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SB 160: "An Act establishing an Alaska health care program to ensure insurance coverage for essential health services for all residents of the state; establishing the Alaska Health Care Board to define essential health care services, to certify health care plans that provide essential health care services, and to administer the Alaska health care program and the Alaska health care fund; establishing the Alaska health care clearinghouse to administer the Alaska health care program under the direction of the Alaska Health Care Board; establishing eligibility standards and premium assistance for persons with low income; establishing standards for accountable health care plans; creating the Alaska health care fund; providing for review of actions and reporting requirements related to the health care program; and providing for an effective date."

00                             SENATE BILL NO. 160                                                                         
01 "An Act establishing an Alaska health care program to ensure insurance coverage for                                     
02 essential health services for all residents of the state; establishing the Alaska Health                                
03 Care Board to define essential health care services, to certify health care plans that                                  
04 provide essential health care services, and to administer the Alaska health care program                                
05 and the Alaska health care fund; establishing the Alaska health care clearinghouse to                                   
06 administer the Alaska health care program under the direction of the Alaska Health                                      
07 Care Board; establishing eligibility standards and premium assistance for persons with                                  
08 low income; establishing standards for accountable health care plans; creating the                                      
09 Alaska health care fund; providing for review of actions and reporting requirements                                     
10 related to the health care program; and providing for an effective date."                                               
11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
12    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
01 to read:                                                                                                                
02       FINDINGS; PURPOSE. (a) The legislature finds that                                                                 
03            (1)  the current health care system is unsustainable;                                                        
04            (2)  improving and protecting the health of Alaskans must be a primary goal of                               
05 the state;                                                                                                              
06            (3)  all Alaskans should have access to essential health care services that are                              
07 affordable, that are based on publicly debated criteria, and that consider the well-being of                            
08 individuals across their life spans;                                                                                    
09            (4)  Alaska has an economic interest in ensuring equitable financing of                                      
10 essential health care for Alaskans who do not have access to basic health care;                                         
11            (5)  health care policies should emphasize public health and encourage the use                               
12 of quality service and evidence-based treatment that are appropriate and safe and that                                  
13 discourage over-treatment;                                                                                              
14            (6)  health care providers and informed patients must be the primary decision                                
15 makers who are accountable for an individual's health;                                                                  
16            (7)  health care funding should be explicit, predictable, and economically                                   
17 sustainable;                                                                                                            
18            (8)  an economically sustainable health care system requires that providers                                  
19 receive fair and adequate compensation;                                                                                 
20            (9)  health care must be balanced with other programs that also affect health;                               
21 and                                                                                                                     
22            (10)  health care must account for the allocation of resources and the human                                 
23 consequences of funding decisions.                                                                                      
24       (b)  The purpose of this Act is to address the findings and concerns listed in (a) of this                        
25 section by creating the Alaska health care program.                                                                     
26    * Sec. 2. AS 18 is amended by adding a new chapter to read:                                                        
27                   Chapter 06. Alaska Health Care Program.                                                             
28            Sec. 18.06.010. Alaska health care program. The Alaska health care program                                 
29       is established to                                                                                                 
30                 (1)  ensure that all residents of the state have access to affordable health                            
31       care;                                                                                                             
01                 (2)  require that every resident of the state have, at a minimum,                                       
02       insurance covering essential health care services;                                                                
03                 (3)  reduce unsustainable health care cost increases;                                                   
04                 (4)  establish a system of public and private health care that integrates                               
05       public involvement and oversight, consumer choice, and competition within the                                     
06       private market;                                                                                                   
07                 (5)  use models of health care benefits, service delivery, and payments                                 
08       that control costs and overuse, emphasizing preventative care and chronic disease                                 
09       management within a primary care environment; and                                                                 
10                 (6)  provide services for humane and dignified end-of-life care.                                        
11            Sec. 18.06.020. Alaska Health Care Board. (a) The Alaska Health Care                                       
12       Board is established in the Department of Health and Social Services to manage the                                
13       Alaska health care program.                                                                                       
14            (b)  The board shall consist of 11 members appointed by the governor, subject                                
15       to confirmation by the legislature. The members of the board shall include                                        
16                 (1)  one representative each from two health care insurers licensed to                                  
17       transact health care insurance in the state;                                                                      
18                 (2)  two representatives of the business community other than health                                    
19       care insurers, one representing large businesses, and one representing small                                      
20       businesses;                                                                                                       
21                 (3)  one representative each from two Alaska hospitals;                                                 
22                 (4)  one representative of a labor organization;                                                        
23                 (5)  two physicians licensed in Alaska; and                                                             
24                 (6)  two health care consumer advocates.                                                                
25            (c)  Each board member serves for a term of three years and until a successor                                
26       has been appointed. A member is eligible for reappointment.                                                       
27            (d)  If there is a vacancy, the governor shall make an appointment, effective                                
28       immediately, for the balance of the unexpired term.                                                               
29            (e)  Members of the board are entitled to per diem and transportation costs                                  
30       under AS 39.20.180.                                                                                               
31            (f)  The board shall select a member to serve as chair and a member to serve as                              
01       vice chair for a term and with duties and powers necessary to perform their functions.                            
