05/02/2022 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| HB265 | |
| HB306 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 265 | TELECONFERENCED | |
| *+ | HB 306 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
May 2, 2022
1:30 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Joshua Revak, Vice Chair (via teleconference}
Senator Peter Micciche
Senator Gary Stevens
Senator Elvi Gray-Jackson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATIONS HEARINGS
Department of Commerce, Community and Economic Development
Commissioner
Julie Sande
- CONFIRMATION ADVANCED
Alcoholic Beverage Control Board
Douglas Moore
Janice Hill
- CONFIRMATIONS ADVANCED
State Board of Registration for Architects, Engineers, and Land
Surveyors
Sterling Strait
Brent Cole
- CONFIRMATIONS ADVANCED
Board of Chiropractic Examiners
Walter Campbell
- CONFIRMATION ADVANCED
Board of Examiners in Optometry
Kathleen Rice
- CONFIRMATION ADVANCED
Fishermen's Fund Advisory and Appeals Council
Clay Bezenek
- CONFIRMATION ADVANCED
Alaska Labor Relations Agency
Paula Harrison
- CONFIRMATION ADVANCED
Marijuana Control Board
Bruce Schulte
Eliza Muse
Ely Cyrus
- CONFIRMATIONS ADVANCED
Board of Marital and Family Therapy
Tristian Monterastelli
- CONFIRMATION ADVANCED
Board of Certified Direct-Entry Midwives
Hannah St. George
- CONFIRMATION ADVANCED
Board of Dental Examiners
Dominic Wenzell
- CONFIRMATION ADVANCED
Board of Massage Therapists
Kelli Shew
Amanda Nosich
- CONFIRMATIONS ADVANCED
Board of Nursing
Lena Lafferty
Jody Miller
- CONFIRMATIONS ADVANCED
Board of Pharmacy
Ashley Schaber
Ramsey Bell
- CONFIRMATIONS ADVANCED
Alaska State Board of Public Accountancy
Elizabeth Stuart
- CONFIRMATION ADVANCED
Board of Certified Real Estate Appraisers
Valery Kudryn
- CONFIRMATION ADVANCED
Real Estate Commission
Devon Thomas
Chad Stigen
- CONFIRMATIONS ADVANCED
Board of Social Work Examiners
Gabriel King
Sharon Woodward
- CONFIRMATIONS ADVANCED
Board of Veterinary Examiners
Ciara Vollaro
- CONFIRMATION ADVANCED
Alaska Workers' Compensation Board
Bradley Austin
Christopher Dean
Randy Beltz
Matthew Barth
Michael Dennis
Sara Faulkner
Sarah Lefebvre
- CONFIRMATIONS ADVANCED
Workers' Compensation Appeals Commission
Stephen Hagedorn
- CONFIRMATION ADVANCED
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 265(FIN)
"An Act relating to telehealth; relating to the practice of
medicine and the practice of nursing; relating to medical
assistance coverage for services provided by telehealth; and
providing for an effective date."
- MOVED CSHB 265(FIN) OUT OF COMMITTEE
HOUSE BILL NO. 306
"An Act extending the termination date of the Board of Pharmacy;
and providing for an effective date."
- MOVED HB 306 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 265
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
01/18/22 (H) PREFILE RELEASED 1/14/22
01/18/22 (H) READ THE FIRST TIME - REFERRALS
01/18/22 (H) HSS, FIN
02/01/22 (H) HSS AT 3:00 PM DAVIS 106
02/01/22 (H) -- MEETING CANCELED --
02/03/22 (H) HSS AT 3:00 PM DAVIS 106
02/03/22 (H) -- MEETING CANCELED --
02/17/22 (H) HSS AT 3:00 PM DAVIS 106
02/17/22 (H) Heard & Held
02/17/22 (H) MINUTE(HSS)
03/03/22 (H) HSS AT 3:00 PM DAVIS 106
03/03/22 (H) Heard & Held
03/03/22 (H) MINUTE(HSS)
03/10/22 (H) HSS AT 3:00 PM DAVIS 106
03/10/22 (H) Moved CSHB 265(HSS) Out of Committee
03/10/22 (H) MINUTE(HSS)
03/14/22 (H) HSS RPT CS(HSS) NEW TITLE 5DP 1NR 1AM
03/14/22 (H) DP: MCCARTY, SPOHNHOLZ, FIELDS,
ZULKOSKY, SNYDER
03/14/22 (H) NR: PRAX
03/14/22 (H) AM: KURKA
03/24/22 (H) FIN AT 9:00 AM ADAMS 519
03/24/22 (H) <Bill Hearing Canceled>
03/29/22 (H) FIN AT 1:30 PM ADAMS 519
03/29/22 (H) Heard & Held
03/29/22 (H) MINUTE(FIN)
04/14/22 (H) FIN AT 1:30 PM ADAMS 519
04/14/22 (H) Moved CSHB 265(FIN) Out of Committee
04/14/22 (H) MINUTE(FIN)
04/20/22 (H) FIN RPT CS(FIN) NEW TITLE 6DP 2NR
04/20/22 (H) DP: ORTIZ, EDGMON, LEBON, WOOL,
MERRICK, FOSTER
04/20/22 (H) NR: CARPENTER, JOHNSON
04/26/22 (H) BEFORE HOUSE IN SECOND READING
04/26/22 (H) CALL FOR THE QUESTION UC
04/27/22 (H) TRANSMITTED TO (S)
04/27/22 (H) VERSION: CSHB 265(FIN)
04/29/22 (S) READ THE FIRST TIME - REFERRALS
04/29/22 (S) L&C, FIN
05/02/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: HB 306
SHORT TITLE: EXTEND BOARD OF PHARMACY
SPONSOR(s): REPRESENTATIVE(s) STORY
02/04/22 (H) READ THE FIRST TIME - REFERRALS
02/04/22 (H) L&C, FIN
02/23/22 (H) L&C AT 3:15 PM BARNES 124
02/23/22 (H) Heard & Held
02/23/22 (H) MINUTE(L&C)
02/28/22 (H) L&C AT 3:15 PM BARNES 124
02/28/22 (H) Moved HB 306 Out of Committee
02/28/22 (H) MINUTE(L&C)
03/02/22 (H) L&C RPT 4DP 3NR
03/02/22 (H) DP: SNYDER, NELSON, SPOHNHOLZ, FIELDS
03/02/22 (H) NR: SCHRAGE, KAUFMAN, MCCARTY
03/11/22 (H) FIN AT 9:00 AM ADAMS 519
03/11/22 (H) Heard & Held
03/11/22 (H) MINUTE(FIN)
03/15/22 (H) FIN AT 9:00 AM ADAMS 519
03/15/22 (H) Heard & Held
03/15/22 (H) MINUTE(FIN)
03/31/22 (H) FIN AT 9:00 AM ADAMS 519
03/31/22 (H) Moved HB 306 Out of Committee
03/31/22 (H) MINUTE(FIN)
04/04/22 (H) FIN RPT 3DP 6NR
04/04/22 (H) DP: ORTIZ, EDGMON, WOOL
04/04/22 (H) NR: LEBON, THOMPSON, JOHNSON,
JOSEPHSON, RASMUSSEN, MERRICK
04/15/22 (H) TECHNICAL SESSION 4/15 - ON 4/19
CALENDAR
04/19/22 (H) NOT TAKEN UP 4/19 - ON 4/20 CALENDAR
04/20/22 (H) TRANSMITTED TO (S)
04/20/22 (H) VERSION: HB 306
04/25/22 (S) READ THE FIRST TIME - REFERRALS
04/25/22 (S) L&C, FIN
04/25/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
04/25/22 (S) -- MEETING CANCELED --
05/02/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
Jody Miller, Appointee
Board of Nursing
Department of Commerce, Community and Economic Development
Haines, Alaska
POSITION STATEMENT: Testified as appointee to the Board of
Nursing.
