SB 175-HEALTH CARE SERVICES BY TELEHEALTH   1:32:19 PM CHAIR WILSON announced the consideration of SENATE BILL NO. 175 "An Act relating to telehealth; relating to the practice of medicine; relating to medical assistance coverage for services provided by telehealth; and providing for an effective date." 1:32:38 PM SENATOR COSTELLO moved to adopt the committee substitute (CS) for SB 175, work order 32-LS1421\I, as the working document. 1:32:50 PM CHAIR WILSON objected for purposes of discussion. He explained that the CS is a good faith compromise with stakeholders that will make a better bill. 1:33:40 PM CHAIR WILSON removed his objection; he found no further objection, and Version I was adopted as the working document. 1:33:49 PM SENATOR HUGHES and SENATOR BEGICH joined the meeting. 1:34:04 PM CHAIR WILSON, speaking as sponsor, paraphrased the following sponsor statement for SB 175: [Original punctuation provided.] The COVID pandemic brought many hardships, but also inspired innovation. The committee has had extensive conversations on telehealth, through both SB 56 (Disaster Bill) and SB 78 (Senator Costello's Telehealth Bill). SB 175 capitalizes on these innovations and conversations. Access to telehealth services were broadened temporarily during the COVID- 19 pandemic. We want to continue these telehealth flexibilities and make them permanent in statute. SB 175: • Improves access to behavioral health and helps to address opioid use disorder. • Reduces bureaucracy. • Makes health care possible when an in-person visit doesn't make sense, or just isn't an option. 1:35:04 PM There is an extensive packet of letters of support to this legislation. Some of the supporters are: Southcentral Foundation, ASHNHA, Alaska Association on Developmental Disabilities, Alaska Behavioral Health Association, AARP, Alaska Primary Care Association Alaska Regional Coalition (TCC, Kawerak, Maniilaq, Chugachmuit, Central Council Tlingit & Haida), Alaska Native Health Board, Family Centered Services of Alaska, Set Free Alaska, and U.S. Renal Care. SB 175: 1) Creates a new section on telehealth for health care providers licensed with the State of Alaska that removes the requirement for an in-person visit and ensures payment parity for telehealth visit. 2) Allows physicians licensed in another state to deliver telehealth services within their scope of practice if: a. There is an established physician-patient relationship, b. The non-resident physician has given the patient an in-person physical exam, c. And the services are related to ongoing treatment or follow-up care related to past treatment. 3) Ensures telehealth availability for services related to opioid use disorder and controlled substances for certain providers. 4) Increases telehealth access for Alaska Medicaid beneficiaries by ensuring coverage and ensures payment parity and Medicaid coverage for virtually any telehealth modality. SB 175 does not require anyone to deliver or receive services through telehealth. Both the provider and the patient may choose to limit or decline a telehealth encounter. 1:36:40 PM CHAIR WILSON noted that Representative Spohnholz sponsored a companion bill. 1:37:02 PM JASMIN MARTIN, Staff, Senator David Wilson, Juneau, Alaska, paraphrased the following sectional analysis on behalf of the sponsor: [Original punctuation provided.] Section 1: Adds a new section (.085 Telehealth) to AS  08 (Business and Professions) .01 (Centralized  Licensing). (a) Allows a healthcare provider (other than physician licensed in in another state) to provide health care services via telehealth without first conducting an in-person visit. (b) Allows an out-of-state physician to provide health care services via telehealth if: (1) The physician and patient have pre- established relationship. (2) There has been an in-person examination. (3) The telehealth visits are a follow-up to previously provided health care services. (c) Creates limits for a telehealth appointment. If a telehealth appointment falls outside a provider's authorized scope of practice, they may refer the patient to an appropriate clinician. Prohibits a healthcare provider from charging for any portion of the visit that was beyond their scope of practice. (d) Requires fees charged for telehealth to be no more than fees charged for in person visits. (e) Allows a physician, podiatrist, osteopath, or physician assistant licensed with the State of Alaska to prescribe controlled substances via telehealth if they comply with Alaska Statute regarding prescribing controlled substances without a physical examination. (f) Allows an advanced practice registered nurse licensed with the State of Alaska to prescribe controlled substances via telehealth. (g) Prohibits a provider from prescribing controlled substances via telehealth other than as provided in (e) and (f). 1:39:00 PM (h) Removes the burden to document barriers to an in-person visit and clarifies that the board or department cannot require health care services to be provided from a certain location. (i) Clarifies that nothing in this section re- quires a provider to provide telehealth services or a patient to use telehealth services. (j) Defines: "health care provider," "licensed," and "telehealth." Section 2: Amends AS 08 (Business and Professions) .64  (Medicine) .364 (Prescription of drugs without a  physical examination). Removes the in-person requirement in AS 08.64.364(b) for an appropriate health care provider to assist a patient during a telehealth appointment with a physician or physician assistant regarding controlled substances. 