02            (g)  A majority of the board constitutes a quorum for transacting business.                                  
03            Sec. 18.06.030. Powers and duties of the Alaska Health Care Board. The                                     
04       Alaska Health Care Board shall                                                                                    
05                 (1)  certify accountable health care plans that provide coverage for                                    
06       essential health services for individuals holding Alaska health cards;                                            
07                 (2)  administer, as a fiduciary, the Alaska health fund established under                               
08       AS 18.06.070 in accordance with the Alaska health care program established by this                                
09       chapter;                                                                                                          
10                 (3)  hold regular and special meetings as the board considers necessary;                                
11       board meetings may be held by teleconference; meetings shall be recorded and made                                 
12       available on request; and                                                                                         
13                 (4)  adopt regulations consistent with this chapter under AS 44.62                                      
14       (Administrative Procedure Act) that                                                                               
15                      (A)  define essential health care services;                                                        
16                      (B)  establish quality standards for the defined set of essential                                  
17            health care services provided by an accountable health care plan;                                            
18                      (C)  certify an accountable health care plan that provides the                                     
19            minimum defined set of essential health care services;                                                       
20                      (D)  establish criteria for participation by residents of the state                                
21            in the Alaska health care program;                                                                           
22                      (E)  establish procedures for enrolling participants in the Alaska                                 
23            health program and providing enrollees with an Alaska health card;                                           
24                      (F)  provide for issuing an Alaska health care voucher to each                                     
25            individual who meets the needs-based participation criteria or who has                                       
26            contributions made to the fund that specify an individual as the beneficiary                                 
27            under AS 18.06.070(b);                                                                                       
28                      (G)  ensure that cardholders are enrolled in an accountable                                        
29            health care plan;                                                                                            
30                      (H)  prescribe the method for determining individual income;                                       
31                      (I)  provide that accountable health care plan costs and charges                                   
01            are available to cardholders;                                                                                
02                      (J)  ensure the capacity of a plan to provide cardholder access to                                 
03            essential health care services; and                                                                          
04                      (K)  establish procedures for notice and hearings for a person                                     
05            aggrieved by a decision of the board or the health care clearinghouse.                                       
06            Sec. 18.06.040. Alaska health care clearinghouse. (a) The Alaska health care                               
07       clearinghouse is established as a division of the Department of Health and Social                                 
08       Services.                                                                                                         
09            (b)  The clearinghouse shall be administered by a director appointed by the                                  
10       commissioner.                                                                                                     
11            (c)  The clearinghouse shall                                                                                 
12                 (1)  administer the Alaska health care program under the direction of                                   
13       the Alaska Health Care Board;                                                                                     
14                 (2)  disseminate information about certified insurance products;                                        
15                 (3)  provide assistance in the enrollment process for a small business or                               
16       individual;                                                                                                       
17                 (4)  assist an individual, employer, or employee with purchasing                                        
18       insurance with pre-tax money;                                                                                     
19                 (5)  assist cardholders who choose to execute an advance health care                                    
20       directive under AS 13.52; and                                                                                     
21                 (6)  establish and maintain a registry of advance health care directives                                
22       executed by cardholders.                                                                                          
23            Sec. 18.06.050. Essential health care services; eligibility. (a) Every resident                            
24       of the state who is not a beneficiary of a health care plan providing coverage for                                
25       essential health care services, or who is not eligible to be enrolled in a publicly funded                        
26       medical assistance program providing services equal to coverage for essential health                              
27       care services, shall participate in the Alaska health care program.                                               
28            (b)  A resident with an income below the poverty guidelines updated                                          
29       periodically in the Federal Register by the United States Department of Health and                                
30       Human Services under the authority of 42 U.S.C. 9902(2) shall receive coverage for                                
31       essential health care services at no cost, paid from the Alaska health care fund.                                 
