SB 78-HEALTH CARE SERVICES BY TELEHEALTH  2:37:07 PM CHAIR WILSON announced the consideration of SENATE BILL NO. 78 "An Act relating to telehealth." He asked Senator Costello and her staff to the table. 2:37:40 PM KATIE MCCALL, Staff, Senator Mia Costello, Alaska State Legislature, Juneau, Alaska, said that in January 2021, Governor Dunleavy asked the legislature to extend the public health disaster emergency with the passage of SB 56, a comprehensive bill with numerous provisions. The legislature instead passed a resolution asking the governor to issue a new emergency disaster declaration as there was not enough time for SB 56 to go through the legislative process before the expiration of the emergency disaster declaration in effect at the time. In the meantime, the legislature has taken individual sections from the governor's bill and created separate legislation to address different provisions. SB 78 was taken directly from Section 6 of the governor's bill to address telehealth expansion. The purpose of introducing this bill is to give the legislative branch the opportunity to determine whether statutes should be more COVID aware rather than rely on an emergency disaster declaration in order to keep the state operational. The Senate Labor and Commerce Committee intends to rely heavily on the administration to explain why certain sections in the disaster extension bill, such as the provisions now found in SB 78, are necessary. The Senate Labor and Commerce Committee has no position on this bill. The committee is introducing it as a courtesy to the administration due to the expiration of the disaster declaration and provisions in the bill have no way to continue. 2:39:52 PM SENATOR COSTELLO explained that this is one of several pieces moving through the process and that her office has been working with the committee chair, administration, and Director Sara Chambers in the Department of Commerce, Community and Economic Development (DCCED,) in addition to stakeholders. Changes can be made to the bill to address temporary needs of the state and long-term changes to make statutes more COVID aware. The committee will probably hear testimony today in opposition to this version of the bill, but she is hopeful that based on her conversations with the stakeholders and the administration that the bill can be crafted to meet the needs of the state as it moves into the recovery stage of the pandemic. The chair has also introduced a measure that has passed the Senate that makes some laws more COVID aware. 2:41:17 PM SENATOR BEGICH noted that the bill has no effective date or expiration. He asked if that is intentional. MS. MCCALL replied that the chair of this committee and of the Senate Labor and Commerce Committee, [Senator Costello], discussed adding a sunset date to the bill. If providers from out of state never become licensed in the state, they can continue to practice telehealth as long as the bill is in effect. A sunset date would not allow those services to continue indefinitely. SENATOR BEGICH said that without an effective date, the bill would take effect 90 days after the end of the session. MS. MCCALL replied that is something to look at changing. SENATOR BEGICH pointed out that without an expiration date, there will be a loss of professional licensing fees for the state of Alaska. He asked if there had an analysis of that and any other impact that it would have on licensed Alaskan residents. 2:43:17 PM SENATOR COSTELLO replied that the governor's disaster declaration stated that there would be no changes to licensing fees. The administration intention would be no changes or impacts to the fees with the disaster declaration, but the fees are directly related to activities that have to be pursued by the licensing board. She had a concern about that. This is a good opportunity for the administration to explain its rationale for that. She understands that some Alaskans who have traveled outside the state for care. For example, one person's daughter has cancer. With the ability to travel curtailed by COVID, the parent wants to continue to see that provider who is out of state. Not many Alaskans are affected by this provision, but enough Alaskans are that it is necessary to allow that continuum of care to continue. It would make sense for the bill to become effective immediately with a sunset date so that it can be reviewed. She does not know what the impact will be on licensure, but perhaps Sara Chambers does. 2:44:55 PM SARA CHAMBERS, Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Juneau, Alaska, said her agency submitted an indeterminate fiscal note because the bill as written would change policy permanently and has no sunset date. Her agency could not determine the loss of revenue to self- funded boards. This is potentially a short-term bill in this season of COVID, so there is less concern about the fiscal impact. It is focused on a smaller constituency and not a long- term change to do away with licensing for all telemedicine. As the bill is written now, the fiscal note is indeterminate, but it would create a loss of revenue. SENATOR REINBOLD said that SB 56 is a big bill. It is amazing that Senator Costello pulled this section out to work on independently. She thanked Senator Costello for that. The legislature has worked on telehealth in the past and worked hard with physicians on Alaskan preference for telehealth. That is important. She supports telehealth but there is nothing like meeting someone in person. She wants sidebars on that. She wants to review the committee discussion on SB 56 and work on amendments. SENATOR HUGHES asked if this applies to behavioral health as there are a lot of mental health needs right now. Telehealth has been the platform for that during the pandemic. For some families in rural areas, it could still be helpful even when there is not a pandemic. She asked if the bill covers a variety of provider types, including behavioral health providers. 