Legislature(2015 - 2016)CAPITOL 106

03/17/2016 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved HB 234 Out of Committee
-- Public Testimony --
Moved HB 237 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
Scheduled but Not Heard
           HB 234-INSURANCE COVERAGE FOR TELEMEDICINE                                                                       
3:07:14 PM                                                                                                                    
CHAIR SEATON announced that the  first order of business would be                                                               
HOUSE BILL  NO. 234, "An  Act relating to insurance  coverage for                                                               
mental health benefits provided through telemedicine."                                                                          
3:08:09 PM                                                                                                                    
ANITA HALTERMAN, Staff, Representative  Liz Vazquez, Alaska State                                                               
Legislature, paraphrased from the  Sponsor Statement [included in                                                               
members' packets], which read:                                                                                                  
     This bill seeks to require health care insurers that                                                                       
     offer, issue, or renew 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.                                                                        
     There is no law in Alaska requiring private insurance                                                                      
     companies that provide mental health benefits to                                                                           
     reimburse for services provided though telemedicine.                                                                       
     There are thousands of Alaskans across the state that                                                                      
     have private health insurance but have little or no                                                                        
     access or choice of professional mental health                                                                             
     providers because some private insurers do not                                                                             
     reimburse for telephonic or video mental health                                                                            
     counseling. Currently, mental health providers and                                                                         
     individuals must demonstrate to some insurance                                                                             
     companies that the individual has a severe mobility                                                                        
     issue and cannot obtain counseling where they live, or                                                                     
     that an emergency exists. In many cases individuals                                                                        
     are still often refused reimbursement for mental                                                                           
     health services furnished through telemedicine.                                                                            
     Alaska's Medicaid program funds most mental health                                                                         
     services for individuals with severe or chronic mental                                                                     
     illness. Medicaid regulations clearly allows payment                                                                       
     for telemedicine delivery, and do not require face-to-                                                                     
     face visits. Thus, there is currently a double                                                                             
     standard in Alaska between public and private health                                                                       
     care reimbursement for services furnished through                                                                          
     telemedicine. The national trend is to allow for                                                                           
     reimbursement for mental health services provided                                                                          
     through telemedicine. According to the Center for                                                                          
     Connected Health Policy, State Telehealth Laws and                                                                         
     Medicaid Programs Policies, 32 states and the District                                                                     
     of Columbia currently have telehealth parity laws,                                                                         
     some of which will go into effect by 2016 and 2017. An                                                                     
     interactive map from the Center for Connected Health                                                                       
     Policy can be retrieved online at                                                                                          
     Historically, there was a reluctance to reimburse for                                                                      
     services delivered through telemedicine because there                                                                      
     was no established code of ethics regarding electronic                                                                     
     counseling and no secure video or telephonic                                                                               
     resources. However, today the mental health counseling                                                                     
     profession has to comply with the national                                                                                 
     Telemedicine Codes of Ethics addressing internet                                                                           
     services. In addition, there are free encrypted, HIPAA                                                                     
     compliant telephone and video conferencing                                                                                 
     applications that work with low broadband internet.                                                                        
     Thus, with the current available technology and code                                                                       
     of ethics regulating the professional use of this                                                                          
     technology, there are numerous advantages to both                                                                          
     patients and Alaskan mental health providers.                                                                              
     Advantages of Telemedicine:                                                                                                
     • Provides for better access/privacy in rural and                                                                          
     remote as well as urban areas of Alaska                                                                                    
     • Early intervention is key to prevention, which saves                                                                     
     • Often individuals will seek counseling earlier in                                                                        
     distress if they aren't seen entering an office                                                                            
     • Alaskans with mild to moderate needs may seek help                                                                       
     that is more convenient/accessible                                                                                         
     • It saves time and money for many patients if they do                                                                     
     not have to leave home or office                                                                                           
     • Greater access for referrals to providers who                                                                            
     specialize in treating specific issues                                                                                     
     • Better access means a potential reduction in                                                                             
     suicides, domestic violence and more serious crises                                                                        
     • Costs are expected to be the same to insurance                                                                           
     companies as face to face counseling                                                                                       
     • Zero impact on state budget                                                                                              
