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CSSB 160(L&C): "An Act establishing an Alaska health care program to ensure insurance coverage for essential health services for residents of the state; establishing the Alaska Health Care Board 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; 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                      CS FOR SENATE BILL NO. 160(L&C)                                                                    
01 "An Act establishing an Alaska health care program to ensure insurance coverage for                                     
02 essential health services for residents of the state; establishing the Alaska Health Care                               
03 Board to administer the Alaska health care program and the Alaska health care fund;                                     
04 establishing the Alaska health care clearinghouse to administer the Alaska health care                                  
05 program under the direction of the Alaska Health Care Board; establishing eligibility                                   
06 standards and premium assistance for persons with low income; creating the Alaska                                       
07 health care fund; providing for review of actions and reporting requirements related to                                 
08 the health care program; and providing for an effective date."                                                          
09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
10    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
11 to read:                                                                                                                
12       FINDINGS; PURPOSE. (a) The legislature finds that                                                                 
01            (1)  the current health care system is unsustainable;                                                        
02            (2)  improving and protecting the health of Alaskans must be a primary goal of                               
03 the state;                                                                                                              
04            (3)  all Alaskans should have access to essential health care services that are                              
05 affordable, that are based on publicly debated criteria, and that consider the well-being of                            
06 individuals across their life spans;                                                                                    
07            (4)  Alaska has an economic interest in ensuring equitable financing of                                      
08 essential health care for Alaskans who do not have access to basic health care;                                         
09            (5)  health care policies should emphasize public health and encourage the use                               
10 of quality service and evidence-based treatment that are appropriate and safe and that                                  
11 discourage over-treatment;                                                                                              
12            (6)  health care providers and informed patients must be the primary decision                                
13 makers who are accountable for an individual's health;                                                                  
14            (7)  health care funding should be explicit, predictable, and economically                                   
15 sustainable;                                                                                                            
16            (8)  an economically sustainable health care system requires that providers                                  
17 receive fair and adequate compensation;                                                                                 
18            (9)  health care must be balanced with other programs that also affect health;                               
19 and                                                                                                                     
20            (10)  health care must account for the allocation of resources and the human                                 
21 consequences of funding decisions.                                                                                      
22       (b)  The purpose of this Act is to address the findings and concerns listed in (a) of this                        
23 section by creating the Alaska health care program.                                                                     
24    * Sec. 2. AS 21.54 is amended by adding new sections to read:                                                      
25                   Article 2A. Alaska Health Care Program.                                                             
26            Sec. 21.54.200. Alaska health care program. The Alaska health care program                                 
27       is established to                                                                                                 
28                 (1)  ensure that residents of the state have access to affordable health                                
29       care insurance;                                                                                                   
30                 (2)  require that residents of the state have, at a minimum, insurance                                  
31       covering essential health care services;                                                                          
01                 (3)  reduce unsustainable health care cost increases;                                                   
02                 (4)  establish a system of health care insurance that integrates public                                 
03       involvement and oversight, consumer choice, and competition within the private                                    
04       health care insurance market;                                                                                     
05                 (5)  use models of health care insurance benefits, service delivery, and                                
06       payments that control costs and overuse, emphasizing preventative care and chronic                                
07       disease management within a primary care environment; and                                                         
08                 (6)  provide services for humane and dignified end-of-life care.                                        
09            Sec. 21.54.210. Alaska Health Care Board. (a) The Alaska Health Care                                       
10       Board is established in the division to manage the Alaska health care program.                                    
11            (b)  The board shall consist of 13 members, including 12 members appointed                                   
12       by the governor, subject to confirmation by the legislature, and the commissioner of                              
13       health and social services or the commissioner's designee, serving ex officio. The                                
14       members of the board appointed by the governor must include                                                       
15                 (1)  one representative who is a licensed insurance producer;                                           
16                 (2)  one representative from a health insurance company licensed to                                     
17       transact health care insurance in the state;                                                                      
18                 (3)  two representatives of the business community other than health                                    
19       care insurers, one representing large businesses, and one representing small                                      
20       businesses;                                                                                                       
21                 (4)  one representative each from two Alaska hospitals;                                                 
22                 (5)  one representative of a labor organization;                                                        
23                 (6)  two physicians licensed in Alaska;                                                                 
24                 (7)  two health care consumer advocates; and                                                            
25                 (8)  one registered nurse.                                                                              
26            (c)  Except for the commissioner or the commissioner's designee, who serves                                  
27       ex officio, each board member serves for a term of three years beginning on January 1                             
28       and until a successor has been appointed. A member is eligible for reappointment.                                 