KATIE MCCALL, Staff
Senator Mia Costello
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Read a letter from Hannah St. George asking
for support in her appointment to the Board of Certified Direct-
Entry Midwives.
REPRESENTATIVE IVY SPOHNHOLZ
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 265.
DR. MELINDA RATHKOPF, Director
Allergy, Asthma, and Immunology Center of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
265.
GENEVIEVE MINA, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB 265,
version E, on behalf of the sponsor.
PAM VENTGEN, Executive Director
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
265, version E.
CHRISTOPHER DIETRICH, Medical Director
Orion Behavioral Health
Palmer, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
265.
PHILIP LICHT, President and CEO
Set Free Alaska
Wasilla, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
265.
NANCY MERRIMAN, Executive Director
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
265.
JAYNE ANDREEN, President
Alaska Public Health Association
Douglas, Alaska
POSITION STATEMENT: Testified in support of HB 265.
LARRY JOHANSEN, representing self
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 265.
REPRESENTATIVE ANDI STORY
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 306.
KRIS CURTIS, Legislative Auditor
Legislative Audit Division
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Reviewed the sunset audit to extend the
Board of Pharmacy during the hearing on HB 306.
JUSTIN RUFFRIDGE, Chair
State Board of Pharmacy
Department of Commerce, Community and Economic Development
Soldotna, Alaska
POSITION STATEMENT: Testified by invitation in support of HB
306.
RENEE ROBINSON, President
Alaska Pharmaceutical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 306.
ACTION NARRATIVE
1:30:20 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:30 p.m. Present at the call to
order were Senators Gray-Jackson, Micciche, Revak (via
teleconference), and Chair Costello. Senator Stevens arrived
immediately thereafter.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
Board of Nursing
Board of Certified Direct-Entry Midwives
1:30:33 PM
CHAIR COSTELLO announced the consideration of governor
appointees to Boards and Commissions.
1:31:05 PM
SENATOR STEVENS joined the committee.
CHAIR COSTELLO asked Jody Miller to tell the committee about her
interest in serving on the [Board of Nursing].
1:31:12 PM
Jody Miller, Appointee, Board of Nursing, Department of
Commerce, Community and Economic Development, Haines, Alaska,
stated that she was appointed to the LPN seat. She is interested
in serving to share her knowledge, experience, and skills
working in various areas of nursing. This includes work in the
emergency department, critical care, medical surgery,
obstetrics, as a floor nurse in Haines, and as a flight nurse.
She is immune compromised so she is now working to support
nurses in a variety of ways. She said she would like to share
her work experience and passion for nursing with others and she
looks forward to serving to ensure that qualified and skilled
nurses are caring for patients.
CHAIR COSTELLO commented that her experience speaks to her
passion. She asked if this was a new appointment.
MS. MILLER replied this was her first appointment.
SENATOR COSTELLO asked what challenges she sees for nurses as
the state and communities are emerging from COVID-19.
1:34:22 PM
MS. MILLER said the greatest challenge she sees is burnout,
noting that the board has been working to help smooth and
expedite the licensing process to help ease the load on nurses.
CHAIR COSTELLO found no questions and advised that the committee
would be forwarding all the names today. She thanked Ms. Miller
for being willing to serve.
1:35:43 PM
CHAIR COSTELLO stated that Katie McCall would read a letter from
appointee Hannah St. George because she was unavailable today.
1:36:24 PM
KATIE MCCALL, Staff, Senator Mia Costello, Alaska State
Legislature, Juneau, Alaska, stated that Ms. St. George is a
midwife who lives in Fairbanks and is the mother of ten children
and two foster children. She has attended more than 30 births as
a support figure and is working on her doula certification with
a focus on post-partum support.
MS. MCCALL stated that Ms. St. George has served on the Board of
Certified Direct-Entry Midwives for nearly four years and has
gained an even deeper appreciation for midwifery. It is a
valuable service upon which many people in the state depend. Her
belief is that these board members are dedicated to keeping
midwifery accessible and safe for mothers and babies. She looks
forward to continuing to serve on this board.
CHAIR COSTELLO advised the listening public that members are not
required to appear or testify.
1:37:41 PM
CHAIR COSTELLO opened public testimony on the appointments of
Hannah St. George to the Board of Certified Direct-Entry
Midwives and Jody Miller to the Board of Nursing; finding none,
she closed public testimony.
1:37:59 PM
CHAIR COSTELLO stated that in accordance with AS 39.05.080, the
Senate Labor and Commerce Committee reviewed the following and
recommends the appointments be forwarded to a joint session for
consideration:
Department of Commerce, Community and Economic Development
Commissioner
Julie Sande
Alcoholic Beverage Control Board
Douglas Moore
Janice Hill
State Board of Registration for Architects, Engineers, and Land
Surveyors
Sterling Strait
Brent Cole
Board of Chiropractic Examiners
Walter Campbell
Board of Examiners in Optometry
Kathleen Rice
Fishermen's Fund Advisory and Appeals Council
Clay Bezenek
Alaska Labor Relations Agency
Paula Harrison
Marijuana Control Board
Bruce Schulte
Eliza Muse
Ely Cyrus
Board of Marital and Family Therapy
Tristian Monterastelli
Board of Certified Direct-Entry Midwives
Hannah St. George
Board of Dental Examiners
Dominic Wenzell
Board of Massage Therapists
Kelli Shew
Amanda Nosich
Board of Nursing
Lena Lafferty
Jody Miller
Board of Pharmacy
Ashley Schaber
Ramsey Bell
Alaska State Board of Public Accountancy
Elizabeth Stuart
Board of Certified Real Estate Appraisers
Valery Kudryn
Real Estate Commission
Devon Thomas
Chad Stigen
Board of Social Work Examiners
Gabriel King
Sharon Woodward
Board of Veterinary Examiners
Ciara Vollaro
Alaska Workers' Compensation Board
Bradley Austin
Christopher Dean
Randy Beltz
Matthew Barth
Michael Dennis
Sara Faulkner
Sarah Lefebvre
Workers' Compensation Appeals Commission
Stephen Hagedorn
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.