     In summary, this proposed legislation is very limited                                                                      
     in scope. First, it does not require insurers to                                                                           
     provide or cover mental health benefits. It only                                                                           
     requires insurers that presently offer mental health                                                                       
     benefits to reimburse for these benefits delivered                                                                         
     through telemedicine. In addition, this bill requires                                                                      
     that the mental health service be provided "by a                                                                           
     health care provider licensed in this state".                                                                              
     In conformance with the mental health profession, this                                                                     
     bill uses the term "mental health" versus "behavioral                                                                      
     health". Research has shown that both terms are used                                                                       
     interchangeably by those in the mental health                                                                              
     profession and that the term "behavioral health" is                                                                        
     not defined within Alaska Statute or regulation.                                                                           
MS. HALTERMAN explained that the bill sponsor had included in                                                                   
members' packets a definition of telemedicine, which read:                                                                      
     7  AAC 12.449.  Definitions.  "Telemedicine" means  the                                                                    
     practice   of   health   care   delivery,   evaluation,                                                                    
     diagnosis,  consultation,   or  treatment,   using  the                                                                    
     transfer  of  medical  data,  audio,  visual,  or  data                                                                    
     communications  that are  performed  over  two or  more                                                                    
     locations   between   providers  who   are   physically                                                                    
     separated from the recipient or from each other.                                                                           
3:14:07 PM                                                                                                                    
MS. HALTERMAN  stated that it was  necessary for a review  of the                                                               
definition for behavioral health to  be included in statute.  She                                                               
relayed that  it was  necessary to address  the concerns  for the                                                               
potential  shortage of  providers for  substance abuse  needs and                                                               
she  spoke about  the possibilities  of  treatment for  substance                                                               
abuse through telemedicine.  She  acknowledged the obligation for                                                               
licensing of the provider, and that  some people felt that a face                                                               
to  face   encounter  was  necessary   prior  to   engagement  in                                                               
telemedicine.  She expressed a  preference to leave the decisions                                                               
for  best  practices to  the  medical  professionals rather  than                                                               
dictate  through public  policy.   She  stated that  she was  not                                                               
supporting this  change, but  would prefer  to keep  the proposed                                                               
bill simple,  as it  ensured parity and  was consistent  with the                                                               
work in  most other  states.  She  relayed that  telemedicine was                                                               
reimbursed in more than 32 states,  and she gave Alaska an A+ for                                                               
its Medicaid  reimbursement for  telemedicine, but  an F  for its                                                               
private sector reimbursement.  She  declared that it was time for                                                               
that [private sector reimbursement for telemedicine] to change.                                                                 
3:17:15 PM                                                                                                                    
CHAIR SEATON  directed attention  to the sponsor  statement which                                                               
stated that mental health and  behavioral health definitions were                                                               
used interchangeably,  yet the  definition for  behavioral health                                                               
in  the  proposed  bill,  which   included  substance  abuse  and                                                               
counseling,  would not  be  covered  in the  proposed  bill.   He                                                               
suggested the need to look at  that more carefully.  He expressed                                                               
his  understanding that  there may  not be  enough providers  for                                                               
substance  abuse, alcohol  treatment, and  other similar  issues.                                                               
He surmised that  should telehealth be eliminated  as a mechanism                                                               
for providing that  counseling, there would not  be any expansion                                                               
of the provider pool because  it was not legal for reimbursement.                                                               
He reported  that this  was concern voiced  by the  Alaska Mental                                                               
Health Board Advisory Board on  Alcoholism and Drug Abuse and may                                                               
be addressed further.                                                                                                           
REPRESENTATIVE VAZQUEZ relayed  that the sponsor did  not want to                                                               
mandate what constituted mental  health services to the insurance                                                               
companies.   The bill simply  stated that mental  health services                                                               
which   were   offered,  also   needed   to   be  available   via                                                               
telemedicine.    She declared  that  this  was not  expanding  or                                                               
mandating  anything  further to  the  insurance  companies.   She                                                               
pointed to  the shortage of  providers, with individuals  in need                                                               
of services, and many outlying villages not very accessible.                                                                    
CHAIR SEATON  offered his belief  that this was not  a discussion                                                               
for  expansion of  the definition  to include  other things,  but                                                               
that  coverage of  substance  abuse,  alcoholism, and  counseling                                                               
should also  be offered through  telemedicine.  He  declared that                                                               
he was not advocating expansion  of the bill or the requirements.                                                               
He  opined that  the  bill  stated that  if  those services  were                                                               
already   offered,  then   they  should   also  be   provided  by                                                               
telemedicine.    He  pointed  out  that  the  current  definition                                                               
specifically excluded  alcoholism or  drug abuse  counseling, and                                                               
he was unclear if that was the intent.                                                                                          