1:39:45 PM Section 3: Adds a new section (.100 Telehealth) to AS  18 (Health, Safety, Housing, Human Rights, and Public  Defenders) .08 (Emergency Medical Services). (a) Allows an individual certified or licensed to provide emergency services to provide emergency services through telehealth. (b) Requires a certified or licensed individual to stay within their scope of practice during a telehealth visit. Prohibits them from charging for any portion of the visit that was beyond their scope of practice. (c) Requires fees charged for telehealth to be no more than fees charged for in person visits. (d) Removes the burden to document attempts at an in person visit and clarifies that the council or department cannot require health care services to be provided from a certain location. (e) Clarifies that nothing in this section requires a provider to provide telehealth services or a patient to use telehealth services. (f) Defines "telehealth" as defined in section 1.   1:40:46 PM Section 4: Adds a new section (.069. Payment for  Telehealth) to AS 47 (Welfare, Social Services, and  Institutions) .07 (Medical Assistance for Needy  Persons). (a) Requires Medicaid to pay for services by telehealth at the same rate they would if the services were provided in person. (b) Requires the department to adopt regulations for services provided through telehealth. Requires these regulations to treat services provided through telehealth in the same manners as services provided in person. Allows the department to limit modes, coverage, and reimbursement of telehealth only if: (1) The department specifically excludes or limits services from telehealth coverage through regulation. (2) Determines, through substantial medical evidence, that a service cannot be safely provided via telehealth. (3) Providing a service through telehealth would violate federal law or render a service ineligible for reimbursement under federal law. (c) Requires all telehealth services comply with HIPAA. (d) Defines "federally qualified health center," "rural health clinic," "state plan," and "telehealth." 1:41:23 PM Section 5: Adds a new section (.585 Telehealth) to AS  47 (Welfare, Social Services, and Institutions) .30  (Mental Health). Identical to section 3 but applies to entities which are approved to receive grant funding by the Department of Health and Social Services to deliver community health services. Section 6: Adds a new section (.145 Telehealth) to AS  47 (Welfare, Social Services, and Institutions) .37  (Uniform Alcoholism and Intoxication Act). Identical to section 3 but applies to public or private treatment facilities approved by the Department of Health and Social Services in AS 47.37.140 to deliver services designated under AS 47.37.40 AS 47.37.270 addressing substance use disorders. Section 7-10  Amends the uncodified law to instruct the Department of Health and Social Services to submit an amendment to the state plan and seek approval from the U.S. Department of Health and Human Services if needed and provides immediate effective dates for other areas of this bill. 1:42:25 PM MS. MARTIN presented the changes from version A to version I of SB 175: [Original punctuation provided.] Section 1 Replaces any reference to "examination" with "visit," and updates corresponding language throughout the bill, except for providers licensed in another state. Removes language in subsection (a) of version A related to the telehealth authority of providers licensed in another state. This language is replaced with subsection (b), which creates an exemption for physicians licensed in another state to deliver health care services within their scope of practice if there is an established physician-patient relationship, the non-resident physician has given the patient an in- person physical exam, and the services are related to ongoing treatment or follow-up care related to past treatment. Cleans up the provisions regarding medication assisted treatment by removing subsection (d) in version A, which pertained to services addressing opioid use disorder. This language was deemed unnecessary to ensure the telehealth delivery of medication assisted treatment to treat opioid use disorder (i.e., medication, counseling, and behavioral health therapies). Revises the prescribing authority provision by separating physicians, podiatrists, osteopaths, and physician assistants in subsection (e) from advanced practice registered nurses (APRNs) in subsection (f). Amends the APRN language in subsection (f) to remove the in-person requirement of prescribing controlled substances (including buprenorphine) via telehealth. This does not change the prescribing scope for these providers. Creates subsection (h) to remove requirements to document all attempts for an in-person visit and prevents the department or board from limiting the physical setting of a health care provider delivering telehealth. Clarifying language is inserted under subsection (j)(2) defining all providers in this section as licensed in good standing. 