2:48:38 PM MS. MCCALL replied that the bill does not specifically address behavioral health providers, but the topic came up in a meeting with the administration. Department of Health and Social Services (DHSS) mentioned that federal public health addresses that issue. CHAIR WILSON said that through federal regulations, behavioral health is covered in the federal disaster declaration, so their guidance for telehealth and some of the waivers will continue. The department has assurance from the Biden administration that that will continue through the end of calendar year 2021. His office has been working on that. It is clear that behavioral health is covered. SENATOR HUGHES thanked the chair for looking into that. Because of Alaska's geography and how spread out the state is, it is important that behavioral health providers continue to provide services through telehealth. She asked if anyone is working on that for once the federal disaster declaration ends. CHAIR WILSON said that his office is looking to continue that as an end-state license process. Through working with the bill sponsor, his understanding is that an end date is being looked out for the out-of-state licensees. Regular boards and commissions will still have jurisdiction over those medical providers in the state and they follow the same process to become licensed medical providers. SENATOR HUGHES clarified that she is asking specifically about behavioral health. CHAIR WILSON replied all health practitioners of healthcare and behavioral health and dental would be covered. They are looking at any licensed person obligated to provide telehealth. SENATOR BEGICH said that federal behavioral health waivers will go away at the end of the calendar year. He clarified that the chair is looking at something more comprehensive that would apply to any provider. He is in agreement with Senator Reinbold. Parameters or sideboards are important to protect the Alaska workforce. He knows the chair will be looking at that in terms of expiration dates and licensing issues. That is the issue in all his questions. He asked who is going to enforce and monitor the healthcare practitioners who are not licensed and residing in the state and who ensures they are in good standing. The bill doesn't seem to address that. He doesn't know what will cover that or to ensure practitioners are acting within the scope of their expertise. The committee has discussed the Prescription Drug Monitoring Program with the State Medical Board. He asked what the prescribing process is. There could be different laws around prescriptions. These are the issues he wants to see addressed. Those monitoring costs have to be reflected in the fiscal note at some point. MS. MCCALL said that for prescribing, the bill mentions the services provided have to be within the scope of practice within the jurisdiction that providers are licensed. Based on conversations she has had with Legislative Legal, licenses tend to be fairly uniform. Her office hasn't had a chance to reach out to Legislative Research to look at different licensing provisions and where there might be discrepancies. Legislative Legal was not concerned that there would be major differences, but that will be looked at more. SENATOR BEGICH said that an easier answer might be to simply require providers to meet Alaska's own standards. 2:54:38 PM CHAIR WILSON opened public testimony. 2:54:46 PM SARAH HETEMI, representing self, Anchorage, Alaska, said that she was happy that Governor Dunleavy asked the legislature to extend the public health disaster emergency with the passage of SB 56. She was especially happy about Section 6 of the bill, which related to the issue of telehealth expansion. Telemedicine is a big part of the future. COVID-19 showed that more than ever. The state needs to empower its healthcare providers to deliver telemedicine as it is a crucial component of healthcare reform that will increase access to all. It could be lifechanging in terms of cost savings. Individuals who reside in underserved rural and urban communities have to wait longer, travel further, and ultimate pay more for healthcare. The state has the ability and opportunity to significantly improve service to these individuals. This bill should have bipartisan support. It is an opportunity to make statutes more up to date and more COVID-19 aware instead of relying on the emergency declaration alone. 2:56:53 PM PORTIA NOBLE, representing self, Anchorage, Alaska, said that Alaskans need more accessibility and convenience, not just during a pandemic. In December of 2020, over 30 policy think tanks and grassroots organizations united to urge policy makers across the country to permanently enact and enhance telehealth capabilities and remove as many barriers as possible. Healthcare groups, clinics, and hospitals in the last two years have innovated and invested in telehealth capabilities. Pandemic or not, there is a great opportunity to embrace and expand the free market in healthcare. Alaska has seen barriers eliminated specifically because of telemedicine. She agrees with Senator Reinbold about the in-person relationship with a doctor, but she sees interesting statistics that providers increased the number of weekly telehealth consultations for Medicare enrollees from 13,000 to 1.7 million. That statistic should be embraced to support elders in Alaska and across the country. She encouraged the committee to move forward with SB 78 and other free market health bills to improve accessibility and convenience for all Alaskans. 2:58:47 PM RYAN MCKEE, Americans for Prosperity, Wasilla, Alaska, said this is a great step in giving the public an easier way to connect with doctors. Some may choose to go out of state, but Senator Reinbold is a big supporter of choice. Individuals should have this choice in healthcare of whether to seek healthcare in state or out of state. Across the nation more states are moving to allow telemedicine to be used more widely. Alaska has many rural communities where access to healthcare is often a struggle. Telehealth can help. Many cancer patients are doing telemedicine appointments right now. That is especially a benefit during the pandemic. Telehealth offers important alternative to some services. Alaska will gain from having it. 3:01:16 PM CHAIR WILSON closed public testimony and held SB 78 in committee.