05/08/1997 03:07 PM House HES

 HB 219 - CHIROPRACTIC CARE BY HMO                                           
                                                                               
 Number 0014                                                                   
                                                                               
 CHAIRMAN BUNDE announced that committee would hear HB 219, "An Act            
 relating to chiropractic health care services provided by a health            
 maintenance organization."                                                    
                                                                               
 Number 0053                                                                   
                                                                               
 NICOLE POIRRIER, Student Intern for Representative Kott, said that            
 HB 219 will allow Alaskans to choose chiropractic services                    
 notwithstanding the positions of their health maintenance                     
 organizations or gatekeepers.  This bill will give Alaskans the               
 right to choose their own initial treatment for their health                  
 services.  Health Maintenance Organizations (HMO's) attempt to                
 control the cost of health care by requiring all participants to              
 initially go through a gatekeeper.  A gatekeeper is usually a                 
 medical doctor or a registered nurse who listens to the health                
 complaint and refers the enrollee to the appropriate health care              
 provider.  There has been a long-standing animosity between                   
 traditional Western medicine and the chiropractic profession.  This           
 animosity has improved in recent years, but a prejudice still                 
 exists.  Many times a gatekeeper will not refer a patient to a                
 chiropractor even if the HMO plan covers chiropractic services and            
 even if such a referral would be the most effective means of                  
 solving the health complaint.                                                 
                                                                               
 MS. POIRRIER stated that the bill addresses the issue of fairness.            
 It would require that an HMO allow their clients to self-refer to             
 a chiropractor, thus guaranteeing a patient's right to choose these           
 types of services.  It also contains language stipulating that an             
 HMO cannot limit a health care provider from disclosure of                    
 information to a patient regarding their condition or treatment               
 options.  At this time, there are no HMO's operating in Alaska, but           
 this bill is being introduced in order to assure fairness and                 
 access in the future.                                                         
                                                                               
 Number 0177                                                                   
                                                                               
 CHAIRMAN BUNDE clarified that there are no HMO's in the state of              
 Alaska and that this bill would be considered pre-emptive                     
 legislation.  He asked if there are other fields of treatment that            
 would also prefer not to go through a gatekeeper.  He questioned              
 whether or not the legislature would be setting up a special                  
 privilege for chiropractors.                                                  
                                                                               
 Number 0234                                                                   
                                                                               
 MITCHELL D. GRAVO, Lobbyist, Alaska Chiropractic Society, answered            
 that the chiropractic profession has been tracking their experience           
 within the HMO system.  He mentioned that chiropractors fall into             
 a category of practitioners who would experience the same type of             
 prejudice.  He thought that instead of waiting until there is a               
 problem in Alaska with HMO's not referring chiropractors, it was              
 better to have legislation such as HB 219 to address the problem              
 now, when there would be little opposition.                                   
                                                                               
 Number 0368                                                                   
                                                                               
 REPRESENTATIVE JOE GREEN repeated the question of whether this type           
 of legislation would lead to the exemption of other types of                  
 treatment from having to go through a gatekeeper.                             
                                                                               
 Number 0414                                                                   
                                                                               
 MR. GRAVO answered no, unless HB 219 was amended to include the               
 other types of treatment.                                                     
                                                                               
 REPRESENTATIVE GREEN suggested that other types of practitioners              
 might use this type of legislation to allow them to avoid the HMO             
 gatekeeper.                                                                   
                                                                               
 Number 0414                                                                   
                                                                               
 MR. GRAVE stated that if he was representing those other interests,           
 he would use that argument, the self-referral argument.  The person           
 who is going to receive the treatment should make the decision                
 about what kind of health care it is, not some large organization.            
                                                                               
 Number 0441                                                                   
                                                                               
 CHAIRMAN BUNDE commented that HMO's put side boards on treatment to           
 save money.  The state can decide to allow those type of side                 
 boards or can choose not to allow HMO's to come into the state.               
                                                                               
 Number 0475                                                                   
                                                                               
 REPRESENTATIVE BRIAN PORTER felt that HB 219 was a balanced                   
 approach.  It allows 30 days of treatment and if the treatment                
 period extends past that, then there is a check and balance by the            
 organization.                                                                 
                                                                               
 Number 0490                                                                   
                                                                               
 CHAIRMAN BUNDE announced that this is the first time HB 219 has               
 been heard and it would be held for further discussion.  He took a            
 brief at ease at 3:14 p.m. which reconvened at 3:16 p.m.  He said             
 the committee might work on the foundation formula over the summer            
 and suggested that the committee take HB 215 and HB 216 back to               
 their district.                                                               
                                                                               
 Number 0571                                                                   
                                                                               
 REPRESENTATIVE DYSON stated that he would be working on Fetal                 
 Alcohol Syndrome issues this summer and that he would keep the                
 chair apprised of his work.