ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 14, 2014
1:30 p.m.
MEMBERS PRESENT
Senator Bert Stedman, Chair
Senator Peter Micciche, Vice Chair
Senator Kevin Meyer
Senator Pete Kelly
Senator Johnny Ellis
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 134(HSS)
"An Act requiring Medicaid payment for medication compliance
packaging, delivery, and dispensing services of a prescription
for specified recipients; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 361
"An Act relating to licensing of behavior analysts."
- MOVED HB 361 OUT OF COMMITTEE
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 281(L&C)
"An Act relating to prescription of drugs by a physician without
a physical examination."
- MOVED CSHB 281(L&C) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 134
SHORT TITLE: MEDICAID PAYMENT FOR MEDISET PRESCRIPTION
SPONSOR(s): REPRESENTATIVE(s) COSTELLO
02/20/13 (H) READ THE FIRST TIME - REFERRALS
02/20/13 (H) HSS, FIN
03/19/13 (H) HSS AT 3:00 PM CAPITOL 106
03/19/13 (H) Heard & Held
03/19/13 (H) MINUTE(HSS)
03/28/13 (H) HSS AT 3:00 PM CAPITOL 106
03/28/13 (H) Heard & Held
03/28/13 (H) MINUTE(HSS)
04/02/13 (H) HSS AT 3:00 PM CAPITOL 106
04/02/13 (H) Heard & Held
04/02/13 (H) MINUTE(HSS)
04/04/13 (H) HSS AT 3:00 PM CAPITOL 106
04/04/13 (H) Scheduled But Not Heard
04/06/13 (H) HSS AT 9:00 AM CAPITOL 106
04/06/13 (H) Heard & Held
04/06/13 (H) MINUTE(HSS)
04/08/13 (H) FIN AT 8:00 AM HOUSE FINANCE 519
04/08/13 (H) Scheduled But Not Heard
03/13/14 (H) HSS AT 3:00 PM CAPITOL 106
03/13/14 (H) Scheduled But Not Heard
03/14/14 (H) HSS AT 8:00 AM CAPITOL 106
03/14/14 (H) Moved CSHB 134(HSS) Out of Committee
03/14/14 (H) MINUTE(HSS)
03/17/14 (H) HSS RPT CS(HSS) NT 4DP 2NR
03/17/14 (H) DP: REINBOLD, NAGEAK, TARR, HIGGINS
03/17/14 (H) NR: PRUITT, KELLER
03/24/14 (H) FIN AT 8:30 AM HOUSE FINANCE 519
03/24/14 (H) Heard & Held
03/24/14 (H) MINUTE(FIN)
03/26/14 (H) FIN AT 7:00 PM HOUSE FINANCE 519
03/26/14 (H) -- MEETING CANCELED --
03/28/14 (H) FIN RPT CS(HSS) NT 6DP 4NR
03/28/14 (H) DP: GUTTENBERG, HOLMES, MUNOZ, GARA,
COSTELLO, STOLTZE
03/28/14 (H) NR: THOMPSON, NEUMAN, T.WILSON,
AUSTERMAN
03/28/14 (H) FIN AT 8:30 AM HOUSE FINANCE 519
03/28/14 (H) Moved CSHB 134(HSS) Out of Committee
03/28/14 (H) MINUTE(FIN)
04/01/14 (H) TRANSMITTED TO (S)
04/01/14 (H) VERSION: CSHB 134(HSS)
04/02/14 (S) READ THE FIRST TIME - REFERRALS
04/02/14 (S) HSS
04/07/14 (S) HSS AT 1:30 PM BUTROVICH 205
04/07/14 (S) -- MEETING CANCELED --
04/09/14 (S) HSS AT 1:30 PM BUTROVICH 205
