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Alaska and Hawaii Delegations Seek Medicare Reimbursement Flexibility for Rural Hospitals | U.S. Senator Lisa Murkowski of Alaska

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Alaska and Hawaii Delegations Seek Medicare Reimbursement Flexibility for Rural Hospitals | U.S. Senator Lisa Murkowski of Alaska


02.02.24

WASHINGTON—U.S. Senators Dan Sullivan and Lisa Murkowski (both R-Alaska), and Senators Brian Schatz and Mazie Hirono (both D-Hawaii), introduced legislation this week to increase the amount that hospitals in Alaska and Hawaii can be reimbursed by Medicare to perform outpatient procedures for enrolled seniors. Historically, rural states have faced significant cost disparities for Medicare reimbursement that drive up costs for both hospitals and patients. This legislation would recognize the unique cost-of-living challenges that hospitals in Alaska and Hawaii face, and would increase reimbursement for ultra-rural hospitals to ensure that they can continue to serve seniors in rural locations.

The legislation follows a letter sent to the Department of Health and Human Services by Senators Sullivan and Murkowski requesting more reimbursement-rate flexibility for Medicare inpatient procedures in Alaska and Hawaii.

“The federal government’s one-size-fits-all Medicare formulas are simply not working for rural states—a challenge that has saddled health care providers and senior citizens in Alaska with outrageous costs relative to other states,” Senator Sullivan said. “Without flexibility in these formulas, hospitals across Alaska are struggling to maintain the level of care our seniors deserve. Our priority must be ensuring seniors on Medicare across the state can continue to access the inpatient and outpatient health services they rely on.”

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“Medicare formulas continue to fall short in addressing the challenges that rural states face. Alaska’s health care system relies on health care facilities to provide care in some of the most remote locations, contributing to increases in cost of care,” said Senator Murkowski. “This legislation will offer greater flexibility for these Medicare formulas, so our facilities can provide critical care to our seniors and rural Alaskans.”

“To make sure hospitals in communities across Hawaii can continue to serve the seniors that rely on them, Medicare must recognize the real cost of providing health care in our state,” said Senator Schatz. “Our bill will help boost reimbursements to providers in Hawaii and make sure seniors have access to the health care services they deserve.”

“Hawaii’s unique geography and high cost of living makes accessing and providing health care more difficult, which is why hospitals in Hawaii have long received higher Medicare reimbursement for inpatient care than those in other states,” said Senator Hirono. “This bill would similarly raise outpatient Medicare reimbursements in Hawaii, helping to ensure our hospitals—especially on neighbor islands—have the resources they need to provide outpatient care for our communities.”

The corresponding letter can be found here. 

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Bangladeshi man flown to Alaska to face federal charges in ‘extensive’ child sexual exploitation case

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Bangladeshi man flown to Alaska to face federal charges in ‘extensive’ child sexual exploitation case


Bangladeshi national Zobaidul Amin is led to an aircraft in Malaysia by FBI agents before flying to Anchorage on Wednesday, March 4, 2026. Amin was indicted in 2022 on charges of operating an international child sex exploition enterprise and spent the past three years in Malaysia. (Photo provided by FBI)

A Bangladeshi man who authorities say operated an international child sexual exploitation enterprise involving hundreds of children, including those in Alaska, arrived in Anchorage this week after spending several years out on bail in Malaysia.

Zobaidul Amin, 28, made his first federal court appearance in Anchorage on Thursday.

A federal grand jury in Alaska indicted Amin in July 2022 on 13 charges related to the production and distribution of child pornography, cyberstalking and child exploitation. Law enforcement in Malaysia was prosecuting him on similar accusations.

Amin is accused of orchestrating a vast online sexual extortion ring that resulted in the abuse of minors, primarily from the United States.

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“Amin delighted in sexually abusing hundreds of minor victims over social media,” prosecutors said in a memorandum filed Thursday recommending that a judge keep Amin jailed while awaiting trial. “He bragged about causing victims to become suicidal and engage in self-harm. He shared hundreds of nude images and videos of minor victims all over the internet and encouraged other perpetrators to do the same.”

The FBI arrested Amin on Wednesday in Malaysia and took him to Alaska, Anchorage FBI spokesperson Chloe Martin said in an emailed statement.

