HB 358-INSURANCE COVERAGE FOR TELEHEALTH  4:48:11 PM CHAIR SPOHNHOLZ announced that the next 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." 4:48:22 PM BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska State Legislature, declared that there had not been any opposition to the proposed bill and she 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. 4:49:44 PM CHAIR SPOHNHOLZ opened invited testimony on HB 358. 4:49:54 PM AROM EVANS, MD, Medical Director, Orion Behavioral Health Network, stated support for the proposed bill, pointing out that telemedicine was an extremely important service for many residents of rural villages as it was not realistic to have a psychiatrist reside in these communities. He pointed out that sometimes private insurance did not pay for telehealth, resulting in difficulties for many patients. He stated that neglect of mental health issues tended to drive up health care costs, and that payment by private insurers for telehealth would save money for the state. 4:53:19 PM REPRESENTATIVE ZULKOSKY asked if the Orion Behavioral Health Network partnered with Alaska providers who had encountered this challenge. DR. EVANS explained that there were Alaska providers in their network and they had encountered difficulties in getting services paid for both in and out of state providers. 4:55:08 PM LYN FREEMAN, Ph.D., Mind Matters Research, declared her support for the proposed bill. She shared some background for her practice, stating that she treated patients who were referred to her with chronic disease and behavioral or emotional issues which contributed to a worsening of the condition. She practiced various forms of integrative approaches, including non-pharmalogical pain management. She reported that about 40 percent of her practice was through tele-health as travel was not possible for these patients. She reported that she had tested her research for psychological interventions for patients with chronic diseases through both live delivery and tele- health, and that improvement outcome was equivalent for both systems of delivery. She shared that she had maintained training for the ethical aspect in the use of telehealth for mental health treatment. She reported that these ethics trainings had pointed out that it was preferable to treat people in your own state as it was easier to know the resources available should something happen during the distance treatments. 4:59:30 PM CHAIR SPOHNHOLZ opened public testimony and after determining no one wished to testify, closed public testimony on HB 358. 4:59:56 PM REPRESENTATIVE EASTMAN asked about the scope of the benefits being provided. 5:00:48 PM CHAIR SPOHNHOLZ, as the sponsor of HB 358, clarified that receiving medical care via telehealth did not mean not seeing a doctor. As telehealth was a delivery system, it was not necessary to limit the scope in the proposed bill. She shared that she did not want to put limits on the creativity of health care providers based on the current ability to imagine what can and cannot be done, and that this would allow the marketplace to develop. 5:01:53 PM REPRESENTATIVE EASTMAN asked if this meant that any benefits a health care insurer provided coverage for should also be covered via telehealth. CHAIR SPOHNHOLZ emphasized that this was intentionally broad, and that this was based on her own experiences for not being able to access health care services via telehealth. This led to the exploration of the concept of telehealth as it related to private insurance. She stated that, as not all health care insurers would currently pay for this, it was time to move in that direction. 5:03:12 PM VICTORIA KNAPP, Chief Operating Officer, Mat-Su Health Services, stated that she was in support of HB 358. She reported that several years ago Mat-Su Health Services had moved to a tele- medicine model for some of their psychiatric evaluations and medication management appointments to meet some of the unmet need for these services in the borough. She declared that they were a safety net provider, funded by the federal government and the Division of Behavioral Health. She shared that, as several large insurance providers in the state did not provide coverage for tele-health services, families and individuals were left with the choice of a very large bill or looking elsewhere for psychiatry services. She declared frustration that these insurers did not cover tele-health psychiatry. 5:05:24 PM REPRESENTATIVE ZULKOSKY moved to report HB 358, Version 30- LS1216\J, out of committee with individual recommendations and the attached zero fiscal notes. 5:05:37 PM REPRESENTATIVE EASTMAN objected. He explained that all his U.S. Department of Veterans Affairs health care through his primary care doctor in Orlando, Florida, was via tele-health. He stated his appreciation for the value, and opined that, although there were cost savings to be gained, the market was not ready for a mandate that any provided health care also be accessible via tele-health. He offered his belief that, if it made financial sense, providers would go that direction. He stated that telehealth was not everything it could be, and that the providers should have the option to not have to use it. 5:07:12 PM REPRESENTATIVE SULLIVAN-LEONARD asked if there was a list of what was approved for telehealth medicine for procedures and oversight for patients. 5:07:39 PM MS. NISBETT said that there was a list of procedures on the Alaska Native Medical Center website that were accepted. CHAIR SPOHNHOLZ pointed out that this was a different category. 5:08:16 PM ANNA LATHAM, Deputy Director, Division of Insurance, Department of Commerce, Community & Economic Development, clarified that the proposed bill allowed for insurance companies to pay for telehealth services in both the group and individual markets. She stated that the benefits that were already in the plans for essential health benefits, as well as any other benefits covered by the plan, would be allowable for telehealth. She stated that the list of benefits for the Alaska Native Health plans was a separate program. 5:09:06 PM REPRESENTATIVE ZULKOSKY asked whether the proposed bill mandated that an individual utilize telehealth services, or whether it just provided the authorization for the insurance plans to be billed for those services. MS. LATHAM replied that there was not a mandate, that it allowed the insurance companies to cover telehealth services beyond mental health, which was currently in statute. 5:09:37 PM REPRESENTATIVE EASTMAN asked whether a current benefit from a health care plan would now also be provided as a telehealth option. MS. LATHAM explained that, with the proposed bill, the insurer can pay if you utilize telehealth. 5:10:11 PM REPRESENTATIVE EASTMAN asked about the definition of shall in this specific context. 5:10:32 PM MS. LATHAM explained that the proposed billed stated that the insurers shall provide coverage for benefits provided through telehealth. This may or may not require in-person contact. This proposed bill simply allowed large, small group, and individual market coverage to pay for telehealth services. CHAIR SPOHNHOLZ asked for clarification that the proposed bill was not requiring people to use telehealth, but it was requiring insurance companies to cover telehealth services should the plan have a provision for such services. She acknowledged that there were some services which did not make sense for delivery via telehealth. She pointed out that there were a lot of insurance plans offered in the State of Alaska which were not required to cover telehealth. She stated that this bill was not saying what kind of health care should be covered by telehealth, it was saying that the insurance provider should pay for the service if it was delivered via telehealth. 5:12:41 PM REPRESENTATIVE EASTMAN asked where he could go to find out what services were available by telehealth. He asked if one insurer decided to provide a benefit via telehealth, did all the other insurers need to match. CHAIR SPOHNHOLZ said that was a decision between him and his health care provider. 5:13:21 PM REPRESENTATIVE EASTMAN maintained his objection. 5:13:27 PM A roll call vote was taken. Representatives Spohnholz, Tarr, Sullivan-Leonard, Johnston, Zulkosky, and Kito voted in favor of HB 358. Representatives Eastman voted against it. Therefore, HB 358 was reported out of the House Health and Social Services Standing Committee by a vote of 6 yeas - 1 nay.