Legislature(2021 - 2022)BELTZ 105 (TSBldg)
09/08/2021 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB3006 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB3006 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
September 8, 2021
1:33 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Joshua Revak, Vice Chair
Senator Peter Micciche
Senator Gary Stevens (via Teams)
Senator Elvi Gray-Jackson (via Teams)
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 3006
"An Act relating to utilization review requirements; making
temporary changes to state law in response to the novel
coronavirus disease (COVID-19); relating to telemedicine and
telehealth; relating to background checks; and providing for an
effective date."
- MOVED CSSB 3006(L&C) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB3006
SHORT TITLE: HEALTH CARE REQS; COVID-19; TELEHEALTH
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
09/02/21 (S) READ THE FIRST TIME - REFERRALS
09/02/21 (S) L&C
09/07/21 (S) L&C AT 1:30 PM BUTROVICH 205
09/07/21 (S) Heard & Held
09/07/21 (S) MINUTE(L&C)
09/08/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
ADAM CRUM, Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Provided opening comments during the second
hearing on SB 3006.
JARED KOSIN, President and CEO
Alaska State Hospital and Nursing Home Association (ASHNHA)
Anchorage, Alaska
POSITION STATEMENT: Answered questions and provided information
related to SB 3006.
RENEE GAYHART, Director
Division of Health Care Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Commented on Amendment 2 and reviewed the
DHSS fiscal note for SB 3006.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions related to SB 3006.
KATHRYN MONFREDA, Director
Division of Statewide Services
Department Public Safety
Anchorage, Alaska
POSITION STATEMENT: Discussed the DPS fiscal note for SB 3006.
ACTION NARRATIVE
1:33:28 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:33 p.m. Present at the call to
order were Senators Micciche, Stevens (via Teams), Revak, Gray-
Jackson (via Teams) and Chair Costello.
SB3006-HEALTH CARE REQS; COVID-19; TELEHEALTH
1:34:20 PM
CHAIR COSTELLO announced the consideration of SENATE BILL NO.
3006 "An Act relating to utilization review requirements; making
temporary changes to state law in response to the novel
coronavirus disease (COVID-19); relating to telemedicine and
telehealth; relating to background checks; and providing for an
effective date."
CHAIR COSTELLO listed the individuals who would provide
testimony or were available to answer questions, and asked
Commissioner Crum to offer any additional comments on SB 3006.
1:36:27 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services (DHSS), Anchorage, Alaska, expressed appreciation for
the hearing and said he looked forward to the conversation about
the bill and the amendments, which he and the chair had
discussed earlier.
CHAIR COSTELLO asked Jared Kosin to provide information that
would set the stage and provide context for the legislation.
1:37:25 PM
JARED KOSIN, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNHA), Anchorage, Alaska, advised
that he would start by responding to the questions that were
asked yesterday. After that he would make observations about
COVID-19 hospital volumes compared to the December 2020 peak,
and conclude by addressing why SB 3006 will help.
MR. KOSIN addressed the four questions the committee asked
during the previous hearing.
1. How many hospitals are in Alaska?
Alaska has 26 hospitals: 13 critical access hospitals, 5
sole community hospitals, 3 general acute care hospitals,
and 5 specialty hospitals, 2 of which are military
hospitals. He said it should be noted that 8 of these
hospitals are run by a robust tribal health system.
2. How many hospital beds are in Alaska?
Alaska hospitals have 1,500 acute care beds, including
about 160 intensive care unit (ICU) beds. Due to Alaska's
unique geography, approximately 21 percent of the acute
care beds are not accessible from the road system. To
provide context for this figure, he said the national
average is 2.5 acute care beds per 1,000 people. If
military hospitals, psychiatric hospitals, and specialty
hospitals are not counted, Alaska has about 2.0 acute care
beds per 1,000 Alaskans.
3. Are people currently being turned away from hospitals?
No; hospitals are subject to federal Emergency Medical
Treatment and Labor Act (EMTALA), which means they have a
legal duty to treat all individuals who present at a
hospital emergency room. No patients have been turned away
but there is the possibility that care could be rationed,
as is happening in northern Idaho hospitals.
4. What is staffing capacity?
Staff capacity reflects the number of beds that can be
filled at any one time. A hospital could have 500 beds, but
if there is only enough staff to care for 50 patients, the
capacity of the facility at that point is 50 beds.
Throughout the pandemic, staffing has been the limiting
factor on hospital capacity, not the physical number of
beds.
MR. KOSIN asked if there were any questions.
1:41:31 PM
SENATOR MICCICHE asked for the current magnitude of staffing
shortages and how much is related to COVID-19.