FBI agents wait on the tarmac as a plane carrying Bangladeshi national Zobaidul Amin from Malaysia arrives in Anchorage on Wednesday, March 4, 2026. Amin was indicted in 2022 on charges of operating an international child sex exploition enterprise and spent the past three years in Malaysia. (Photo provided by FBI)

Amin pleaded not guilty at Thursday’s hearing.

U.S. Magistrate Judge Kyle Reardon assigned Amin a public defender and ordered that he remained jailed while his case proceeds.

Amin, wearing a yellow Anchorage Correctional Complex jumpsuit, quietly spoke only two words during the hearing: “Yes,” when Reardon asked whether he understood his rights, and “yes” after Reardon asked if Amin agreed to waive his right to a speedy trial to allow his attorney to adequately prepare.

For more than three years, federal officials sought to have Amin “expelled” from Malaysia, where he was a medical student, to face charges in the U.S., prosecutors said in their memorandum.

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Authorities have said they uncovered the sophisticated child sexual abuse material production scheme after a 14-year-old girl told Alaska State Troopers in 2021 that Amin coerced her via social media into sending him lewd images of herself and participating in sexually explicit conduct over video calls.

When the girl stopped communicating with Amin, prosecutors said, he carried out previous threats to distribute the images to her friends and social media followers.

“Dozens of search warrants, subpoenas, and legal process revealed that Amin did the same thing to hundreds of minor victims,” prosecutors said in the detention memo, adding that it was one of the “most extensive” operations of its kind investigated by law enforcement.

But authorities had been unable to extradite Amin from Malaysia, they said.

Malaysian authorities, with help from U.S. law enforcement, also charged Amin for offenses related to the production and distribution of child sexual abuse images in 2022.

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He was released from custody in Malaysia after his family paid a bail equivalent to $24,000, according to the detention memo.

The requirements of Amin’s release included that he surrender his passport, not contact his victims or engage in child sexual abuse image conduct, and report to police monthly, according to the memo.

Prosecutors said they were not aware of any violations but added that it was unclear how strictly the requirements were enforced.

Had Amin fled to Bangladesh, he would have been able to evade prosecution because the U.S. doesn’t have an extradition treaty with the South Asian country, according to the memo.

Officials didn’t publicly disclose additional details about the circumstances that led to his arrest and transfer to Alaska or why he hadn’t been moved to the U.S. sooner.

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The FBI and U.S. Department of Justice have been working “in conjunction with Malaysian authorities” to get Amin transferred to U.S. custody, the U.S. Attorney’s Office in Alaska said in a prepared statement Thursday.

A child exploitation and human trafficking task force based out of the FBI’s Anchorage offices investigated the case with the support of numerous agencies, including the Anchorage Police Department and Alaska State Troopers, the Royal Malaysia Police, and a long list of law enforcement entities in Wyoming, Oregon, West Virginia and Florida as well as cities including Atlanta, Los Angeles, Minneapolis, Newark, Salt Lake City and Seattle.





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Bill allowing physician assistants to practice independently passes Alaska Senate

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Bill allowing physician assistants to practice independently passes Alaska Senate


JUNEAU — The Alaska Senate has passed a bill that would allow physician assistants with sufficient training to practice under an independent license, removing the state’s current requirement that they work under a formal collaborative agreement with physicians.

Supporters say the change would reduce administrative burdens that can delay and increase the cost of care. But physicians who opposed the bill argue it lowers the bar for training and could affect patient care.

Senate Bill 89, sponsored by Anchorage Democratic Sen. Löki Tobin, passed by a unanimous vote in the Senate on Wednesday, with 18 votes in favor and two members absent. The bill would allow physician assistants to apply for an independent license after completing 4,000 hours of postgraduate supervised clinical practice.

Under current law, physician assistants in Alaska must operate under a collaborative plan with physicians. These plans outline the medical services a physician assistant can provide and require oversight from doctors.

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The Alaska State Medical Board regulates physician assistants and authorizes them to provide care only within the scope of their training. Most physician assistants in Alaska work in family practice, though some are specially trained in particular fields. All care must be provided under a physician’s license through a collaborative agreement that also requires a second, alternate physician to sign off.

For some clinics, particularly in more remote areas, finding those physicians can be difficult.

Mary Swain, CEO of Cama’i Community Health Center in Bristol Bay, testified in support of the bill before the Senate Labor and Commerce Committee in March 2025. Her practice employs two physicians to maintain collaborative plans for its physician assistants. She said neither of them lived in the community, and the primary physician lived out of state.

