Legislature(2015 - 2016)BUTROVICH 205

04/13/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
Scheduled but Not Heard
-- Public Testimony <Time Limit May Be Set> --
Moved HCR 9 Out of Committee
-- Public Testimony <Time Limit May Be Set> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
             SB 98-PRESCRIPTION WITHOUT PHYS. EXAM.                                                                         
1:37:38 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 98.                                                                             
SENATOR PETER  MICCICHE, Alaska  State Legislature, sponsor  of SB
98, explained  that the bill  will drive  down the cost  of health                                                              
care in  Alaska, improve health  care access for  rural residents,                                                              
and  prohibit unprofessional  conduct claims  against a  physician                                                              
who  is licensed  in  Alaska, but  out  of state  at  the time  of                                                              
prescribing a prescription drug.                                                                                                
He related that  in 2014 the legislature passed HB  281 by a near-                                                              
unanimous  vote to allow  physicians to  prescribe a  prescription                                                              
drug  to  a person  without  conducting  a  physical  examination,                                                              
within  certain parameters.  A prescription  drug could  not be  a                                                              
controlled  substance,   unless  the  health  care   provider  was                                                              
present   with  the   patient  to   assist   the  physician   with                                                              
examination, diagnosis, and treatment.                                                                                          
He  said HB  281  required  the physician  to  be  located in  the                                                              
state.  For example,  a  physician in  Ketchikan  could conduct  a                                                              
remote  diagnosis  and  prescribe  a  drug  in  any  community  in                                                              
Alaska. Alaska  is the  only state that  does not allow  stateside                                                              
physicians  to practice telemedicine  across  state lines,  so the                                                              
pool  of physicians  that  can  provide  this service  is  greatly                                                              
SENATOR  MICCICHE  stated  that   SB  98  addresses  the  lack  of                                                              
physicians  available  to  do  remote  consults  by  removing  the                                                              
"physical,  in-state presence" requirement.  The physicians  would                                                              
still  require an  Alaska  medical license.  He  pointed out  that                                                              
telemedicine services  average less than one-third of  the cost of                                                              
an in-person office  visit and less than one-tenth  the cost of an                                                              
ER visit.                                                                                                                       
He  said what  some  physicians  are  concerned about  is  already                                                              
allowed  in Alaska.  There is  remote  prescription of  medication                                                              
occurring  now with  no in-person  visits required  as per  HB 281                                                              
from last  year. The only difference  is that a physician  may now                                                              
be out of Alaska  to do so. From the patient's  perspective, there                                                              
is  zero difference.  The  Alaska  State  Medical Board  has  been                                                              
issuing  Alaska  Medical  Licenses  to  stateside  physicians  for                                                              
decades. The Department  of Health and Social Services  (DHSS) has                                                              
been using stateside  physicians for years to deliver  health care                                                              
via telemedicine  to Alaskans  at a far  more reasonable  rate and                                                              
it has worked out very well.                                                                                                    
He noted  a report by  the Federation of  State Medical  Boards of                                                              
the  United  States,  a  national   non-profit  organization  that                                                              
represents  70  state  medical and  osteopathic  boards  on  model                                                              
policy for  the appropriate use  of telemedicine  technologies and                                                              
the  practice   of  medicine.  The   report  concludes   that  the                                                              
physician/patient  relationship  is  clearly  established  when  a                                                              
physician  agrees  to undertake  diagnosis  and treatment  of  the                                                              
patient,  and the patient  agrees  to be treated,  whether  or not                                                              
there  has been  a personal  encounter between  the physician  and                                                              
the patient.                                                                                                                    
SENATOR  MICCICHE  summarized that  SB  98  does five  things:  it                                                              
clarifies   that   the   legislature's  intent   is   to   support                                                              
telemedicine  in Alaska,  prevents the Alaska  Medical Board  from                                                              
blocking  telemedicine  to  private   sector  insurance  programs,                                                              
ensures  the patient  controls  their medical  records,  including                                                              
their  psychiatric  records,  removes  the  requirement  that  the                                                              
physician  must be  physically located  in  Alaska, maintains  the                                                              
requirement  that the  physician  is licensed  in  Alaska, and  it                                                              
provides  substantive  cost  savings   to  individuals  in  public                                                              
He said both AETNA  and Premera Blue Cross Blue  Shield of America                                                              
support the  bill. State  employees currently  have this  benefit.                                                              
He  shared a  personal story  of how  the benefit  might help  his                                                              
1:42:52 PM                                                                                                                    
CHUCK   KOPP,  Staff,   Senator  Peter   Micciche,  Alaska   State                                                              
Legislature, presented  information related  to SB 98.  He related                                                              
that Section  1 prohibits  the State  Medical Board from  imposing                                                              
discipline on  a physician licensed  in the state for  rendering a                                                              
diagnosis   or   providing   a  treatment   without   a   physical                                                              
examination,  if the physician  or another  physician or  licensed                                                              
health care provider's  practice is available for  follow-up care,                                                              
and the  physician requests that  the patient consents  to release                                                              
copies  of   records  of  the   encounter  to  the   primary  care                                                              
physician, and, if  the patient does consent, the  physician sends                                                              