HB 265-HEALTH CARE SERVICES BY TELEHEALTH
1:40:13 PM
CHAIR COSTELLO announced the consideration of CS FOR HOUSE BILL
NO. 265(FIN) "An Act relating to telehealth; relating to the
practice of medicine and the practice of nursing; relating to
medical assistance coverage for services provided by telehealth;
and providing for an effective date."
She advised the public that the committee was very familiar with
this issue.
1:41:15 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 265, stated that in the interest of time
she would bypass the presentation. She presented the legislation
paraphrasing the following sponsor statement for CSHB 265(FIN):
The COVID-19 pandemic relaxed Alaska's telehealth laws
and enabled broader access to behavioral health and
specialty care, created cost-savings from reduced
travel, and increased the convenience of high-quality
health care to patients across the state. However,
Alaskans have faced barriers to telehealth
appointments due to regulatory hurdles across
professions and inconsistent Medicaid coverage for
services delivered via telehealth. Furthermore, COVID-
19 related flexibilities were regulatory suspensions
and not permanent.
HB 265 maintains these pandemic-related telehealth
flexibilities and expands Alaska Medicaid coverage of
telehealth services in statute as follows.
1) Creates a new section on telehealth for all health
care providers licensed with the State of Alaska
that removes the requirement for an in-person visit
and documentation of a barrier to an in-person visit
prior to the delivery of telehealth.
2) Allows telehealth follow-up visits from physicians
licensed in another state who have established a
physician-patient relationship and conducted an in-
person physical examination with an Alaska patient.
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 for services for
behavioral health, home and community-based
services, rural health clinics, federally qualified
health centers, and other programs eligible for
Alaska Medicaid reimbursement. Ensures payment
parity and Medicaid coverage for telehealth
modalities (e.g., appointments over the Internet,
phone, etc.).
5) There is no requirement to deliver services through
telehealth, and both the provider and the patient may
choose to limit or decline a telehealth encounter.
Comprehensive telehealth delivery has revolutionized
health care in Alaska by creating another tool for
providers to care for patients when they cannot
physically be together. HB 265 will continue to
modernize the state's health care system to the
benefit of all Alaskans.
1:44:13 PM
REPRESENTATIVE IVY SPOHNHOLZ stated that HB 265 aligns the
statute regarding controlled substances via telehealth with the
federal Drug Enforcement Agency (DEA) regulations so Alaska
providers have to comply with just one set of regulations. DEA
regulations require an in-person examination prior to
prescribing a controlled substance, and the bill ensures that
people have access via telehealth to controlled substances once
they have established a relationship with a provider. The bill
supports the marketplace for telehealth by ensuring equal pay
for equal work, but allows lower Medicaid payments when services
are not comparable. This supports reduced health care spending.
She noted that between FY 2020 and FY2021, Medicaid increased
telehealth spending and reduced Medicaid travel for a net
savings of 38 percent or $46 million.
1:45:34 PM
REPRESENTATIVE SPOHNHOLZ highlighted the narrow exception
crafted in HB 265 to allow Alaskans to receive follow-up care
with doctors they have seen from out of state. The Alaska State
Medical Association supports this change to help eliminate
unnecessary travel. The Division of Corporations, Business, and
Professional Licensing has oversight and the ability to recoup
costs in the event there is a bad actor licensed in another
state. The bill also allows more flexibility in the mode of
delivery of telehealth and it protects the patient/provider
relationship. Nothing in the bill requires the provider to
deliver care via telehealth or the patient to receive care via
telehealth.
REPRESENTATIVE SPOHNHOLZ underscored that HB 265 does not allow
non-Alaskan providers to practice in Alaska without state
licensure. This was important to stakeholders, and the
telemedicine business registry for Alaska shows that 84 percent
of registrants are Alaskan providers and the 16 percent of non-
Alaskan providers are licensed in Alaskan. The bill also does
not increase access to controlled substances. Both prescription
drug limits and the Prescription Drug Monitoring Program (PDMP)
remain in place, and DEA regulations still require in-person
examinations before an opioid is prescribed. She highlighted
that providers throughout the state report being able to provide
high-quality care to Alaskan patients. She said the invited and
public testimony will talk about how telehealth has increased
access to care without a reduction in quality.
REPRESENTATIVE SPOHNHOLZ extended her thanks to the diverse
group of stakeholders her office had been working with over the
last 18 months to get HB 265 passed. She added that the robust
expansion the bill proposes could not have been accomplished
without the partnership with both DCCED and DHSS.
1:49:16 PM
CHAIR COSTELLO turned to invited testimony and recognized Dr.
Melinda Rathkopf, the director of the Allergy, Asthma, and
Immunology Center of Alaska.
1:49:37 PM
DR. MELINDA RATHKOPF, Director, Allergy, Asthma, and Immunology
Center of Alaska (AAICA), Anchorage, Alaska, stated that she has
been practicing medicine at AAICA for 16 years and she wanted to
share how telehealth has made it easier for the clinic to serve
the entire state. She explained that the clinic has satellite
clinics and had already started looking into telehealth before
the pandemic. They had purchased some of the software and
hardware, which made the transition easier.
DR. RATHKOPF said she wanted to speak to the bill to stress the
importance of pay parity for telehealth. Her clinic accepts all
payment options and it's challenging to continue to provide care
as the cost of everything continues to rise except
reimbursements. It wouldn't be sustainable if they go down.
She explained that by paying in parity she can block a half day
and see patients in outlying areas via telehealth and still pay
the ongoing costs to maintain the brick and mortar office in
Anchorage. Doing telehealth doesn't eliminate the need to pay
her receptionist and other staff or order supplies. These costs
are ongoing regardless of the mode of delivery of care. She said
allowing parity in pay will continue to be key in continuing to
be able to provide annual and follow up service for instate
physicians.
DR. RATHKOPF stated that allowing out-of-state providers to
provide follow-up care works well for her business. For example,
she sees some rare immune deficiency patients some of whom have
to utilize services through Seattle. It's been very helpful for
these high risk patients to get follow-up care without having to
take time to fly down and risking potential exposures during
that flight. She described HB 265 as a very good compromise that
allows Alaska physicians to provide care for their patients
while also allowing those patients to receive care from an out-
of-state provider when it's appropriate.
1:54:13 PM
CHAIR COSTELLO commented that it seems that her particular
specialty lends itself to in-person visits. She asked her to
talk about what happens differently for her patients when they
have a telehealth appointment versus an in-person appointment.