04/09/14 (S) Scheduled But Not Heard
04/11/14 (S) HSS AT 1:30 PM BUTROVICH 205
04/11/14 (S) -- MEETING CANCELED --
04/14/14 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: HB 361
SHORT TITLE: LICENSING OF BEHAVIOR ANALYSTS
SPONSOR(s): REPRESENTATIVE(s) SADDLER
02/26/14 (H) READ THE FIRST TIME - REFERRALS
02/26/14 (H) HSS, FIN
03/18/14 (H) HSS AT 3:00 PM CAPITOL 106
03/18/14 (H) Moved Out of Committee
03/18/14 (H) MINUTE(HSS)
03/19/14 (H) HSS RPT 1DP 3NR
03/19/14 (H) DP: TARR
03/19/14 (H) NR: PRUITT, REINBOLD, KELLER
04/04/14 (H) FIN AT 8:30 AM HOUSE FINANCE 519
04/04/14 (H) Heard & Held
04/04/14 (H) MINUTE(FIN)
04/07/14 (H) FIN RPT 9DP 1NR
04/07/14 (H) DP: GUTTENBERG, MUNOZ, THOMPSON,
EDGMON, T.WILSON, GARA, COSTELLO,
STOLTZE,
04/07/14 (H) AUSTERMAN
04/07/14 (H) NR: NEUMAN
04/07/14 (H) FIN AT 1:30 PM HOUSE FINANCE 519
04/07/14 (H) Moved Out of Committee
04/07/14 (H) MINUTE(FIN)
04/09/14 (H) TRANSMITTED TO (S)
04/09/14 (H) VERSION: HB 361
04/11/14 (S) READ THE FIRST TIME - REFERRALS
04/11/14 (S) HSS, FIN
04/14/14 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: HB 281
SHORT TITLE: PRESCRIPTION WITHOUT PHYSICAL EXAMINATION
SPONSOR(s): REPRESENTATIVE(s) GATTIS
01/27/14 (H) READ THE FIRST TIME - REFERRALS
01/27/14 (H) HSS, L&C
02/13/14 (H) HSS AT 3:00 PM CAPITOL 106
02/13/14 (H) Heard & Held
02/13/14 (H) MINUTE(HSS)
02/27/14 (H) HSS AT 3:00 PM CAPITOL 106
02/27/14 (H) Moved CSHB 281(HSS) Out of Committee
02/27/14 (H) MINUTE(HSS)
02/28/14 (H) HSS RPT CS(HSS) 4DP
02/28/14 (H) DP: SEATON, PRUITT, KELLER, HIGGINS
03/17/14 (H) L&C AT 3:15 PM BARNES 124
03/17/14 (H) Heard & Held
03/17/14 (H) MINUTE(L&C)
03/26/14 (H) L&C AT 3:15 PM BARNES 124
03/26/14 (H) Heard & Held
03/26/14 (H) MINUTE(L&C)
03/28/14 (H) L&C AT 3:15 PM BARNES 124
03/28/14 (H) Moved CSHB 281(L&C) Out of Committee
03/28/14 (H) MINUTE(L&C)
03/31/14 (H) L&C RPT CS(L&C) 2DP 4NR
03/31/14 (H) DP: CHENAULT, OLSON
03/31/14 (H) NR: HERRON, JOHNSON, SADDLER, JOSEPHSON
04/07/14 (H) TRANSMITTED TO (S)
04/07/14 (H) VERSION: CSHB 281(L&C)
04/08/14 (S) READ THE FIRST TIME - REFERRALS
04/08/14 (S) HSS, L&C
04/11/14 (S) HSS AT 1:30 PM BUTROVICH 205
04/11/14 (S) -- MEETING CANCELED --
04/14/14 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
CHARLES GUINCHARD, Staff
Representative Mia Castello
Alaska State Legislature
Juneau, Alaska, presented HB 134 on behalf of the sponsor.
POSITION STATEMENT:
GERALD BROWN, Pharmacist
Fairbanks, Alaska,
POSITION STATEMENT: Testified in opposition to several
provisions in HB 134.
