consider eliminating it
because providing updated information is behavior that should be
encouraged.
CHAIR WILSON deferred to Ms. Robb since the provision was
already in regulation.
4:34:19 PM
MS. ROBB opined that since the change fee was in the current
regulations, it was difficult to say whether eliminating it
would change behavior.
SENATOR DUNBAR asked how often the $100 renewal fee is charged
currently.
MS. ROBB replied that the telemedicine business registry is
perpetual. The registration does not expire so there is no
renewal fee. Responding to an additional question, she confirmed
that Amendment 1 adds the renewal fee.
SENATOR DUNBAR asked if she agreed that, should the amendment
pass and the registration is renewed every two years, the
department will get updated information about the businesses
every two years.
4:35:23 PM
MS. ROBB agreed.
SENATOR DUNBAR asked if she believes that the renewal process
will be sufficient to collect the data that's needed or if the
provision in paragraph (3) to report changes in the registration
information is also needed.
4:35:51 PM
MS. ROBB responded that she views it as a policy call. She added
that the data on the telemedicine business registry isn't used
very much, but if that were to change it would be beneficial to
have up-to-date data.
4:36:25 PM
SENATOR DUNBAR suggested the committee remove paragraph (3) from
Amendment 1.
4:36:45 PM
SENATOR GIESSEL said a reason for keeping paragraph (3) and
collecting a $50 to update a healthcare business's registration
information is that email addresses and names sometimes change
and it's helpful to licensees and the division to have that
information recorded somewhere.
CHAIR WILSON opined that the $50 change fee would be
insignificant for most healthcare businesses.
SENATOR DUNBAR asked the bill sponsor for his view of subsection
(d)(3) of Amendment 1 which imposes a $50 fee for a business to
report changes in their business registration information.
4:38:24 PM
SENATOR CLAMAN responded that in light of all the proposed
changes, he views the $50 change fee as a disincentive for
businesses to provide the information. He added that he was
always hesitant to legislate things that are usually done by
regulation. Thus he would support an amendment to remove
paragraph (3) on lines 15 and 16 of Amendment 1.
4:39:53 PM
SENATOR DUNBAR asked for confirmation that the department could
impose a similar change fee through regulation.
CHAIR WILSON said that's correct.
4:40:09 PM
SENATOR DUNBAR moved to adopt Conceptual Amendment 4 to
Amendment 1.
CONCEPTUAL AMENDMENT 4 TO AMENDMENT 1
Page 1, lines 15-16:
Delete: "(3) fee to report changes in the
business's registration information, $50."
4:40:23 PM
CHAIR WILSON objected for purposes of discussion. He said wanted
the business registry to remain viable and he thought it was
reasonable for a business to pay a fee for the department to
process changes in its registry information. He added that he
was hesitant to rely on the department imposing a fee through
regulation because that process is so slow.
4:42:11 PM
SENATOR GIESSEL agreed with his thoughts; the cost of state
government is increasing and the Division of Corporations,
Business & Professional Licensing is shorthanded, so the $50 fee
could make a difference in funding the activities related to the
bill.
4:42:45 PM
CHAIR WILSON asked for further discussion; he found none and
asked for roll call vote on Conceptual Amendment 4 to Amendment
1.
4:43:01 PM
A roll call vote was taken. Senators Dunbar and Tobin voted in
favor of Conceptual Amendment 4 to Amendment 1 and Senators
Giessel, Kaufman, and Wilson voted against it. The vote was 2:3.
4:43:23 PM
CHAIR WILSON announced that on a vote of 2 yeas and 3 nays,
Conceptual Amendment 4 to Amendment 1 failed.
CHAIR WILSON asked for further discussion on Amendment 1 as
amended; he found none.
4:43:44 PM
SENATOR KAUFMAN removed his objection.
4:43:44 PM
CHAIR WILSON found no further objection and Amendment 1 as
amended, was adopted.
4:43:49 PM
CHAIR WILSON solicited a motion for Amendment A.8 (Amendment
2") by Senator Giessel.
4:43:54 PM
SENATOR GIESSEL moved to adopt Amendment A.8 ("Amendment 2"),
work order 33-LS0193\A.8, to SB 91.
33-LS0193\A.8
Bergerud
4/6/23
AMENDMENT 2
OFFERED IN THE SENATE
Page 1, line 8, following "AS 08.01.087.":
Insert "A member of a physician's
multidisciplinary care team may provide a health care
service through telehealth to a patient located in
this state only if the health care service is not
otherwise available in the state."
Page 3, lines 3 - 5:
Delete "that includes a physician licensed in
another state who meets the requirements of (b)(1) of
this section"
Page 3, following line 5:
Insert new bill sections to read:
"* Sec. 3. AS 08.02.130(j) is amended by adding a
new paragraph to read:
(5) "member of a multidisciplinary care
team" means an audiologist, speech-language
pathologist, behavior analyst, professional counselor,
dietitian, nutritionist, naturopath, marital and
family therapist, podiatrist, osteopath, physician
assistant, nurse, pharmacist, psychologist or
psychological associate, or a social worker who is a
member of a team that includes a physician licensed in
another state who meets the requirements of (b)(1) of
this section.
* Sec. 4. AS 08.02.130 is amended by adding a new
subsection to read:
(k) A member of a multidisciplinary care team
shall register with the department before providing
telehealth services to a patient located in the state.
