02/11/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB60 | |
| SB83 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 60 | TELECONFERENCED | |
| *+ | SB 83 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 11, 2025
3:33 p.m.
MEMBERS PRESENT
Senator Forrest Dunbar, Chair
Senator Matt Claman
Senator Löki Tobin
Senator Shelley Hughes
MEMBERS ABSENT
Senator Cathy Giessel, Vice Chair
COMMITTEE CALENDAR
SENATE BILL NO. 60
"An Act establishing May 12 as Myalgic Encephalomyelitis/Chronic
Fatigue Syndrome Day of Recognition."
- HEARD & HELD
SENATE BILL NO. 83
"An Act relating to health care insurance; relating to insurance
reimbursement for health care services provided through
telehealth; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 83
SHORT TITLE: TELEHEALTH REIMBURSEMENT RATES
SPONSOR(s): SENATOR(s) CLAMAN
01/31/25 (S) READ THE FIRST TIME - REFERRALS
01/31/25 (S) HSS, FIN
02/11/25 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 60
SHORT TITLE: ESTABLISH ME/CHRONIC FATIGUE SYNDROME DAY
SPONSOR(s): SENATOR(s) TOBIN
01/24/25 (S) READ THE FIRST TIME - REFERRALS
01/24/25 (S) HSS
02/11/25 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
LOUIE FLORA, Staff
Senator Löki Tobin
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis for SB 60.
DAVID PENN, MD
Anchorage, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
HOLLIS MICKEY, representing self
Anchorage, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
SALLIE REDISKE, representing self
Homer, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
DONNA WAYNE ADERHOLD, Member
Homer City Council
Homer, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
SIMONETTA MIGNANO, representing self
Anchorage, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
MICHAEL DICKERSON, representing self
Anchorage, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
FRANCESCA DUBROCK, representing self
Anchorage, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
MERCEDES HARNESS, representing self
Homer, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
SARA TABBERT, representing self
Fairbanks, Alaska
POSITION STATEMENT: Invited testimony on SB 60.
SARENA HACKENMILLER, Staff
Senator Matt Claman
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis for SB 83.
JAMES REBITZER, Economist
Boston University
Boston, Massachusetts
POSITION STATEMENT: Invited testimony on SB 83.
SAMMY MACK, Co-owner
Alaska Telepsychology
Anchorage, Alaska
POSITION STATEMENT: Invited testimony for SB 83.
CHRISTINE SAGAN, Owner
Vitae Integrative Medical Center
Anchorage, Alaska
POSITION STATEMENT: Invited testimony on SB 83.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 83.
ACTION NARRATIVE
3:33:11 PM
CHAIR DUNBAR called the Senate Health and Social Services
Standing Committee meeting to order at 3:33 p.m. Present at the
call to order were Senators Hughes, Claman, Tobin and Chair
Dunbar.
SB 60-ESTABLISH ME/CHRONIC FATIGUE SYNDROME DAY
3:34:47 PM
CHAIR DUNBAR announced the consideration of SENATE BILL NO. 60
"An Act establishing May 12 as Myalgic Encephalomyelitis/Chronic
Fatigue Syndrome Day of Recognition."
3:35:01 PM
SENATOR LÖKI TOBIN, District I, speaking as sponsor of SB 60
began introducing the bill.
3:35:14 PM
LOUIE FLORA, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, introduced himself.
3:35:21 PM
CHAIR TOBIN paraphrased the following sponsor statement for SB
60:
[Original punctuation provided.]
Sponsor Statement
SB 60
Senate Bill 60 establishes May 12 as Myalgic
Encephalomyelitis (ME) Awareness Day to help spread
knowledge of the disease, the need for research and
appropriate medical care, and to support individuals
and their families living with Myalgic
Encephalomyelitis.
Myalgic Encephalomyelitis, also known as chronic
fatigue syndrome (CFS) or ME/CFS, is a serious,
chronic, neurologic disease affecting as many as nine
million Americans of all ages, including children.
ME/CFS causes dysfunction across all body systems that
severely impacts quality of life and ability to work.
ME/CFS often causes a lifetime of disability, with 75
percent of people unable to work or attend school and
25 percent of people housebound or bedbound. As many
as 90 percent of people with ME/CFS are undiagnosed.
Covid has increased the prevalence of ME/CFS three to
five times since 2020 with 50 percent of Long Covid
cases meeting the diagnostic criteria for ME/CFS. Long
Covid is affecting as many as 56 million Americans
with an estimated economic impact of $3.7 trillion
dollars.
ME/CFS is underfunded relative to disease burden and
has no known treatments or cures. Experts and
advocates for years have been requesting increased
funding, research, medical education, and
multidisciplinary collaboration. Medical education
pertaining to ME/CFS is lacking. According to the U.S.
Center for Disease Control and Prevention most medical
schools in the United States do not have ME/CFS as
part of their physician training. This leaves the
average medical practitioner untrained and unprepared
to treat people with ME/CFS & associated diseases.
Establishing May 12 as Myalgic Encephalomyelitis
Awareness Day in Alaska mirrors the international
designation, chosen to memorialize the birth date of
Florence Nightingale, the English army nurse who
inspired the founding of the International Red Cross,
and who was believed to have contracted a chronic
immunological and neurological illness in her mid-
thirties and spent the last 50 years of her life
virtually bedridden.