MR. KOSIN replied staffing is the largest issue inside these
facilities. For example, two weeks ago ASHNHA issued an emergent
request for staffing from member facilities to share with DHSS
to support efforts to get help from the federal government. A
mix of 17 hospitals and nursing homes responded and requested
support to fill approximately 450 positions, most of which were
for nurses and certified nursing assistants. He said testimony
from hospital operators over the last few months also
demonstrates the critical nature of staffing shortages. They
have repeatedly highlighted that strain on staff and shortages
is the number one issue right now.
MR. KOSIN said some of the current COVID statistics provide even
more clarity. On September 6, 182 Alaskans were in the hospital
with COVID-19. This is 52 percent more than a month ago and 21
percent higher than the hospitalizations during the December 5,
2020 peak. As the COVID-19 population increases, staff must
focus on fewer patients because COVID-19 patients are much more
complex. When these patients end up on ventilators, staffing
capacity is further reduced. According to clinical staff at some
facilities, a patient who ends up on a ventilator and does not
pass away within the first seven days, may be in that bed in the
ICU for 21-28 days. Not only is there a surge in the number of
COVID-19 patients, COVID-19 patients also stay longer and tie up
the hospital's assets and staffing.
MR. KOSIN recounted that one month ago, 14 percent of the adults
in a hospital had a COVID-19 diagnosis. During the December 2020
peak, that number was 18 percent. Today, 22 percent of the
hospital population has COVID-19, and half of the 182 COVID-19
hospitalizations are in Anchorage. During the December 2020
peak, 61 percent of the COVID-19 patients were in Anchorage.
This means there are a significant number of complex COVID-19
patients in outlier facilities, primarily MatSu Regional,
Fairbanks Memorial, and Central Peninsula Hospital. Those
facilities account for close to 40 percent of hospitalizations
statewide.
1:49:02 PM
MR. KOSIN said his last observation is about the meaning of
staffing capacity. On September 6 occupancy at Anchorage
hospitals was about 91 percent with two of the three hospitals
showing no beds available. The ICU occupancy was 95 percent, but
that did not include the 12-18 patients in the emergency room
waiting for a bed on the hospital floor. Practically speaking,
he said these hospitals have been running at or above 100
percent occupancy for some time. He said Central Peninsula
Hospital put out a graphic last week showing it was running at
120 percent occupancy when all the people in the emergency room
waiting for a bed were factored.
MR. KOSIN said staff cannot keep up at these levels and this
does not consider days off, vacation, burnout, and people
exiting markets for other reasons. The fact that about half the
ASHNHA facilities have requested help to fill more than 400
positions to support the current surge, and occupancy levels are
what they are, staffing is unquestionably the largest problem.
He asked if there were questions before he briefly discussed SB
3006.
CHAIR COSTELLO determined there were no questions and asked him
to continue.
1:51:28 PM
MR. KOSIN shared that a director of an emergency department
cries on the way to and from work to be able to be strong for
the staff during the workday. In another facility, the ICU
directors are all in counseling because they have witnessed the
deaths of so many young, health, vibrant people. He said the
obvious answer going forward is to hit the peak, but nobody
knows when that will be. Some hospital operators feel this will
be around at significant levels for a month or two, particularly
in the hospital environment. He said the second thing that can
help is any and all resources around staffing. He thanked
Commissioner Crum and his team for trying to procure staff from
federal contracting agencies; it means a lot to his facilities.
1:54:00 PM
MR. KOSIN said he views SB 3006 as a series of one-off tools
that can make the current situation a little easier. He
described the background check provision as the most important
tool in the bill because the 10-15 business days to turn around
a background check is not feasible when facilities have such a
need for clinical and non-clinical staff. He pointed out that if
there is a shortage of environmental service workers to clean a
room after somebody is discharged, that bed is not available.
The longer it takes to make that bed available, the bigger the
bottleneck. He said eliminating the duplicative processes for
background checks will save time.
1:57:04 PM
MR. KOSIN said SB 3006 also reinstates telehealth and that is a
win-win from the standpoint of preventing spread of the virus.
It also potentially paves the way to restart in-home patient
monitoring, which is a program Providence Alaska Medical Center
ran. It saves beds when patients do not have to enter the acute
care setting.
MR. KOSIN said SB 3006 also suspends the utilization review.
This has to do with prior authorization before a service is
provided to a patient, and it can be a real barrier. He opined
that waiving this requirement provides an opportunity for more
efficient patient throughput. For example, it can take days to
get authorization for a patient to be discharged from the
hospital into a nursing home. He said this provision provides a
tool that will help the department and the Division of Insurance
speed the process along and free up the acute care bed.
MR. KOSIN concluded that SB 3006 provides a practical toolkit
that ASHNHA believes will be very helpful.