DR. RATHKOPF responded that she was initially concerned about
not being able to lay her hands on her patients, but quite a bit
of an exam can be done over video and her patients have a
primary physician who has done an in-person exam. She
acknowledged that certain procedures like skin and pulmonary
testing require an in-person visit, but pointed out that
allergists treat a lot of diseases that do not require any
testing. She advised that one reason her clinic started
telehealth pre-pandemic was to screen out those who had to be
seen in person versus via telehealth. Sometimes she determines a
patient really needs an in-person visit but the telehealth
option cuts down up to 75 percent of the people that will
require travel or need to be put on a waitlist so she can travel
to meet them. Telehealth makes her more efficient both at her
satellite clinics and her office.
1:56:22 PM
SENATOR STEVENS referenced a book he'd been reading on longevity
that offers statistical evidence that patients who have a
personal relationship with their doctor live longer than those
who do not have that type of relationship. He asked if she had
any further reflection on the importance of a personal
relationship with a doctor.
DR. RATHKOPF said her experience is that doctor/patient
relationships that were established in person can easily
continue online. What she believes would be very difficult is to
establish a relationship in the telehealth model where the
patient calls a national line and gets a different provider each
call. She assured the committee that most providers in Alaska
that are participating in telehealth are using it to support
established patients.
1:58:53 PM
SENATOR MICCICHE stated that when he worked on an early
telehealth bill he was led to believe that telehealth would be
at a lower cost because there wouldn't be the facility and
materials costs and the visits would be shorter than in-person
visits. He asked for her logic on why pay parity is the correct
path.
2:00:11 PM
DR. RATHKOPF said it would be difficult to justify blocking half
or a whole day clinic to treat telehealth patients if she
weren't paid the equivalent because she could easily fill the
clinic with in-person patients. She said most providers squeeze
telehealth into blocks during the day, but the overhead costs
still exist and the telehealth appointments generally take the
same amount of time as the in-person visits. She explained that
when she sees patients in person she can have three patients in
separate exam rooms at the same time whereas with telehealth
it's a one-on-one appointment. Telehealth is not a cost savings
for the provider and without pay parity it would be too easy for
providers to say they didn't want to do telehealth.
2:02:50 PM
SENATOR MICCICHE said the argument was very convincing and he'd
like her to send the chair that explanation in writing.
DR. RATHKOPF agreed to do so.
CHAIR COSTELLO asked the sponsor if she had anything to add.
2:03:18 PM
REPRESENTATIVE SPOHNHOLZ said she had two things to add. First,
she clarified that the cost savings between FY2020 and FY2021
was 23 percent, not 38 percent but the $48 million savings was
correct.
Second, she said the testimony and questions about pay parity
target the underlying issue of ensuring that patients continue
to receive treatment from their established providers and that
Alaskan providers continue to be able to provide the care. She
shared her personal experience using telehealth when she had
COVID-19 last month and was able to see both her long-time
physician and a specialist. She agreed with Dr. Rathkopf's
explanation of the need for pay parity and highlighted her
earlier testimony that 84 percent of telehealth care in Alaska
is provided by Alaska-based organizations and providers.
CHAIR COSTELLO asked Genevieve Mina to present the sectional
analysis for HB 265.
2:05:19 PM
GENEVIEVE MINA, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, Juneau, Alaska, read the sectional analysis
for CSHB 265(FIN), version E:
[Original punctuation provided.]
Section 1
Adds a new section on telehealth under Title 8 for all
health care providers licensed with the State of
Alaska.
Subsection (a) removes the requirement for an in-
person visit prior to a telehealth appointment.
Subsection (b) narrowly exempts physicians licensed
in another state to deliver health care services via
telehealth if there is an established physician-
patient relationship, an in-person physical exam,
and the services are related to ongoing treatment or
follow-up care related to past treatment. The
language also references new enforcement language in
Section 2.
Subsections (c) and (d) create limits for a
telehealth appointment. If a telehealth appointment
falls outside of a provider's authorized scope of
practice, they may refer a patient to an appropriate
clinician. The cost of a service delivered through
telehealth must be the same as if it were delivered
in person.
? Subsections (e), (f), and (g) ensure that only
authorized providers licensed with the State of
Alaska can prescribe controlled substances (e.g.,
buprenorphine, Adderall, etc.) via telehealth
without conducting an in-person visit. These
providers must comply with the state and federal
laws regarding the prescription of controlled
substances via telehealth.
o Subsection (e) pertains to providers in Title
8, Chapter 64 (Medicine) (i.e., physicians,
podiatrists, osteopaths and physician
assistants).
o Subsection (f) pertains to Advanced Practice
Registered Nurses (APRNs) in Title 8, Chapter
68 (Nursing).
Subsection (h) removes 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.
? Subsection (i) confirms that health care providers
under this section are not required to deliver
telehealth services.
? Subsection (j) provides definitions for all health
care providers applicable to this section, specifies
that the provider must be licensed in good standing,
and defines telehealth.
Section 2 Creates AS 08.64.33 defining the State
Medical Board's authority to enforce against exempted
physicians in Section 1 and ensures these providers
must comply with Alaska laws for licensed physicians.
o Subsection (a) describes the grounds for the board
to sanction a physician licensed in another state
providing telehealth services in Section 1: if
they violate Alaska laws for Alaska-licensed
physicians; exceed the defined scope of
telehealth services in Section 1; or prescribe,
administer, or dispense a controlled substance to
an Alaska patient located in the state.
o Subsection (b) and (c) ensures that the board can
enforce exempted physicians in the same manner as
Alaska-licensed physicians. In addition to this
authority, they can issue a ceaseand-desist
order and notify the licensing authority for each
state the physician is licensed.
o Subsection (d), (e), (g), and (h) details the
board's disciplinary actions for exempted
physicians, mirroring similar language regarding
sanctions for Alaska-licensed physicians.
o Subsection (f) ensures that the board can recover
costs related to the proceedings and
investigation directly from an exempted physician
in Section 1.
2:09:21 PM
Section 3 Amends language related to the prescription
of controlled substances via telehealth under the
State Medical Board. This deletes language requiring
an additional health care provider to assist a patient
during a telehealth appointment with a physician or
physician assistant regarding the prescription,
dispensing, and administration of controlled
substances.
2:09:45 PM
Section 4-5 Adds sections related to the prescription
of controlled substances via telehealth under the
Board of Nursing. This does not change the Board of
Nursing's authority or the scope of practice for APRNs
ensures regulatory equity between the Board of Nursing
and the State Medical Board regarding the prescription
of controlled substances via telehealth for all DEA-
registered practitioners.
? Section 4 amends the Board of Nursing's regulatory
authority to include controlled substances via
telehealth in Section 5, mirroring statutory
language for the State Medical Board.
? Section 5 creates a new section AS 08.68.710
defining the telehealth prescriptive authority of
APRNs in statute. This section removes the
regulatory in-person requirement for APRNs under
12 AAC 44.925(c), mirroring the deletion of
language for the State Medical Board in Section
3.