3:22:23 PM                                                                                                                    
MS.  HALTERMAN  pointed out  that  neither  Alaska's statute  nor                                                               
regulation  currently  defined  behavioral health,  although  she                                                               
discovered that behavioral health was  defined in 7 AAC 70.996 as                                                               
"the  outpatient  evaluation  or  treatment  of  an  individual's                                                               
mental health  or substance use."   In  7 AAC 160.990.87,  it was                                                               
defined  as a  behavioral health  clinic  service; and  in 7  AAC                                                               
135.010(c),   behavioral  health   rehabilitation  services   was                                                               
identified.  She stated that  mental health benefits were defined                                                               
as  the   following  in  state   statute,  AS   21.54.500,  under                                                               
definitions (22), she read:                                                                                                     
     benefits  provided   for  mental  health   services  as                                                                    
     defined  under the  terms of  a  health care  insurance                                                                    
     plan  but does  not include  benefits for  treatment of                                                                    
     substance abuse or chemical dependency.                                                                                    
MS.  HALTERMAN reiterated  that  behavioral health  had not  been                                                               
defined  in  the   insurance  statute,  hence  the   lack  for  a                                                               
consistent  definition.    She   reported  that  a  general  term                                                               
definition for  behavioral health had  been found in  the federal                                                               
agency,    Substance   Abuse    and   Mental    Health   Services                                                               
Administration  (SAMHSA)  which   encompassed  the  promotion  of                                                               
emotional health, the prevention  of mental illness and substance                                                               
abuse  use  disorders,  and treatment  and  services  for  mental                                                               
and/or substance  use disorders.   She relayed  that the  lack of                                                               
definition in state statute had road blocked them.                                                                              
CHAIR  SEATON  asked whether  this  bill  would require  coverage                                                               
through telemedicine  for a  private insurance  company currently                                                               
covering substance abuse or behavioral  health.  He asked if this                                                               
was the intention of the bill.                                                                                                  
REPRESENTATIVE TARR  shared that she  had not yet  fully resolved                                                               
her  comfort level  regarding the  requirement for  the in-person                                                               
contact, as  there could  be an  emergency circumstance,  and she                                                               
would  not  want that  to  preclude  the delivery  of  telehealth                                                               
services.   She added that  a lot  of the experience  with mental                                                               
health  services   and  its   indicators  related   to  demeanor,                                                               
behavior, and  overall appearance.   She  suggested a  search for                                                               
the sweet spot  where things were not  limited unnecessarily, but                                                               
to also encourage the initial in-person assessment.                                                                             
MS. HALTERMAN  offered to share  an analysis which  addressed the                                                               
states' positioning on telemedicine.   She stated that there were                                                               
also national  standards provided for telemedicine.  [Included in                                                               
members' packets.]   She declared that the proposed  bill did not                                                               
change  the provider  responsibility  to determine  its own  best                                                               
practice, it left  the decision in the hands of  the provider and                                                               
not the insurance company.                                                                                                      
REPRESENTATIVE TARR directed attention to  page 1, line 9, of the                                                               
proposed bill,  and read:   "and may  not require that  prior in-                                                               
person contact occur...  "  She questioned  whether this language                                                               
could be  made less  restrictive, as  her interpretation  was the                                                               
opposite  of  that  from  Ms.  Halterman.   She  asked  that  the                                                               
Legislative Legal  Services "help sort  that out."   She directed                                                               
attention to the 288 page Best Practices document.                                                                              
MS. HALTERMAN  replied that the  bill addressed an  obligation of                                                               
the  insurance  industry, not  the  medical  professional, as  it                                                               
imposed the requirement that the  insurance company not enact the                                                               
face  to face  requirement.   She relayed  that, if  the provider                                                               
determined  that  the  face  to   face  encounter  was  the  best                                                               
practice, they had  the right to make that  medical decision when                                                               
dealing with the patient.                                                                                                       
3:30:06 PM                                                                                                                    
CHAIR  SEATON  directed attention  to  page  1,  line 5,  of  the                                                               
proposed  bill, and  clarified that  nothing  precluded a  health                                                               
care  insurer from  offering mental  health  and substance  abuse                                                               
counseling  through telemedicine,  although nothing  required the                                                               
insurer to offer this through telemedicine.                                                                                     
MS. HALTERMAN expressed her agreement.                                                                                          
3:31:36 PM                                                                                                                    
CHAIR SEATON opened public testimony.                                                                                           
3:32:00 PM                                                                                                                    
LYN FREEMAN, MD,  Mind Matters Research, reported that  she was a                                                               
clinical researcher,  as well as  a private provider  for chronic                                                               
diseases, mental illness,  and mental stress.   She mentioned the                                                               
issue  of provider  determination  for  appropriate treatment  by                                                               
telemedicine,  and  assured the  committee  that  even the  first                                                               
contact  through  telemedicine  was  good.   She  encouraged  the                                                               
committee not to  limit this contact.  She reported  that she had                                                               