1:59:03 PM
CHAIR COSTELLO thanked him for connecting the dots as to how SB
3006 will help. She described the comments about the background
checks as helpful and expressed appreciation that he clarified
that the telemedicine provisions in the bill are a very small
slice of the topic of telemedicine. Alaska already has
telemedicine statutes in place and the telehealth provisions in
this legislation relate specifically to health care providers
who are not in this jurisdiction. These provisions accommodate
Alaskans who do not want to have to travel to receive care from
their health care providers who reside outside the state.
2:00:32 PM
SENATOR STEVENS said it is tangential but he would like Mr.
Kosin to comment on mandatory vaccinations to work in hospitals
because he is hearing from constituents who are very upset and
threatening to leave.
CHAIR COSTELLO responded that is not addressed in SB 3006, but
she too has constituents who have expressed concern about
mandatory vaccinations to keep a job. She asked Mr. Kosin if he
was aware of the issue.
2:01:28 PM
MR. KOSIN replied the federal government currently requires
health care workers in nursing homes to be vaccinated, and that
order is in the process of being implemented. He noted that some
facilities are also taking independent steps to align their
vaccine protocols with measures like the flu vaccine. He
acknowledged that it is a tense issue, but said ASHNHA members
have not expressed concern to date about potentially losing
staff because of a vaccination mandate.
SENATOR STEVENS thanked the chair for allowing the discussion.
CHAIR COSTELLO said she was not sure this was the legislation to
address the issue but she would be happy to look at it together
if he wanted to move forward.
2:03:56 PM
At ease to distribute amendments.
2:06:26 PM
CHAIR COSTELLO reconvened the meeting and advised that she had
four amendments for the committee to consider.
2:07:02 PM
SENATOR MICCICHE moved Amendment 1, work order 32-GS3384\A.2.
32-GS3384\A.2
Fisher
9/8/21
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR COSTELLO
TO: SB 3006
Page 2, line 28, through page 3, line 2:
Delete all material.
Reletter the following subsection accordingly.
SENATOR REVAK objected for discussion purposes.
2:07:24 PM
CHAIR COSTELLO advised that Amendment 1 deletes subsection (c)
in bill Section 3. She said it gives the commissioner the broad
authority to "waive any state law or regulation if compliance
would substantially prevent or impede the provision of health
care services under this section." yet it was not even mentioned
in the sectional analysis the committee heard yesterday and it
is not in the title.
She asked Commissioner Crum to tell the committee whether he
supports Amendment 1, what powers and authorities he has now,
and how it will affect his ability to address COVID-19 if it
were removed from the bill.
COMMISSIONER CRUM stated support for Amendment 1, saying it gets
rid of superfluous language that does not affect the intent of
the section.
SENATOR MICCICHE asked if he already has some ability to waive
certain regulations if they are impeding the delivery of health
care.
COMMISSIONER CRUM answered that HB 76 granted the commissioner
public health emergency powers and he has used but at this point
he wanted to make sure that the state powers align with the
federal standard under Appendix K of the Centers for Medicare
and Medicaid Services (CMS) 1135 Waiver. He said inserting the
suspension of statute seemed like the easiest way to do that.
2:10:43 PM
SENATOR REVAK withdrew his objection.
2:11:26 PM
CHAIR COSTELLO found no further objection and Amendment 1
passed.
2:11:43 PM
SENATOR MICCICHE moved Amendment 2, work order 32-GS3384\A.5.
32-GS3384\A.5
Fisher
9/8/21
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR COSTELLO
TO: SB 3006
Page 2, line 7:
Delete "beginning from the effective date of this
Act and until July 1, 2022,"
Page 2, lines 28 - 29:
Delete "beginning from the effective date of this
Act and until July 1, 2022,"
Page 3, lines 7 - 12:
Delete all material and insert:
"BACKGROUND CHECKS; APPLICABILITY.
Notwithstanding any other provision of law, a hospital
or nursing facility may employ a person without
obtaining a background check from the Department of
Health and Social Services if the hospital or nursing
facility
(1) provides sufficient information to the
department attesting to the hiring process for each
person employed at the facility and confirms that a
background check has been conducted as part of the
hiring process; and
(2) not later than July 1, 2022, obtains a
background check from the Department of Health and
Social Services for each person hired by the hospital
or nursing facility between the effective date of this
Act and July 1, 2022.
* Sec. 5. Sections 3 and 4 of this Act are repealed
July 1, 2022."
Renumber the following bill section accordingly.
2:11:55 PM
SENATOR REVAK objected for discussion purposes.
2:12:03 PM
CHAIR COSTELLO explained that Amendment 2 clarifies that a
hospital or nursing facility initially may employ a person
without obtaining a background check from DHSS, but the
department must come back and process a full background check
for those individuals by July 1, 2022.