2:10:50 PM
Section 6 Adds a new section on telehealth under Title
18 for emergency medical services. This section
removes the requirement for an in-person examination
prior to a telehealth encounter. This section
replicates the same provisions on cost, scope of
services, documentation, physical setting, and patient
protections as Section 1.
Section 7 Adds a new section on telehealth payment
under Title 47 for Alaska Medicaid.
? Subsection (a) requires the Department of Health
to pay for telehealth services in the same manner
as an in person service for the following:
behavioral health services, home and community
based services (HCBS), services provided by a
community health aide or community health
practitioner, behavioral health aide or
behavioral health practitioner, dental health
aide therapist, chemical dependency counselor,
non-HCBS services covered under a federal waiver
or demonstration, other services provided by an
individual or entity eligible for department
certification and Medicaid reimbursement, and
services provided at rural clinics and federally
qualified health centers.
2:11:59 PM
This subsection also allows for a telehealth
visit to be conducted through any means which
could be useful in a patient-provider
relationship, including an audio-only (i.e.,
phone call) appointment.
? Subsection (b) requires the department to adopt
regulations regarding payment of telehealth
services. This provision also allows the
department to limit or restrict Medicaid coverage
under this section if a service delivered via
telehealth cannot be safely delivered according
to substantial medical evidence, or if the
federal government will not reimburse the
delivery of the service via telehealth.
? Subsection (c) specifies that the coverage of
services in Alaska Medicaid must be HIPAA
compliant.
Section 8-9 Adds sections on telehealth under Title 47
for grantees that deliver community mental health
services, or facilities approved by the department to
deliver substance use disorder treatment. Both
sections replicate the same telehealth provisions on
cost, scope of services, patient protections,
documentation, and physical setting as Section 1.
? Section 8 creates AS 47.30.585 to include entities
approved to receive grant funding by the
Department of Health to deliver community mental
health services.
? Section 9 creates AS 47.37.145 to include public
or private treatment facilities approved by the
Department of Health to deliver services
addressing substance use disorders.
Section 10 Provides an immediate effective date.
2:13:32 PM
CHAIR COSTELLO referenced Section 1(d) and shared a
constituent's experience of flying to Seattle and having a
telemedicine appointment while in the Board Room at the airport
because the physician was not licensed in Alaska. Following the
appointment, her constituent got back on a plane to return to
Alaska. She said she brought it up because there are Alaskans
who have established relationships with physicians that are not
licensed in Alaska and when COVID-19 happened those Alaskans
weren't able to travel to get care from those physicians. She
asked the sponsor to talk about the balance the bill strikes in
that regard and whether it also allows telemedicine counseling
and mental health appointments to be conducted by an attending
physician who is not licensed in Alaska.
2:15:02 PM
REPRESENTATIVE SPOHNHOLZ replied that constituent's experience
is the reason for the provision in Section 1 of the bill. She
described the work to get stakeholders to agree to this narrow
exception and shared that her focus was to reduce unnecessary
travel while ensuring that Alaska licensees wouldn't bear the
cost of investigations into potential bad actors from out-of-
state. The bill authorizes the State Medical Board to recoup the
costs of those investigations.
She clarified that the bill does not provide an exception for
counseling and behavioral health care via telemedicine when the
provider is not licensed in Alaska. Licensing for the
professionals that typically provide this type of care is
simpler and less time consuming than for medical doctors.
According to the chair of the Psychology Board, it takes about
six weeks to get an Alaska license as a psychologist, whereas
the barrier is higher and it takes a lot longer to become
licensed as a physician in Alaska.
CHAIR COSTELLO asked Pam Ventgen whether the Alaska State
Medical Association supports the current version of HB 265.
2:18:19 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association (ASMA), Anchorage, Alaska, answered yes; ASMA fully
supports the current version of HB 265. ASMA worked closely with
the many stakeholders to craft the narrow language to allow out-
of-state specialists to continue to care for their Alaska
patients via telemedicine.
2:19:52 PM
CHAIR COSTELLO asked the sponsor to talk about the urgency and
timeliness of this legislation, and thus the reason for the
immediate effective date.
REPRESENTATIVE SPOHNHOLZ explained that both DCCED and DHSS
indicated they would be able to implement the legislation within
the 90-day window of an immediate effective date. This will
ensure that Alaskans continue to have access to the care they
have been receiving after the federal public health emergency
expires on July 22, 2022.
SENATOR MICCICHE noted that a constituent who is an optometrist
contacted his office to articulate the concern that the [Board
of Examiners in Optometry] did not feel that all examinations
can take place online via video. He asked how the bill proposes
to address those limited situations.
2:21:38 PM
REPRESENTATIVE SPOHNHOLZ agreed that not all examinations are
appropriate for online. The decision in HB 265 was to provide a
framework for telehealth and leave the regulations for the many
individual license types to the appropriate board because they
have the expertise and understand the scope of practice better
than legislators.
SENATOR MICCICHE summarized that certain procedures could be
excluded from telehealth through regulation.
REPRESENTATIVE SPOHNHOLZ confirmed that was the intention
because it would be too onerous to define every license type by
statute.
CHAIR COSTELLO recognized Christopher Dietrich as the next
person invited to testify.
2:24:40 PM
CHRISTOPHER DIETRICH, Medical Director, Orion Behavioral Health
(OBH), Palmer, Alaska, testified by invitation in support of HB
265. He stated that he is a member of the American Academy of
Physician Assistants and on the board for PAs in Virtual
Medicine and Telemedicine. He opined that from a behavioral
health perspective, HB 265 will break down barriers to patient
care, particularly with controlled substances. OBH has many
patients from rural areas who currently have to travel to the
clinic to meet with a nurse and get medication to maintain their
behavioral health even when they have been taking the medication
for years. The bill will eliminate the need for much of this
travel, make it more likely that patients stay on their
medication, and reduce behavioral health crises. He also spoke
in support of payment parity for care delivered via
telemedicine.
2:27:55 PM
PHILIP LICHT, President and CEO, Set Free Alaska (SFA), Wasilla,
Alaska, testified by invitation in support of HB 265. He stated
that SFA offers substance abuse and mental health services in
both MatSu and Homer. It provides residential and outpatient
care for adults and behavioral health services for children. In
2016, SFA began exploring telehealth as a way to remove
barriers, such as lack of transportation, in an effort to
improve access to care. Individuals who need treatment for
substance abuse often don't have a driver's license, so getting
to an intensive outpatient treatment program several times a
week is extremely challenging. He cited a study from
Massachusetts that found that living more than a mile from their
intensive outpatient treatment center made it significantly less
likely that the client would complete their treatment. Clearly,
not many Alaskans who need treatment live within that critical
radius. When SFA started offering telehealth care they saw a
significant increase in show rates both pre and during the
pandemic. The point is that telehealth increases the likelihood
of successful outcomes for individuals who need substance abuse
and mental health services.