ARLENE BRISCOE, Registered Nurse
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 134.
BERRY CHRISTENSEN, Co-Chair
Alaska Pharmacists Association - Legislative Committee
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of the concept of
Mediset, but in opposition to limiting the number of pharmacies.
REPRESTENTATIVE DAN SADDLER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 361.
ANNETTE BLANAS, Director
Capacity Building and Autism Interventions Project
Center for Human Development
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 361.
SUZANNE LETSO, CEO
Alaska Center for Autism
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 361.
SARA CHAMBERS, Director
Division of Corporation, Business, and Professional Licensing
Department of Commerce, Community and Economic Development
(DCCED)
Juneau, Alaska
POSITION STATEMENT: Answered questions related to HB 361 and HB
281.
REPRESENTATIVE LYNN GATTIS, Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 281.
DR. HENRY DEPHILLIPS, Corporate Chief Medical Officer
Teladoc
Nashville, Tennessee
POSITION STATEMENT: Answered questions related to HB 281.
JENNIFER MEYHOFF
Alaska Association of Health Underwriters
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 281.
ACTION NARRATIVE
1:30:39 PM
CHAIR BERT STEDMAN called the Senate Health and Social Services
Standing Committee meeting to order at 1:30 p.m. Present at the
call to order were Senators Micciche, Ellis, and Chair Stedman.
Senators Kelly and Meyer arrived shortly thereafter.
HB 134-MEDICAID PAYMENT FOR MEDISET PRESCRIPTION
1:31:25 PM
CHAIR STEDMAN announced the consideration of HB 134. [CSHB
134(HSS) was before the committee.]He said it was the first
hearing of the bill. The intent is to have the sponsor introduce
the bill, take public testimony, and set the bill aside for
further review.
1:31:50 PM
CHARLES GUINCHARD, Staff, Representative Mia Castello, Alaska
State Legislature, Juneau, Alaska, presented HB 134 on behalf of
the sponsor. He related that the bill is the sponsor's intent to
memorialize in statute a program that exists at the level of
regulation. The goal of the mediset program is to save the state
long-term costs by helping the most vulnerable Alaskans stay
compliant with their medications. He referred to a legislative
research brief in members' packets that shows cost of care
decreases when patients are compliant with their medication.
Medication management services such as mediset helps them stay
compliant.
He listed the support for the bill from the Alaska Mental Health
Board, the Chugiak-Eagle River Senior Center, the Alaska
Commission on Aging, the Alaska Mental Health Trust Authority,
the Alaska Nurses Association, the Governor's Council on
Disabilities, Hope Community Resources, the Alaska Pharmacist
Association, and various assisted living homes and pharmacies.
1:33:56 PM
MR. GUINCHARD showed a video relating to mediset prescriptions
and who they apply to. It described the difficulties the frail
and elderly have with taking prescriptions and how mediset
assists them. It explained some of the costs saved by the
dispensing services.
1:38:35 PM
MR. GUINCHARD explained the sections of the bill. In Section 1
(a) the Department of Health and Social Services (DHSS)
establishes the fee to pay a qualified pharmacy for a
prescription that requires scheduled units of use to a qualified
medical assistance recipient. He pointed out on line 9, "for a
prescription that requires" is the language that will result in
a physician needing to physically write "Mediset" on the
prescription.
He related that in Section 1 (b), the bill addresses pharmacies
that are qualified to dispense with five qualifiers - the cost
drivers when preparing and dispensing a mediset. These five cost
drivers will be incorporated into one mediset fee determined by
DHSS. He said that Section 1 (c) addresses who under Medicaid
will qualify for a mediset. It was language added at the
department's request so that the bill will not expand nor
contract the scope of who is currently eligible. Section 1 (d)
consists of two definitions; "medication compliance packaging"
and "units of use."