29            (d)  If there is a vacancy, the governor shall make an appointment, effective                                
30       immediately, for the balance of the unexpired term.                                                               
31            (e)  Members of the board are entitled to per diem and transportation costs                                  
01       under AS 39.20.180.                                                                                               
02            (f)  The board shall select a member to serve as chair and a member to serve as                              
03       vice-chair for a term and with duties and powers necessary to perform their functions.                            
04            (g)  A majority of the board constitutes a quorum for transacting business.                                  
05            Sec. 21.54.220. Powers and duties of the Alaska Health Care Board. (a)                                     
06       The Alaska Health Care Board shall                                                                                
07                 (1)  administer, as a fiduciary, the Alaska health care fund established                                
08       under AS 21.54.280 in accordance with the Alaska health care program established by                               
09       AS 21.54.200 - 21.54.310;                                                                                         
10                 (2)  establish types or categories of health care insurance plans offered                               
11       through the Alaska health care clearinghouse;                                                                     
12                 (3)  classify each plan offered through the clearinghouse as a                                          
13       comprehensive or basic health care insurance plan, based on criteria including the                                
14       financial cost of the plan, including premium cost, deductible costs, and co-pay                                  
15       provisions;                                                                                                       
16                 (4)  establish criteria for participation by residents and insurers in the                              
17       Alaska health care program;                                                                                       
18                 (5)  establish an Alaska health care voucher system that provides health                                
19       care insurance to each individual who meets the needs-based participation criteria set                            
20       out in AS 21.54.240 or who is the beneficiary of contributions made to the fund that                              
21       specify the individual as the beneficiary under AS 21.54.280(b);                                                  
22                 (6)  ensure that eligible individuals are enrolled in a health care                                     
23       insurance plan that provides essential health care services;                                                      
24                 (7)  prescribe the method for determining individual income for the                                     
25       purpose of the Alaska health care program;                                                                        
26                 (8)  establish procedures for enrolling a participant in the Alaska health                              
27       care program, including enrollment procedures describing when an individual may                                   
28       enroll or select a different health insurance plan offered through the Alaska health care                         
29       clearinghouse; the procedures established under this paragraph must allow an                                      
30       individual insured by a health care insurance plan offered through the Alaska health                              
31       care clearinghouse to select a different health care insurance plan from the plans                                
01       offered through the clearinghouse and to make that selection at least annually;                                   
02                 (9)  require that participants receive complete information regarding the                               
03       cost of obtaining health care insurance; and                                                                      
04                 (10)  establish procedures for notice and hearings for a person                                         
05       aggrieved by a decision of the board or the Alaska health care clearinghouse;                                     
06                 (11) ensure that every Alaskan who is required to participate in the                                    
07       Alaska health care program is offered health care insurance that protects the insured                             
08       from severe financial hardship caused by the cost of receiving medical care.                                      
09            (b)  The board may hold regular and special meetings as the board considers                                  
10       necessary; board meetings may be held by teleconference; meetings shall be recorded                               
11       and made available on request.                                                                                    
12            Sec. 21.54.230. Alaska health care clearinghouse. (a) The Alaska health care                               
13       clearinghouse is established in the division.                                                                     
14            (b)  The clearinghouse shall be administered by the director.                                                
15            (c)  The clearinghouse shall                                                                                 
16                 (1)  administer the Alaska health care program under the direction of                                   
17       the Alaska Health Care Board;                                                                                     
18                 (2)  disseminate information about health care insurance products                                       
19       available through the clearinghouse; and                                                                          
20                 (3)  provide assistance in the enrollment process for a small business or                               
21       an individual.                                                                                                    
22            Sec. 21.54.240. Essential health care services; eligibility. (a) Every resident                            
23       of the state shall participate in the Alaska health care program except a resident who                            
24                 (1)  is a beneficiary of a health care plan that provides health care                                   
25       benefits that meet or exceed the benefits for essential health care services;                                     
26                 (2)  is eligible to be enrolled in a publicly funded medical assistance                                 
27       program providing services that meet or exceed the benefits required as essential                                 
28       health care services;                                                                                             
29                 (3)  is enrolled in Medicaid or Medicare;                                                               
30                 (4)  is receiving health care benefits under a health benefit plan                                      
31       regulated by 29 U.S.C. 1001 - 1461 (Employee Retirement Income Security Act of                                    
01       1974) that meet or exceed the benefits for essential health care services;                                        
02                 (5)  has resided in the state for less than one year; however, a person                                 
03       who has resided in the state for less than one year may receive services provided by                              
04       the Alaska health care clearinghouse under AS 21.54.230;                                                          
05                 (6)  is an individual insured under an individual state plan of health                                  
06       insurance under the Comprehensive Health Insurance Association under AS 21.55;                                    
07                 (7)  is receiving health care benefits under a medical care program of                                  
08       the Indian Health Service; however, a person receiving health care benefits under a                               
09       medical care plan of the Indian Health Service may elect to participate in the Alaska                             