This day of recognition will lead to increased
awareness of ME/CFS in Alaska. It is our hope that
this recognition will lead to increased funding for
research by the federal government and private
entities, directed clinical education of the disease,
and development of diagnostic testing and appropriate
treatments, resulting in better medical care for those
living with ME/CFS.
3:38:29 PM
MR. FLORA provided the sectional analysis for SB 60:
[Original punctuation provided.]
Sectional Analysis
SB 60
Section 1 (Page 1, lines 4-9) Establishes Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome Day of
Recognition as Alaska Statute 44.12.167.
3:39:12 PM
DAVID PENN, MD, Anchorage, Alaska, invited testimony on SB 60,
moved to slide 1, ME/CFS myalgic Encephalomyelitis, and stated
he is not an expert; there are very few experts in the US or
world. He stated that myalgic encephalomyelitis is a chronic,
complex neuro-immune disease that severely impacts the health
and productivity of affected individuals. He explained that
while the exact cause and physiology are not fully understood,
it is often triggered by viral infections. He emphasized that
there is no diagnostic test, cure, or FDA-approved treatment. He
noted that most patients live with the disease for life, and
only about 5 percent are estimated to recover.
3:40:21 PM
DR. PENN moved to slide 2, a picture of listed symptoms pointing
to the area of the body they affect. He stated that the symptoms
of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
are numerous and impact all body systems. He explained that
symptoms include fatigue, brain fog, orthostatic intolerance
(worsening symptoms with upright posture), pain in muscles,
joints, and nerves, sensory sensitivity, flu-like symptoms,
chest pain, palpitations, shortness of breath, gastrointestinal
issues, loss of appetite, nausea, and bowel and bladder
dysfunction. He emphasized the profound and widespread effect of
the disease on patients.
3:41:04 PM
DR. PENN moved to slide 3, Diagnostic Criteria for ME/CFS, and
explained that due to the absence of diagnostic tests for
ME/CFS, clinicians rely on criteria established by the Institute
of Medicine in 2015. He stated that diagnosis requires a
substantial reduction or impairment in the ability to function
at pre-illness levels across multiple domains for more than six
months, accompanied by profound fatigue of new or definite
onset. He clarified that the fatigue is not lifelong from birth
but typically becomes lifelong, is not caused by excessive
exertion, and is not significantly relieved by rest. He
emphasized that post-exertional malaise is a pathognomonic
feature of the disease, along with unrefreshing sleep and either
cognitive impairment (brain fog) or orthostatic intolerance.
3:42:04 PM
DR. PENN moved to slide 4, Post Exertional Malaise (PEM), and
elaborated that post-exertional malaise, the hallmark symptom,
involves a worsening of symptoms or even the onset of new
symptoms following exertion. He noted that this can occur 24 to
72 hours after physical, cognitive, or emotional exertion. He
added that patients often describe the experience as feeling
poisoned, hungover, drained like a low battery, or as if they
are moving through wet cement. He stressed that this is distinct
from normal post-exercise fatigue, is not relieved by sleep, is
not due to deconditioning, and is not simply being unusually
tired after activity. He concluded that this symptom
significantly reduces quality of life.
3:43:05 PM
DR. PENN moved to slide 5, Health-Related Quality of Life by
Disease, and presented data showing that individuals with ME/CFS
report a lower quality of life than those with many other
serious conditions, including cancer, stroke, and multiple
sclerosis. He attributed part of this impact to the widespread
lack of awareness about the disease, both among the general
public and within the medical community.
3:43:31 PM
DR. PENN moved to slide 6, a graph showing the average time in
years from symptom onset to ME/CFS diagnosis by diagnosis year.
He shared his personal experience as a physician, stating that
he was unfamiliar with ME/CFS when his partner's condition began
to worsen. It took several years to reach a diagnosis, which he
did not make himself. His partner went from a successful
professional career to being fully disabled and unable to work.
He said a 2022 survey reported an average delay of 16.2 years
from symptom onset to diagnosis. He emphasized that this long
diagnostic delay reflects the broader lack of knowledge
surrounding the disease.
3:44:44 PM
DR. PENN moved to slide 7, a picture of Florence Nightingale,
and stated that the proposed recognition of International
myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Awareness Day in Alaska aims to raise public and medical
awareness, enabling earlier recognition and diagnosis. He
emphasized that early identification is critical, especially
when treatment is limited to symptom management, as preventing
post-exertional malaise is essential to avoid long-term
deterioration. He noted that avoiding these episodes requires
awareness, making education the most effective tool for
preserving function and improving lives. He explained that May
12 was chosen by an American advocate in the early 1990s to
honor Florence Nightingale, founder of modern nursing, who
became bedridden later in life with what historians believe was
likely ME/CFS.
3:46:19 PM
DR. PENN moved to slide 8, International ME/CFS Awareness Day,
and expressed appreciation to the committee for their
consideration of the condition and efforts to raise awareness.
He stated his belief that this initiative has the potential to
significantly improve the health of Alaskans.
3:47:44 PM
CHAIR DUNBAR continued invited testimony on SB 60.