He related that Sections 2 and 3 are a complicated effective
date. Because of any change to the state's Medicaid program
requires federal approval, Section 2 specifies that. Section 3
says when DHSS has received approval, the statute will come into
effect.
CHAIR STEDMAN noted one zero fiscal note from Department of
Health and Social Services (DHSS).
He opened public testimony.
1:43:23 PM
GERALD BROWN, Pharmacist, Fairbanks, Alaska, testified in
opposition to several provisions in HB 134. He noted a
restriction included in the bill that says 75 percent of a
pharmacy's business must be medisets in order to receive payment
for unit-dosing prescriptions for individuals. He said his
pharmacy does not have that ratio, yet does over 900 bubble
packs per month. He maintained that the ratio is not reasonable
and all pharmacies should be eligible to receive the unit dosing
fee. As written, the bill is limited to certain pharmacies in
Anchorage.
MR. BROWN addressed the dispensing fee, which was last
established on 50 cents per unit. He said it takes $3 to do so
now. He requested that it be equitable to the pharmacy costs in
preparing the units and keeping records. He emphasized that the
mediset service is much needed. It is important that the fees
cover the actual costs.
CHAIR STEDMAN noted a forthcoming committee substitute that
would address those issues.
MR. BROWN suggested the bill provisions should be open to all
pharmacies.
1:47:42 PM
ARLENE BRISCOE, Registered Nurse, Alaska Nurses Association,
Anchorage, Alaska, testified in support of HB 134. She shared
that many of her patients suffer from severe mental illness
which precludes them from remembering to take their medications.
She stressed that they need the assistance this bill provides.
She voiced concern about the department's reimbursement policy
for pharmacies - that 75 percent of their business must be
providing medisets in order to qualify. She noted that at her
hospital patients often have to be kept longer because they are
waiting for mediset medications, which is costing Medicaid and
other insurance plans money. She stressed that the program
should be available to all pharmacies in the state, including
rural pharmacies.
1:50:24 PM
BERRY CHRISTENSEN, Co-Chair, Alaska Pharmacists Association -
Legislative Committee, Ketchikan, Alaska, testified in support
of the concept of mediset, but in opposition to limiting the
number of pharmacies who can quality for the dosage unit fee.
1:51:26 PM
CHAIR STEDMAN closed public testimony.
CHAIR STEDMAN held HB 134 in committee.
HB 361-LICENSING OF BEHAVIOR ANALYSTS
1:52:04 PM
CHAIR STEVENS announced the consideration of HB 361. He said it
was the first hearing on the bill. The intent is to have the
sponsor introduce the bill, take public testimony, and look to
the will of the committee.
1:52:41 PM
REPRESTENTATIVE DAN SADDLER, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 361. He read from the following sponsor
statement:
Autism is a significant and growing problem in Alaska.
Statistics show that about 2 percent of Alaska
children are born with this developmental disability,
characterized by a diminished ability to communicate,
social isolation, and other symptoms.
While not curable, autism is treatable. Scientific,
peer-reviewed studies have shown that early intensive
treatment in the form of Applied Behavioral Analysis
offers the best opportunity to help people with autism
improve their ability to function productively in
society.
Applied Behavior Analysis is recognized as the basis
for the most effective form of treatment for autism by
the U.S. Surgeon General, The National Institute of
Child Health, and the American Academy of Pediatrics.
You can best understand ABA as behavior modification
therapy: It seeks to encourage appropriate behavior by
assessing and managing the relationship between the
environment and the desired behavior.
Forty years of research shows that nearly half of
people with autism who receive intensive early
intervention and treatment do not require lifelong
services and support - and half can achieve normal
functioning after two to three years. This can mean
lifetime savings of $200,000 to $1.1 million for a
person through the age of 55.
One of the most important elements in successful
autism treatment is having it provided by well-trained
behavioral therapists - those who hold the nationally
recognized credential of Board-Certified Behavioral
Analyst, or BCBA.
