CSHB 176(L&C): "An Act relating to insurance; relating to direct health care agreements; relating to unfair trade practices; and providing for an effective date."
00 CS FOR HOUSE BILL NO. 176(L&C) 01 "An Act relating to insurance; relating to direct health care agreements; relating to 02 unfair trade practices; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 21.03 is amended by adding a new section to read: 05 Sec. 21.03.025. Direct health care agreements. (a) A direct health care 06 agreement is a written health care agreement between a health care provider and a 07 government entity, an individual patient, or the employer of a patient to provide health 08 care services in exchange for payment of an annual fee. 09 (b) The health care provider shall disclose the services to be provided under 10 the direct health care agreement to the patient and to the person paying the annual fee 11 under the agreement. The annual fee must be comparable to the annual fee for 12 comparable services provided by the health care provider to other patients under the 13 provider's other direct health care agreements and may not be based solely on the 14 patient's health status or sex. The health care provider may not assess charges or
01 receive compensation other than the annual fee for health care services and additional 02 fees specified in the agreement. However, a patient may submit a health care insurance 03 claim and the health care provider may assess charges or receive compensation for 04 health care services not included in the agreement. 05 (c) A direct health care agreement between a health care provider and a 06 government entity, an individual patient, or the employer of a patient must 07 (1) describe the health care services to be provided by the health care 08 provider; 09 (2) specify the annual fee for the health care services and additional 10 fees that the health care provider may charge in addition to the annual fee; 11 (3) prominently state that the agreement is not health insurance and 12 does not meet an individual or other health insurance mandate that may be required by 13 federal law; 14 (4) be printed in a font not smaller than 12 points and written using 15 plain language that an individual with no medical training can understand; 16 (5) identify and include contact information for the person responsible 17 for receiving and addressing a complaint made by a patient; 18 (6) state that the annual fee under the agreement for services 19 (A) must be comparable to the annual fee for comparable 20 services provided by the health care provider to other patients under the 21 provider's other direct health care agreements; and 22 (B) may not be based solely on the patient's health status or 23 sex; and 24 (7) specify the number of patients the health care provider has the 25 capacity to serve and the number of patients the health care provider is currently 26 serving. 27 (d) A direct health care agreement between a health care provider and a 28 patient must allow a patient to terminate the agreement in writing within 30 days after 29 entering into the agreement. If a patient terminates an agreement under this subsection, 30 the provider shall, not later than 30 days after the patient terminates the agreement, 31 refund to the patient payments made under the agreement, less payments made for
01 services the provider has already performed. The provider may charge a nominal 02 termination fee for termination of an agreement under this subsection. 03 (e) A direct health care agreement between a health care provider and a patient 04 must allow a party to terminate the agreement in writing after at least 30 days' notice 05 and in accordance with the agreement. The agreement must provide for a refund and 06 may provide for a nominal termination penalty or a nominal termination fee for 07 termination of an agreement under this subsection. 08 (f) A direct health care agreement between a health care provider and a 09 government entity or the employer of a patient may be terminated in accordance with 10 the agreement. An agreement must provide for a refund and may provide for a 11 nominal termination penalty or a nominal termination fee. 12 (g) The parties to a direct health care agreement may modify or renew the 13 agreement by written agreement of the parties and in a manner consistent with this 14 section. A health care provider may not change the annual fee under the agreement 15 more than once a year, and shall provide at least 45 days' written notice of a change in 16 the annual fee. 17 (h) A direct health care agreement and health care services provided under a 18 direct health care agreement are subject to consumer protection statutes and 19 regulations, including AS 45.45.915. 20 (i) Offering or executing a direct health care agreement does not constitute 21 engaging in the business of insurance or underwriting in this state, and, except as 22 provided by this section, a direct health care agreement and health care services 23 provided under a direct health care agreement are exempt from regulation by the 24 division under this title. A health care provider is not a health maintenance 25 organization, insurer, or insurance producer by virtue of the offering or execution of a 26 direct health care agreement or the provision of health care services under a direct 27 health care agreement. A certificate of authority or license to market, sell, or offer to 28 sell a direct health care agreement or health care services under a direct health care 29 agreement is not required to offer or execute a direct health care agreement or provide 30 health care services under a direct health care agreement. 31 (j) A person may not make, publish, or disseminate an assertion,