created a  mental health intervention,  through a grant  from the                                                               
National  Institutes of  Health, to  overcome the  long term  and                                                               
late term side  effects of cancer and its treatments.   She noted                                                               
that this intervention had been  clinically designed, tested, and                                                               
delivered in  Alaska.   She stated that  it was  delivered "first                                                               
and  foremost" to  improve the  quality of  life and  the medical                                                               
outcomes  of  Alaskans.    She  added that  this  had  also  been                                                               
delivered in the  State of Washington as "a  multi trial effect."                                                               
She delivered this  mental health support to  patients in Alaska,                                                               
as  it had  been found  to be  highly effective  in reducing  and                                                               
reversing  symptoms.   She  relayed that  she  had been  treating                                                               
patients in her  office, but had recognized that  access for face                                                               
to face treatment was too expensive  for many areas of the state.                                                               
She declared  that, although she would  prefer to have a  face to                                                               
face  delivery,  the  telemedicine  delivery was  "every  bit  as                                                               
efficacious and beneficial to the  patients it served as the ones                                                               
that I treated in person."   She directed attention to nationwide                                                               
research on  telemedicine for similar results.   She acknowledged                                                               
that  there were  situations when  it was  necessary to  have the                                                               
patient in person, and that  professionals were aware of the need                                                               
to  identify these  situations.   She stated  her support  of the                                                               
proposed bill.                                                                                                                  
REPRESENTATIVE  VAZQUEZ  asked for  an  example  to the  lack  of                                                               
telemedicine becoming a barrier to access for treatment.                                                                        
DR. FREEMAN declared  that there were five people  just this week                                                               
who she  had not been  able to schedule  for weekly visits  for a                                                               
variety of reasons.                                                                                                             
REPRESENTATIVE VAZQUEZ asked how  many patients had been affected                                                               
so far this year due to the lack of telemedicine.                                                                               
DR. FREEMAN  opined that there  were about 40  patients, although                                                               
she had  severely limited  her treatment  schedule to  those whom                                                               
she  could personally  treat.   She  stated that  passage of  the                                                               
proposed  bill  would  allow  her to  make  this  treatment  more                                                               
REPRESENTATIVE TARR  asked for a  description regarding  the face                                                               
to face meetings and whether they were a necessity.                                                                             
DR. FREEMAN explained that she  used HIPAA compliant programs for                                                               
phone  calls  which allowed  for  the  ability to  visualize  the                                                               
patient and  interact live in  real time.   She pointed  out that                                                               
telemedicine was defined in some states  as face to face, per the                                                               
ability to see someone's face,  although that definition did vary                                                               
from state to state.  She  declared that often a phone call could                                                               
offer plenty of evidence for  whether there should be a treatment                                                               
in-person.   She said that  she was  able, almost every  time, to                                                               
have  a first  meeting  with  a patient  with  a  visual form  of                                                               
telemedicine.    She reported  that  the  patient only  needed  a                                                               
computer  with  a  screen,  and  a quiet,  private  place.    She                                                               
declared that the  purpose and intent was to serve  people in the                                                               
least  stressful and  most convenient  way  as these  populations                                                               
were already  overwhelmed and did  not need  additional stressors                                                               
and barriers in their way.                                                                                                      
3:42:00 PM                                                                                                                    
MICHAEL  SOBOCINSKI, Alaska  Psychological Association,  declared                                                               
support of the  proposed bill by the association.   They believed                                                               
that the  use of technology,  such as telemedicine,  was critical                                                               
in  Alaska in  order  to  provide access  to  needed health  care                                                               
services, especially in the provision  of mental health services.                                                               
He affirmed that there had been  many obstacles to access, and he                                                               
opined that the proposed bill would help advance health care.                                                                   
CHAIR  SEATON asked  if there  was any  problem with  the various                                                               
definitions  for   mental  health  when  billing   the  insurance                                                               
companies for care provision to  mental health or substance abuse                                                               
MR.  SOBCINSKI replied  that he  worked in  the community  mental                                                               
health center, and  he was not as familiar with  insurance in the                                                               
private sector.   He  stated that very  often people  with mental                                                               
health issues  had co-occurring substance use  problems, and that                                                               
most providers  would see  people with both  issues.   He offered                                                               
his  belief  that the  definitions  would  be determined  by  the                                                               
private insurance providers.                                                                                                    
3:44:50 PM                                                                                                                    
ROBERT LANE, MD, Alaska  Pacific University, Alaska Psychological                                                               
Association, expressed his  support for the proposed  bill, as it                                                               
put  private  providers  on  equal  footing  with  those  in  the                                                               
Medicaid  system.   He reported  that,  as part  of the  training                                                               
facility, they  were teaching students to  be well-practiced with                                                               
the  ability   to  do  telemedicine.     He  added  that,   as  a                                                               
