HB 234-INSURANCE COVERAGE FOR TELEMEDICINE  2:09:03 PM CHAIR COSTELLO announced the consideration of HB 234. She stated that the intent is to hear from the sponsor and the administration, take questions from members, hear public testimony and hold the bill for further review. 2:09:34 PM ANITA HALTERMAN, Staff, Representative Liz Vazquez, Alaska State Legislature, stated that HB 234 seeks to require health care insurers that offer, issue, or renew health insurance plans in Alaska to reimburse mental health professionals for medically necessary services delivered using telemedicine via secure phone or internet video applications. This legislation would not require an initial face-to-face visit but requires providers be licensed in Alaska. HB 234 is a parity bill. Currently, 32 states and the District of Columbia have telehealth parity laws that require the option of telemedicine. Only Arizona requires a face-to-face visit before mental health services can be delivered via telehealth. 2:11:20 PM CHAIR COSTELLO asked if the lack of face-to-face interactions has been an issue in other states. MS. HALTERMAN replied it is appropriate for a mental health professional to require a face-to-face encounter if they deem it appropriate. This legislation seeks to prohibit the insurance industry from imposing that requirement. CHAIR COSTELLO summarized that the insurance would not check to see if there was a face to face interaction. The claim would be handled absent that information. MS. HALTERMAN agreed. 2:13:21 PM REPRESENTATIVE LIZ VAZQUEZ, Alaska State Legislature, sponsor of HB 234, stated that this legislation provides access to medical care that is often difficult for people living in rural areas to access. Even in a city as large as Fairbanks there can be access issues. Some people are also limited by age, mobility, stamina, and transportation from making a trip to a health care provider. CHAIR COSTELLO asked if this would cover Medicaid recipients. She shared that a constituent's son came home from the Alaska Psychiatric Institute (API) and wasn't willing to visit the doctor to renew a prescription. The doctor wasn't willing to make a home visit because transportation wasn't reimbursed. MS. VAZQUEZ answered yes; Medicaid has the gold standard regulations for telehealth delivery. CHAIR COSTELLO asked if she was saying that a phone call to the doctor would have sufficed. REPRESENTATIVE VAZQUEZ replied "it could be in that situation." SENATOR STEVENS asked if the Alaska Native Tribal Health Consortium delivers mental health services via telemedicine. MS. HALTEMAN offered her understanding that tribal entities have federal exemptions that allow flexibility in the use of telemedicine. She said many of those beneficiaries have dual eligibility through Medicaid so there is a parity issue and the private sector is falling behind. She directed attention to the 50-state analysis that gives Alaska an A+ for telehealth for Medicaid policies and an F for the private sector. She said this bill is the first of many to come to help improve for people who currently don't have access. SENATOR STEVENS commented that parity is crucial and it shouldn't matter what race you are. 2:18:40 PM SENATOR GIESSEL added that the Alaska Native Tribal Health Consortium has been very successful in providing mental health services through telemedicine for many years. It leads the nation in this area. 2:19:05 PM LORI WING-HEIER, Director, Division of Insurance, Department of Commerce, Community and Economic Development (DCCED), stated that, as the sponsor said, HB 234 provides for telemedicine. Currently, MODA provides for telemedicine in its policies but Premera does not in the majority of its plans. The division worked with the sponsor in the drafting and has no comments. 2:20:12 PM STACY TONER, Deputy Director, Division of Behavioral health, Department of Health and Social Services (DHSS), stated support for HB 234. She stressed the importance of having mental health services delivered via telehealth. She said tribal organizations that use the division's services use telehealth to give village residents access to psychiatrists and mental health professionals. She noted that telemedicine has been available in the Medicaid service array for years. The only recommendation is to use the term "telehealth" rather than telemedicine. 2:21:32 PM CHAIR COSTELLO opened public testimony. 2:21:44 PM LYN FREEMAN, Mind Matters Research, testified in support of HB 234. She described her professional experience and education. She described the mental health intervention she designed and tested specifically for Alaskans. When she published the outcomes, the National Institute of Health (NIH) directed her to make the intervention available to people across Alaska. She was specifically directed to utilize telemedicine as much as possible to overcome the barriers to access to care. The NIH wrote letters of support and asked insurance providers for assurance that the intervention would be available for patients in the office setting and through telemedicine. She said she approached the insurance providers in the state asking for their support and was stonewalled at every point. She was told that her patients would not be covered unless she became part of one of their programs or joined their Teladoc program. She decided not to treat patients via telemedicine until legislation passed that would protect both her patients and herself. She urged the committee to pass the bill. 2:26:33 PM KELLY PUFF, representing herself, testified in support of HB 234. She related her experience as a parent of a son with autism and said the family wouldn't be intact if it weren't for home telehealth. It's made all the difference to their family. 2:28:24 PM DR. AROM EVANS, Medical Director, Orion Behavioral Health Network, testified in support of HB 234. He described the services the company provides throughout the state for children and adolescents with mental health conditions. This is a vulnerable population, many of which would not have access to these services if it weren't for telehealth. Medicaid beneficiaries are able to receive telehealth services in their home, but individuals with private insurance don't have access to these service because their insurance company won't pay. Oftentimes the option is to pay for an expensive flight to Anchorage or forego the care. He urged the committee to pass the bill. 2:32:45 PM CHAIR COSTELLO closed public testimony on HB 234 and held the bill in committee for further review.