for the records.                                                                                                                
He said  Section 2 is  a conforming amendment  - on page  1, lines                                                              
9-14  are deleted  and  on page  2, line  1  is deleted.  It is  a                                                              
stylistic drafting change recommended by Legislative Legal.                                                                     
1:44:01 PM                                                                                                                    
CHAIR STEDMAN noted the arrival of Senator Ellis.                                                                               
SENATOR  GIESSEL asked  about removing  the  physical presence  of                                                              
the  prescribing  clinician  in  Section 2.  She  maintained  that                                                              
something significant  happens; it removes the provision  that the                                                              
subscriber  must be  in  Alaska.  She also  asked,  in Section  2,                                                              
lines  14  and  15, who  the  "appropriate  licensed  health  care                                                              
provider" is.                                                                                                                   
MR. KOPP  answered the first  question noting that  the "physician                                                              
is located  in the state" is deleted  in Section 1. To  the second                                                              
question, he  explained that the  "licensed health  care provider"                                                              
is taken  from current law that  deals with prescription  of drugs                                                              
without physical  examination.  The law is  currently worded  that                                                              
an appropriated  licensed health  care provider  is to  be present                                                              
with  the  physician  to  assist with  the  exam,  diagnosis,  and                                                              
treatment  if  a controlled  substance  is  involved.  He said  he                                                              
would  have to look  up the  definition of  "licensed health  care                                                              
1:46:22 PM                                                                                                                    
CHAIR STEDMAN said  it is the first hearing on SB  98 and he would                                                              
be setting  the bill aside, providing  ample time for  the sponsor                                                              
to get back to committee questions and concerns.                                                                                
SENATOR  GIESSEL said  she  needs to  confirm  that pharmacies  in                                                              
Alaska  fill  prescriptions  from  out-of-state  prescribers.  She                                                              
asked   who  the   sponsor  would   call  late   at  night   using                                                              
SENATOR  MICCICHE said  it would  be a Teledoc  person within  the                                                              
SENATOR GIESSEL  said Arizona  uses a  statewide nurse  call line,                                                              
not necessarily a physician employed by Teledoc.                                                                                
1:48:19 PM                                                                                                                    
SENATOR STOLTZE asked for clarification of Teledoc.                                                                             
SENATOR MICCICHE  recalled that in  the new Teledoc plan  the idea                                                              
was  that there  would  be an  M.D. on  the  end of  the line.  He                                                              
opined that  in many  cases, calls  could be  handled by  a nurse,                                                              
nurse practitioner, or other health care provider.                                                                              
SENATOR  STOLTZE asked  if it  creates a  new billing  opportunity                                                              
for doctors.                                                                                                                    
SENATOR MICCICHE  thought the effort nationally was  to reduce the                                                              
cost of office  visits by allowing calls, and  a Teledoc physician                                                              
can manage phone calls for less cost.                                                                                           
SENATOR STOLTZE repeated the question.                                                                                          
SENATOR MICCICHE said insurance companies look at it as savings.                                                                
1:51:40 PM                                                                                                                    
CHAIR STEDMAN opened public testimony.                                                                                          
DR.  MIKE  HAUGEN,   Executive  Director,  Alaska   State  Medical                                                              
Association  (ASMA),   testified  in  opposition  to   SB  98.  He                                                              
maintained  that  ASMA  had  concerns   last  year  about  HB  281                                                              
expanding  the use  of  telemedicine by  allowing  a physician  to                                                              
prescribe  medication   via  telemedicine  without   conducting  a                                                              
physical  exam   and  without  establishing   a  physician/patient                                                              
relationship.  He said  that ASMA  took a neutral  position  on HB
281, providing there  were safeguards put in place.  He maintained                                                              
that  SB 98  removes  one of  the primary  safeguards  - that  the                                                              
physician be located  in Alaska. He said the  Alaska State Medical                                                              
Board  is currently  working on  guidelines  for telemedicine.  He                                                              
requested that  the bill  be held until  those regulations  are in                                                              
1:54:37 PM                                                                                                                    
SENATOR GIESSEL  asked whether  there is  a provision  for billing                                                              
for phone consultations.                                                                                                        
DR. HAUGEN said he did not know.                                                                                                
DR. HENRY DEPHILLIPS,  Teladoc, testified in support  of SB 98. He                                                              
said the  legislative intent  in Alaska,  considering the  passage                                                              
of HB 281,  is to allow telemedicine  in the state. This  bill has                                                              
a major  provision, removing  the requirement  that the  physician                                                              
or  licensed practitioner  practicing  telemedicine be  physically                                                              
present  in the  state.  He said  Alaska is  the  only state  that                                                              
requires the physician to be present in the state.                                                                              
He noted  the mismatch  between  the need for  services in  Alaska                                                              
and  the  number  of  physicians  available.  He  thought  it  was                                                              
interesting that the  Alaska State Medical Board seems  to want to                                                              
allow physicians  in the state  to practice telemedicine,  but not                                                              
those licensed in  Alaska, but living elsewhere.  The compensation                                                              
for physicians in  Alaska is three times that in  other states. He                                                              
