SB 78-HEALTH CARE SERVICES BY TELEHEALTH  1:50:28 PM CHAIR WILSON announced the consideration of SENATE BILL NO. 78 "An Act relating to telehealth." SENATOR COSTELLO stated that Governor Dunleavy introduced legislation extending the disaster declaration retroactively and into the future. She opined that Alaskans are ready to move into a recovery phase so it would be better to make laws that are COVID aware. The Labor and Commerce Committee introduced a suite of bills to determine whether practices, which began following the disaster declaration, would be allowed to continue. SB 78 is one of those bills. 1:52:38 PM KATIE MCCALL, Staff, Senator Mia Costello, Alaska State Legislature, Juneau, Alaska, stated SB 78 was taken from Section 6 of the Governor's disaster declaration bill. It allows licensed healthcare providers and nurses to provide services through telehealth in their licensed field. 1:53:56 PM CHAIR WILSON moved Amendment 1. AMENDMENT 1  32-LS0532\A.1 Fisher 4/14/21 OFFERED IN THE SENATE BY SENATOR WILSON TO: SB 78 Page 1, following line 2: Insert new bill sections to read:  "* Section 1. AS 08.15 is amended by adding a new section to read: Sec. 08.15.045. Telehealth. (a) A person licensed under this chapter may practice behavior analysis through telehealth as defined in AS 47.05.270(e). A person licensed to practice behavior analysis in another jurisdiction may practice behavior analysis through telehealth with a patient in this state if the person's license is in good standing in that jurisdiction. (b) If a person licensed to practice behavior analysis determines in the course of a telehealth encounter with a patient that the encounter will extend beyond the licensee's authorized scope of practice, the licensee shall advise the patient that the licensee is not authorized to provide the services to the patient, recommend that the patient contact an appropriate provider, and terminate the encounter. The licensee may not charge for services provided during an encounter described in this subsection. (c) A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not be more than five percent above the ordinary fee typically charged for that service.  * Sec. 2. AS 08.29 is amended by adding a new section to article 3 to read: Sec. 08.29.240. Telehealth. (a) A person licensed under this chapter may practice professional counseling through telehealth as defined in AS 47.05.270(e). A person licensed to practice professional counseling in another jurisdiction may practice professional counseling through telehealth with a client in this state if the person's license is in good standing in that jurisdiction. (b) If a person licensed to practice professional counseling determines in the course of a telehealth encounter with a client that the encounter will extend beyond the scope of practice or scope of services permitted under (a) of this section, the licensee shall advise the client that the licensee is not authorized to provide the services to the client, recommend that the client contact an appropriate provider, and terminate the encounter. The licensee may not charge for services provided during an encounter described in this subsection. (c) A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not be more than five percent above the ordinary fee typically charged for that service.  * Sec. 3. AS 08.63 is amended by adding a new section to read: Sec. 08.63.250. Telehealth. (a) A person licensed under this chapter may practice marital and family therapy through telehealth as defined in AS 47.05.270(e). A person licensed to practice marital and family therapy in another jurisdiction may practice marital and family therapy through telehealth with a client in this state if the person's license is in good standing in that jurisdiction. (b) If a person licensed to practice marital and family therapy determines in the course of a telehealth encounter with a client that the encounter will extend beyond the scope of practice or scope of services permitted under (a) of this section, the licensee shall advise the client that the licensee is not authorized to provide the services to the client, recommend that the client contact an appropriate provider, and terminate the encounter. The licensee may not charge for services provided during an encounter described in this subsection. (c) A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not be more than five percent above the ordinary fee typically charged for that service." Page 1, line 3: Delete "Section 1" Insert "Sec. 4" Renumber the following bill sections accordingly.   Page 3, following line 31: Insert a new bill section to read:  "* Sec. 8. AS 08.86 is amended by adding a new section to article 6 to read: Sec. 08.86.225. Telehealth. (a) A psychologist or psychological associate licensed under this chapter may practice psychology or provide psychological services, as applicable, through telehealth as defined in AS 47.05.270(e). A person licensed to practice psychology or provide psychological services in another jurisdiction may practice psychology or provide psychological services through telehealth with a client in this state if the person's license is in good standing in that jurisdiction. (b) If a person licensed to practice psychology or provide psychological services determines in the course of a telehealth encounter with a client that the encounter will extend beyond the scope of practice or scope of services permitted under (a) of this section, the licensee shall advise the client that the licensee is not authorized to provide the services to the client, recommend that the client contact an appropriate provider, and terminate the encounter. The licensee may not charge for services provided during an encounter described in this subsection. (c) A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not be more than five percent above the ordinary fee typically charged for that service." SENATOR HUGHES objected for purposes of discussion. 1:54:09 PM CHAIR WILSON explained that SB 78 attempts to fix a parity in Alaska's healthcare services by allowing behavioral healthcare providers to participate in telehealth services. There is a need to change the behavioral healthcare section of the Governor's disaster declaration bill to codified law. He stated there is a follow up amendment regarding behavioral healthcare providers that removes the pay parity section. 