3:47:58 PM
HOLLIS MICKEY, representing self, Anchorage, Alaska, invited
testimony on SB 60 and stated that she has severe myalgic
encephalomyelitis (ME) and is among the 25 percent of patients
who are fully housebound and mostly bedridden. She shared that
she lost her active professional and personal life in Alaska,
where she had worked as an educator, arts administrator, artist,
and professor at the University of Alaska Anchorage. She
explained that even minor cognitive efforts now trigger symptom
escalation lasting hours to weeks, and she struggles daily with
basic self-care. She emphasized that due to widespread lack of
awareness in both the medical field and general public, patients
are often left to manage their healthcare alone and experience
social isolation. She urged support for the SB 60 as a
meaningful gesture to recognize ME patients, help them feel
seen, and promote more informed and compassionate care.
3:50:32 PM
SALLIE REDISKE, representing self, Homer, Alaska, invited
testimony on SB 60 and stated that she is a medically retired
physical therapist who developed ME/CFS as a child following a
severe fever after a hypothermic event. She described lifelong
cycles of appearing outwardly healthy while internally
struggling, followed by prolonged infections and debilitating
fatigue throughout her youth and into adulthood. She was not
diagnosed until age 32 in the year 2000.
MS. REDISKE explained that she lost her physical therapy
business, which had been designed around her healthcare needs
and served others with complex chronic conditions. At its peak,
the clinic employed 13 people who received strong benefits and
wages, contributing to the local economy. As her illness
progressed, she became fully disabled in 2016, closed the
business, and many employees left the community. She experienced
social isolation, losing friends who did not understand or
believe her condition.
MS. REDISKE shared that she spent three years bedridden, is now
mostly housebound, uses a power wheelchair, cannot drive, and
requires a live-in caregiver. She noted severe cognitive
challenges, including difficulty reading and following multi-
step instructions. In nearly 50 years of living with ME/CFS, she
has encountered only three healthcare providers in Alaska who
recognized the name of the diseasenone of whom knew how to
treat it. She urged support for the SB 60, emphasizing that
ME/CFS is not rare but rarely diagnosed, and stated that this is
a critical opportunity to improve care and access to management
strategies for Alaskans living with the disease.
3:53:52 PM
DONNA WAYNE ADERHOLD, Homer City Council Member, Homer, Alaska,
invited testimony on SB 60 and shared her experience with
ME/CFS, emphasizing the importance of recognizing the condition
and advocating for further research to ease the path for future
patients. She stated that her symptoms began in the late 1990s
with sudden fatigue and cognitive impairment, followed by years
of being dismissed by doctors. After multiple consultations, she
was eventually diagnosed with Epstein-Barr Virus, though it took
even longer to find a physician who could manage her condition.
She explained that after more than a decade of gradual
improvement, she contracted COVID-19 in August 2022, which
developed into long COVID and reactivated the Epstein-Barr
Virus. Her health significantly declined again, and despite
supportive doctors and years of effort, she continues to
experience severe energy crashes if she overexerts. She noted
that although she appears well in public, she often hides the
days when she cannot get off the couch or complete basic tasks.
She concluded that each ME/CFS journey is different, often
triggered by various infections, and that a day of recognition
would validate the condition as real and deeply impactful. She
urged support to raise awareness and help those living with
ME/CFS feel seen and understood.
3:56:36 PM
SIMONETTA MIGNANO, representing self, Anchorage, Alaska, invited
testimony on SB 60 and expressed support for the proposed day of
recognition to raise awareness of myalgic encephalomyelitis (ME)
and long COVID. She urged the medical community to take the
condition seriously, describing the experience of a close
frienda high-functioning professionalwho was forced to
completely withdraw from her life due to the severity of the
illness. She stated that witnessing her friend's physical and
emotional decline was heartbreaking and prompted her to learn
more about the disease. She emphasized that her friend's
experience is not unique and that many others are enduring
similarly devastating outcomes. She concluded that ME is more
than a collection of symptoms; it is a daily struggle that
demands validation and understanding.
3:58:58 PM
MICHAEL DICKERSON, representing self, Anchorage, Alaska, invited
testimony on SB 60 and stated that he has witnessed the impact
of myalgic encephalomyelitis (ME) on Hollis Mickey, who
contributed significantly to Alaska's arts and education
communities but can no longer engage with the creative work for
which she was known. He described her suffering as both acute
and chronic, and noted the broader loss of her leadership,
artistic voice, and friendship. He emphasized that the societal
cost of ME reaches beyond one individual and affects millions
worldwide. He expressed support for designating a day of
recognition as a meaningful step toward raising awareness, which
can lead to increased resources, better understanding, and
progress toward effective treatment or a cure.