1:43:36 PM Section 3 Creates subsection (h) under Title 18 to remove requirements to document all attempts for an in-person visit. This section replicates the same provisions on documentation and physical setting for emergency medical services as Section 1. Section 4 Amends telehealth services included in Alaska Medicaid by explicitly including home and community-based waiver services in subsection (a)(2) and adding services provided under a state plan option (e.g., 1915(k) services) in subsection (a)(3). Adds language in subsection (b), line 13 to ensure the department must revise regulatory language to include telehealth in the definition of a "visit." Section 5-6 These are new sections adding telehealth provisions to entities in Title 47. These entities represent grantees which deliver community mental health services, or facilities approved by the department to deliver substance use disorder treatment. Their authority to deliver telehealth was previously unaddressed in version W because they are not applicable to the provisions in Title 8 or the Alaska Medicaid provisions in Title 47. Both sections replicate the same telehealth provisions on cost, scope of services, patient protections, documentation, and physical setting as Section 1. 1:44:23 PM Section 5 creates AS 47.30.585 to include entities designated under AS 47.30.520 AS 47.30.620, which are approved to receive grant funding by the Department of Health and Social Services to deliver community mental health services. Section 6 creates AS 47.37.145 to include public or private treatment facilities approved by the Department of Health and Social Services in AS 47.37.140 to deliver services designated under AS 47.37.40 AS 47.37.270 addressing substance use disorders. 1:45:07 PM SENATOR REINBOLD stated that when the telehealth bill was introduced by former Representative Vasquez, Alaska physicians were adamant about the requirement for an in-person visit before online visits could occur. She asked for an explanation of what SB 175 does in that regard that wasn't in that House bill. MS. MARTIN responded that the bill removes the burden of documenting an attempted in-person visit. It would also establish payment parity for telehealth and in-person visits. 1:46:03 PM SENATOR REINBOLD asked if SB 175 would address prescribing related to telehealth. 1:46:21 PM At ease 1:48:52 PM CHAIR WILSON reconvened the meeting. 1:48:57 PM SENATOR REINBOLD asked whether HB 275 and SB 175 were identical because the fiscal notes talk about two different bills. 1:49:12 PM CHAIR WILSON replied that the bills were the same. He deferred to the Division of Healthcare Services, Department of Health and Social Services (DHSS) to address the fiscal notes and the reason an additional person is needed to provide services the division is already providing to the public. 1:49:57 PM RENEE GAYHART, Director, Division of Health Care Services, Department of Health and Social Services (DHSS), Juneau, Alaska, related that the department would retain some flexibilities for public health emergency care. It would require regulatory changes and quality assurance reviews of payments, which would require additional staff time. The additional staff was to ensure quality assurance. She noted that the Division of Behavioral Health and Senior and Disability Services staff were online. 1:51:34 PM CHAIR WILSON asked if the department should wait to determine if there are additional costs to the administration. The fiscal note does not say how many more patients would use telehealth as a modality versus in-patient care. According to the fiscal note, it appears the department adds this as a cost into perpetuity and not just as a one-time charge. He asked why the department would not just request temporary funds in the supplemental budget. MS. GAYHART responded that the department has been working with Representative Spohnholz and others on what could be added through SB 175 and the companion bill. Due to the pandemic, the flexibilities put in place added many recipients to telehealth. She indicated that if the changes in the bill are permanent, they require additional regulations, system edits, and post- payment claims review. She stated that the Centers for Medicare and Medicaid Services (CMS) temporarily waived the requirements because of the pandemic, noting that CMS reimburses the department for services it provides to recipients through providers. However, making those changes permanent would require additional staff. 1:53:40 PM CHAIR WILSON expressed concern about the ongoing costs in SB 175. He offered his view that the regulation changes would not happen until FY 2027 and FY 2028. 1:54:05 PM GENNIFER MOREAU-JOHNSON, Director, Division of Behavioral Health, Department of Health and Social Services (DHSS), Anchorage, Alaska, stated that the Division of Behavioral Health was very interested in supporting access to care. She highlighted that part of their mission is to ensure effective care and assurance of quality outcomes. The full-time position in the division's fiscal note would provide review and monitoring to assure the clinical appropriateness of the services and for ongoing review to ensure national best practices related to telehealth. She envisioned that telehealth would be a method of delivery that would continue to develop over time. Thus, the division believes the position should be a full-time permanent position to stay abreast of national best practices and ensure quality. 1:55:19 PM CHAIR WILSON wondered whether the division was currently doing so. MS. MOREAU-JOHNSON answered yes. However, this bill proposes language that would require regulatory changes for the administration of telehealth, which would require additional staff support. 