SB 83-TELEHEALTH REIMBURSEMENT RATES  4:30:31 PM CHAIR DUNBAR reconvened the meeting and announced the consideration of SENATE BILL NO. 83 "An Act relating to health care insurance; relating to insurance reimbursement for health care services provided through telehealth; and providing for an effective date." 4:32:01 PM CHAIR DUNBAR solicited a motion. 4:32:04 PM SENATOR GIESSEL moved to adopt the committee substitute (CS) for SB 83, work order 34-LS0413\I, as the working document. 4:32:15 PM CHAIR DUNBAR objected for purposes of discussion. 4:32:24 PM ARIELLE WIGGIN, Staff, Senator Forrest Dunbar, Alaska State Legislature, Juneau, Alaska, provided the summary of changes for SB 83 from version N to I. [Original punctuation provided.] Senate Bill 83  Explanation of Changes Version N to Version I (CS- SHSS)   This version of SB 83 moves multiple sections that had been added to or referred to a new section in Version N (AS 21.42.450) into the existing statute covering telehealth (AS 21.42.422) and makes conforming changes. This version adds a requirement for health care insurers to equally apply reimbursement rates for each health care provider. Title Change Expanded to include "relating to health care insurance reimbursement rates" on account of new language in Section 3. Section 1 (new section) AS 21.42.422(b). Coverage for telehealth. Adds new paragraph (3) to reference the definition of "health care provider" as given in AS 21.07.250. Section 2 Prior version Section 1 language is moved from AS 21.42.450 to existing statutes covering telehealth, AS 21.42.422. Prior version Section 2 removed: referenced definition of "telehealth" as given in AS 47.05.270. Section 3 (new section) AS 21.54.190. Reimbursement rates. Requires health care insurers to equally apply reimbursement rates for each health care provider. Section 4 (prior version Section 3) Section 5 (prior version Section 4; updates telehealth reference AS 21.42.422) Section 6 (prior version Section 5; updates telehealth reference AS 21.42.422) Section 7 (prior version Section 6; updates telehealth reference AS 21.42.422) Prior version Section 7 removed: repealed definition of "telehealth" in AS 21.42.422 Section 8 (no change) 4:34:55 PM SENATOR GIESSEL said Section 3 of CSSB 83 was her amendment requiring uniform and equal pay for health care providers under Current Procedural Terminology (CPT) codes, so if the service is the same, the pay is equitable and uniform. She stated this results in no change to the zero fiscal notes. 4:35:35 PM CHAIR DUNBAR sought confirmation that the change achieves the intended purpose. SENATOR GIESSEL replied yes. 4:35:42 PM CHAIR DUNBAR removed his objection, found no further objection and CSSB 83 was adopted as the working document. 4:36:08 PM SENATOR HUGHES said that, according to Ms. Wing-Heier, insurance companies are paying parity. She stated her understanding that during COVID, under Medicaid laws, parity was provided with a sunset date in 2030, and insurance companies typically follow Medicaid's model. She referenced a provider who testified she only received 60 percent of what she would for an in-person [visit], which conflicted with Ms. Wing-Heier's testimony. She asked for an update on whether insurance companies are already paying parity and, if so, expressed reservations about the mandate. She said she viewed telehealth as a way to reduce health care costs. She acknowledged the sponsor's point that frequent provider visits can improve patient outcomes and reduce long-term costs, however, she suggested compromise is needed. 4:38:25 PM SENATOR CLAMAN deferred the question. 4:38:49 PM HEATHER CARPENTER, Deputy Director, Division of Insurance, Department of Commerce, Community, and Economic Development, Juneau, Alaska, answered questions on SB 83, stated that the Medicaid legislation referenced was House Bill 265, passed in 2022. She clarified that the 2030 sunset applied only to Medicaid. She confirmed that insurers are generally paying at parity. Moda reported paying at parity, and Premera stated it follows Centers for Medicare and Medicaid Services (CMS) guidelines, meaning payment depends on the patient's location, which often results in parity, but not when the location is somewhere other than the patient's home location. 4:40:11 PM SENATOR HUGHES asked if the testimony from the provider who said she only received 60 percent meant that payment was based on location, even though the location was in-state. 4:40:30 PM MS. CARPENTER replied that it depends on who the payor was. She said the Division of Insurance only oversees about 15 percent of the health insurance market. 4:41:26 PM SENATOR HUGHES asked if SB 83 became law, would the federal payors have to follow the law. She commented that 15 percent of payors are currently paying at parity voluntarily. She asked would the remaining 85 percent not regulated by the Division have to comply if SB 83 became law. MS. CARPENTER stated that SB 83 does not direct Medicaid or Employee Retirement Income Security Act (ERISA) plans, except that it does target AlaskaCare through SB 83, Sections 6 and 7. She added that it also applies to two municipal plans under Sections 4 and 5. SB 83 currently impacts the Division of Insurance under AS 21. She directed the committee's attention to Section 3, addressing Senator Giessel, and acknowledged understanding her intent. However, she explained that the way the drafter wrote it limits application to group insurance coverage only, meaning it would not apply to all plans. It would not affect plans in the individual market. She offered to suggest alternatives to better achieve the intended policy goals. 4:42:48 PM SENATOR HUGHES asked if, based on the way SB 83 is drafted, it covers the 15 percent regulated by the Division, AlaskaCare, and any plans provided by municipalities in the state, but not the 85 percent outside the Division's authority. 4:43:04 PM MS. CARPENTER replied that is the Division understanding. 4:43:15 PM SENATOR HUGHES said that, for the provider who was reimbursed at 60 percent, it could be that the payer was one to which SB 83 would not apply. She reiterated her reservations regarding the potential for telehealth to reduce health care costs and expressed a preference for a compromise. However, she stated she was not objecting to adopting the SB 83 and was fine with it moving out. 4:43:47 PM SENATOR GIESSEL said she believes everyone supports reducing the cost of health care, but not at the expense of underfunding providers who are trying to maintain clinics. She stated the purpose of the amendment is to enforce parity of pay. Currently, nurse practitioners and physician assistants are not reimbursed at the same rate as physicians for the same CPT codes and services. 4:44:24 PM SENATOR HUGHES said she agreed with Senator Giessel and clarified that her concern is the payment amount for a telehealth visit compared to an in-person visit, noting that seeing more patients reduces overhead costs. She stated that a nurse practitioner providing the same service as a physician should be reimbursed at the same rate. 4:45:02 PM At ease. 4:46:03 PM CHAIR DUNBAR reconvened the meeting and held SB 83 in committee. 4:46:32 PM SENATOR CLAMAN stated that Senator Hughes raised interesting points about the cost of care but stated his belief that her analysis viewed the issue too narrowly, focusing only on the cost comparison of a single telehealth and in-person visit. He argued that a broader economic perspective, including overall medical costs, shows that her analysis does not hold up. He cited repeated evidence of cost savings and improved access through telehealth. He added that the strongest indicator of telehealth's value is the lack of opposition from insurance companies, who support the legislation because it reduces overall insurance costs. He concluded that while Senator Hughes's view may be accurate within a narrow scope, the larger picture shows telehealth improves access, keeps patients healthier, and benefits both employers and insurers through long-term savings.