01 representation, or statement with respect to the business of direct health care 02 agreements, or with respect to a person in the conduct of the person's direct health care 03 agreement business, that is untrue, deceptive, or misleading, and may not 04 (1) misrepresent the benefits, advantages, conditions, sponsorship, 05 source, or terms of a direct health care agreement; 06 (2) use a name or title of a direct health care agreement 07 misrepresenting its true nature; or 08 (3) make a false or misleading statement as to a direct health care 09 agreement. 10 (k) Not later than September 1 of each year, a health care provider that enters 11 into direct health care agreements with government entities, patients, or employers of 12 patients shall file with the division, in the form prescribed by the division, a report 13 relating to direct health care agreements entered into or maintained by the provider's 14 health care practice in the preceding calendar year. The report must include 15 (1) the number of health care providers in the health care practice; 16 (2) the number of direct health care patients the health care practice 17 has the capacity to serve; 18 (3) the number of government entities, patients, and employers of 19 patients that entered into or maintained a direct health care agreement with the health 20 care practice in the preceding calendar year and the annual fee paid by each 21 government entity, patient, and employer of a patient, as applicable, under the direct 22 health care agreement; 23 (4) the percentage of the patients that entered into or maintained a 24 direct health care agreement with the health care practice in the preceding calendar 25 year who are paying fees and costs under a direct health care agreement through 26 (A) the federal Medicare program; and 27 (B) medical assistance under AS 47.07; 28 (5) other information requested by the division. 29 (l) In this section, 30 (1) "health care practice" means a business that provides health care 31 services;
01 (2) "health care provider" means a firm, corporation, association, 02 institution, or other person licensed or otherwise authorized in this state to provide 03 health care services; 04 (3) "health care service" means a service or procedure, other than a 05 service or procedure that is immediately necessary to prevent the death or serious 06 impairment of the health of the patient, that is provided in person or remotely by 07 telemedicine or other means by a health care provider for the care, prevention, 08 diagnosis, or treatment of a physical or mental illness, health condition, disease, or 09 injury. 10 * Sec. 2. AS 45.45 is amended by adding a new section to read: 11 Sec. 45.45.915. Direct health care agreements. (a) A health care provider 12 may not decline to enter into a direct health care agreement with a new patient or 13 terminate a direct health care agreement with an existing patient solely because of the 14 patient's race, religion, color, national origin, age, sex, physical or mental disability, 15 marital status, change in marital status, pregnancy, parenthood, or any other 16 characteristic of a class of persons protected by federal or state laws that prohibit 17 discrimination. 18 (b) A health care provider may decline to enter into a direct health care 19 agreement with a new patient or terminate a direct health care agreement with an 20 existing patient based on the patient's health status only if the health care provider is 21 unable to provide to the patient the level or type of care the patient requires for a 22 medical condition. Before terminating a direct health care agreement with an existing 23 patient, a health care provider shall ensure that the patient is referred to a health care 24 provider who 25 (1) is able to provide the level or type of care the patient requires; and 26 (2) agrees to provide to the patient the level or type of care the patient 27 requires. 28 (c) A health care provider may decline to enter into a direct health care 29 agreement with a new patient if the health care provider does not have the capacity to 30 accept new patients. 31 (d) In this section,
01 (1) "direct health care agreement" means an agreement described in 02 AS 21.03.025; 03 (2) "health care provider" has the meaning given in AS 21.03.025(l). 04 * Sec. 3. AS 45.50.471(b) is amended by adding new paragraphs to read: 05 (58) violating AS 21.03.025 (direct health care agreements); 06 (59) violating AS 45.45.915 (direct health care agreements). 07 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 08 read: 09 TRANSITION: REGULATIONS. The director of the division of insurance may adopt 10 regulations necessary to implement the changes made by this Act. The regulations take effect 11 under AS 44.62 (Administrative Procedure Act), but not before the effective date of the law 12 implemented by the regulations. 13 * Sec. 5. Section 4 of this Act takes effect immediately under AS 01.10.070(c). 14 * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2023.