SB 197: "An Act relating to direct health care agreements; and relating to unfair trade practices."
00 SENATE BILL NO. 197 01 "An Act relating to direct health care agreements; and relating to unfair trade 02 practices." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 18.23 is amended by adding a new section to read: 05 Article 5. Direct Health Care Agreements. 06 Sec. 18.23.500. Direct health care agreements. (a) A direct health care 07 agreement is a written health care agreement between a health care provider and a 08 government entity, an individual patient, or the employer of a patient to provide health 09 care services in exchange for payment of an annual fee. The health care provider shall 10 disclose the services to be provided under the agreement to the patient and to the 11 person paying the fee. The health care provider may not assess charges or receive 12 compensation other than the annual fee for health care services and additional fees 13 specified in the agreement. However, a patient may submit a health care insurance 14 claim and the health care provider may assess charges or receive compensation for
01 health care services not included in the agreement. A direct health care agreement 02 must 03 (1) describe the health care services to be provided by the health care 04 provider; 05 (2) specify the annual fee for the health care services and additional 06 fees that the health care provider may charge in addition to the annual fee; 07 (3) prominently state that the agreement is not health insurance and 08 does not meet an individual or other health insurance mandate that may be required by 09 federal law; 10 (4) prominently state that the patient is not entitled to the protections 11 under AS 21.07 (Patient Protections Under Health Care Insurance Policies) or 12 AS 21.36 (Trade Practices and Frauds); 13 (5) identify and include contact information for the person responsible 14 for receiving and addressing a complaint made by a patient; and 15 (6) state that the annual fee under the agreement for services 16 (A) must be comparable to the annual fee for comparable 17 services provided by the health care provider to other patients under the 18 provider's other direct health care agreements; and 19 (B) may not be based solely on the patient's health status or 20 sex. 21 (b) A direct health care agreement between a health care provider and a 22 patient must allow a patient to terminate the agreement in writing within 30 days after 23 entering into the agreement. If a patient terminates an agreement under this subsection, 24 the provider shall, not later than 30 days after the patient terminates the agreement, 25 refund to the patient payments made under the agreement, less payments made for 26 services the provider has already performed. The provider may charge a nominal 27 termination fee for termination of an agreement under this subsection. 28 (c) A direct health care agreement between a health care provider and a patient 29 must allow a party to terminate the agreement in writing after at least 30 days' notice 30 and in accordance with the agreement. The agreement may provide for a refund, a 31 nominal termination penalty, or a nominal termination fee for termination of an
01 agreement under this subsection. 02 (d) A direct health care agreement between a health care provider and a 03 government entity or the employer of a patient may be terminated in accordance with 04 the agreement. An agreement may provide for a refund, a nominal termination penalty, 05 or a nominal termination fee. 06 (e) The parties to a direct health care agreement may modify or renew the 07 agreement by written agreement of the parties and in a manner consistent with this 08 section. A health care provider may not change the annual fee under the agreement 09 more than once a year, and shall provide at least 45 days' written notice of a change in 10 the annual fee. 11 (f) A direct health care agreement and health care services provided under a 12 direct health care agreement are not subject to AS 21.07 (Patient Protections Under 13 Health Care Insurance Policies) or AS 21.36 (Trade Practices and Frauds), but are 14 subject to other consumer protection statutes and regulations, including AS 45.45.915. 15 (g) A person may not make, publish, or disseminate an assertion, 16 representation, or statement with respect to the business of direct health care 17 agreements, or with respect to a person in the conduct of the person's direct health care 18 agreement business, that is untrue, deceptive, or misleading, and may not 19 (1) misrepresent the benefits, advantages, conditions, sponsorship, 20 source, or terms of a direct health care agreement; 21 (2) use a name or title of a direct health care agreement 22 misrepresenting its true nature; or 23 (3) make a false or misleading statement as to a direct health care 24 agreement. 25 (h) Offering or executing a direct health care agreement does not constitute 26 engaging in the business of insurance or underwriting in this state, and a direct health 27 care agreement and health care services provided under a direct health care agreement 28 are exempt from regulation by the division of insurance, Department of Commerce, 29 Community, and Economic Development. A health care provider is not a health 30 maintenance organization, insurer, or insurance producer by virtue of the offering or 31 execution of a direct health care agreement or the provision of health care services
01 under a direct health care agreement. A certificate of authority or license to market, 02 sell, or offer to sell a direct health care agreement or health care services under a direct 03 health care agreement is not required to offer or execute a direct health care agreement 04 or provide health care services under a direct health care agreement. 05 (i) In this section, 06 (1) "health care provider" means a firm, corporation, association, 07 institution, or other person licensed or otherwise authorized in this state to provide 08 health care services; 09 (2) "health care service" means a health care service or procedure, 10 other than a health care service or procedure that is immediately necessary to prevent 11 the death or serious impairment of the health of the patient, that is provided in person 12 or remotely by telemedicine or other means by a health care provider for the care, 13 prevention, diagnosis, or treatment of a physical or mental illness, health condition, 14 disease, or injury. 15 * Sec. 2. AS 45.45 is amended by adding a new section to read: 16 Sec. 45.45.915. Direct health care agreements. (a) A health care provider 17 may not decline to enter into a direct health care agreement with a new patient or 18 terminate a direct health care agreement with an existing patient solely because of the 19 patient's race, religion, color, national origin, age, sex, physical or mental disability, 20 marital status, change in marital status, pregnancy, parenthood, or any other 21 characteristic of a class of persons protected by federal or state laws that prohibit 22 discrimination. 23 (b) A health care provider may decline to enter into a direct health care 24 agreement with a new patient or terminate a direct health care agreement with an 25 existing patient based on the patient's health status only if the health care provider is 26 unable to provide to the patient the level or type of care the patient requires for a 27 medical condition. Before terminating a direct health care agreement with an existing 28 patient, a health care provider shall ensure that the patient is transferred to a health 29 care provider who 30 (1) is able to provide the level or type of care the patient requires; and 31 (2) agrees to provide to the patient the level or type of care the patient
01 requires. 02 (c) In this section, 03 (1) "direct health care agreement" means an agreement described in 04 AS 18.23.500; 05 (2) "health care provider" has the meaning given in AS 18.23.500. 06 * Sec. 3. AS 45.50.471(b) is amended by adding new paragraphs to read: 07 (58) violating AS 18.23.500 (direct health care agreements); 08 (59) violating AS 45.45.915 (direct health care agreements).