To qualify as a BCBA, applicants must have a minimum
of a master's degree, plus extensive training and
experience requirements of up to 1,500 hours of
supervised practice in the field, 225 hours of
graduate-level classroom work, or a year's experience
teaching ABA at the university level. They must also
pass the challenging BCBA certification examination.
The Board-Certified Assistant Behavioral Analyst, or
BCaBA credential, requires slightly lower standards.
The state already supports the training of BCBAs
through a grant to the Center for Human Development,
at the University of Alaska Anchorage. There are about
20 to 30 BCBAs and BCaBAs in Alaska today, although
not all of them are currently working in the field.
Under current state law, Alaskans with BCBAs cannot
bill health insurance companies or Medicaid for their
services at a rate that reflects their high degree of
training and professional skill because they are not
formally licensed.
HB 361 addresses this situation by providing for those
holding the BCBA or BCaBA credentials in Alaska to be
licensed by the Division of Professional Licensing, in
the Alaska Department of Commerce, Community and
Economic Development. Fourteen other states currently
provide licensing and regulate behavior analysts. This
approach has the strong support of Alaska BCBAs and of
national autism advocacy groups.
By ensuring licensing and higher standards of practice
for BCBAs and BCaBAs, HB 361 will:
· encourage more people to provide autism services in
Alaska
· offer higher reimbursement rates for professional
providers
· provide better outcomes for Alaska children with
autism
· save the state money by avoiding the need for costly
institutional care, and
· improve the quality of life for hundreds of Alaskans
and their families
1:56:15 PM
CHAIR STEDMAN noted two fiscal notes; one indeterminate note
from Department of Health and Social Services (DHSS), and one
fiscal note for $46,600 receipt-supported services from
Department of Commerce, Community and Economic Development
(DCCED).
SENATOR MICCICHE asked about the fiscal note from DCCED.
REPRESENTATIVE SADDLER explained that it covers the initial cost
of setting up the database and arranging for professional
licensing. The subsequent $1,700 is a minimal cost that covers
the cost of fingerprinting for new applicants, potential hearing
mediation costs, legal support, and paperwork. He noted the
advantage of professional licensing by a department, rather than
by a professional licensing board; lower need for meetings,
travel, and administrative staff support.
CHAIR STEDMAN opened public testimony.
1:57:54 PM
ANNETTE BLANAS, Director, Capacity Building and Autism
Interventions Project, Center for Human Development, Anchorage,
Alaska, testified in support of HB 361. She said she is also a
licensed board certified Behavioral Analyst and the mother of an
autistic child. She described how desperate people are to
receive services for autism. She related that some services
provide inadequate and unsafe programs and there is very little
parents can do to address problems. Rural communities have
little access to professionals and are at risk of receiving
services from practitioners who are not providing quality or
safe services. She spoke of the importance of licensure and the
advantage of allowing practitioners to bill insurance companies.
SUZANNE LETSO, CEO, Alaska Center for Autism, Anchorage, Alaska,
testified in support of HB 361. She said she is also on the
Behavioral Analyst Certification Board. She stated that in
addition to helping families in rural areas, there is also a
need to protect large schools like Anchorage who are spending
well over $1 million a year on ABA services. She opined that the
state would save money if even one person is able to come home
from an out-of-state placement or prevented from needing such a
placement. She referred to documents in members' packets that
depict cost savings in this area.
She maintained that this legislation will save money, protect
consumers, and enhance the quality of life for people with
autism and their families. She noted that this legislation also
has applicability for other populations like fetal alcohol
syndrome and traumatic brain injury sufferers. .
2:02:37 PM
At ease
CHAIR STEDMAN closed public testimony.
2:03:03 PM
SARA CHAMBERS, Director, Division of Corporation, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, answered questions
related to HB 361. She said bill would create a new licensing
program governed by the division instead of by a board. The
division would deliver administrative services to make sure that
the statutes and ensuing regulations are complied with. She said
the department does not take a position on the bill, but has
been working with the sponsor to analyze the impact to the
division. The department is prepared to implement the bill,
should it become law.