4:00:27 PM
FRANCESCA DUBROCK, representing self, Anchorage, Alaska, invited
testimony on SB 60 and shared a personal account of witnessing
the impact of ME/CFS through her friend and former colleague,
Hollis. She described Hollis as operating at the highest level
intellectually, creatively, professionally, and physicallywhen
they worked together at the museum. She recalled Hollis's
vibrant lifestyle, including athletic activities and hosting
elaborate dinner parties. She explained that beginning in the
summer of 2022, Hollis's health visibly declined, leading to
short-term and then long-term disability. Since a brief driveway
visit in the summer of 2023, they have not seen each other in
person. She described witnessing Hollis endure painful
treatments that worsened her condition and caused immense
suffering, leaving loved ones feeling helpless due to the lack
of research and treatment options. She expressed deep admiration
for Hollis's strength and ongoing advocacy despite the
devastating nature of the illness. She concluded by stating that
recognizing May 12 as ME/CFS Awareness Day is the bare minimum
the community can do to raise awareness and help improve health
outcomes.
4:02:33 PM
MERCEDES HARNESS, representing self, Homer, Alaska, invited
testimony on SB 60 and stated that she is the parent of a
medically complex child receiving treatment for long COVID,
which has manifested as ME/CFS and autonomic nervous system
dysfunction. She shared that as her child's condition worsened
over the past yearafter two years of illnessefforts to seek
care in Alaska were repeatedly dismissed, with providers
minimizing her concerns and attributing the symptoms to frequent
childhood illness. She explained that her 10-year-old daughter
has effectively lost her childhood, having been hospitalized
twice at age nine, including one episode where her fatigue was
so severe she could not walk. Due to the lack of awareness and
diagnostic resources in Alaska, they traveled out of state to
seek answers. They eventually found support through a local
primary care provider working with out-of-state specialists, but
her daughter remains unable to attend school or maintain regular
social activities. She emphasized that her child's ongoing
health struggles are not the life any parent would hope for and
noted the devastating limitations ME/CFS places on both the
patient and the family. She urged that formal recognition of
ME/CFS is a vital step toward improving treatment, raising
awareness, and supporting affected individuals and their
caregivers.
4:05:24 PM
SARA TABBERT, representing self, Fairbanks, Alaska, invited
testimony on SB 60 and stated that she became aware of ME
through Hollis's work at the Anchorage Museum and her advocacy,
which came at significant personal cost. She shared that she now
knows two other individuals with MEof different ages and in
different regionswho both face varying levels of severity and
lack the support they need. She reflected on having witnessed
many serious illnesses among friends and family, including
cancer, severe mental illness, and AIDS, and stated that
watching someone live with severe ME has been the most
difficult. She emphasized the lack of relief, minimal public
understanding, and the painful reality that even well-
intentioned gestures of support can worsen symptoms. She urged
support for SB 60 to raise awareness in Alaska and contribute to
research that could lead to better treatment and a cure.
4:07:01 PM
SENATOR HUGHES described the testimonies as powerful and helpful
in providing a foundational understanding of myalgic
encephalomyelitis/chronic fatigue syndrome (ME/CFS). She asked
whether the condition is more prevalent among females than
males.
4:07:44 PM
DR. PENN responded that ME/CFS is diagnosed two to four times
more frequently in women than in men. He noted that the reasons
for this disparity are not fully understood, though some
speculative explanations exist. He added that it may also
reflect underreporting by men or under recognition by providers.
He emphasized that ME/CFS affects people of all ages, from
children to elders, and spans all racial, ethnic, and
socioeconomic groups.
4:08:34 PM
SENATOR HUGHES asked how many states have recognized a day for
myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
awareness. She acknowledged that raising awareness is an
important step toward securing research funding and ultimately
improving treatment and finding a cure.
4:09:04 PM
MR. FLORA suggested Dr. Penn might know the answer.
4:09:27 PM
MS. HOLLIS responded that she did not know the exact number of
states that have recognized a day for myalgic
encephalomyelitis/chronic fatigue syndrome (ME/CFS) awareness.
She noted, however, that May 12 is an internationally recognized
day, with organizations around the world observing it to raise
awareness.
CHAIR DUNBAR recognized the committee had received many letter
from doctors.
4:10:13 PM
SENATOR HUGHES stated that even if Alaska is among the first to
formally recognize ME/CFS Awareness Day, it is a necessary and
important step. She asked whether ME/CFS is considered a
disability under Medicare and the Veterans Administration (VA),
and whether it is a recognized diagnosis by Medicare, Medicaid,
and private insurance.
4:10:42 PM
DR. PENN stated that myalgic encephalomyelitis/chronic fatigue
syndrome (ME/CFS) has a recognized diagnosis code under ICD-10.
He confirmed that it can qualify as a disability but
acknowledged that the lack of awareness among medical and
administrative systems often makes the process of obtaining
disability recognition challenging.
4:11:07 PM
SENATOR HUGHES asked whether fibromyalgia is a subset of myalgic
encephalomyelitis (ME), related to it, or a separate condition.
She noted some similarities between the two based on her
observations of a friend with fibromyalgia and wondered if her
friend may have actually had ME, given the overlap in symptoms.
4:11:28 PM
DR. PENN stated that some researchers believe fibromyalgia and
myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may
exist on a spectrum, though the underlying pathophysiology of
both conditions remains unclear. He explained that it is common
for individuals to be diagnosed with both, especially given the
significant pain experienced by many ME/CFS patients. He added
that due to limited awareness of ME/CFS, more familiar diagnoses
like fibromyalgia are often applied, even when they may not
fully match the patient's condition.