MR. LICHT mentioned payment parity and highlighted that SFA's
experience has been that telehealth is a little more expensive
to provide. Personnel costs and overhead remain the same, but
there has been an increase in costs due to the Zoom subscription
and the technology and hardware that's needed. Internet speed is
critical and it's more practical for each clinician to have dual
monitors so they can have clinical notes on one screen and the
clients on the other. For SFA it is very important that
telehealth appointments are reimbursed at the same rate as in-
person visits.
2:31:55 PM
NANCY MERRIMAN, Executive Director, Alaska Primary Care
Association (APCA), Anchorage, Alaska, provided the following
testimony in support of HB 265:
The Alaska Primary Care Association (APCA) supports
the operations and development of Alaska's 29 Health
Centers (also commonly referred to as Community Health
Centers or Federally Qualified Health Centers). Health
Centers provide comprehensive whole person care, which
includes medical, dental, behavioral, pharmacy and
care coordination services.
APCA and Alaska's Health Centers support HB265 because
it increases access to primary care and behavioral
health services and expands telehealth in Alaska. This
legislation:
? Includes a range of telehealth modalities, including
audio-only, now & into the future
? Allows patients and providers to engage in
telehealth services outside a clinic setting if they
so choose
? Provides adequate reimbursement for telehealth
visits, providing new points of access to whole person
care, including behavioral health and substance use
disorder treatment.
In the most recent year of full reporting, 2020,
Alaska's Health Centers served 105,000 patients
through 450,000 visits delivering medical, dental,
behavioral health, substance use disorder treatment
and other care. Behavioral health and substance use
disorder services are Health Centers' fastest growing
area of service. 40% of these visits were accommodated
via telehealth. In the subspecialty of substance use
disorder services, 45% of visits were via telehealth.
Alaska's Health Centers have weathered many emerging
challenges brought on by the pandemic and APCA
appreciates the actions taken by the Department of
Health Social Services, which have allowed Health
Centers to reach their patients via telehealth.
The temporary telehealth policy changes 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' unique payment
system, called the prospective payment system (PPS).
APCA supports HB265 as this key legislation allows
these temporary telehealth provisions to become
permanent for patients and providers in Alaska.
Health Centers, by definition, serve hard-to-reach
communities. The majority of Health Center patients
experience a range of challenges in accessing health
care that include facing long distances to reach local
providers, cost of care, transportation, language, and
cultural barriers. In Alaska, over half of Health
Center patients are racial/ethnic minorities, a
majority are low-income, and most patients live in
rural communities.
Health Centers can best serve their patient
populations if they have the ability to use technology
to better support their patients. Additionally,
workforce shortages, particularly in the behavioral
health sector, 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 41 percent by audio and 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 stronger continuity of care for patients,
reduced travel costs, has resulted in fewer dropped
visits and a reduction in delayed (and more costly)
care. We understand that delivering quality whole
person care ultimately leads to better health
outcomes, saves lives and in the long run, it saves on
cost.
MS. MERRIMAN urged the committee to support HB 265.
2:35:51 PM
CHAIR COSTELLO opened public testimony on HB 265.
2:36:10 PM
JAYNE ANDREEN, President, Alaska Public Health Association
(APHA), Douglas, Alaska, stated that she was testifying from a
personal perspective as well as on behalf of APHA in support of
HB 265. She shared that she and her husband had to make four
trips to Seattle for care in 2021. This was difficult and time
consuming despite having a good relationship with the out-of-
state provider. On the last trip they spent 10 minutes with the
specialist who said they were following the treatment plan and
that it was too bad the appointment couldn't have been done on
the phone. They left Juneau at 5:30 a.m. that morning and got
back to Juneau that evening at 9:30 p.m.
MS. ANDREEN emphasized that it was critical for Alaska to have a
good telehealth system that maintains Alaska's standards. For
this reason, she wholeheartedly supported HB 265.
2:37:57 PM
LARRY JOHANSEN, representing self, Ketchikan, Alaska, stated
that he was testifying in support of HB 265 because it will save
him money and allow him to receive the health care he needs. He
shared that he was diagnosed with Parkinson Disease 14 years ago
and has been able to keep the symptoms under control with expert
specialty care that is not available in Alaska. Early on he was
told he should move to Seattle, but he loves Alaska and doesn't
want to leave. He was living in Haines late last winter when he
got sick and had to go to Seattle to get the specialty treatment
he needed. He advocated for Alaskans to be able to access the
specialty care they need via telehealth using audio and video
and online computer-aided treatment. He restated his strong
support for HB 265.
2:44:19 PM
CHAIR COSTELLO closed public testimony on HB 265.
2:44:35 PM
SENATOR STEVENS moved to report HB 265, work order 32-LS0754\E,
from committee with individual recommendations and attached
fiscal note(s).
CHAIR COSTELLO found no objection and CSHB 265(FIN) was reported
from the Senate Labor and Commerce Standing Committee.
She thanked the sponsor and her staff for the background work
that was done on the bill and voiced her personal support for
telemedicine for Alaskans.
REPRESENTATIVE SPOHNHOLZ thanked the chair and committee for
supporting the bill and offered to answer any additional
questions.
CHAIR COSTELLO noted that Senator Micciche asked Dr. Rathkopt to
follow up in writing about the cost for her office to provide
telemedicine compared to in-person visits. That information
would be forwarded to the next committee of referral.
REPRESENTATIVE SPOHNHOLZ said she'd make sure the committee
received the information.
HB 306-EXTEND BOARD OF PHARMACY
2:46:30 PM
CHAIR COSTELLO announced the consideration of HOUSE BILL NO. 306
"An Act extending the termination date of the Board of Pharmacy;
and providing for an effective date."
She noted that this was the first hearing and the intention was
to hear the introduction, take invited and public testimony, and
look to the will of the committee.
2:46:49 PM
REPRESENTATIVE ANDI STORY, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 306, introduced the legislation
paraphrasing the following sponsor statement:
House Bill 306 extends the termination date of the
Board of Pharmacy until June 30, 2028. The current
sunset date is June 30, 2022.
The first Alaska Board of Pharmacy was created in
1913. Those provisions were repealed in 1955 and a new
board was enacted with many of the same functions.
The Board of Pharmacy benefits Alaskans by regulating
pharmacies, pharmacists, pharmacy technicians, and
pharmacy interns, and ensuring the practice of
pharmacy is done safely and within the bounds of state
law. Allowing the board to terminate would not be in
the best interest of the state.
The Division of Legislative Audit (DLA) found in their
2021 audit of the Board of Pharmacy that the "board
served the public's interest by effectively conducting
its meetings and actively amending regulations;
however, improvements over the board's licensing
functions are needed." DLA recommended the extension
of the board for six years to reflect "the need for
more timely oversight of the board's evolving role in
combating the public health opioid crisis."
REPRESENTATIVE STORY relayed that the Board of Pharmacy has
seven members, five of which must be licensed pharmacists who
have been actively engaged in the practice of pharmacy in Alaska
for three years immediately preceding their appointment. The
remaining two positions are public members who must not have a
direct financial investment in the health care industry.