2:04:28 PM
SENATOR ELLIS noted he served on the Autism Task Force along
with the sponsor. He stated that HB 361 is important legislation
and gets more professionals into the field to help families that
face major challenges.
SENATOR ELLIS moved to report HB 361 from committee with
individual recommendations and attached fiscal notes.
CHAIR STEDMAN announced that without objection, HB 361 is
reported from the Senate Health and Social Services Standing
Committee.
HB 281-PRESCRIPTION WITHOUT PHYSICAL EXAMINATION
2:05:19 PM
CHAIR STEVENS announced the consideration of HB 281. [CSHB
281(L&C) was before the committee.] He said it was the first
hearing on the bill. The intent is to have the sponsor introduce
the bill, take public testimony, and look to the will of the
committee.
2:05:35 PM
REPRESENTATIVE LYNN GATTIS, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 281. She said HB 281 is the companion bill
to SB 80 and is, essentially, Section 2 of that bill. She noted
that she has provided a comparison table of HB 281 and SB 80.
She related that HB 281 clarifies in statue that physicians may
not be sanctioned for dispensing or administering prescription
medications without a physical examination of the patient. This
practice is called telemedicine.
She explained that telemedicine-based medical care would be
delivered by primary care physicians located in Alaska. Anyone
needing medical care would be a candidate for this system. She
gave examples of who might benefit and be able to attain over-
the-phone or online consultations where physicians can diagnose
an ailment and, if necessary, provide a prescription. This bill
stipulates that physicians would not be able to prescribe
controlled substances.
She listed the benefits of telemedicine: convenience for the
patient, affordability, rapid access, higher productivity from a
healthy workforce, and primary care access for rural residents.
The efficient quality comes down to cost and access. She pointed
out that telemedicine does not replace the relationship with a
primary care provider. By requesting a consultation and filling
out an intake form, consent and medical history forms, a person
is entering into a doctor/patient relationship. If a patient
does not have a primary care provider, they may designate a
telemedicine provider as such. Patient privacy, the Health
Insurance Portability and Accountability act (HIPA), and privacy
laws apply to telemedicine.
She noted that telemedicine already exists and is working in
Alaska. Alaska has been one of the pioneers of telemedicine. The
Alaska Native Tribal Health Consortium, the Veterans
Administration, and the military, use telemedicine. Outside of
the state, major employees like Home Depot and Costco use
telemedicine.
She gave examples of medical conditions of people who seek
telemedicine: acute respiratory illness, uterine track
infections, skin problems, abdominal pain, and back and joint
problems. She said 20 percent of Alaska's population lives in
rural areas and needs quick and economical medical care.
2:09:56 PM
CHAIR STEDMAN noted that the committee is familiar with the
concept of telemedicine.
REPRESENTATIVE GATTIS said the bill has not been heard in the
Senate Health and Social Services Committee. She emphasized that
there is a difference between the two bills. She explained that
HB 281 requires physicians to be located in Alaska. Another
difference is SB 80 required that physicians bill insurance
companies, a provision not included in HB 281.
CHAIR STEDMAN noted one zero fiscal note from Department of
Commerce, Community and Economic Development (DCCED).
2:11:56 PM
SENATOR MICCICHE asked why out-of-state doctors cannot be used.
REPRESENTATIVE GATTIS replied that the bill has gone through
various House committees and Alaska doctors said they wanted to
protect Alaskan doctors.
SENATOR MICCICHE reported that currently there are several
thousand people using doctors who would no longer be allowed to
use them.
REPRESENTATIVE GATTIS said the Native Health Consortium has a
federal exemption that allows them to go out of state for
telemedicine.
SENATOR MICCICHE said several companies also use out-of-state
physicians.