4:12:25 PM
SENATOR HUGHES referenced the legislature's support for the
WWAMI program (Washington, Wyoming, Alaska, Montana, and Idaho
regional medical education) and noted that Senator Tobin's
sponsor statement mentioned most medical schools do not include
instruction on myalgic encephalomyelitis/chronic fatigue
syndrome (ME/CFS). She asked whether WWAMI students currently
receive any education or training on this condition.
SENATOR TOBIN responded she didn't know but would find out.
4:13:03 PM
CHAIR DUNBAR concluded invited testimony and opened public
testimony on SB 60; finding none, he closed public testimony.
4:13:34 PM
CHAIR DUNBAR held SB 60 in committee.
4:13:39 PM
SENATOR TOBIN stated that many legislative efforts are deeply
personal and shared that this SB 60 holds personal significance
for her. She recalled working with Hollis at the Anchorage
Museum and emphasized the importance of elevating Alaskan
voices. She expressed that SB 60 could provide hope and solace
by affirming individuals' presence in the community, even when
they are not physically present.
4:14:08 PM
At ease.
SB 83-TELEHEALTH REIMBURSEMENT RATES
4:14:49 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 83 "An Act relating to health
care insurance; relating to insurance reimbursement for health
care services provided through telehealth; and providing for an
effective date."
4:15:08 PM
SENATOR MATT CLAMAN, District H, speaking as sponsor of SB 83
introduced the legislation:
[Original punctuation provided.]
Thank you Chair Dunbar and members of the Senate
Health & Social Services Committee. For the record
this is Matt Claman, Senator for District H in West
Anchorage.
Senate Bill 83 was brought forward by health care
providers in my district who provide both in-person
and telehealth services to Alaskans across the state.
SB 83 will ensure pay parity for telehealth, requiring
health care insurers to reimburse at the same payment
rate for telehealth services as in-person care.
Telehealth reduces barriers to care and allows
patients to receive timely and convenient care from
the comfort of their own homes. In Alaska, barriers to
care affect individuals in rural areas, those with
disabilities, and those with limited transportation
options. Telehealth is especially important for
chronic disease management, mental health services,
and preventative care.
The COVID-19 pandemic highlighted the critical need
for telehealth access, prompting the Centers for
Medicare & Medicaid Services (CMS) to temporarily
implement telehealth parity. While this federal
mandate has expired, some telehealth provisions remain
in place. What was once a temporary need is now
standard practice, and many states have made efforts
to solidify permanent access to these services. Over
33 states have enacted similar legislation to SB 83 to
ensure fair reimbursement for telehealth services.
Alaska's Medicaid program already has telehealth pay
parity. This legislation builds upon that existing
framework to require the same parity by private
insurers. Passage of this legislation will expand
access to care, improve and maintain quality of care,
and incentivize continued telehealth utilization.
4:16:50 PM
SARENA HACKENMILLER, Staff, Senator Matt Claman, Alaska State
Legislature, Juneau, Alaska, Provided the sectional analysis for
SB 83.
Senate Bill 83
Sectional Analysis Version N
Section 1 AS 21.42.450. Coverage for telehealth.
Establishes a new section requiring health care
insurers to reimburse health care providers for
telehealth services at the same rate as for in-person
services.
Section 2 AS 21.42.599. Definitions. Adds new
paragraph (9) for the definition of "telehealth" as
given in AS 47.05.270.
Section 3 AS 29.10.200. Limitation of home rule
powers. Adds new paragraph (68) "AS 29.20.420 (health
care insurance plans)" to the list of provisions which
apply to home rule municipalities.
Section 4 AS 29.20.420. Health care insurance plans.
Establishes a new section requiring a home rule or
general law municipality offering a group health care
insurance plan to meet the requirements of AS
21.42.450 (Section 1). Provides the definition of
"health care insurance plan" as given in AS 21.52.500.
Section 5 AS 39.30.090(a). Adds a new subsection (13)
requiring a policy or policies of group insurance
covering state employees and other specific employee
groups under the Department of Administration to meet
to the requirements of AS 21.42.450 (Section 1).
Section 6 AS 39.30.091. Authorization for self-
insurance and excess loss insurance. Amends this
statute to require those employers with a self-insured
group health insurance plan covering active state
employees to meet the requirements of AS 21.42.450
(Section 1).
Section 7 AS 21.42.422(b)(2). Coverage for telehealth.
Subsection (b), paragraph (2) is repealed.
Section 8 Establishes an effective date of July 1,
2025.
4:19:09 PM
SENATOR TOBIN asked what SB 83 repeals on page 5, line 2.
4:19:36 PM
MS. HACKENMILLER replied that Section 7 updates a definition and
in Section 2 points to a different statute.
SENATOR TOBIN asked for the definition.
MS. HACKENMILLER provided the definition of AS 47.05.270(e), "In
this section, "telehealth" means the practice of health care
delivery, evaluation, diagnosis, consultation, or treatment,
using the transfer of health care data through audio, visual, or
data communications, performed over two or more locations
between providers who are physically separated from the
recipient or from each other or between a provider and a
recipient who are physically separated from each other.
4:21:02 PM
SENATOR HUGHES recalled that during the COVID-19 pandemic,
legislation addressed telemedicine by allowing its use and
possibly establishing payment parity. She expressed uncertainty
about whether the change long-term. She asked if anyone could
clarify what was ultimately decided.