01            (c)  A resident with an income between 100 percent and 300 percent of the                                    
02       federal poverty guidelines shall pay premiums on a sliding scale established by the                               
03       Alaska Health Care Board.                                                                                         
04            (d)  An employer may offer health insurance coverage that meets or exceeds                                   
05       coverage for essential health care services. If an employer provides insurance that                               
06       meets or exceeds coverage for essential health care services but does not enroll at least                         
07       25 percent of the employer's employees, or does not offer to pay at least 33 percent of                           
08       the premium, the employer shall pay the department as follows:                                                    
09                 (1)  if an employer has at least 10 and not more than 20 full-time                                      
10       employees, the employer shall pay one percent of the employer's gross payroll; or                                 
11                 (2)  if an employer has more than 20 full-time employees, the employer                                  
12       shall pay two percent of the employer's gross payroll.                                                            
13            (e)  Individuals or employers may contract with an accountable health care                                   
14       plan for health care services in addition to the essential health care services coverage.                         
15            Sec. 18.06.060. Accountable health care plans; preexisting conditions. (a)                                 
16       An accountable health care plan is a plan approved by the Alaska Health Care Board                                
17       that provides coverage for essential health care services and meets the other                                     
18       requirements established under this chapter.                                                                      
19            (b)  An accountable health care plan may not deny enrollment to an individual                                
20       holding an Alaska health care card.                                                                               
21            (c)  For an individual holding an Alaska health care card who is subject to a                                
22       preexisting condition exclusion, the individual's employer or another person on behalf                            
23       of the cardholder may purchase additional coverage for an excluded preexisting                                    
24       condition from an accountable health care plan.                                                                   
25            (d)  An accountable health care plan provision that covers children must                                     
26       provide that the coverage will continue until the earlier of the child reaching 25 years                          
27       of age or two years after the child no longer resides with the family.                                            
28            Sec. 18.06.070. Alaska health fund. (a) The Alaska health fund is established                              
29       as a separate trust fund of the state. The fund consists of                                                       
30                 (1)  state money appropriated to subsidize uncompensated care;                                          
31                 (2)  federal money appropriated to the fund;                                                            
01                 (3)  private employer and employee health care contributions received                                   
02       by the department and appropriated to the fund;                                                                   
03                 (4)  health care premiums received by the department and appropriated                                   
04       to the fund;                                                                                                      
05                 (5)  other appropriations by the legislature;                                                           
06                 (6)  contributions appropriated to the fund from the United States                                      
07       government and its agencies, or from any other source, public or private, provided for                            
08       purposes that are consistent with the goals of the Alaska health care program; and                                
09                 (7)  interest earnings from investments of the fund appropriated to the                                 
10       fund.                                                                                                             
11            (b)  Contributions may be made to the fund by an employer, employers, or an                                  
12       individual that is specified for a particular beneficiary. If a contribution is made to the                       
13       fund for the benefit of a particular beneficiary, the beneficiary shall receive a health                          
14       care voucher in the amount of the contribution that may be used to purchase an                                    
15       accountable health care plan. Money collected under AS 18.06.050(d) is not                                        
16       considered made for the benefit of a particular beneficiary.                                                      
17            (c)  The board may use the fund for the purpose of administering the Alaska                                  
18       health care program consistent with this chapter.                                                                 
19            Sec. 18.06.080. Disputes and appeals. A person is entitled to notice and an                                
20       opportunity for a hearing under regulations adopted by the Alaska Health Care Board                               
21       if                                                                                                                
22                 (1)  the board or the Alaska health care clearinghouse denies enrollment                                
