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Alaska May Open its Doors to Telemedicine

A Medicaid reform bill that passed unanimously in the state's Senate would allow out-of-state telemedicine consults without an in-person relationship.

By Eric Wicklund

- Alaska lawmakers are uniting behind a bill that would, for the first time, enable the state’s Medicaid participants to access telemedicine services from out-of-state providers.

SB 74 “could be a major change that will affect the entire Alaska healthcare industry,” the Alaska Journal recently wrote of the bill, which passed unanimously in the Senate on March 11 and “has a lot of Senate horsepower lined up behind the bill.” The proposed legislation would, among other things, enable out-of-state telemedicine providers to treat Alaska residents without first establishing an in-person relationship, and also allow them to prescribe some medications.

The proposed bill would still require out-of-state telemedicine providers to be licensed in Alaska, and would compel them to register with the state.

Alaska now offers a wide array of telemedicine services and is paid millions of dollars in federal grants to expand and maintain that network, especially among the large percentage of Native Americans. But all programs must be run in-state, and any healthcare providers based in other states must have facilities in Alaska and an in-person relationship with the patients being treated.

SB 74, proponents say, would open that network to even more telemedicine providers and services.

“We are one of only two states that does not allow telemedicine to be practiced across state lines, this bill will change that,” Sen. Peter Micciche, R-Soldotna, said during Senate discussion of the bill, adding that telemedicine would cost about one-third of a typical primary care visit and about one-tenth of an ER visit.

Cost savings may be the prime motivator in Senate support for telemedicine. SB 74 would reportedly save the state more than $31 million in fiscal year 2017 if passed into law, with that figure jumping up to $114 million by 2022. While the bill covers a broad range of changes to the state’s Medicaid system, whose expenses have grown 70 percent in the past decade, supporters have said that expanding telemedicine access – particularly to remote villages and Alaska’s large Native population – would greatly reduce chronic and emergency care costs.

Included in the proposed legislation is a new primary case management system that would funnel Medicaid enrollees into primary care services instead of ER and specialty care. The system would include a reform program that would reduce travel expenses paid through Medicaid by compelling enrollees to use healthcare services closer to home or telemedicine programs for primary, behavioral and urgent care.

“The Legislature has clearly indicated a desire to move to new payment models, which is a significant shift,” Becky Hultberg, CEO of  the Alaska State Hospital and Nursing Home Association, told State of Reform. “For now, this will be accomplished through pilot projects, as the state and providers test new strategies and gain experience. This is probably the most significant long-term system change.”

“The telemedicine provisions could be significant in the short term,” she added.

Another piece of legislation making its way through the state capital would require insurance plans in the state to cover telemental health services the same as in-person services and without the need for an in-person visit first. Medicaid already covers such services, but other federal programs, Medicare and commercial health plans don’t necessarily have to.

This bill may face a tougher road. The Alaska Department of Health and Social Services hasn’t taken a position on the issue yet, and the head of the state’s suicide prevention board said she isn’t yet sure if it would help.

“Therapy is effective because of the relationship between the provider and the client, so we’re trying to understand what is the service that (the state) is anticipating if there’s no in-person encounter,” Kate Burkhart, executive director of the Statewide Suicide Prevention Council, told the Peninsula Clarion


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