SENATOR CLAMAN stated that he did not specifically recall what
was decided regarding telehealth under COVID-19 regulations but
offered to follow up. He noted that a telehealth bill sponsored
by Representative Spohnholz passed recently and described it as
the first significant telehealth legislation from the last
session. He mentioned that his office had introduced a related
bill focused on specialized care through coordinated care teams
for individuals with amyotrophic lateral sclerosis (ALS) and
similar disabilities. He characterized SB 83 as a follow-up or
adjustment to earlier telehealth legislation and part of broader
efforts to promote medical innovation and cost savings.
SENATOR HUGHES expressed concern about the cost structure of
telehealth services. She stated that while telehealth was a
valuable innovation during COVID-19providing convenience,
access, and the hope of affordabilityshe is disappointed it has
not lowered healthcare costs as expected. She emphasized that,
unlike in-person visits with higher overhead costs such as
staff, facilities, and maintenance, telehealth appointments
require fewer resources. She questioned why telehealth services
are being reimbursed at the same rate as in-person care and
urged further explanation to help her understand the
justification for payment parity.
4:24:47 PM
SENATOR CLAMAN stated that invited testimony would be provided
by economist Dr. Rebitzer who authored the book "Why Not Better
and Cheaper?" He said Dr. Roberts is better qualified to address
the question.
4:25:10 PM
CHAIR DUNBAR announced invited testimony on SB 83 and asked that
testifiers keep in mind the question regarding telemedicine
costs. He said he would also like to know which states have
addressed telehealth similar to SB 83.
4:25:55 PM
JAMES REBITZER, Professor of Economics, Management and Public
Policy, Boston University, Boston, Massachusetts, testified by
invitation on SB 83 and said:
[Original punctuation provided.]
My name is James Rebitzer and I am the Peter and
Deborah Wexler Professor of Economics, Management and
Public Policy at the Questrom School of Business,
Boston University. I am also a Research Associate at
the National Bureau of Economic Research.
My area of research and teaching is primarily in the
area of health economics. In addition to teaching
university classes in applied microeconomics,
managerial economics and health economics, I have
published many academic papers about the economics of
the U.S. healthcare system. I also recently published
a book on innovation in healthcare published by Oxford
University Press. It is called Why Not Better and
Cheaper? Healthcare and Innovation.
I am here to testify about a new piece of legislation
regarding reimbursement for telehealth services. The
bill requires a health insurer to reimburse for
telehealth services on the same basis and at least at
the same rate as comparable healthcare services
provided in person.
Let me begin with my conclusion: This is a reasonable
piece of legislation worthy of your support. However,
my reasoning may be of more interest to the committee
than my conclusion.
As an economist who studies management, I normally
don't think that a state legislature should determine
how much private insurers contract to pay for
services. As a rule, legislatures lack key information
and incentives and move too slowly to set relative
reimbursement rates. Better to leave that to
negotiations between insurers and providers. However,
telehealth may be the exception that proves the rule.
Mandating equal payment can help solve an economic
problem that private parties can't solve on their own.
Like every new treatment modality, telehealth requires
providers to develop new capabilities to deliver
distant care. Payers may be willing to pay something
to induce providers to make these costly investments,
but will they pay enough on their own? Maybe not. In
our fragmented payment system, each provider treats
patients from many different payers: Medicare,
Medicaid, The State of Alaska, Private Insurers,
Private Employers. And this diversity of payers
creates the opportunity for free-riding.
4:28:41 PM
MR. REBITZER continued his testimony:
Suppose a provider deals with 10 different payers,
each paying $50 for a telehealth visit. Suppose
providers are happy to invest adequately in telehealth
capacity at this price. What would happen if one payer
decided to pay $40 for a telehealth visit? Providers
might still be willing to deliver telehealth care to
this payer because they have already borne the upfront
cost of developing the telehealth capacity. The
insurer who pays $40 would, in effect, be "free-
riding" on the other payers' generosity. That would be
annoying to the other payers. If the rest followed
suit, the result would be an inadequate investment in
telehealth capacity or, in the extreme case, no
investment at all.
You can see where this is going. The proposed bill can
help because it makes it harder for a single insurer
to free-ride on other payers because it makes it more
costly to cut rates on telehealth. There is no
guarantee that the "parity" required by the bill gets
relative telehealth reimbursements exactly right, but
it makes free-riding less likely. Since the cost of
delivering telehealth care is partly determined by
what else providers could do with their time, parity
also has the advantage of not making telehealth more
expensive relative to in-person care.
4:30:10 PM
MR. REBITZER continued his testimony:
Although I am not an Alaskan, I am impressed by the
vast distances healthcare providers must travel to
reach all Alaskans. The cost of underinvestment in and
under provision of telehealth is especially severe for
Alaska, so the proposed legislation's value is likely
to be high.
4:30:40 PM
SENATOR HUGHES questioned the claim that providers must make
costly investments in telehealth capacity. She stated that most
clinics already have broadband and secure systems, which are not
comparable to purchasing expensive medical or surgical
equipment. She argued that parity concerns should focus on
consistency among telemedicine payers rather than equating
telemedicine with in-person visits, since the two have different
costs and overhead. She concluded that she remained unconvinced
by the reasoning for payment parity between telemedicine and in-
person care, as the modalities differ significantly.