23       to the person;                                                                                                    
24                 (2)  an accountable health care plan refuses to enroll an individual with                               
25       an Alaska health care card or fails to provide essential health care services; or                                 
26                 (3)  the person is adversely affected or aggrieved by a decision of the                                 
27       board or the clearinghouse.                                                                                       
28            Sec. 18.06.090. Reporting. The Alaska Health Care Board shall submit a                                     
29       written report on the operation of the Alaska health care program to the legislature by                           
30       January 1 of each odd-numbered year. The report must include                                                      
31                 (1)  the number of individuals who have an Alaska health care card and                                  
01       are enrolled in an accountable health care plan;                                                                  
02                 (2)  the cost savings to the state, to employers, and to health care                                    
03       providers resulting from the operation of the Alaska health care program;                                         
04                 (3)  a measure of patient satisfaction with the essential health care                                   
05       services received from an accountable health care plan;                                                           
06                 (4)  an assessment of patient access to essential health care services;                                 
07                 (5)  a description of the changes or adjustments made to the program                                    
08       during the period covered by the report;                                                                          
09                 (6)  a discussion of the state agencies delivering redundant services, if                               
10       any, relating to health care benefits;                                                                            
11                 (7)  an evaluation of the efficiencies of state programs that regulate or                               
12       deliver health care benefits;                                                                                     
13                 (8)  recommendations for legislative changes necessary to meet the                                      
14       goals of the program.                                                                                             
15            Sec. 18.06.990. Definitions. In this chapter,                                                              
16                 (1)  "accountable health care plan" means a plan that is certified by the                               
17       Alaska Health Care Board to provide essential health care services;                                               
18                 (2)  "board" means the Alaska Health Care Board;                                                        
19                 (3)  "cardholder" means an individual issued an Alaska health card                                      
20       under regulations adopted under AS 18.06.030(4);                                                                  
21                 (4)  "commissioner" means the commissioner of health and social                                         
22       services;                                                                                                         
23                 (5)  "essential health care services" means the services and products                                   
24       approved for treatment of conditions defined by the Alaska Health Care Board under                                
25       AS 18.06.030(4);                                                                                                  
26                 (6)  "fund" means the Alaska health fund;                                                               
27                 (7)  "resident" or "residency" has the meaning given in AS 01.10.055.                                   
28    * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to                          
29 read:                                                                                                                   
30       TRANSITIONAL PROVISIONS. Notwithstanding AS 18.06.020, enacted by sec. 2                                          
31 of this Act, the initial terms for members of the Alaska Health Care Board are as follows:                              
01            (1)  five members shall be appointed to serve for a term ending January 1,                                   
02 2010;                                                                                                                   
03            (2)  three members shall be appointed to serve for a term ending January 1,                                  
04 2011; and                                                                                                               
05            (3)  the remaining members shall be appointed to serve for a term ending                                     
06 January 1, 2012.                                                                                                        
07    * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to                          
08 read:                                                                                                                   
09       TRANSITIONAL PROVISIONS: REGULATIONS. The Alaska Health Care Board                                                
10 established under AS 18.06.020, enacted by sec. 2 of this Act, may proceed to adopt                                     
11 regulations necessary to implement this Act. The regulations take effect under AS 44.62                                 
12 (Administrative Procedure Act), but not before January 1, 2009.                                                         
13    * Sec. 5. AS 18.06.020, 18.06.030, and 18.06.040, enacted by sec. 2 of this Act, and sec. 4                        
14 of this Act take effect immediately under AS 01.10.070(c).                                                              
15    * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2009.