SENATE BILL NO. 44 "An Act relating to the prescription of drugs by a physician assistant without physical examination." 9:06:43 AM SENATOR CATHY GIESSEL, SPONSOR, explained that the goal of SB 44 was to increase access to medical and behavioral health in the state. She shared that the 2016 Medicaid Reform bill (SB 74) provided for the use of telehealth by revising Alaska statutes to require the Alaska State Medical Board to adopt regulations and guidelines for physicians rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.64.364. She furthered that SB 74 only addressed physicians, and the Board's interpretation was the bill's provisions should not apply to physician assistants (PAs), and issued guidelines outlining different requirements for PAs and physicians. This has effectively barred PAs from practicing telemedicine, requiring them to first conduct in-person examinations. She offered a brief history of the role of PAs. She spoke to a document in members packets that outlined the education and experience required for Pas (copy on file). She relayed that education included taking medical histories, doing physical exams, lab testing, and prescribing medications. She shared that, typically, the education of a PA lasted 27 months, with usual medical rotations: medical and surgical, family and internal medicine, pediatrics, obstetrics, emergency medicine and psychiatry. She said that PAs complete 2,000 hours of supervised clinical practice. Nearly all PAs educational programs were masters degrees and would be required to be so by 2020. 9:10:11 AM Senator Giessel noted the Alaska State Medical Board guidelines for PAs (copy on file). She said that the collaborative practice agreement must be maintained with the PAs physician supervisor. The collaborating physician authorized where the PA could practice and what medications they could prescribe. The agreement also required monthly contact with the supervision physician. She shared that, in Alaska, PAs were authorized to prescribe certain controlled substances. She said that SB 44 would allow the approximately 700 PAs in the state the ability to provide telemedicine in the same manner as physicians. She revealed that prior to SB 74, PAs had been able to provide this function, she lamented that this was a consequence of the passage of that bill. She detailed the available backup that could be found in member packets and online. 9:12:58 AM Senator Shower thought the bill might drive down costs. He asked whether there was potential to lower healthcare costs by providing telemedicine rather than paying for travel. Senator Giessel answered in the affirmative. 9:13:58 AM JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, discussed the Sectional Analysis (copy on file): Section 1:  Amends AS 08.64.101(a)(6) by requiring the board to adopt regulations for a physician assistant practicing telehealth under AS 08.64.364, and that the regulations must use a recognized national model for standards of telehealth care. Section 2:  Amends AS 08.64.364(a) by saying that disciplinary action cannot be directed toward a physician assistant for prescribing drugs via telehealth if the drugs are not controlled substances, if follow up care can be provided from its medical group, and if consent has been given by the patient for care and sharing of records to the primary care provider. Section 3:  Amends AS 08.64.364(b) by saying that a physician assistant may administer botulinum toxin (Botox) if they meet all the requirements set out in 08.64.363 and is supervised by an appropriate licensed health care provider. Section 4:  Amends AS 08.64.364(c) by renumbering and adds that a physician or physician assistant may not prescribe, dispense or administer a prescription drug via an Internet questionnaire or email message without having a prior patient/doctor relationship. Section 5:  Adds an effective date of March 1, 2020 9:16:19 AM Senator Wielechowski asked for the rationale for changing patient to person in Sections 2 and 3. Ms. Conway thought "patient" was medically terminology, while "person" was legal terminology; the drafter chose to use the legal terminology. 9:16:54 AM Senator Shower was curious about Section 3 pertaining to Botox. He asked why botulinum toxin had to be specifically named. Senator Giessel informed that there had been existing statute and believed that because botulinum was a paralytic agent, it had been specifically named. 9:17:56 AM Co-Chair von Imhof addressed Section 5 and asked why the effective date was chosen. Ms. Conway relayed that the sponsor had conferred with Sara Chambers from the Division of Corporations, Businesses and Professional Licensing who had recommended the date. 9:18:40 AM Co-Chair von Imhof OPENED public testimony. CHRISTOPHER DIETRICH, ORION BEHAVIORAL HEALTH NETWORK, PALMER (via teleconference), testified in support of the bill. He provided an overview of his work in the state. He believed that the bill would make it easier for patients to receive adequate treatment, particularly rural patients. 9:20:35 AM Co-Chair von Imhof CLOSED public testimony. Co-Chair von Imhof asked if the committee had further comments. 9:20:57 AM Senator Wielechowski felt that he needed a better understanding of Section 4, (c) (1), and the administration of abortion-inducing drugs. DEBORA STOVERN, EXECUTIVE ADMINISTRATOR, STATE MEDICAL BOARD, ANCHORAGE (via teleconference), addressed Senator Wielechowski's question pertaining to the change from or to and under Section 4. She did not know the answer to the question about changing "or" to "and," and mused that there had been a decision by the bill drafter to assure that both items (1) and (2) would be limited. She added that the limitation already applied to physicians. 9:23:24 AM Senator Wielechowski said that he would research the issue further. Co-Chair von Imhof relayed that her office would assist in answering committee questions. 9:24:02 AM Senator Micciche reviewed FN 1 from DCCED, OMB Component 2360: SB044 adds Physician Assistants (PAs) as authorized practitioners of telemedicine. When the telemedicine bill was passed during a previous Legislature, it was specific to physicians. This bill would expand that authority to physician assistants. If the bill passes the division will require $5.3 to cover legal costs to amend regulations, printing, and postage in the first year. Professional licensing programs within the Division of Corporations, Business and Professional Licensing are funded by Receipt Supported Services, fund source 1156 Rcpt Svcs (DGF). Licensing fees for each occupation are set per AS 08.01.065 so the total amount of revenue collected approximately equals the occupation's actual regulatory costs. SB 44 was HEARD and HELD in committee for further consideration. 9:25:36 AM AT EASE 9:29:52 AM RECONVENED