4:33:26 PM
MR. REBITZER explained that the true cost of telehealth is not
only the setup, training, and maintenance of systems but also
the opportunity cost of what providers are not doing while
delivering telehealth. He stated that if compensation for
telehealth falls too far below that of other services, providers
may stop investing attention and resources, leading to
infrastructure decline. He warned that this free-riding problem
could reduce telehealth capacity in Alaska. He emphasized that,
given Alaska's large distances and the high value of telehealth,
reducing capacity would be a serious mistake.
4:35:15 PM
SAMMY MACK, Co-owner, Alaska Telepsychology, Anchorage, Alaska,
testified by invitation on SB 83. She said she is a clinical
psychologist and supports SB 83:
[Original punctuation provided.]
In 2018, our company became the first private Alaskan
mental health practice to offer mental health services
through HIPAA encrypted videoconferencing. Over the
past 7 years we have provided psychotherapy,
psychological testing, and psychiatric care via
Telehealth and also maintain an in-person office space
for patients if they come to town. Our practice
includes clinical psychologists, social workers,
professional counselors, marriage and family
therapists, and a psychiatric nurse practitioner.
We are in-network with most major insurance providers,
and nearly all of our providers have a waitlist-- the
demand for our services is great. For many,
Teletherapy is their only option for accessing timely,
high-quality mental health care. For most, paying out-
of-pocket is a financial impossibility, and therefore
insurance billing is a must.
Unfortunately, many Alaskan mental health providers
are requiring payment in full at the time of service
because negotiated insurance reimbursement rates have
failed to keep up with the rising cost of living and
inflation.
A further complication is a lack of parity between
Telepsychology and in-person services. Providers are
disinclined to provide Telehealth services when these
are reimbursed at lower rates than in-person care.
Inadequate Telehealth coverage drives patients toward
large, nationwide online therapy platforms, where they
experience inconsistent care and a revolving door of
therapists unfamiliar with the unique challenges of
life in Alaska.
4:37:22 PM
MS. MACK added that this relates to what Senator Hughes'
mentioned regarding seeing more patients on telehealth. Many
national platforms crank out many sessions in a day and provide
inadequate care because they are overburdened.
4:37:44 PM
MS. MACK continued reading her testimony:
[Original punctuation provided.]
Pay parity will allow providers to offer high-quality,
accessible mental health services without financial
disincentives. Without pay parity, we risk losing
providers to cash-pay models or losing them altogether
- a particularly acute problem in rural Alaska where
rates of suicide and abuse are among the highest in
the nation. As a lifelong Alaskan, I am proud to own
Alaska Telepsychology and to provide services to
Alaskans across our state. Please support pay parity
so that Alaskans from Savoonga to Dillingham to Sitka,
Alaskans regardless of location, can access high-
quality mental health care moving forward. Thank you
for your time and consideration. Please let me know if
you have any questions.
4:38:45 PM
CHRISTINE SAGAN, Nurse Practitioner, Vitae Integrative Medical
Center, Anchorage, Alaska, testified by invitation on SB 83. She
said she is in strong support of the bill and commented that her
experience as a nurse practitioner since 2007 and in private
practice since 2015 showed the importance of telemedicine,
especially during COVID-19. She explained that reimbursement
parity matters because, while care quality and effort remain the
same, insurers such as Blue Cross paid 40 percent less for
telemedicine visits, which forced her clinic to bring patients
back in person despite ongoing pandemic concerns. She noted that
telemedicine improved compliance, reduced no-shows, increased
access, and lowered indirect costs for patients by saving travel
time and expenses. She emphasized that clinics still carry
overhead costs such as staff, electronic medical records,
billing, and facilities, and argued that paying 40 percent less
for telemedicine undermines continuity of care in Alaska, where
distance makes access difficult.
4:44:48 PM
CHAIR DUNBAR thanked the testifiers, acknowledging the time and
cost burdens for medical providers. He noted that he had
answered his own earlier question regarding other states'
practices. He stated that a document provided in the bill packet
showed 21 other states required payment parity for telehealth
services on a permanent basis, according to the American Medical
Association. He clarified that this information was from 2023
and may have changed. He invited Ms. Wing-Heier to come forward
to answer questions.
4:45:24 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community, and Economic Development, Juneau, Alaska,
answered questions on SB 83. She put herself on the record.
CHAIR DUNBAR stated that he did not see any statements from the
division, aside from a possible zero fiscal note. He asked what
the anticipated impact on rates would be from a bill like SB 83.
4:45:53 PM
MS. WING-HEIER stated that conversations with insurers revealed
a disconnect between providers and payers. She explained that
the insurers the division spoke to believe they are paying at
parity for telehealth and in-office visits, with only minor
exceptions. She acknowledged that Senator Claman had received
constituent concerns about a lack of parity but said she had not
been able to find exactly where it is. She added that both
commercial insurers affirmed parity and neither submitted a
letter of opposition to the bill.