To register with the department, a member of a
multidisciplinary care team shall submit
(1) the name of the physician leading the
multidisciplinary care team;
(2) the area of health care in which the
member of the multidisciplinary care team will be
practicing and proof of licensure in a state or
territory of the United States in that area;
(3) any applicable fees, as determined by
the department."
Renumber the following bill section accordingly.
4:43:57 PM
CHAIR WILSON objected for purposes of discussion.
4:44:01 PM
SENATOR GIESSEL stated that her goal is to ensure that to every
extent possible, Alaskans are providing the telehealth services
that are offered in Alaska. The provision on page 1, lines 2-4
clarifies that the members of a physician's multidisciplinary
care team may provide health care through telehealth to a
patient in Alaska only if the service is not available in
Alaska. The language on page 1, line 12 through page 2, line 4
identifies the professions that logically would be part of a
multidisciplinary care team that provides telehealth services.
She said not all of the professions initially identified in the
bill were logical for telehealth services. Section 4 defines the
requirements for the members of a multidisciplinary care team
which includes registering with the department. The amendment
also removes the provision on page 3, lines 3-5 of the bill
because it's redundant.
CHAIR WILSON asked if there were any questions
4:46:44 PM
SENATOR DUNBAR asked which professions were removed from the
list of telehealth providers.
4:46:57 PM
SENATOR GIESSEL directed attention to the health care providers
identified on page 2 line 20 through page 3, line 1 of the bill.
The professions removed from that list include chiropractor,
dental hygienist, dentist, direct-entry midwife, dispensing
optician, physical therapist, and occupational therapist.
4:47:34 PM
SENATOR DUNBAR said the list makes sense with the exception of
physical therapist and perhaps occupational therapist. He asked
if she could think of any circumstances where those services
could be provided through telehealth. He cited his personal
experience with physical therapy that only initially was in-
person; thereafter he was given pictures to use as a guide.
4:48:28 PM
SENATOR GIESSEL said it's a good point but physical therapists
also have to assess the patient's progress, and that's generally
hands-on. The same applies to occupational therapy assessments.
CHAIR WILSON asked her to clarify that an in-state physical
therapist could offer telehealth services.
SENATOR GIESSEL answered yes.
4:49:31 PM
SENATOR KAUFMAN offered his understanding that smart phone
technology is capable of measuring one's eyes, so optometry
services could be delivered via telehealth. He was aware of
statutes in Texas that addresses optometry services via
telehealth.
SENATOR GIESSEL described the differences between an optician,
an optometrist, and an ophthalmologist.
4:50:57 PM
SENATOR KAUFMAN asked how businesses that provide glasses by
mail would fit.
CHAIR WILSON responded that the purpose is to allow out-of-state
providers to provide services for life-threatening conditions.
He didn't consider ordering glasses through the mail in that
category.
4:51:41 PM
SENATOR DUNBAR asked the bill sponsor whether any of the
professions that the amendment excludes would have affected the
multidisciplinary care team for his constituent who has ALS and
others in similar circumstances that prompted the bill.
4:52:29 PM
SENATOR CLAMAN stated that his constituent who has ALS has both
a physical therapist and an occupational therapist on her
multidisciplinary care team and she sometimes uses telehealth
for those services. In addition, the ALS group in Alaska and the
American Cancer Society raised questions about the first
provision in the amendment regarding a member of the
multidisciplinary care team only providing health care services
through telehealth to an Alaskan if the health care services are
not otherwise available in the state. Both organizations asked
whether it was the insurance company or the patient who would
have the burden of showing that the service was not otherwise
available. To Senator Kaufman's question about telehealth
services for optometry and the possibility of using an iPhone
app, he said significant brain cancer can affect brain function
and it's reasonable to think that somebody in that circumstance
would want to see the optician who saw them last. He articulated
concern with Section 3 of the amendment, pointing out that
making a list of the professions that can be part of a
multidisciplinary care team could unintentionally be either
over-inclusive or under-inclusive. He argued that the best way
to strike a balance between providing care for the patient who
wants the care and maximizing the use of providers in Alaska
wherever possible was through Section 4 of Amendment 2.
4:58:29 PM
SENATOR GIESSEL noted that she had neglected to mention that
optometrist was not on the list in Section 3.
4:59:00 PM
SENATOR DUNBAR asked Senator Claman if his concern could be
alleviated by amending the language on page 1, lines 2-4 of the
amendment.
4:59:31 PM
SENATOR CLAMAN said his initial thought was to change the
language on page 1, line 4 from "not otherwise available in the
state." to "not reasonably available in the state." However, he
would like to hear from the American Cancer Society and the ALS
group in Alaska first, because those organizations have first-
hand experience working with highly specialized
multidisciplinary care teams and the people who leave the state
to receive very specialized care.
5:00:26 PM
At ease.
5:00:58 PM
CHAIR WILSON reconvened the meeting and advised that the
committee's time had run out for the day.
5:01:08 PM
CHAIR WILSON held SB 91 in committee with Amendment 2 pending.
5:01:25 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 5:01 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 91 Supporting Testimony - MS Society Letter of Support 4.4.23.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |
| 3.23.23 David Barnes Medical App_Redacted.pdf |
SHSS 4/11/2023 3:30:00 PM |
Consideration of Governor's Appointees - David Barnes - State Medical Board |
| SB 106 DOH Medicaid Svcs.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 106 |
| SB 24 Amendment A.1.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 24 |
| SB 91 Amendment A.6.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |
| SB 91 amendment A.8.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |
| SB 91 Amendment A.6 am 4.11.23.pdf |
SHSS 4/11/2023 3:30:00 PM |
SB 91 |