10       health care program; or                                                                                           
11                 (8) demonstrates satisfactorily to the board, under criteria established                                
12       by the board, that the person has deeply held religious beliefs contrary to the Alaska                            
13       health care program and the requirement to purchase health care insurance for                                     
14       essential health care services.                                                                                   
15            (b)  The Alaska Health Care Board shall provide a voucher to a resident with                                 
16       an income that is not more than 450 percent of the most recent federal poverty                                    
17       guidelines, updated periodically in the Federal Register by the United States                                     
18       Department of Health and Human Services under the authority of 42 U.S.C. 9902(2),                                 
19       and who is only eligible for coverage through the Comprehensive Health Insurance                                  
20       Association (AS 21.55). A voucher authorized by this subsection must equalize the                                 
21       cost of insurance under the Comprehensive Health Insurance Association with the cost                              
22       of purchasing a health care insurance plan that provides substantially equivalent                                 
23       benefits through the Alaska health care clearinghouse. For purposes of cost                                       
24       comparison under this subsection, the Alaska Health Care Board shall determine                                    
25       whether a plan provided under the Comprehensive Health Insurance Association                                      
26       provides substantially equivalent benefits to a health care insurance plan offered                                
27       through the clearinghouse.                                                                                        
28            (c)  A resident with an income that is not more than the most recent federal                                 
29       poverty guidelines, updated periodically in the Federal Register by the United States                             
30       Department of Health and Human Services under the authority of 42 U.S.C. 9902(2),                                 
31       who is required to participate in the Alaska health care program shall receive private                            
01       health care insurance coverage for essential health care services at no cost, paid from                           
02       the fund.                                                                                                         
03            (d)  A resident with an income between 100 percent and not more than 300                                     
04       percent of the most recent federal poverty guidelines, updated periodically in the                                
05       Federal Register by the United States Department of Health and Human Services                                     
06       under the authority of 42 U.S.C. 9902(2), who is required to participate in the Alaska                            
07       health care program shall pay premiums for health care insurance for essential health                             
08       care services on a sliding scale established by the board.                                                        
09            (e)  A resident with an income of 300 percent or more of the most recent                                     
10       federal poverty guidelines, updated periodically in the Federal Register by the United                            
11       States Department of Health and Human Services under the authority of 42 U.S.C.                                   
12       9902(2), who is required to participate in the Alaska health care program shall pay the                           
13       premium for health care insurance for essential health care services.                                             
14            (f)  A person who is an alien is not eligible for assistance under AS 21.54.200 -                            
15       21.54.310 unless the person is a qualified alien, as defined under 8 U.S.C. 1641, or an                           
16       alien excepted under 8 U.S.C. 1612(b). However, a qualified alien may only be                                     
17       eligible for assistance under AS 21.54.200 - 21.54.310 if the person is not precluded                             
18       by the limited eligibility provision of 8 U.S.C. 1613.                                                            
19            Sec. 21.54.250. Essential health care services. For purposes of AS 21.54.200                               
20       - 21.54.310, essential health care services means medical services performed for an                               
21       individual covered by a health care plan for the diagnosis or treatment of                                        
22       nonoccupational disease or nonoccupational injury. The medical services that must be                              
23       performed for an individual covered by a health care plan include, as a minimum,                                  
24                 (1)  preventative and primary care;                                                                     
25                 (2)  emergency services;                                                                                
26                 (3)  inpatient services and hospital treatment;                                                         
27                 (4)  ambulatory patient services;                                                                       
28                 (5)  prescription drug coverage; and                                                                    
29                 (6)  mental health services.                                                                            
30            Sec. 21.54.260. Alternative or additional health care services. (a) An                                     
31       employer may offer health insurance coverage that meets or exceeds coverage for                                   
01       essential health care services.                                                                                   
02            (b)  An individual or employer may purchase health care insurance for health                                 
03       care services in addition to the essential health care services required under                                    
04       AS 21.54.200 - 21.54.310.                                                                                         
05            (c)  If an employer does not provide a health care insurance plan for all                                    
06       employees or provides a health care insurance plan that meets or exceeds coverage for                             
07       essential health care services but does not enroll at least 25 percent of the employer's                          
08       employees in the plan or does not offer to pay at least 33 percent of the premium for                             
09       health care insurance under the plan, the employer shall pay the department as                                    
10       follows:                                                                                                          
11                 (1) if an employer's annual gross payroll paid to employees who are                                     
12       required to participate in the Alaska health care plan under AS 21.54.240 is $500,000                             
13       or less, no payment is required;                                                                                  
14                 (2)  if an employer's annual gross payroll paid to employees who are                                    
15       required to participate in the Alaska health care plan under AS 21.54.240 is greater                              
16       than $500,000 but less than $1,000,000, the employer shall pay one percent of the                                 
17       gross payroll; or                                                                                                 
18                 (3)  if an employer's annual gross payroll paid to employees who are                                    
19       required to participate in the Alaska health care program under AS 21.54.240 is                                   
20       $1,000,000 or greater, the employer shall pay two percent of the gross payroll.                                   