CHAIR DUNBAR observed that if the bill had a significant
financial impact, insurers would likely have submitted comments,
but they had not. He noted this could also suggest the bill
simply codifies existing practice. He then asked whether there
could be any unintended consequences from passing the bill.
4:47:06 PM
MS. WING-HEIER stated she could not predict future actions by
insurers but emphasized the state's ongoing effort to reduce
health care costs. She noted that parity is not currently in
statute and acknowledged uncertainty about the source of the
reported disconnect. She referenced a testifier's claim of a 40
percent difference in payment and expressed interest in
reviewing the billing code used to investigate the discrepancy
further. She reiterated the difficulty in forecasting how
insurers might respond when negotiating future rates with
providers.
4:47:46 PM
CHAIR DUNBAR noted that at least 21 states had adopted payment
parity legislation as of 2023. He asked if there were any known
trends or impacts on rates in those states following the
adoption of similar legislation.
4:48:00 PM
MS. WING-HEIER stated that parity for telehealth and behavioral
health is an ongoing issue in many states. She confirmed
awareness that several states have adopted similar legislation.
She added that there have been no reports of negative impacts
from states that have already passed such laws.
4:48:16 PM
CHAIR DUNBAR asked whether the concern mentioned referred to a
lack of payment parity or to the payment parity laws themselves.
4:48:22 PM
MS. WING-HEIER clarified that the concern is about a lack of
payment parity, which is being addressed in various states.
4:48:35 PM
SENATOR TOBIN stated that her main question was what problem SB
83 aims to fix, a question more appropriate for the bill sponsor
than the division. She noted that both the Division of Insurance
and the Department of Retirement and Benefits submitted zero
fiscal notes. She sought clarification that the SB 83 would have
no impact on AlaskaCare and no fiscal impact to the state unless
renegotiation occurs.
4:49:06 PM
MS. WING-HEIER stated she could not speak officially for the
Department of Retirement and Benefits but, based on her
conversations with them, they indicated they are currently
paying at parity. She acknowledged the possibility of some
losses within the plan but said the Department believes it is
meeting the intent of the statute.
4:49:37 PM
SENATOR HUGHES asked whether there was a rough estimate of the
percentage of appointments conducted via telehealth versus in
person. She suggested that if telehealth visits were reimbursed
even 10 percent less than in-person visits, AlaskaCare could
potentially reduce health care costs. She noted this could lead
to savings for both consumers and the State of Alaska. She asked
if such a percentage is known and whether it is reasonable to
assume that lower telehealth reimbursement could help reduce
overall costs.
4:50:44 PM
MS. WING-HEIER responded that she did not currently have data on
the percentage of telehealth visits compared to in-person visits
but would work to gather that information. She emphasized that
the division is actively seeking ways to reduce health care
costs without harming the overall system. She stated that any
opportunity to save money is being considered for inclusion not
only in plans regulated under Title 21 and the Division of
Insurance but also in AlaskaCare and other plans across the
state. She acknowledged that Alaska's health care costs are high
and that employers are struggling to manage them.
4:51:31 PM
SENATOR HUGHES posed a hypothetical policy scenario in which
telehealth visits are reimbursed at 90 percent of in-person
visit rates. She asked whether, if private insurers and
AlaskaCare adopted this approach, it would result in reduced
health care costs for Alaskans.
4:51:58 PM
MS. WING-HEIER stated her belief that such a policy would have
to result in reduced health care costs.
4:52:15 PM
CHAIR DUNBAR concluded invited testimony on SB 83.
4:52:37 PM
SENATOR CLAMAN responded to questions raised by Senator Hughes
and offered a perspective that differed from Ms. Wing-Heier's.
He stated that while paying telehealth at 90 percent of in-
person rates might appear to save money if focusing solely on
per-visit costs, this view overlooks the broader economic
impact. He referenced testimony from Alaska providers who
emphasized that telehealth improves access and consistency of
care, which can reduce costly emergency and complex care. He
argued that paying parity enables preventive care that lowers
total health care spending, and that analyzing costs per visit
without considering overall patient outcomes and system-wide
expenses presents a flawed understanding.
4:54:31 PM
CHAIR DUNBAR stated that affordability is a key priority for
both the committee and the administration regarding health care
costs, but noted that quality, effectiveness, and availability
are equally important. He emphasized that the testimony from the
second provider highlighted availability as a critical benefit
of telehealth. He shared that delays in accessing care can
negatively affect both physical and psychological health.
4:55:16 PM
SENATOR HUGHES emphasized the value of preventive care, noting
that early intervention reduces long-term health care costs. She
acknowledged that parity in telehealth increases patient
compliance, particularly in remote areas, but pointed out that
this also increases provider income, as more visits are
completed and reimbursed at full rate. She expressed concern
that this dynamic may unintentionally increase overall health
care spending in Alaska. She underscored the financial burden on
businesses, school districts, and families, and urged the
committee to prioritize consumer affordability. She advocated
for a compromisesuch as reimbursing telehealth at 90 or 95
percentto maintain access while achieving some cost savings.
4:58:27 PM
CHAIR DUNBAR held SB 83 in committee.
4:59:49 PM
There being no further business to come before the committee,
Chair Dunbar adjourned the Senate Health and Social Services
Standing Committee meeting at 4:59 p.m.