suggested  that telemedicine  costs  in Alaska  would  have to  be                                                              
tripled to  be effective.  He concluded that  it makes  more sense                                                              
to allow out-of-state practitioners to practice telemedicine.                                                                   
1:58:22 PM                                                                                                                    
SENATOR  GIESSEL  asked  Dr.  DePhillips  if he  agrees  with  the                                                              
controlled substance provision in the bill.                                                                                     
DR. DEPHILLIPS said  the Teledoc program is in 48  states and does                                                              
not allow the  prescribing of DEA controlled substances  under any                                                              
scenario. He noted prisons in Alaska as an exception.                                                                           
2:00:11 PM                                                                                                                    
DR.   JOHN   PAPPENHEIM,  representing   himself,   testified   in                                                              
opposition  to SB  98. He  said he  is a  psychiatrist and  opined                                                              
that   while   telemedicine   and   tele-psychiatry,   when   done                                                              
appropriately,  can provide  safe  and effective  treatment  while                                                              
improving access  to health care  providers, SB 98 in  its current                                                              
form  does  not  do  that. He  requested  waiting  for  the  State                                                              
Medical Board to write telemedication regulations.                                                                              
2:01:30 PM                                                                                                                    
SHEELA  TALLMAN, Senior  Manager  of Legislative  Policy,  Premera                                                              
Blue Cross Blue  Shield of Alaska, testified in support  of SB 98.                                                              
She stated  that telemedicine  can reduce  health care  costs. She                                                              
said  this  year Premera  launched  a  virtual care  benefit  that                                                              
enabled  all   members  to  access  health-related   services  and                                                              
information  via  a variety  of  telecommunication  channels.  She                                                              
noted  growing interest  for those  services. SB  98 will  promote                                                              
the use of telemedicine in Alaska.                                                                                              
SENATOR STOLTZE  asked if other states have  expanded telemedicine                                                              
to outside the borders of the U.S.                                                                                              
MS. TALLMAN  said they have been  successful in other  states, but                                                              
she did not know about other countries.                                                                                         
SENATOR  GIESSEL   said  Medicaid  currently  does   not  pay  for                                                              
providers outside Alaska. She asked if it does in other states.                                                                 
MS. TALLMAN said yes.                                                                                                           
2:04:27 PM                                                                                                                    
CRIAG KESTRAN,  Senior Account Executive Benefits  Manager, Alaska                                                              
USA Insurance Brokers,  testified in support of SB  98. He related                                                              
that due  to the doctor  shortage, telemedicine  is in  name only.                                                              
Telemedicine removes  the barriers  to entering the  Alaska market                                                              
and  makes quality  health  care available.  It  will provide  for                                                              
low-cost, high-quality health care.                                                                                             
2:06:04 PM                                                                                                                    
REBECCA LING,  Director of  Recovery Services,  Cook Inlet  Tribal                                                              
Council, testified in  support of SB 98. She spoke  of the success                                                              
of tele-psychiatry  service for behavioral health  issues provided                                                              
by  physicians outside  the  state, but  licensed  in Alaska.  She                                                              
said  the  services  have  been  provided  by  the  University  of                                                              
Colorado for  seven years.  She described  how the process  works.                                                              
She  spoke of  the  reluctance of  patients  to  sign releases  to                                                              
share records with  primary care physicians, which  is required by                                                              
law. She  said Recovery  Services does  not prescribe  medications                                                              
other than basic  medications. She said SB 98  would benefit their                                                              
2:08:23 PM                                                                                                                    
CAM   CARLSON,  Public   Member,  Alaska   State  Medical   Board,                                                              
testified in opposition  to SB 98. She said the  previous bill, SB
281, did  not assure that  there would  be a health  care provider                                                              
involved,  nor did  it  provide an  adequate  standard of  patient                                                              
care. She  maintained that the doctors  calling from out  of state                                                              
are in it for the money.                                                                                                        
2:10:25 PM                                                                                                                    
KATE  BURKHARDT, Executive  Director, Alaska  Mental Health  Board                                                              
and  Advisory Board  on Alcoholism  and Drug  Abuse, testified  in                                                              
support of  SB 98.  She said she  had concerns about  out-of-state                                                              
physicians and the  sharing of patient records as  contained in SB
281. She  spoke about  the use  of telemedicine  in the  community                                                              
behavior  health  system.  She   gave  examples  of  who  provides                                                              
psychiatric  services and  the  way the  system  is designed.  She                                                              
said  a physician's  relationship is  created at  the outset.  She                                                              
testified in  favor of removing  the provision that  the physician                                                              
must  be inside  the state.  She  also liked  the consent  request                                                              
section in SB 98 because Section 2 alleviates their concerns.                                                                   
2:13:50 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
MR. KOPP thanked the committee for hearing the bill.                                                                            
CHAIR  STEDMAN  commented  that they  will  work  on the  bill  to                                                              
rectify concerns.                                                                                                               
CHAIR STEDMAN held SB 98 in committee.                                                                                          

Document Name Date/Time Subjects