21            (d)  An employer that establishes a cafeteria plan under 26 U.S.C. 125 (Internal                             
22       Revenue Code) that offers employees the option to elect health care insurance                                     
23       coverage that meets or exceeds essential health care services is not subject to the                               
24       payment requirements under (c) of this section, regardless of whether an employee                                 
25       elects to receive the offered health care insurance.                                                              
26            (e)  In this section, "essential health care services" means those services set out                          
27       in AS 21.54.250.                                                                                                  
28            Sec. 21.54.270. Health care insurance plan; children's coverage. (a) A                                     
29       health care insurance plan that is approved by the director that provides coverage for                            
30       essential health care services under AS 21.54.200 - 21.54.310 and meets the other                                 
31       requirements established under this title may be offered through the Alaska health care                           
01       clearinghouse.                                                                                                    
02            (b)  A health care insurance plan offered through the Alaska health care                                     
03       clearinghouse may not deny enrollment to an eligible individual.                                                  
04            (c)  A health care insurance plan offered through the Alaska health care                                     
05       clearinghouse may include                                                                                         
06                 (1)  different benefits for network or out-of-network providers;                                        
07                 (2)  varied levels of copayment, coinsurance, deductable amounts, out-                                  
08       of-pocket maximums;                                                                                               
09                 (3)  high deductible health plans as defined by 26 U.S.C. 223(c)(2)                                     
10       (Internal Revenue Code); and                                                                                      
11                 (4)  special insurance terms applicable only to individuals between 18                                  
12       and 30 years of age.                                                                                              
13            (d)  A health care insurance plan offered through the Alaska health care                                     
14       clearinghouse that covers children must provide that the coverage will continue until                             
15       the earlier of the child's reaching 25 years of age or two years after the child no longer                        
16       resides with the family.                                                                                          
17            Sec. 21.54.280. Alaska health care fund. (a) The Alaska health care fund is                                
18       established as a separate trust fund of the state. The fund consists of                                           
19                 (1)  state money appropriated to the fund;                                                              
20                 (2)  federal money appropriated to the fund;                                                            
21                 (3)  private employer and employee health care contributions or fees                                    
22       received by the department and appropriated to the fund;                                                          
23                 (4)  health care premiums received by the department and appropriated                                   
24       to the fund;                                                                                                      
25                 (5)  other appropriations by the legislature;                                                           
26                 (6)  contributions appropriated to the fund from the United States                                      
27       government and its agencies, or from any other source, public or private, provided for                            
28       purposes that are consistent with the goals of the Alaska health care program; and                                
29                 (7)  interest earnings from investments of the fund appropriated to the                                 
30       fund.                                                                                                             
31            (b)  Contributions may be made to the fund by an employer, employers, or an                                  
01       individual that is specified for a particular beneficiary. If a contribution is made to the                       
02       fund for the benefit of a particular beneficiary, the beneficiary shall receive a health                          
03       care voucher in the amount of the contribution that may be used to purchase a health                              
04       care insurance plan. Money collected under AS 21.54.260(c) is not considered made                                 
05       for the benefit of a particular beneficiary.                                                                      
06            (c)  The board may use the fund for the purpose of administering the Alaska                                  
07       health care program consistent with AS 21.54.200 - 21.54.310.                                                     
08            Sec. 21.54.290. Disputes and appeals. A person is entitled to notice and an                                
09       opportunity for a hearing under regulations adopted by the Alaska Health Care Board                               
10       if                                                                                                                
11                 (1)  the board or the Alaska health care clearinghouse denies enrollment                                
12       to the person;                                                                                                    
13                 (2)  an accountable health care plan refuses to enroll an individual or                                 
14       fails to provide essential health care services; or                                                               
15                 (3)  the person is adversely affected or aggrieved by a decision of the                                 
16       board or the clearinghouse.                                                                                       
17            Sec. 21.54.300. Reporting. The Alaska Health Care Board shall submit a                                     
18       written report on the operation of the Alaska health care program to the commissioner                             
19       and to the legislature by January 1 of each year. The report must include                                         
20                 (1)  the number of individuals enrolled in the Alaska health care                                       