1:55:46 PM SENATOR BEGICH asked what additional work the bill required. He related that the division would need to develop new regulations for one year, but she indicated the department currently reviews and monitors telehealth activities. Thus, he was unsure of the additional work that SB 175 would require. MS. MOREAU-JOHNSON answered that language in SB 175 relates to substantial medical evidence, and because telehealth is an emerging platform, the division wants to ensure patients receive quality telehealth care. She said the bill focuses on providing behavioral services through telehealth, and the division supports that access but wants to ensure adequate services are provided. She highlighted that the division is small and has taken on substantial work to implement the [Medicaid Section] 1115 waiver. 1:57:02 PM SENATOR BEGICH stated he could understand up to a five-year follow-up; however, SB 175 should reduce documentation once enacted, so he was not comfortable with the fiscal note. He offered his view that the fiscal note is inflated by half a million dollars. He surmised that it would likely take a year or 18 months at most. He said he did not see the need for an ongoing full-time position over time and suggested that the division clearly assess the time required to determine quality telehealth delivery. 1:58:08 PM SENATOR HUGHES expressed concern about the cost of SB 175 for Alaskans because it allows fees for a telehealth visit at the same rate as an in-person visit. She recalled stipulating years ago that telehealth would reduce health care costs in the state, especially for villages. She stated that the costs associated with telehealth are less than for a clinic. For example, no medical assistant takes the patient's blood pressure and performs other duties, resulting in lower overhead. She highlighted that Alaska has a problem with high health care costs, so she questioned why the medical fees for telehealth and in-person visits would be the same. CHAIR WILSON commented that his office worked with other telehealth providers during a Medicaid Policy conference and found that there were two reasons for including payment parity in SB 175. One reason was that it helps incentivize the use of telehealth since most doctors prefer in-patient visits for the profitability of their practice. He offered to distribute information from the National Conference of Legislatures (NCSL) on this. NCSL researched the issue and found it also related to the initial cost for some of the rural community health providers in the nation to provide telehealth. Thus, payment parity allows providers to recoup the initial costs of setting up private and secure telehealth communications equipment. This is particularly important for small practices in underserved communities because they may not have the financial means to offer telehealth if the reimbursement rates are substantially lower. He noted that he was working with stakeholders and the sponsor of the companion bill to consider an amendment for a sunset date for payment parity. 2:01:52 PM SENATOR HUGHES opined that telehealth costs affect individuals and will also be reflected in savings to the Medicaid budget. She referred to page 6, line 9 of Version I, that says the Department of Health and Social Services (DHSS) has the responsibility to decide what will be covered, excluded, limited, or reimbursed for services provided by telehealth. She offered her belief that the medical board decides what doctors can do, and the nursing board decides what nurse practitioners can do. She wondered how DHSS would determine what is appropriate for telehealth. She suggested that the medical board would want to determine what is suitable for telehealth. CHAIR WILSON replied that this section was addressing reimbursable services. It allows the department to determine which provided services will be reimbursed. For example, certain case management providers may not be covered through Medicaid for in-patient visits, but the visit may be covered through another private insurance. This provision would allow them to say which service modalities will be reimbursed. It would allow the state to set the regulations accordingly for current procedural terminology (CPT) codes and determine which ones would be set for reimbursable services in Alaska. 2:04:29 PM MS. MOREAU-JOHNSON agreed that the language in SB 175 provides the department the authority to establish regulations for reimbursement and to maintain like reimbursement for like services to the extent possible. 2:04:51 PM SENATOR HUGHES referred to Section 1, which states that in-state providers may use telehealth without conducting a patient's physical exam. In contrast, out-of-state providers must have an in-person medical exam before providing service. She questioned the constitutionality of having different telehealth requirements for using non-Alaskan licensed physicians. CHAIR WILSON replied that he did not believe it caused any constitutional issues. He explained that Section 1 relates to licensing requirements for doctors, creating parity for Alaska and out-of-state physicians. 