Multiple bills aim to expand telehealth services in Alaska

  • Augusta Williams, Community Health Practitioner at the Yukon-Kuskokwim Health Corp. Napaskiak Village Clinic, explains the functionality of one of the clinic’s telemedicine carts to visitors from the Rasmuson Foundation during a late June 2017 visit. Pending legislation seeks to expand telehealth offerings around the state to allow for standard reimbursements and to allow physician assistants to serve patients remotely. (Photo/Mitchell Forbes/YKHC)

Medical providers may have more options for offering services digitally if the Legislature approves a set of bills targeted at expanding telehealth availability.

Telehealth includes a variety of services delivered by the provider communicating digitally with a patient or transmitting data such as imaging scans. In a state like Alaska, where much of the population is spread thin and medical providers are concentrated in urban areas, telehealth has the potential to connect those who live in rural areas or without reliable or affordable transportation to regular medical care.

When the Legislature reformed the Medicaid program in 2016, one provision required the state Medical Board to create regulations for physicians to diagnose, prescribe and administer prescriptions without conducting a physical examination on a patient.

That allowed doctors to begin offering a broader array of services. In the intervening years, a number of telehealth services have popped up in the state and some insurers, including Premera Blue Cross Blue Shield, offer coverage for telehealth services for members in Alaska.

A suite of bills in the Legislature would expand telehealth services further. House Bill 29, sponsored by Rep. Ivy Spohnholz, D-Anchorage, would allow providers to bill state-regulated insurers for health care services delivered by telehealth without an initial in-person appointment.

HB 97 and its companion legislation Senate Bill 44 would allow physician assistants to deliver telehealth services under the same statutory regulation as physicians.

None of the bills have received much opposition, and providers and insurers have come out in support. Telehealth is billed as a way to improve access to care and potentially decrease costs by delivering them more effectively and through preventative care visits.

“We need to look at the overall cost of health,” said Division of Insurance Director Lori Wing-Heier in a House Labor and Commerce Committee hearing on April 24. “We need to look at ways to reduce the cost of health care while expanding access … This is an excellent way to do that.”

Spohnholz told the House Labor and Commerce Committee that the bill allows for reimbursement to any provider who delivers services via telehealth, not just telehealth-specific companies.

Teladoc, a New York-based telemedicine company, already offers services in Alaska and supports the bill. The company contracts with Premera and the AlaskaCare Employee Health Plan, which covers State of Alaska employees, among other health plans.

Claudia Tucker, the vice president of government affairs for Teladoc, told the committee in an April 29 hearing that telemedicine services saved Alaskans $3.5 million in health care costs in 2018.

One of the concerns committee members had is where the doctors who are answering the calls are located. Tucker said while the company has a preference in the state for doctors who live in Alaska, they aren’t always available.

“About 30 percent of (Alaska-based) calls were answered by physicians who lived in Alaska,” she said. “All of them are answered by physicians licensed in Alaska.”

Robin Minard, the chief communications officer for the Mat-Su Health Foundation, said two of the major barriers to care identified in the Mat-Su Regional Medical Center’s Community Health Needs Assessment are lack of access to care and transportation. Expanded telehealth options would help address both, she said.

The Alaska Commission on Aging also noted this in a letter of support. Medicare does not currently allow for telehealth visits to be reimbursed, but an expanded program from the Centers for Medicare and Medicaid Services called Medicare Advantage would allow telehealth services delivered in a recipient’s home to be reimbursable, commission chair Gordon Glaser and executive director Denise Daniello wrote in the letter.

“Medicare Advantage is not yet available in Alaska, however, there has been growing interest in exploring managed care plans as a means to control costs in our State,” they wrote. “The Commission on Aging will be following these developments.”

HB 97, sponsored by Rep. Jonathan Kreiss-Tomkins, D-Sitka, and SB 44, sponsored by Senate President Cathy Giessel, R-Anchorage, both seek to include physician assistants in the regulations on telehealth delivery. The intent of the original revision to Medicaid was to include them, but the state Medical Board wanted specific mention of physician assistants, according to a letter to Giessel from board President Catherine Hyndman.

Most of Interior Alaska is considered a medically underserved area with a health professional shortage, according to the Health Resources and Services Administration. Physician assistants are allowed to prescribe schedule 2 to 5 substances and be supervised by a doctor in order to practice medicine.

The House Labor and Commerce Committee passed HB 29 out of committee but was waiting for amendments on HB 97, which were due May 2. The Senate Finance Committee passed SB 44 out of committee on April 15.

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Elizabeth Earl can be reached at [email protected].

Updated: 
05/01/2019 - 9:09am

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