21       program;                                                                                                          
22                 (2)  the cost savings to the state, to employers, and to health care                                    
23       providers;                                                                                                        
24                 (3)  a measure of patient satisfaction;                                                                 
25                 (4)  an assessment of patient access to essential health care services;                                 
26                 (5)  a description of the changes or adjustments made to the program                                    
27       during the period covered by the report;                                                                          
28                 (6)  a discussion of the state agencies delivering redundant services, if                               
29       any, relating to health care benefits;                                                                            
30                 (7)  an evaluation of state programs that regulate or deliver health care                               
31       benefits;                                                                                                         
01                 (8)  recommendations for legislative changes necessary to meet the                                      
02       goals of the program;                                                                                             
03                 (9)  an evaluation of and recommendations on the following topics:                                      
04                      (A)  the use of electronic health records;                                                         
05                      (B)  children's health insurance programs;                                                       
06                      (C)  the effectiveness of Medicaid and the potential expansion                                     
07            of the Alaska Medicaid program, including a comparison between the costs of                                  
08            expanding the Alaska Medicaid program and the cost of providing benefits                                     
09            through the Alaska health care program;                                                                      
10                      (D)  the effect of mandated benefits;                                                              
11                      (E)  prescription drug bargaining;                                                                 
12                      (F)  evidence-based treatment procedures including a                                               
13            comparison of the use of evidence-based treatment in other states;                                           
14                      (G)  the recruitment and retention of medical professionals in                                     
15            the state;                                                                                                   
16                      (H)  expanding offerings of the University of Alaska in medical                                    
17            fields;                                                                                                      
18                      (I)  maximizing federal funding to implement the program;                                          
19                      (J)  innovations that could produce health care cost savings,                                      
20            including waivers under 42 U.S.C. 1315 (sec. 1115, Social Security Act),                                     
21            which allows experimental, pilot, or demonstration projects likely to assist in                              
22            promoting the objectives of the Medicaid statute.                                                            
23            Sec. 21.54.310. Regulations. The Alaska Health Care Board shall adopt                                      
24       regulations under AS 44.62 (Administrative Procedure Act) consistent with                                         
25       AS 21.54.200 - 21.54.310.                                                                                         
26    * Sec. 3. AS 21.54.500 is amended by adding new paragraphs to read:                                                
27                 (30)  "alien" means a person who is not a citizen or national of the                                    
28       United States;                                                                                                    
29                 (31)  "board" means the Alaska Health Care Board;                                                       
30                 (32)  "fund" means the Alaska health care fund;                                                         
31                 (33)  "resident" or "residency" has the meaning given in AS 01.10.055.                                  
01    * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to                          
02 read:                                                                                                                   
03       TRANSITIONAL PROVISIONS. Notwithstanding AS 21.54.210, enacted by sec. 2                                          
04 of this Act, the initial terms for members of the Alaska Health Care Board, except for the                              
05 commissioner of health of social services who serves ex officio, are as follows:                                        
06            (1)  four members shall be appointed to serve for a term ending December 31,                                 
07 2009;                                                                                                                   
08            (2)  four members shall be appointed to serve for a term ending December 31,                                 
09 2010; and                                                                                                               
10            (3)  the remaining members shall be appointed to serve for a term ending                                     
11 December 31, 2011.                                                                                                      
12    * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to                          
13 read:                                                                                                                   
14       TRANSITIONAL PROVISIONS: REGULATIONS. The Alaska Health Care Board                                                
15 established under AS 21.54.210, enacted by sec. 2 of this Act, may proceed to adopt                                     
16 regulations necessary to implement this Act under AS 21.54.310, enacted by sec. 2 of this                               
17 Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not                                 
18 before the effective date of the statutory changes.                                                                     
19    * Sec. 6. AS 21.54.210, 21.54.220, and 21.54.230, enacted by sec. 2 of this Act, and sec. 5                        
20 of this Act take effect immediately under AS 01.10.070(c).                                                              
21    * Sec. 7. Except as provided in sec. 6 of this Act, this Act takes effect January 1, 2009.