psychologist in  private practice he had  focused almost entirely                                                               
on substance abuse, and that there  had never been a problem with                                                               
his billing  for treatment  under his  psychologist license.   He                                                               
pointed out that  a letter for support had been  sent.  [Included                                                               
in members' packets.]                                                                                                           
3:46:59 PM                                                                                                                    
DIANE INGLE  reported that she  had sent  a letter in  support of                                                               
the  proposed  bill  from  a  patient  perspective  [included  in                                                               
members' packets].  She shared  that she had long term challenges                                                               
with mental  health, and  that she had  been fortunate  enough to                                                               
always receive treatment for services,  which allowed her to have                                                               
a successful  educational experience,  earning a  graduate degree                                                               
in  public  health.     She  reported  that  she had  served  the                                                               
Municipality of  Anchorage as the  Director of the  Department of                                                               
Health and  Human Services.  She  shared that she had  found that                                                               
mental  health   counseling  in  conjunction  with   any  medical                                                               
management was the best way to  deal with the issue.  She pointed                                                               
out  that many  people in  Alaska  were socially  isolated for  a                                                               
variety of reasons including sexual  and physical abuse, and were                                                               
not  given the  opportunity to  easily leave  their home  to seek                                                               
counseling.   She noted  that there  were times  when it  was not                                                               
possible to go  to the provider, which were often  the times when                                                               
she was most in need to talk  with her provider.  She shared that                                                               
she felt compelled  to share her story because  she believed that                                                               
mental health had all too often  been pushed out of sight, and it                                                               
was necessary  to "bring  good quality  services and  help people                                                               
who can be successful, be successful."                                                                                          
3:53:15 PM                                                                                                                    
ROBIN   MINARD,   Director,   Public   Affairs,   Mat-Su   Health                                                               
Foundation,  reported that  the Mat-Su  Health Foundation  shared                                                               
ownership in the Mat-Su Regional  Medical Center and invested its                                                               
profits from  this partnership back  into the community  in order                                                               
to  improve the  health and  wellness of  Alaskans living  in the                                                               
area.   She  declared support  for HB  234, as  it increased  the                                                               
access   to   needed   mental   health   services   provided   by                                                               
telemedicine.   She asked that  there be inclusion  for substance                                                               
abuse disorders  along with mental  health in the  proposed bill,                                                               
as it would encourage more providers  to do the necessary work to                                                               
"get  into telemedicine."   She  reported that  a 2013  community                                                               
health needs assessment  from more than 500  Mat-Su residents had                                                               
identified that  the top five  health and wellness goals  for the                                                               
community  were  all related  directly  to  access to  behavioral                                                               
health care.   She  stated that this  assessment data  made clear                                                               
that the residents  did not have access to vital  care for mental                                                               
health  and substance  abuse disorder  needs.   She shared  that,                                                               
without  this access,  many  people could  not  seek needed  care                                                               
until  the  situation  became  a  crisis, with  a  visit  to  the                                                               
emergency  room of  a  hospital.   She  reported  that, in  2013,                                                               
alcohol  related disorders  for behavioral  health care  were the                                                               
number  one  reason  for  emergency room  visits  to  the  Mat-Su                                                               
Regional Medical Center,  at a cost of $23  million not including                                                               
the  doctor, emergency  medical service  (EMS), or  police costs.                                                               
She  declared that  telemedicine  was a  proven  way to  increase                                                               
access  to   health  care,  pointing  out   that  recruiting  and                                                               
retaining an effective behavioral  health workforce was difficult                                                               
in states with  large rural populations, similar to  Alaska.  She                                                               
stated that,  statewide, Alaska had significantly  lower rates of                                                               
psychiatrists,  psychologists,  substance abuse  counselors,  and                                                               
marriage and family counselors compared  to the national average,                                                               
with  both Alaska  and the  Mat-Su designated  as federal  mental                                                               
health shortage  areas.   She reported that  data had  shown that                                                               
there were several  behavioral health providers who  had not been                                                               
able to  find psychiatrists to  work on-site, hence the  need for                                                               
telemedicine to get access to  medication management services for                                                               
the clients.   She reported that  there was a tremendous  need in                                                               
the  Matanuska-Susitna Borough  for  infant  and early  childhood                                                               
mental  health specialists.   She  emphasized that  the cost  for                                                               
travel to receive  and provide mental health  and substance abuse                                                               
care  was tremendous,  and ultimately  lead to  the treatment  of                                                               
problems  at a  crisis level,  instead of  earlier when  care was                                                               
less expensive.   She shared the experiences of  a local provider                                                               
now offering  telemedicine, stating  that the provider  had "seen                                                               
no  significant difference  in the  effectiveness of  the service                                                               
provided via  telemedicine versus traditional  in-office visits."                                                               
She  reported that  86 percent  of those  telehealth clients  had                                                               