2:05:55 PM SARAH CHAMBERS, Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Juneau, Alaska, related her understanding that Section 1 eliminates licensure for out-of- state providers. Out-of-state providers must be licensed in Alaska to provide care in the state. SB 175 would allow out-of- state physicians licensed in another jurisdiction to practice in Alaska via telehealth, but they must follow Alaska's laws. She related that during the pandemic, some Alaskans had a Seattle doctor for specialty care but had health restrictions and could not travel to Seattle. Their provider had limited access to in- patient services, or it was cost prohibitive. 2:07:32 PM SENATOR HUGHES stated the explanation makes sense. She wondered if this was opening the door to allow out-of-state physicians to live in the state and provide telehealth services indefinitely without obtaining an Alaska license. CHAIR WILSON opined that the requirements would make that difficult and deferred to Ms. Chambers. MS. CHAMBERS replied that the intent is to have a bifurcated system where a physician practicing in Alaska must have an Alaska license. She offered to research when out-of-state physicians would need an Alaska license to clarify the bill's intent for the future. 2:09:19 PM CHAIR WILSON stated he would add the suggestion to his list of potential amendments. 2:09:38 PM NANCY MERRIMAN, Executive Director, Alaska Primary Care Association, Anchorage, Alaska, paraphrased her testimony as follows: [Original punctuation provided.] The Alaska Primary Care Association (APCA) supports the operations and development of Alaska 29 federally qualified health centers, also known as community health centers, or FQHC. Health centers provide comprehensive whole person care which includes medical, dental, behavioral, pharmacy and care coordination services. A PCA and Alaska's health centers support SB 175 because it increases access to primary care and behavioral health services, and it expands telehealth in this space. This legislation does several things that are important to help centers. First, it includes a range of telehealth modalities, including audio only, both now and into the future. Second, it allows patients and providers to engage in telehealth services outside of clinic setting if they so choose. And third, it provides adequate reimbursement for telehealth visits, providing new points of access to whole person care, including behavioral health and substance use disorder treatment. In 2020, health centers served 105,000 patients through 450,000 visits. Telehealth and substance use disorder services are our fastest growing area of service, and of those visits 40 percent were accommodated via telehealth. In the subspecialty area of substance use disorder services, 45 percent of visits were via telehealth. The temporary telehealth policy changes have benefited health centers because they have allowed health centers to be recognized as telehealth treating providers to furnish some behavioral health services via audio only technology, and to be paid for telehealth services furnished to Medicaid beneficiaries under the health centers bundled payment reimbursement model. 2:11:47 PM MS. MERRIMAN continued her testimony: Health centers serve hard to reach community. The majority of health center patients experienced challenges in accessing health care that include long distances to reach local providers, cost of care, transportation, language, and cultural barriers. In Alaska, over half of our patients are from racial or ethnic minorities, a majority are low income, and most patients live in rural communities. Health centers best serve their patient populations if they have the ability to use technology to meet their patients where they are at. Additionally, workforce shortages, particularly in behavioral health providers, impact health centers uniquely as nonprofit safety net providers. And telehealth allows health centers to use their clinical workforce most nimbly. In 2021, a cohort of health centers reported that of their telehealth interactions 59 percent occurred by phone and 40 percent by audio or video. Through the pandemic demand for tele behavioral health now represents 35 percent of all telehealth usage. Health centers have witnessed how telehealth has provided a stronger continuity of care for patients, reduced travel costs, and has resulted in fewer dropped visits, and less delayed and more costly care. And we understand that delivering quality whole person care ultimately leads to better health outcomes, saves lives, and in the long run saves on cost. So, on behalf of the Alaska Primary Care Association and health centers across the state, I urge you to support SB 175. And we appreciate your support. 2:13:39 PM SENATOR REINBOLD stated she made a commitment when she supported telehealth six years ago to support Alaska's physicians. She said she is pleased that SB 175 requires physicians to have an established patient relationship before offering telehealth services. She expressed concern that SB 175 might mean more patients would seek medical care from physicians in the Lower 48, which could be difficult for local providers who established small clinics. She wants to ensure that patients do not turn to out-of-area telemedicine and leave local doctors without patients. CHAIR WILSON asked Ms. Merriman whether Alaskan providers would have that concern. MS. MERRIMAN opined that SB 175 seeks to establish and protect the patient-provider relationship. 