2:48:53 PM
REPRESENTATIVE STORY stated that the legislative auditor made
five recommendations.
CHAIR COSTELLO pointed out that the auditor was in the room and
available to discuss the audit.
REPRESENTATIVE STORY responded that she wanted to talk about the
recommendations to improve the monitoring and enforcement of the
Prescription Drug Monitoring Program (PDMP) because it was a
topic during the House committee process.
She explained that while the PDMP is housed in the Board of
Pharmacy, it is just one of six licensing boards that is
responsible for monitoring and enforcing the requirements
related to the PDMP.
REPRESENTATIVE STORY reported that the audit found that at the
time of the audit only the Board of Pharmacy was effectively
monitoring both registration and reporting to the PDMP. She
assured the committee that steps were taken to improve
compliance with the PDMP. The chairs of the six boards and
division staff now meet twice monthly to discuss the ongoing
efforts to improve the shortcomings in the program. She
highlighted that the Department of Health intends to use federal
opioid grant funds to hire a contractor to evaluate the
suggested improvements to the PDMP, which will help the chairs
of the six licensing boards. She said it's important to extend
the Board of Pharmacy so it can continue to protect the health
and safety of Alaska.
CHAIR COSTELLO asked Kris Curtis to present the overview of the
sunset audit for the Board of Pharmacy.
2:52:19 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
Alaska State Legislature, Juneau, Alaska, stated that the audit
concluded that the Board of Pharmacy was serving the public's
interest by effectively conducting meetings and actively
amending regulations, but improvements are needed in the
licensing functions. The audit further concluded that the
Division of Corporations, Business, and Professional Licensing
(DCBPL) staff actively worked to implement the new requirements
of the PDMP database. However, at the time of the audit the
occupational boards were not enforcing or monitoring the
requirement. The audit recommended a six year extension. This is
two years less than the maximum extension, which is a reflection
of the need for more timely oversight of the board's evolving
role in helping the public combat the public health opioid
crisis.
2:53:17 PM
MS. CURTIS directed attention to Exhibit 4 on page 13 that shows
that there were 4,280 active licenses. This includes both
facility and individual licenses and reflects a 14 percent
increase since the last sunset audit in 2017. The increase is
due to three new facility license types.
The board's schedule of revenues and expenditures on page 15
shows a surplus of nearly $800,000 as of January 2021. During
the February meeting, the board discussed, but decided against,
reducing licensing fees because it planned to add a new
licensing examiner position. There was also concern that
establishing a disciplinary matrix of all noncompliance with the
controlled substance prescription database (CSPD) likely would
result in increased investigation expenditures. The schedule of
fees appears on page 14.
MS. CURTIS stated that much of the audit was dedicated to
evaluating the board's changing role in administering the CSPD.
The sunset audit in 2017 concluded that changes in the laws
governing the database would give the board a more active role
in combating the misuse of controlled substances. That audit
recommended just a four year extension to allow the legislature
time to review the board's progress in administering the new
laws.
2:54:56 PM
MS. CURTIS reviewed the information in the audit about the
controlled substance prescription database (CSPD). She
paraphrased the first paragraph on page 5:
Senate Bill 196, passed in 2008, required the Board of
3
Pharmacy (board) to establish and maintain a CSPD. The
law was passed with the intent to improve patient care
and foster the goal of reducing misuse, abuse, and
diversion of controlled substances. The statute
requires each dispenser submit to the board, by
electronic means, information regarding each
prescription dispensed for a controlled substance. The
CSPD electronically collects information from in-state
pharmacies, as well as other dispensers of controlled
substance prescriptions.
MS. CURTIS advised that it soon became clear that the 2008
legislation lacked important authority that prevented the CSPD
from meeting its intent. The law was significantly amended in
2017 and 2018 and those changes affected how the board
administers the database.
2:55:56 PM
MS. CURTIS turned to the report conclusions that begin on page
16. The changes to the database included that licensees from the
six occupational boards that dispense controlled substances are
required to register with the CSPD. Regulations were updated to
require daily reporting of prescription data, and review is
required.
In general, the audit concluded that the changes made the
database more capable of combatting opioid abuse. Implementing
the laws requires the coordination of six occupational boards.
The Board of Pharmacy administers the database and provides
information to the other occupational boards, but each board is
required to enforce and monitor the requirements for their
respective licensees.
As of January 2021, each board had started implementing the
requirements, but none were fully enforcing the requirements.
Exhibit 7 on page 17 summarizes the progress each board had made
to monitor the requirement to register and report to the
database. Only the Board of Pharmacy was monitoring compliance
with both the registration and reporting requirements. Regarding
reviewing the database prior to dispensing, prescribing, and
administering controlled substances, the audit concluded that
none of the boards were monitoring individual licensee
compliance with this requirement. The Board of Pharmacy
Prescription Drug Monitoring Program (PDMP) coordinator does
provide summary information regarding the percent of the
prescribers checking the database for the respective boards but
the summary does not show individual licensee compliance.
MS. CURTIS directed attention to Exhibit 8 on page 18 that shows
that according to a 2021 legislative report of the Alaska
Prescription Drug Monitoring Program, a majority of
practitioners were not checking the CSPD.
The audit also found that enforcement was limited by inadequate
enforcement matrices, which guide a board's resolution of cases.
Board disciplinary matrices did not cover noncompliance with the
CSPD requirements during the audit period. Exhibit 9 on page 20
summarizes the status of the disciplinary matrices as of January
31, 2021. Several board matrices covered the failure to
register, but not failure to report to the board or failure to
review the database.
2:58:49 PM
MS. CURTIS reviewed the provision of unsolicited reports,
paraphrasing the text on pages 20-21:
Statutes authorize the Board of Pharmacy to provide
unsolicited notifications to a pharmacist or
practitioner if a patient has received one or more
prescriptions for controlled substances inconsistent
with generally recognized standards of safe practice.
The term "generally recognized standards of safe
practice" must be defined by the respective boards. At
the time of the audit, the standards had not been
fully defined. Only two of the applicable boards set
prescription limitations in regulation. The State
Medical Board set a limitation of 50 morphine
milligram equivalents (MME) for initial opioid
prescriptions only and the Board of Dental Examiners
set a limitation of 60 MME. (See Recommendation 3)
The Board of Pharmacy may, but is not required to,
send patient-specific utilization notifications to
pharmacists and practitioners. Instead of sending
patient-specific notifications, the PDMP coordinator
provided summary data to applicable occupational
boards as part of standard board reports and to
practitioners as part of prescriber report cards. The
following three metrics, referred to as "clinical
alerts," were provided:
1. Number of patients treated with over 90 and 120
MME;
2. Number of patients treated with dangerous
combinations;
and
3. Number of patients who received controlled
substances from five prescribers, at five pharmacies,
over a three month period.