evidenced  a  reduction  in  substance  use,  while  100  percent                                                               
reported being treated with respect,  and 85 percent evidenced an                                                               
increase in  their quality of  life as a result  of participation                                                               
in the program.                                                                                                                 
MS. MINARD shared a University  of Maryland study from 2003 which                                                               
examined the  distance travelled for out-patient  substance abuse                                                               
treatment  and  its impact  of  client  retention.   This  report                                                               
stated  that clients  who travelled  less than  one mile  were 50                                                               
percent  more  likely  to  complete   treatment  than  those  who                                                               
travelled more  than one mile,  with everything  else consistent.                                                               
She noted that  clients in the local telehealth  program, with no                                                               
distance  to travel,  had a  33 percent  lower no-show  rate than                                                               
clients in traditional treatment groups.                                                                                        
3:59:09 PM                                                                                                                    
MARGARET  BRODIE, Director,  Division  of  Health Care  Services,                                                               
Department  of   Health  and  Social  Services,   said  that  the                                                               
department fully supported telemedicine and  that it was a really                                                               
good way for the state to save money.                                                                                           
3:59:32 PM                                                                                                                    
RANDALL BURNS,  Director, Central Office, Division  of Behavioral                                                               
Health,  Department of  Health  and  Social Services,  reiterated                                                               
that  the  department was  fully  in  support of  telehealth  and                                                               
believed that parity was a very important issue.                                                                                
CHAIR SEATON asked if the  department had any further comments on                                                               
parity, and if they dealt with any private insurance.                                                                           
MR.  BURNS said  that the  department did  not deal  with private                                                               
MS. BRODIE  said that this  would affect the Medicaid  program as                                                               
many services it  currently paid for would be billed  back to the                                                               
insurance companies, thereby recovering the money for the state.                                                                
CHAIR SEATON  mused that a  private insurance company  which paid                                                               
for counseling for chemical dependency  was not required to offer                                                               
this  through  telemedicine.   He  asked,  if the  proposed  bill                                                               
required  that private  insurance which  offered substance  abuse                                                               
services must  also offer  counseling through  telemedicine, what                                                               
effect this would have on Medicaid.                                                                                             
MS.  BRODIE  replied that  this  would  increase the  collectable                                                               
amount from insurance companies, as the services would increase.                                                                
REPRESENTATIVE VAZQUEZ asked  for a specific example  for how the                                                               
proposed bill would benefit the Medicaid program.                                                                               
MS.  BRODIE  explained  that  for  the  use  of  telehealth  with                                                               
chemical dependency  counseling, if  an individual  had insurance                                                               
and Medicaid for these services,  the Medicaid program would bill                                                               
the insurance companies for those  costs, and would save money in                                                               
other areas  by reducing the  utilization of emergency  rooms and                                                               
primary  care.    Patients  would receive  the  proper  care  and                                                               
treatment in the appropriate setting.                                                                                           
MR. BURNS added  that there were occasions when  the provision of                                                               
tele-behavior health  services for consultation to  an individual                                                               
awaiting transfer to Alaska  Psychiatric Institute (API), thereby                                                               
avoiding the necessity for transfer,  would allow for the private                                                               
insurance to be billed.                                                                                                         
REPRESENTATIVE VAZQUEZ  asked how much  this would have  saved in                                                               
MR. BURNS  replied that it  did not happen  that often as  it was                                                               
currently difficult to  connect a patient with  a psychiatrist in                                                               
an  emergent  situation,  although  it  had  been  possible  upon                                                               
REPRESENTATIVE WOOL asked for clarification  about a patient with                                                               
private insurance and Medicaid.                                                                                                 
MS. BRODIE explained that Medicaid  was the payer of last resort,                                                               
so  any other  health care  insurer  was billed  for any  covered                                                               
REPRESENTATIVE WOOL  mused that, as  Medicaid was the  safety net                                                               
for covering costs  that private insurance did not  cover, it was                                                               
important for the  State of Alaska to have  private insurance pay                                                               
for telemedicine.  He asked  if insurance covered substance abuse                                                               
with telemedicine if it was not the primary issue.                                                                              
MS.  BRODIE, in  response  to Chair  Seaton,  explained that,  if                                                               
insurance does not  cover a service through  telemedicine, and an                                                               
individual  has  Medicaid, then  the  state  would pay  for  this                                                               
through  Medicaid  because  Medicaid  does  cover  that  service.                                                               
However, if the  insurance company did cover this  service and it                                                               
was also  offered through telemedicine,  it would be  possible to                                                               
bill them.                                                                                                                      
REPRESENTATIVE  WOOL   asked  about   the  travel   expenses  for                                                               
treatment paid  by Medicaid,  and offered  his belief  that there                                                               
would be savings with telemedicine.                                                                                             
MS. BRODIE  said that  was correct, that  there would  be savings                                                               
for travel and lodging, as well.                                                                                                