REPRESENTATIVE GATTIS deferred to Dr. DePhillips to discuss
Costco and Home Depot.
SENATOR MICCICHE said they were not the only companies.
2:13:56 PM
DR. HENRY DEPHILLIPS, Corporate Chief Medical Officer, Teladoc,
Nashville, Tennessee, answered questions related to HB 281. Dr.
DePhillips responded to Senator Micciche's question by
explaining that there a three large telemedicine companies and
two of those three have put together a national network of
physicians. He said Teladoc has several Alaska physicians. He
noted Teladoc has a difference in interpretation of the Alaska
Medical Board rules than the Board does, which is what prompted
the bill. He said Teladoc has been operating in Alaska for a
while under the "cross coverage exemption." He said Teladoc and
other companies are looking for regulatory coverage through the
bill, which would include Alaska licensed and resident
physicians. He reported that Teladoc worked closely with the
Alaska Medical Association and agreed that the care of Alaskans
should be rendered by Alaska physicians.
2:15:52 PM
SENATOR MICCICHE asked why telemedicine is limited to
physicians, especially in rural areas.
DR. DEPHILLIPS said nurse practitioners, physician assistants
and others, are not included because Teladoc made a conscious
business decision to keep the standard of patient care very
high. He said they knew they would be a target and they have
been a target over the last 12 years. Toledo's model is a
physician-only model, as are the other two companies. Another
reason is because the Medical Board censured physicians doing
telemedicine, which is the reason behind the need for the
legislation. He thought lower level providers were regulated by
a different board.
SENATOR MICCICHE inquired about dispensing controlled substances
via telemedicine. He brought up a concern regarding post-op care
medications.
DR. DEPHILLIPS said that is a topic that has been discussed with
the Department of Corrections and others during the evolution of
the bill. He stated it is a balancing act. The concern was with
past history of internet prescribing controlled substances. He
said it was Toledo's decision not to allow DEA controlled
substances. He believed the other two companies also have that
policy. It keeps the abuse issue at bay and makes the Medical
Boards happy. He noted the Department of Corrections allows DEA
controlled substances to be prescribed via telemedicine because
there is a clinically trained person on site. The bill provides
for that exception.
2:19:38 PM
SENATOR MICCICHE used an example of a post-op patient in rural
Alaska who requires medication back in the village. He asked if
there is a way for controlled substances to be prescribed.
DR. DEPHILLIPS said there is currently not a way for controlled
substances to be prescribed using telemedicine. He observed that
if someone post-op in a village requires pain control requiring
a controlled substance, they would also need an in-person
assessment. He concluded that there is currently not a vehicle
to dispense a controlled substance.
2:21:30 PM
JENNIFER MEYHOFF, Alaska Association of Health Underwriters,
Anchorage, Alaska, testified in support of HB 281. She opined
that telemedicine has the potential to help contain high health
care costs.
SARA CHAMBERS, Director, Division of Corporation, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, answered questions
related to HB 281.
CHAIR STEDMAN asked if the department has any concerns about the
bill.
MS. CHAMBER said the department does not have concerns. She said
she believes the State Medical Board has gone on record with
their concerns.
CHAIR STEDMAN closed public testimony.
REPRESENTATIVE GATTIS concluded that HB 281 is not a catch-all
and not a hospital, but brings Alaska into the 21st Century and
will provide access to low-level health care. She shared a story
about her experience with telemedicine.
2:25:20 PM
At ease
2:28:03 PM
SENATOR MICCICHE moved to report CS for HB 281 from committee
with individual recommendations and attached zero fiscal note.
CHAIR STEDMAN announced that without objection, CSHB 281(L&C) is
reported from the Senate Health and Social Services Standing
Committee.
2:28:39 PM
There being nothing further to come before the committee, Chair
Stedman adjourned the Senate Health and Social Services Standing
Committee at 2:28 p.m.