The process of sending board reports evolved during
the audit period. Not all boards were sent reports on
a routine basis and not all board reports included the
three metrics. Exhibit 10 on page 21 that summarizes
the number of board reports issued during the audit
period and the number of reports that included one or
more of the three clinical alert metrics.
3:00:42 PM
MS. CURTIS described the prescriber report cards, paraphrasing
the text on page 22:
Beginning FY 18, CSPD information, referred to as
Prescriber Report Cards, was provided to prescribing
practitioners. The report cards were intended to give
practitioners the ability to review their prescribing
activity and compare the activity to other
practitioners within the same occupation and within a
specific specialty. Quarterly report cards included:
• the three clinical alerts;
• the prescriber's current prescribing controlled
substance volumes and duration, including comparison
to peers;
• the top three prescribed controlled substances; and
• the number of patients searched in the CSPD.
Exhibit 11 illustrates the number of practitioners who
received a prescriber report card by occupational
board.
MS. CURTIS moved to the findings and recommendations starting on
page 25:
Recommendation No. 1:
The board chair and DCBPL's director should improve
procedures and training to ensure applicants meet
requirements prior to licensure.
MS. CURTIS said the audit found that 20 percent of the 25
facility licenses it tested did not include required regulatory
documentation. By statute, a board may deny a license if an
applicant has been convicted of a crime or has acted in a way
that does not conform to professional standards. To help
evaluate an applicant's professional fitness, the application
asks a series of questions. Division policy is that a supervisor
must review and approve applications of applicants who answered
"yes" to the professional fitness questions. This usually
involves referral to the board's investigative section for
follow up. Three facility applicants answered "yes" to
professional fitness questions, but there was no evidence that a
supervisor either reviewed or referred the application to the
investigative arm for follow up prior to the issuance of the
license.
DCBOL management attributed the facility license errors to
turnover in the licensing examiner position, a lack of training,
and human error.
3:03:08 PM
Recommendation No. 2:
The board should adopt regulations for renewing
outsourcing facilities and third-party logistics
provider licenses.
MS. CURTIS explained that the renewal regulations weren't
changed to reflect the addition when these two new facility
license types were added, so the fix shouldn't be difficult.
Recommendation No. 3:
Applicable occupational boards and DCBPL's director
should continue to coordinate efforts to improve the
monitoring and enforcement of CSPD requirements.
Recommendation No. 4:
The Department of Commerce, Community, and Economic
Development's (DCCED) commissioner should allocate
sufficient resources to ensure licensees holding a
Drug Enforcement Administration (DEA) registration
number are consistently recorded in DCBPL's licensing
database.
MS. CURTIS explained that this is important to ensure the
ability to electronically monitor the requirement to register
with the CSPD.
Recommendation No. 5:
DCCED's commissioner should allocate sufficient
resources to ensure the CSPD requirements are
enforced.
MS. CURTIS noted that the audit found that cases weren't
investigated because of insufficient resources.
3:04:13 PM
MS. CURTIS directed attention to management's response to the
audit on page 47. The DCCED commissioner generally agreed with
the conclusions and recommendations and reported that corrective
action was taken to address several of the deficiencies. She
indicated that training had been provided and procedures
instituted regarding recording the DEA number in the licensing
database.
The response from the Board of Pharmacy is on page 51. The board
chair agreed with the recommendations and said the board had
taken action to address the regulatory deficiency and forwarded
the suggested regulations to DCBPL. The chair also stated that
being able to use the controlled substance prescription database
to identify issues, promote better prescribing practices, and
investigate those who fall outside guidelines requires people
and process, both of which are in short supply. The chair stated
that the board will continue to request resources be dedicated
to the database to combat opioid abuse.
CHAIR COSTELLO asked Board of Pharmacy chair Justin Ruffridge to
comment on the audit.
3:05:44 PM
JUSTIN RUFFRIDGE, Chair, State Board of Pharmacy, Department of
Commerce, Community and Economic Development (DCCED), Soldotna,
Alaska, stated that he agreed with the audit findings, many of
which had been addressed. Processes and people were a work in
progress, but the division was working hard to find and train
personnel. Since the 2017 audit the board has been working to
overhaul outdated regulations and that package had been
delivered to the regulatory specialists for processing. He
reported that the board worked through the pandemic to ensure
that licensing was accessible, that there was emergency access
to medications, and that patients had access to care. The board
has also continued to serve the public by restarting onsite
inspections, reducing license fees, and working on regulations
to support changes in the field of pharmacy.
MR. RUFFRIDGE stated that he was proud of the work the Board of
Pharmacy had done the last few years and he fully supports the
suggested board extension.
CHAIR COSTELLO asked if he had found the Division of
Corporations, Business, and Professional Licensing to be
responsive to the board's needs.
MR. RUFFRIDGE replied that the division is working hard and it
tries to be responsive but it is plagued by budgetary
constraints and hiring difficulties, so the response is slow.
CHAIR COSTELLO expressed appreciation for the candor.
3:08:51 PM
CHAIR COSTELLO opened public testimony on HB 306.
3:09:08 PM
RENEE ROBINSON, President, Alaska Pharmaceutical Association,
Anchorage, Alaska, stated that she had been a practicing
pharmacist in the state for more than 14 years and she supported
HB 306 to extend the Board of Pharmacy. She opined that the
board had done an excellent job the last couple of years to make
significant changes in the profession. She urged the committee
to support HB 306 to keep the board from sunsetting for the next
six years.
3:09:57 PM
CHAIR COSTELLO closed public testimony on HB 306. She found no
questions and solicited a motion.
3:10:04 PM
SENATOR STEVENS moved to report HB 306, work order 32-LS1434\A,
from committee with individual recommendations and attached
fiscal note(s).
CHAIR COSTELLO found no objection and HB 306 was reported from
the Senate Labor and Commerce Standing Committee.
3:10:35 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor and Commerce Standing
Committee meeting at 3:10 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Jody Miller Application_Redacted.pdf |
SL&C 5/2/2022 1:30:00 PM |
GOVERNOR'S APPOINTEES |
| Hannah St. George Application_Redacted.pdf |
SL&C 5/2/2022 1:30:00 PM |
GOVERNOR'S APPOINTEES |
| HB 265 v. E.PDF |
SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Sponsor Statement v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Sectional Analysis v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Explanation of Changes v. W to v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Presentation 04.28.22.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Testimony Received as of 04.28.22.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 306 v. A.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 306 |
| HB 306 Sponsor Statement.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 306 |
| HB 306 Sectional Analysis v. A.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 306 |
| HB 306 Legislative Audit Division Sunset Review BOP 7.15.21.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 306 |
| HB 306 Letters of Support received as of 2.25.22.pdf |
SL&C 5/2/2022 1:30:00 PM |
HB 306 |
| HB 306 Fiscal Note 2360 - DCCED.PDF |
SL&C 5/2/2022 1:30:00 PM |
HB 306 |