1:55:11 PM At ease 1:56:21 PM CHAIR WILSON reconvened the meeting. SENATOR REINBOLD stated she supports telehealth. She continues to be a strong proponent of the established patient in-person meeting requirement. She commented that if any members have conflicts of interest, they need to be forthright and put it on the record. 1:57:21 PM SENATOR HUGHES withdrew her objection. 1:57:28 PM CHAIR WILSON found no further objection and Amendment 1 passed. 1:57:38 PM SENATOR HUGHES moved Amendment 2. AMENDMENT 2  32-LS0532\A.2 Fisher 4/12/21 OFFERED IN THE SENATE BY SENATOR HUGHES TO: SB 78 Page 2, lines 22 - 24: Delete "consistent with the ordinary fees typically charged for that service and may not be more than five percent above the ordinary fees typically charged for that service" Insert "may not exceed the ordinary fees typically charged for that service" Page 3, lines 25 - 27: Delete "consistent with the ordinary fees typically charged for that service and may not be more than five percent above the ordinary fees typically charged for that service" Insert "may not exceed the ordinary fees typically charged for that service" CHAIR WILSON objected for purposes of discussion. 1:57:52 PM SENATOR HUGHES read Amendment 2 and stated there is no reason for a telehealth provider's fee to be more than an in-office visit. Telehealth is a savings to the provider, requires less staff and appointments are typically shorter. The purpose of the amendment is to remove the additional five percent fee allowance because there is no justification for it. SENATOR COSTELLO stated she supports Amendment 2. She asked if Amendment 2 was written with contemplation of Amendment 1 passing so that language regarding the five percent fee was consistent. CHAIR WILSON replied that for the record Amendment 2 would cover both the bill and Amendment 1. Drafters at Legislative Legal Services will make the conforming changes. 2:00:00 PM CHAIR WILSON withdrew his objection and asked if there was further objection; finding none, Amendment 2 passed. SENATOR REINBOLD stated she understands the need for the bill but struggled with page 3 line 16-18 and line 12, which removes the established provider requirement to meet in-person at least once. She is unsure how she will vote on the floor but will not hold up the bill. SENATOR HUGHES asked if the Alaska Medical Association commented on the removal of the established patient requirement of at least one in-person visit. An in-person exam is foundational to most medical care. She asked if there are restrictions in place prohibiting telehealth providers from diagnosing and treating conditions that should be done in-person. 2:02:20 PM SENATOR COSTELLO responded that in context of last year's disaster declaration, the state was allowed to waive every regulation and law, which is why the environment of a disaster should be seriously considered. She stated she spoke with the Alaska Medical Association. SB 78 was drafted to address changes brought about by the disaster declaration. Changes to Alaska hire was one of those concerns. She opined that she did not necessarily want people to get care from doctors who are not licensed in Alaska. In her initial discussion with the state administration, she was told some Alaskans were established patients of out of state doctors. Due to the COVID environment, they could not fly outside of the state to receive care. Instead, they received care through telemedicine. In-person visits are also valued. She does want Alaskans to see Alaska licensed doctors. SB 78 will go to the Labor and Commerce Committee next. It is her intent to place a sunset date on the bill. She stated she will work with Senator Begich's office on language related to Alaska hire. She commented that the telehealth measures that were passed were of value during the COVID time period because they allowed the elderly and fragile to continue receiving care. Many Alaskans like receiving mental health treatments online. Telehealth is something to appreciate. SB 78 tries to bridge the gap of what was done under the pandemic environment and how we move forward without a disaster declaration. She stated she will consider the points made and intents to make improvements to the bill before it goes to the floor. 2:05:42 PM SENATOR REINBOLD shared that she is not in favor of the bill because the Alaska State Medical Association is not. She opined that the disaster declaration by the Governor should not have lasted more than 30 days and might have been an abuse of power. Waiving statutes and regulations should be done through the administrative regulation review committee with legislature approval. SENATOR BEGICH asked for the word jurisdiction to be defined in Section 2 line 11 and Section 4 line 13 14. He will vote to move SB 78. 2:08:21 PM SENATOR HUGHES stated she will support SB 78. She stated there is a wide range of services providers can offer; not all of them are appropriate without an in-person physical examination. She respects the Alaska Medical Association and opined that this is a concern for them. She asked that a providers scope of practice be limited to only services that do not require a physical exam. CHAIR WILSON noted that Labor and Commerce is the next committee of referral, and the intent is to move the bill so that committees can continue refining it. 2:10:29 PM CHAIR WILSON solicited a motion to move the bill from committee. 2:10:41 PM SENATOR HUGHES moved SB 78, work order 32-LS0532\A as amended, from committee with individual recommendations and attached fiscal notes (s). 2:10:48 PM SENATOR REINBOLD objected. 2:10:52 PM CHAIR WILSON called for a roll call vote. A roll call vote was taken. Senators Begich, Hughes, Costello, and Wilson voted in favor of reporting SB 78 as amended from committee and Senator Reinbold voted against it. Therefore, the motion passed by a 4:1 vote. CHAIR WILSON announced that with 4 yeas and 1 nay, CSSB 78(HSS) moved from the Senate Health and Social Services Standing Committee.