HB 358-INSURANCE COVERAGE FOR TELEHEALTH  3:21:17 PM REPRESENTATIVE TARR announced that the first order of business would be HOUSE BILL NO. 358, "An Act relating to insurance coverage for benefits provided through telehealth; and providing for an effective date." 3:21:34 PM BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska State Legislature, paraphrased from the Sponsor Statement [Included in members' packets] [original punctuation provided], which read: HB 358 will enhance access to health care services, primarily mental health and primary care, for Alaskans who have insurance plans with Moda, Premera Blue Cross, United Healthcare, and Aetna Life Insurance, to name a few. HB 358 does this by requiring the insurers previously listed to provide insurance coverage for health care services provided through telehealth. Increasing access to health care services throughout Alaska is crucial. Because of our unique geographical landscape and our rural and aging communities spread out across the state, telehealth can enhance access to health care and improve clinical outcomes. Here are some of the advantages of telehealth: ? Better access and privacy in rural, remote, and urban areas of Alaska ? Early intervention which can lead to savings ? Greater access for referrals to providers who specialize in treating specific health issues ? Better, and potentially quicker, access means a potential reduction in suicides, domestic violence and other serious events ? Zero impact on state budget Under HB 358, telehealth benefits for all covered health care services, including mental health benefits, will be reimbursable for health care providers licensed in the state without an initial in person appointment. Depending on the patient's needs, a telehealth appointment can provide education, reviewing of prescriptions and checking symptoms, all at a distance on a secure system. Health care services delivered via telehealth is happening all over the country, and Alaska is at the forefront of providing telehealth services for urban, rural, aging, and the underserved communities across the state. MS. NISBETT presented the definition of tele-health as it was written in AS 47.05.27(e), and read: the practice of health care delivery, evaluation, diagnosis, consultation, or treatment using the transfer of health care data through audio, visual, or data communications performed over two or more locations between providers who are physically separated from the recipient or from each other or between a provider and a recipient who are physically separated from each other. MS. NISBETT reported that prominent health care organizations in Alaska had stated that tele-health can increase access, an issue recommended by the Alaska Health Care Commission for the Alaska State Legislature to address. She noted that the legislature had passed Senate Bill 74 in 2016, which was primarily a Medicaid reform bill with significant tele-health components. She pointed out that the proposed bill would only impact insurance plans regulated by the Division of Insurance. 3:24:49 PM MS. NISBETT paraphrased from the Sectional Analysis [included in members' packets], which read: Section 1. AS 21.42.422 has been amended to require insurance coverage for benefits provided via telehealth. Section 2. AS 21.42.422 is a new subsection that defines health care insurer as a person transacting the business of health care insurance except for a nonfederal governmental plan. It also adds the definition of telehealth under 47.05.270(e) as the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of health care data through audio, visual, or data communications, performed over two or more locations between providers who are physically separated from the recipient or from each other or between a provider and a recipient who are physically separated from each other. Section 3  The changes to Section 1 of this bill applies to health care insurance plans that are offered, issued, delivered, or renewed on or after the effective date. Section 4  The effective date is July 1, 2019. 3:26:12 PM REPRESENTATIVE SULLIVAN-LEONARD asked if a patient in a rural area would need to see a primary physician prior to the use of tele-health. 3:27:20 PM ANNA LATHAM, Deputy Director, Juneau Division, Division of Insurance, Department of Commerce, Community & Economic Development, offered her belief that, although this had not been addressed in the proposed bill, as the bill read, it was not necessary for an in-person appointment prior to the use of tele- health. REPRESENTATIVE SULLIVAN-LEONARD opined that it was "really important that we do have coverage for our tele-health process and network for patients that don't have access to physicians." She wanted to ensure there was not a gap in the process allowing that someone did not receive the proper oversight from a physician while in a rural area. REPRESENTATIVE TARR noted that this had previously been limited to mental health services, but, was now expanded for all telehealth. MS. LATHAM said that was correct. 3:29:07 PM REPRESENTATIVE SULLIVAN-LEONARD asked to hear from a physician or nurse practitioner for the effect of the proposed bill on their practice. MS. NISBETT, in response to Representative Sullivan-Leonard, explained that providers primarily used telehealth for follow up appointments, consultation, education, and review of prescriptions. However, if a patient in rural Alaska had a serious condition, it was suggested they travel to an urban area to see a doctor. She declared that telehealth was not the initial or primary service of care. REPRESENTATIVE SULLIVAN-LEONARD asked to ensure that everything was covered by the providers. 3:31:39 PM REPRESENTATIVE CLAMAN asked, as the proposed bill restricted telehealth to providers licensed in Alaska, if it would be more difficult to receive telehealth services from mental health providers from out of state. MS. NISBETT asked for clarification. REPRESENTATIVE CLAMAN explained that there were instances in which mental health providers worked with social workers in Alaska to provide person to person counseling services, even though the medication was managed by an out of state provider who only communicated with the patient from afar. He asked if the out of state provider would not receive an insurance payment because they were not licensed in Alaska. MS. NISBETT said that she would research this. 3:33:41 PM REPRESENTATIVE JOHNSTON asked for clarification that there was telemedicine through the Indian Health Service (IHS), and whether this proposed bill would expand service to community members in rural villages not covered by the Indian Health Service. MS. NISBETT replied that this was correct. 3:34:13 PM MS. LATHAM stated that the proposed bill expanded telehealth and removed it from solely mental health benefits, for the individual and small group market, as those markets were regulated by the Division of Insurance. REPRESENTATIVE JOHNSTON asked if this was covered as a Medicaid reimbursement, rather than the IHS. MS. LATHAM offered her belief that, as the IHS was the payer of last resort, a plan in the individual market would cover telehealth benefits. She stated that she was not familiar with the benefits covered under IHS, although her understanding was that it would be covered under both scenarios. 3:35:28 PM REPRESENTATIVE TARR asked if the proposed changes would impact the benefits covered by Medicaid, noting that this proposed bill was for private and group plans. MS. LATHAM explained that the proposed bill only covered plans regulated by the Division of Insurance, which included large groups, small groups, and the individual market. REPRESENTATIVE TARR referenced House Bill 234 in 2016 which did not include a section regarding licensure by the state. 3:36:34 PM REPRESENTATIVE TARR said that HB 358 would be held over.