2:15:17 PM SENATOR REINBOLD stated she supports SB 175 because it prevents providers from requiring patients to be vaccinated before receiving treatment. She is concerned about the opioid crisis in Alaska and whether SB 175 would increase access to opioids in Alaska. CHAIR WILSON responded no. He stated that SB 175 would not increase access because there are still state statutes that out- of-state providers must follow. He said he would follow up to ensure that all entities are required to follow Alaska's prescribing rules. SENATOR REINBOLD recalled that opioid prescriptions were limited to a 7-day maximum prescription. 2:16:22 PM SENATOR REINBOLD asked if SB 175 mirrors or complements HB 172 related to psychotropic medication use in sub-acute medical facilities. CHAIR WILSON answered no. 2:17:09 PM SENATOR REINBOLD related her understanding that the local physicians, physician's assistants, and nurse practitioners were represented by APCA. She acknowledged that APCA testified in support of SB 175, but she would like to know if Alaska's healthcare providers support SB 175. CHAIR WILSON replied that other invited testimony would speak to her concern. 2:17:37 PM JOHN SOLOMON, Director, Behavior Health, Maniilaq Association, Kotzebue, Alaska, stated that Maniilaq is the only association serving the Northwest Arctic area villages on the North Slope. Before becoming an administrator, he was a counselor who flew to villages to see patients, carrying his backpack and sleeping bag. He emphasized the importance of telehealth to his region, which he hopes was happening in other rural Alaska areas. MR. SOLOMON explained that previously many logistical barriers prevented patients from obtaining treatment. Still, once restrictions were removed, the flexibilities allowed telehealth, which brought about an explosion in the number of clients asking for and receiving care. Telehealth for substance abuse groups went up 800 percent in six months. People had been waiting and wanting care but lacked access to providers. The substance abuse program grew from five to 70 ongoing clients. He emphasized the importance of the telephonic provision in SB 175 for rural Alaskans. The Northwest Arctic has clinics that do not have behavioral health aides (BHAs) and organizations with clinics that are not staffed. The telephonic option provides access to obtain care. In rural Alaska, telehealth is not about better or best practices but about care or no care for rural Alaskans. MR. SOLOMON highlighted that Maniilaq has worked to develop the local workforce in villages, so village BHA's can provide care to other villages. The hope is to fill the remaining BHA positions. In closing, he stated that the Maniilaq Association is a strong advocate for SB 175. 2:20:23 PM CHAIR WILSON related that BHA stands for behavior health aide. MR. SOLOMON agreed and elaborated that in the tribal health organizations, a behavior health aide works as a village-based counselor. 2:20:43 PM CHAIR WILSON opened public testimony on SB 175. 2:21:09 PM SUZANNE ISHII-REGAN, representing self, Anchorage, Alaska, said she is a member of a family who has benefited from telehealth. She thanked the state for a quick pivot to provide the flexibility of telehealth during the pandemic, which helped protect many vulnerable citizens. She said she has a male family member who uses a ventilator and has a primary immune deficiency. She noted that telehealth helped the family stay connected to doctors and avoid exposure to illnesses and infection, so they did not bring them home. Telehealth provided an opportunity for first-time access to services when he needed to transition to a new provider. It also reduced barriers that allowed him to continue receiving medical care. Telehealth was beneficial during extreme cold and icy weather, which further complicate mobility issues. She said it was easier to communicate since masks did not have to be worn during the telehealth appointments. 2:23:40 PM SARAH ELIASEEN, representing self, Eagle River, Alaska, stated she is a 96-year-old retired schoolteacher who appreciated being able to stay home and receive medical care. She has been declared legally blind and must use a walker. She can no longer use public transportation but would like to remain as independent as possible. She surmised that she is not the only person who finds transportation to Anchorage difficult. She mentioned that while visiting with her doctor online, an assistant kept records and facilitated the call. She asked the committee to make telehealth a permanent option for the elderly, disabled, those in rural areas, and anyone else who needs it. She thanked members and urged them to pass SB 175. 2:27:30 PM CODY CHIPP, Director, Alaska Native Tribal Health Consortium (ANPHC), Anchorage, Alaska, stated that the telehealth flexibility that came about through COVID created a greater ability to provide greater access to care. ANPHC launched a telehealth behavioral health clinic to address COVID-related distress. He stated that ANTHC uses OQ 45, the gold standard of patient-reported outcome measures, to measure clinical outcomes. Telehealth was found to be accessible, safe, and effective. The clinical outcomes were equal to or greater than the national averages. Client surveys expressed patient gratitude for easy access to services previously not available. Alaska's fiscal analysis has shown that telehealth could also save the state money, as noted in the Medicaid Reform report in response to SB 74. Telehealth also saves individuals time and money because it eliminates driving time. 2:29:32 PM CHAIR WILSON held SB 175 in committee with public testimony open.