She asked Renee Gayhart to comment on the intent of Amendment 1.
2:14:13 PM
At ease
2:16:13 PM
CHAIR COSTELLO reconvened the meeting.
2:16:54 PM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health and Social Services (DHSS), Juneau, Alaska,
stated support for Amendment 2. She confirmed that the
department would process the full background check for
individuals hired during this time and have those completed by
July 1, 2022.
CHAIR COSTELLO restated what Amendment 2 would do.
2:17:57 PM
SENATOR REVAK removed his objection.
2:18:07 PM
CHAIR COSTELLO found no further objection and Amendment 2
passed.
2:18:13 PM
SENATOR MICCICHE moved Amendment 3, work order 32-GS3384\A.4.
32-GS3384\A.4
Fisher
9/8/21
AMENDMENT 3
OFFERED IN THE SENATE BY SENATOR COSTELLO
TO: SB 3006
Page 2, following line 14:
Insert a new paragraph to read:
"(2) the health care provider or the
employer of the health care provider obtains a
business license under AS 43.70.020 and pays the
required fee under AS 43.70.030;"
Renumber the following paragraphs accordingly.
Page 2, line 26:
Delete "(a)(3)"
Insert "(a)(4)"
SENATOR REVAK objected for discussion purposes.
CHAIR COSTELLO explained that Amendment 4 requires out-of-state
telehealth providers who are not licensed in Alaska to obtain a
business license. She asked Ms. Chambers if this requirement
would be cumbersome for the telehealth providers.
2:19:19 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, advised that
existing state law requires health care providers to have a
business license and register with the Telemedicine Business
Registry. Amendment 3 would not change the existing requirement.
2:19:55 PM
CHAIR COSTELLO withdrew Amendment 3.
2:20:03 PM
At ease
2:20:08 PM
CHAIR COSTELLO reconvened the meeting and solicited a motion.
2:21:17 PM
SENATOR MICCICHE moved to report SB 3006, work order 32-GS3384\A
as amended, from committee with individual recommendations and
attached fiscal note(s).
CHAIR COSTELLO asked if there was objection to moving the bill.
2:21:50 PM
SENATOR GRAY-JACKSON asked what happened to the last amendment.
CHAIR COSTELLO replied it was not offered.
2:22:03 PM
SENATOR STEVENS said he had questions about the fiscal notes
that he would like to be addressed before the bill moves.
CHAIR COSTELLO asked Renee Gayhart to speak to the DHSS fiscal
note.
2:22:52 PM
MS. GAYHART advised that the DHSS fiscal note reflects delayed
revenue based on projections from previous fiscal years. On
average, 4,800 applications come through the system for
hospitals and nursing homes and each applicant is charged $88.25
for the background check. DHSS takes $40.00 as a processing fee,
which amounts to $192,000 for the department. The remaining
$48.25 per application goes to the Department of Public Safety
(DPS).
SENATOR STEVENS asked if the revenue would be delayed to 2023.
MS. GAYHART said she should back up and clarify that it is a
zero fiscal note. The numbers are an estimate based on previous
fiscal years and the delayed revenue will start to come in once
the department restarts the background check process.
2:26:16 PM
SENATOR MICCICHE observed that the delayed revenue could be
either higher or lower than the $192,000 projection depending on
how many applications actually come in.
MS. GAYHART agreed that the revenue would depend on the number
of applications that come through. She reiterated that 4,800
applications was an estimate based on previous fiscal years. She
described the figure as well within the mark.
CHAIR COSTELLO asked Kathryn Monfreda to talk about the
Department of Public Safety (DPS) fiscal note.
2:27:01 PM
KATHRYN MONFREDA, Director, Division of Statewide Services,
Department Public Safety, Anchorage, Alaska, stated that the DPS
fiscal note is based on the DHSS estimated numbers. However,
passage of Amendment 2 [A.5] means the background checks will be
completed before the end of the fiscal year so the delayed
revenue will be realized in FY2022. She opined that the fiscal
note should be revised to make it truly zero and remove the
discussion about it being indeterminate with $177,600 in delayed
revenue.
2:28:23 PM
CHAIR COSTELLO found no further objection and CSSB 3006(L&C) was
reported from the Senate Labor and Commerce Standing Committee
2:29:27 PM
There being no further business to come before the committee,
Senator Costello adjourned the Senate Labor and Commerce
Committee meeting at 2:29 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 3006 Fiscal Note DHSS.pdf |
SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Fiscal Note DPS.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - ASHNHA.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - Providence.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - AK Native Health Board.pdf |
SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - Teledoc Health.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.2.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.3.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.4.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.5.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - ASMA.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |