HB 22: "An Act establishing the Alaska Children's Health Corporation and the Alaska Healthy Start Program; relating to insurance; and providing for an effective date."
00HOUSE BILL NO. 22 01 "An Act establishing the Alaska Children's Health Corporation and the Alaska 02 Healthy Start Program; relating to insurance; and providing for an effective 03 date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 21 is amended by adding a new chapter to read: 06 CHAPTER 56. HEALTHY START PROGRAM. 07 ARTICLE 1. ALASKA CHILDREN'S HEALTH CORPORATION. 08 Sec. 21.56.010. CREATION OF CORPORATION. The Alaska Children's 09 Health Corporation is created as a public corporation. The corporation is an 10 instrumentality of the state within the Department of Administration, but it has a legal 11 existence independent of and separate from the state. 12 Sec. 21.56.020. PURPOSE OF THE CORPORATION. (a) The corporation's 13 purpose is to 14 (1) administer the Alaska children's health care plan as described in
01 this chapter; 02 (2) purchase health insurance coverage for children and pregnant 03 women who are eligible for the plan under AS 21.56.110; and 04 (3) manage the Alaska children's health fund created under 05 AS 21.56.200. 06 (b) The corporation is not considered an insurer. The directors and employees 07 of the corporation are not considered to be agents of an insurer. Neither the 08 corporation nor a director or employee of the corporation is subject to the licensing 09 requirements of this title. However, the division of insurance may require that a 10 marketing representative used and compensated by the corporation be appointed as a 11 representative of the insurers with which the corporation contracts. 12 Sec. 21.56.030. BOARD OF DIRECTORS. (a) The corporation is governed 13 by a board of directors consisting of the commissioner of administration, the 14 commissioner of health and social services, and five other members appointed by the 15 governor. The five appointed members must include persons who are experienced in 16 providing health care, managing large funds, providing health insurance, and promoting 17 child welfare. At least one member must be a person who resides in a rural area of 18 the state or is familiar with health care delivery in rural areas of the state. 19 (b) Board members shall serve staggered terms of four years. 20 (c) The board members shall select from among themselves a chair and a vice-chair. 21 (d) Members of the board receive no compensation for their services but are 22 entitled to per diem and travel allowances authorized by law for other boards and 23 commissions under AS 39.20.180. 24 (e) The board shall meet at least twice a year at times and locations 25 determined by the chair. Four members of the board constitute a quorum. 26 (f) The board may hire an executive director to assist it in carrying out its 27 duties. The executive director may hire other necessary staff. The executive director 28 and other employees of the board serve at the pleasure of the board and are in the 29 exempt service under AS 39.25.110. 30 ARTICLE 2. ALASKA CHILDREN'S HEALTH CARE PLAN. 31 Sec. 21.56.100. CONTENTS OF PLAN. (a) The Alaska children's health
01 care plan consists of the following medical services for children who are eligible under 02 AS 21.56.110: 03 (1) routine examinations; 04 (2) diagnostic and screening services; 05 (3) immunizations and preventive services; 06 (4) laboratory and x-ray services; 07 (5) outpatient physician services; 08 (6) outpatient surgery; 09 (7) emergency room services; 10 (8) prescription lenses, eyeglass frames, and vision care; 11 (9) dental services, except orthodontics; 12 (10) prescription drugs; and 13 (11) other services, as approved by the board under (b) of this section. 14 (b) The board may, by regulations adopted under AS 44.62 (Administrative 15 Procedure Act), determine the scope of the services listed in (a) of this section and add 16 other categories of services for children that will be covered under the plan. A new 17 category of service is not covered under the plan until an insurer agrees to cover it. 18 (c) The plan also includes prenatal services, delivery services, and at least 19 three months of postnatal services for pregnant women. The board may, by regulations 20 adopted under AS 44.62 (Administrative Procedure Act), determine the scope of 21 services covered under this subsection, including the duration of postnatal services 22 beyond the minimum set under this subsection. 23 (d) In addition to the premium copayment required under AS 21.56.140, the 24 board may require a copayment for a service, establish deductibles, set duration and 25 usage limits, develop and implement procedures related to utilization review, and 26 establish other reasonable conditions relating to the provision of services under (a) - 27 (c) of this section to limit the cost of the plan's operation and to ensure the efficiency 28 and efficacy of the services provided under the plan. 29 Sec. 21.56.110. ELIGIBILITY FOR THE PLAN. (a) A child is eligible for 30 coverage under AS 21.56.100(a) and (b) if 31 (1) the child is under the age of 19 and has been a resident of the state
01 for the 12 months immediately preceding application for plan coverage or, if the child 02 is less than one year old, at least one of the child's parents has been a resident of the 03 state for the 12 months immediately preceding application for plan coverage; 04 (2) the child does not have health care coverage under another public 05 or private health insurance plan; 06 (3) the child's household income is below 300 percent of the income 07 level established under AS 47.25.310 - 47.25.420 for eligibility for aid to families with 08 dependent children; 09 (4) the child is not eligible for medical coverage under AS 47.07 10 (Medicaid); and 11 (5) a portion of the premium for plan coverage is paid on behalf of the 12 child, as determined by the board under AS 21.56.140. 13 (b) A pregnant woman is eligible for coverage under AS 21.56.100(c) if 14 (1) the woman has been a resident of the state for the 12 months 15 immediately preceding the woman's application for plan coverage; 16 (2) the woman does not have coverage for prenatal, delivery, or 17 postnatal services under another public or private health insurance plan; 18 (3) the woman's income is below 300 percent of the income level 19 established under AS 47.25.310 - 47.25.420 for eligibility for aid to families with 20 dependent children; 21 (4) the woman is not eligible for medical coverage under AS 47.07 22 (Medicaid); and 23 (5) a portion of the premium for plan coverage is paid on behalf of the 24 woman, as determined by the board under AS 21.56.140. 25 Sec. 21.56.120. APPLICATION PROCESS. (a) A pregnant woman or the 26 parent or guardian of a child may request an application packet for plan coverage by 27 notifying the board directly or by completing the relevant section of the woman's or 28 child's permanent fund dividend application form as provided under AS 43.23.017. 29 (b) Upon direct notification by an interested person or upon notification from 30 the Department of Revenue of the name and mailing address of a person who has 31 requested an application packet for the plan under (a) of this section, the board shall
01 send an application packet to the person requesting it. 02 (c) An application packet sent under (b) of this section must include 03 (1) a description of the health care coverage available under the plan; 04 (2) a copy of the sliding fee schedule used by the board to determine 05 the premium copayment responsibility and a description of deductibles and copayment 06 requirements the board has established under AS 21.56.100(d); 07 (3) an explanation of the eligibility requirements for the plan; and 08 (4) an application form to be returned to the board if the person wants 09 to apply for coverage personally or on behalf of an eligible child. 10 (d) Within 30 days after receiving a completed application for plan coverage, 11 the board shall either notify the applicant about whether the plan coverage is approved 12 or request additional information necessary to determine the eligibility. If the board 13 determines that a pregnant woman or a child is eligible for the plan, the notification 14 of eligibility sent under this subsection must include a determination of amount of the 15 premium copayment required under AS 21.56.140. 16 (e) The board's denial or withdrawal of plan coverage may be appealed to the 17 superior court. 18 Sec. 21.56.130. ADMINISTRATION OF PLAN. (a) The board shall 19 administer the Alaska children's health care plan by 20 (1) soliciting and accepting funds from private sources for deposit into 21 the children's health fund created under AS 21.56.200; the board may also accept 22 donations of services, supplies, personnel, and other in-kind donations; 23 (2) evaluating bids and purchasing insurance from one or more insurers 24 to provide plan coverage; 25 (3) marketing the plan in a manner designed to make its existence 26 known to pregnant women and the parents and guardians of children who may be 27 eligible for the plan; 28 (4) evaluating applications for plan coverage and determining eligibility 29 for plan coverage; 30 (5) determining the premium copayment that is required under 31 AS 21.56.140.
01 (b) The board shall adopt regulations under AS 44.62 (Administrative 02 Procedure Act) to implement this chapter. 03 Sec. 21.56.140. COPAYMENTS OF PREMIUMS. (a) Coverage under the 04 plan is contingent upon copayment of part of the insurance premium, as determined 05 by the board. The board shall adopt a sliding scale for copayments that takes into 06 account the income and resources of the eligible person's household. The board shall 07 determine whether two copayments are required when eligible children are in a 08 household that includes a woman who is eligible because of pregnancy. 09 (b) The board, in cooperation with the Department of Revenue, shall adopt 10 regulations under which a pregnant woman or a parent or guardian may request that 11 a permanent fund dividend to which the woman or child is entitled be reduced by the 12 Department of Revenue to provide the premium copayment for the women's or child's 13 plan coverage. 14 (c) The board shall deposit copayments received under this section into the 15 general fund. The department of administration shall separately account for premium 16 copayments deposited into the general account by the board. The estimated annual 17 balance in the account may be used by the legislature to make appropriations to the 18 fund established under AS 21.56.200. 19 Sec. 21.56.150. CONFIDENTIALITY OF RECORDS. (a) Information 20 received by the board in an application for plan coverage is confidential and is not 21 subject to public inspection and copying under AS 09.25.110 - 09.25.120. 22 (b) A board member or employee of the corporation who divulges information 23 in violation of (a) of this section is guilty of a class B misdemeanor. 24 ARTICLE 3. ALASKA CHILDREN'S HEALTH FUND. 25 Sec. 21.56.200. CREATION OF FUND. The Alaska children's health fund 26 is created in the corporation. It consists of money donated to the corporation from 27 private sources and appropriations made to the fund. 28 Sec. 21.56.210. USE OF THE FUND. The board may use money in the fund 29 (1) to pay insurance premiums for the Alaska children's health care 30 plan; and 31 (2) for the board's expenses incurred in administration of the plan and
01 the fund. 02 ARTICLE 4. GENERAL PROVISIONS. 03 Sec. 21.56.290. DEFINITIONS. In this chapter, 04 (1) "board" means the board of directors of the Alaska Children's 05 Health Corporation established under AS 21.56.010; 06 (2) "corporation" means the Alaska Children's Health Corporation 07 established under AS 21.56.010; 08 (3) "fund" means the Alaska children's health fund established under 09 AS 21.56.200; 10 (4) "plan" means the Alaska children's health care plan described under 11 AS 21.56.100. 12 Sec. 21.56.299. SHORT TITLE. This chapter may be cited as the Healthy 13 Start Program. 14 * Sec. 2. AS 39.25.110 is amended by adding a new paragraph to read: 15 (30) the executive director and other employees of the Alaska 16 Children's Health Corporation (AS 21.56). 17 * Sec. 3. AS 39.30 is amended by adding a new section to read: 18 Sec. 39.30.092. BIDDER REQUIREMENT. An insurer may not submit a bid 19 under AS 39.30.090 for a type of medical care coverage that is included in the Alaska 20 children's health care plan under AS 21.56 unless the insurer also submits a bid to the 21 Alaska Children's Health Corporation to cover that type of medical care under 22 AS 21.56. 23 * Sec. 4. AS 43.23 is amended by adding a new section to read: 24 Sec. 43.23.017. ALASKA CHILDREN'S HEALTH PLAN. (a) The 25 department shall include on the permanent fund dividend application form a question 26 requesting whether the applicant wishes to 27 (1) apply for coverage of a child or pregnant woman under the Alaska 28 children's health care plan established under AS 21.56; 29 (2) pay for the coverage under AS 21.56 by deduction from the 30 permanent fund dividend. 31 (b) Within 30 days after receiving an application form that indicates interest
01 in the Alaska children's health plan, the department shall notify the Alaska Children's 02 Health Corporation of the names and mailing addresses of persons who have indicated 03 on a permanent fund dividend form that they would like to apply for coverage under 04 the Alaska children's health care plan. 05 (c) The department, in cooperation with the Alaska Children's Health 06 Corporation, shall adopt regulations governing how it will honor a request that a 07 permanent fund dividend be reduced by the department to provide the premium 08 copayment for coverage under the Alaska children's health care plan. 09 * Sec. 5. TRANSITIONAL PROVISION. Notwithstanding AS 21.56.030(b), enacted by 10 sec. 1 of this Act, the governor shall set the terms of the first five appointed members of the 11 board of directors of the Alaska Children's Health Corporation so that one of the appointed 12 members serves a two-year term, two members serve three-year terms, and two members serve 13 four-year terms. 14 * Sec. 6. EVALUATION OF COST OPTIONS. The board of directors of the Alaska 15 Children's Health Corporation established under this Act shall, after appropriate consultation 16 with interested persons, prepare an estimate of the fiscal costs to the state and to eligible 17 persons of purchasing insurance to cover the services described in AS 21.56.100, enacted by 18 sec. 1 of this Act. The estimate must present at least two alternative funding levels and 19 include an explanation of the scope of services proposed by the board for each funding level. 20 The board shall submit the estimate and explanation to the governor and the legislature by 21 March 1, 1993. 22 * Sec. 7. AS 21.56.010 - 21.56.030, 21.56.130(a)(1), and 21.56.200 - 21.56.299, enacted 23 by sec. 1 of this Act, and secs. 2, 5, and 6 of this Act take effect immediately under 24 AS 01.10.070(c). 25 * Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect July 1, 1994.