REPRESENTATIVE  VAZQUEZ  asked for  the  amount  of savings  from                                                               
travel and lodging.                                                                                                             
MS. BRODIE  said that she  did not  have a figure  available, and                                                               
that she was unsure for finding them.                                                                                           
4:12:19 PM                                                                                                                    
CHAIR SEATON  closed public testimony after  ascertaining that no                                                               
one further wished to testify.                                                                                                  
4:12:26 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ  said that the Medicaid  program had model                                                               
regulations   for  telemedicine   legislation,  touted   as  best                                                               
practices nationally.                                                                                                           
CHAIR SEATON  questioned whether behavioral health  and substance                                                               
abuse should  also be required  for coverage by  telemedicine, if                                                               
it was  already covered in  an insurance  plan.  He  relayed that                                                               
testimony had indicated telemedicine  was much more effective for                                                               
consistency and  follow up, and  that improvement to  the success                                                               
rate for substance  abuse would go up.  He  acknowledged that the                                                               
House Health and  Social Services Standing Committee  did not "do                                                               
too much  with private insurance,"  although the bill  would next                                                               
be  heard in  the  House Labor  and  Commerce Standing  Committee                                                               
which  specifically worked  with these  definitions.   He offered                                                               
his  belief  that  the  committee  should  arrive  at  a  correct                                                               
definition to ensure that the  behavioral health services covered                                                               
by private insurance should also  be covered by telemedicine.  He                                                               
stated that this  would not be an expansion  of private insurance                                                               
coverage.     He  expressed  concern   for  forwarding   his  own                                                               
conceptual amendment, and asked that  the sponsor of the proposed                                                               
bill write an  amendment to be included with the  bill during its                                                               
hearing in the  House Labor and Commerce Standing  Committee.  He                                                               
offered his belief that:                                                                                                        
     it's a  good bill  and has  a lot  of issues  that it's                                                                    
     covering,  but  I  think that  substance  abuse  is  so                                                                    
     profound  and prolific  here in  our state  that if  we                                                                    
     could  address that  and  make  treatment of  substance                                                                    
     abuse  more effective,  I think  that that's  something                                                                    
     that we  should seriously  consider in the  offering of                                                                    
4:15:46 PM                                                                                                                    
REPRESENTATIVE  TARR expressed  her  concern  for a  circumstance                                                               
with co-occurring disorders when the  provider states that it can                                                               
only help  with part of the  problem.  She acknowledged  that the                                                               
proposed  bill only  dealt with  one  specific component,  mental                                                               
health services.                                                                                                                
CHAIR  SEATON  asked if  substance  abuse  was defined  in  state                                                               
statute, suggesting that this definition could be cited.                                                                        
MS.  HALTERMAN offered  her belief  that the  definition was  not                                                               
included in  state statute.   She  shared that  there had  been a                                                               
change within the  Department of Health and  Social Services that                                                               
integrated   behavioral  health,   mental   health  issues,   and                                                               
substance  abuse, and  these all  used the  same standard  set of                                                               
billing codes  for these  services.  She  pointed out  that there                                                               
was the potential side effect  that individuals had to lose their                                                               
employment in order  to gain Medicaid coverage  for the necessary                                                               
4:18:28 PM                                                                                                                    
MR. BURNS  opined that  there were still  some issues  around the                                                               
coding  for the  services that  these were  not as  integrated as                                                               
MS.  BRODIE reported  that the  Department of  Health and  Social                                                               
Services was  working to make  headway on  the coding to  make it                                                               
work for the providers in Alaska.   She noted that there had been                                                               
substantial  changes to  the medical  billing  and the  diagnosis                                                               
REPRESENTATIVE  TARR   asked  whether  the  accessibility   to  a                                                               
computer and  internet service  for an  individual who  could not                                                               
afford these  would be considered  a part  of the service  so the                                                               
insurance provider would assist with availability.                                                                              
MS. BRODIE explained that telemedicine  was not limited to video,                                                               
that it could be telephonic, as well.                                                                                           
REPRESENTATIVE   TARR  asked   if  a   telephone  was   the  only                                                               
technological necessity.                                                                                                        
MS. BRODIE expressed her agreement.                                                                                             
4:22:16 PM                                                                                                                    
CHAIR SEATON re-opened public testimony.                                                                                        
4:22:28 PM                                                                                                                    
KATE BURKHART,  Executive Director, Advisory Board  on Alcoholism                                                               
&  Drug  Abuse,  Division  of Behavioral  Health,  Department  of                                                               
Health  and Social  Services, offered  a definition  of substance                                                               
abuse treatment,  as defined in statute,  AS 47.37.270(15), which                                                               
she read:                                                                                                                       