Roughly 15% of physicians who hold collaborative agreements with Alaska-based physician assistants do not live in the state, according to Tobin. At the same time, Alaskans face some of the highest health care costs in the nation.

Jared Wallace, a physician assistant in Kenai and owner of Odyssey Family Practice, testified in support of the bill at a committee meeting in April.

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Wallace said maintaining collaborative agreements is one of the most difficult parts of running his clinic. He said he pays a collaborative physician about $2,000 per physician assistant per month, roughly $96,000 a year, simply to maintain the required agreement.

“In my experience, a collaborative plan does not improve nor ensure good patient care,” Wallace said. “Instead, it is a barrier in providing good health care in a rural community where access is limited, is a threat that delicately suspends my practice in place, and if severed, the 6,000 patients that I care for would lose access to (their) primary provider and become displaced.”

Opposition to the bill largely came from physicians, who testified that physician assistants do not receive the same depth of training as doctors.

Dr. Nicholas Cosentino, an internal medicine physician, testified in opposition to the bill last April. He said that medical school training provides crucial experience in diagnosing complex cases.

“It’s not infrequent that you get a patient that you’re not exactly sure you know what’s going on, and you have to fall back on your scientific background, the four years of medical school training, the countless hours of residency to come up with that differential, to think critically and come up with a plan for that patient,” Cosentino said. “I think the bill as stated, 4,000 hours, does not equate to that level of training.”

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The Alaska Primary Care Association said it supports the intent of the bill but argued that physician assistants should complete 10,000 hours in a collaborative practice model with a physician before practicing independently.

Other states that have moved to allow independent licensure for physician assistants have adopted a range of thresholds. North Dakota requires 4,000 hours, while Montana requires 8,000 hours. Utah requires 10,000 hours of postgraduate supervised work, while Wyoming does not set a specific statewide minimum hour requirement.

Tobin said the hour requirement chosen in the bill came from conversations with experts during the bill’s drafting.

“When we were working with stakeholders on this piece of legislation, we came to a compromise of 4,000 hours, recognizing and understanding that there was concerns, but also … understanding that it is a bit of an arbitrary choice,” she said.

The bill now heads to House committees before a potential vote on the House floor.

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Dunleavy, EPA visit UAF to discuss regulations in the arctic environment

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Dunleavy, EPA visit UAF to discuss regulations in the arctic environment


Fairbanks, Alaska (KTUU/KTVF) – On Wednesday, Gov. Mike Dunleavy, Alaska Attorney General Stephen Cox and Lee Zeldin, the administrator for the Environmental Protection Agency (EPA), spoke to press at the University of Alaska Fairbanks power plant.

During their time at the university, the federal and state leaders spoke about developing resources such as coal, oil, gas and critical minerals in the 49th state.

During his 24-hour trip to Fairbanks, Zeldin said he has spoke to business and state leaders about environmental regulations impacting operations in Alaska, saying the EPA needs to consider whether regulations are solving problems or are solutions in search of a problem.

He also discussed the concept of “cooperative federalism,” where the EPA takes its cues from state leaders to determine where regulations and help are needed.

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“We’re here at the University of Alaska’s coal plant, and the most modern coal plant in the United States of America,” Dunleavy said.

Zeldin said visiting Fairbanks in winter helps inform decisions the agency is considering.

“There are a lot of decisions right now in front of this agency that the first-hand perspective of being here on the ground helps inform our agency to make the right decision,” he said.

Zeldin also said the agency is hearing concerns from Alaska truckers about diesel exhaust rules in extreme cold.

“We then met with truckers who have been dealing with unique cold weather concerns with the implementation of EPA regulations related to diesel exhaust fluid system,” he said.

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When asked about PFAS in drinking water, Zeldin said the EPA is not rolling back the standards.

“So the PFAS standards are not being rolled back at all,” he said.

On Fairbanks air quality and PM2.5 regulations, Zeldin said the agency wants to work with the state.

“We want, at the EPA, to help the Fairbanks community be able to be in attainment on PM 2.5. We want to make it work,” he said.

Dunleavy said energy costs and heating needs remain a major factor in Interior air quality discussions.

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“People have to be able to live. They’ve got to be able to afford to live,” he said.

Zeldin said EPA is considering further changes to diesel regulations and urged Alaskans to participate in the rulemaking process.

“We need Alaskans to participate in that public comment period,” he said.

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