     a broad  range of emergency,  outpatient, intermediate,                                                                    
     and in-patient  services and care that  may be extended                                                                    
     to  alcoholics, intoxicated  persons, or  drug abusers,                                                                    
     including diagnostic  evaluation, medical, psychiatric,                                                                    
     psychological  and  social   service  care,  vocational                                                                    
     rehabilitation, and career counseling.                                                                                     
MS. BURKHART  stated that  this was  a different  definition than                                                               
that  definition  for  treatment  for mental  illness  or  mental                                                               
health in the community mental health act.                                                                                      
4:24:01 PM                                                                                                                    
CHAIR SEATON closed public testimony on HB 234.                                                                                 
4:24:18 PM                                                                                                                    
REPRESENTATIVE  TARR   said  that  she  was   supportive  of  the                                                               
intentions of the  proposed bill, although she  had some concerns                                                               
with the substance abuse issues.                                                                                                
REPRESENTATIVE  VAZQUEZ  opined  that,  as  the  bill  was  being                                                               
referred  to the  House Labor  and  Commerce Standing  Committee,                                                               
they were  well versed in  insurance issues.  She  suggested that                                                               
some of  these issues  may be  moot per  mandates of  the Patient                                                               
Protection  and Affordable  Care Act,  although, she  admitted to                                                               
being not versed on these requirements.                                                                                         
CHAIR SEATON stated that the  focus was only for the telemedicine                                                               
portion, and that  it was either [PP]ACA compliant  or offered by                                                               
private insurance.  He pointed  out that if coverage was offered,                                                               
it had to be extended to include telemedicine.                                                                                  
REPRESENTATIVE WOOL asked about  a limitation to the availability                                                               
of providers,  as well  as considerations  for the  coding issues                                                               
and co-occurrence with other mental illness.                                                                                    
MS.  HALTERMAN  expressed  her agreement  that  there  were  some                                                               
outstanding  questions   that  still  needed  to   be  addressed,                                                               
including  a clear  definition in  state  statute for  behavioral                                                               
health,   and  the   shortage  of   providers   to  serve   these                                                               
populations.   She  stated that  she would  like to  move forward                                                               
with the requirement  for mental health coverage,  with a promise                                                               
to explore these other issues.                                                                                                  
REPRESENTATIVE VAZQUEZ  reported that  there was a  definition of                                                               
mental illness in AS 47.30.915(c)(14), and she stated:                                                                          
     mental  illness means  an organic  mental or  emotional                                                                    
     impairment that  has substantial adverse effects  on an                                                                    
     individual's ability  to exercise conscious  control of                                                                    
     the  individual's   actions  or  ability   to  perceive                                                                    
     reality  or  to   reason  or  understand;  intellectual                                                                    
     disability,   developmental    disability,   or   both;                                                                    
     epilepsy, drug addiction, and alcoholism  do not per se                                                                    
     constitute mental illness,  although person's suffering                                                                    
     from  these  conditions  may  also  be  suffering  from                                                                    
     mental illness.                                                                                                            
REPRESENTATIVE VAZQUEZ  pointed out  that the  current definition                                                               
excluded drug addiction and alcoholism.                                                                                         
CHAIR SEATON  clarified that  this was not  an attempt  to expand                                                               
the  definition of  mental  health.   If  coverage for  substance                                                               
abuse treatment  was offered,  then this  should also  be offered                                                               
through telemedicine.   He  said that  he was  comfortable moving                                                               
forward with the proposed bill.                                                                                                 
REPRESENTATIVE  VAZQUEZ expressed  her agreement  that she  would                                                               
prefer  to  move  the  bill  forward to  the  next  committee  of                                                               
CHAIR SEATON suggested having an amendment written.                                                                             
REPRESENTATIVE TARR said that she  would not object to moving the                                                               
proposed bill, and expressed her  desire that the House Labor and                                                               
Commerce Standing Committee could resolve the issue.                                                                            
4:31:43 PM                                                                                                                    
REPRESENTATIVE  VAZQUEZ  moved  to  report HB  234,  Version  29-                                                               
LS1251\A, out  of committee  with individual  recommendations and                                                               
the accompanying fiscal notes.   There being no objection, HB 234                                                               
was  moved from  the House  Health and  Social Services  Standing                                                               

Document Name Date/Time Subjects
HB 237 Support_American Osteopathic_ 3 15 16.pdf HHSS 3/17/2016 3:00:00 PM
HB 237
HB234 Lynn Edwards email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Lita White email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Maureen Lawlor email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Pamela Lund.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Sheila Gallagher.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Joel Wieman - Licensing board member.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Bryan Thomas email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB 234 Support _Lise Kirsis 3.14.2016.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Bobbie email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Support Alaska Mental Health Trust Of Support.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Support_Alaska Mental Health Board-Advisory Board on Alcholism and Drug Abuse 3-15-16 (3).pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB 237 Opposition_Maureen Powers.pdf HHSS 3/17/2016 3:00:00 PM
HB 237
HB234 Support_american osteopathic association_ 3 15 16.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Support_Diane Ingle.pdf HHSS 3/17/2016 3:00:00 PM
HB 234