Legislature(1999 - 2000)
04/10/2000 01:28 PM House JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 211-HEALTH CARE INSURANCE CHAIRMAN KOTT announced that the next order of business would be HOUSE BILL NO. 211, "An Act relating to liability for providing managed care services, to regulation of managed care insurance plans, and to patient rights and prohibited practices under health insurance; and providing for an effective date." Number 0252 REPRESENTATIVE ROKEBERG informed the committee that there are letters of endorsement for Version N as amended from the Alaska State Medical Association (ASMA) and the Alaska Physicians & Surgeons, Incorporated. Representative Rokeberg explained that the these groups are asking that the committee "recede from our amendment by adopting the definition on medical necessity and go with all the other amendments that the subcommittee had done." Therefore, Representative Rokeberg said he understood that the doctors and the insurance industry are in agreement. The ASMA letter recognizes that the short time remaining in session along with the complexity of the two issues [the liability issue and the medical necessity issue] does not provide those two issues with the amount of attention warranted for the legislature to make a reasoned policy decision this session; ASMA believes the bill [version N as amended] should move forward. REPRESENTATIVE MURKOWSKI pointed out that although ASMA and the Alaska Physicians & Surgeons, Inc., support Version N, that version did not receive subcommittee recommendations. REPRESENTATIVE ROKEBERG interjected that they'd supported Version N as amended, which is basically Version S. REPRESENTATIVE MURKOWSKI surmised, then, that [the support] is for Version S without the "medical necessity" language. CHAIRMAN KOTT called an at-ease at 8:11 p.m. and the committee reconvened at 8:13 p.m. Number 0380 DON ETHERIDGE, AFL-CIO, informed the committee that the AFL-CIO is still opposed to HB 211. The trustees from the various Locals have the same concerns as to the increasing cost to the [AFL-CIO] membership. He noted that Mr. Ed Burgan, Brady Company, has brought to his attention that AFL-CIO members could expect cost increases to the membership due to HB 211. REPRESENTATIVE ROKEBERG clarified that the primary cost drivers are the medical necessity and the liability issues. He pointed out that the point of service option is self-funding due to underwriting differentials. Representative Rokeberg said, "The only thing I think that could cost anything would be utilization review, ... that model that's in the bill is being adopted by most insurance companies in the state." Therefore, he did not understand where this cost analysis is coming from, but he offered to talk with Mr. Burgan about this. Representative Rokeberg stated that he believes Mr. Burgan's estimates and analysis is unfounded and incorrect. Furthermore, he believes that the unions are largely unaffected as the unions are ERISA (Employee Retirement and Income Security Act) covered. However, he acknowledged that there are unions, although a minority, that do have underwritten coverage from insurers that may not be covered by ERISA. REPRESENTATIVE ROKEBERG related his belief that the medical necessity provisions of the external review procedures should largely satisfy the concerns of [ASMA and the Alaska Physicians & Surgeons, Incorporated] about medical necessity. The other issue that was brought up was the three-step external review, which he is "not sure it's a misunderstanding on their part what that really is." He further noted that there was the desire to have a policy statement from the legislature that said if there was any ERISA jurisdiction that they would be exempt from it since they are ERISA. Representative Rokeberg said he did not believe that to be the correct policy call. Number 0520 REPRESENTATIVE KERTTULA asked whether the deletion of the liability and the medical necessity provisions would make the bill more palatable. MR. ETHERIDGE agreed that deletion of those two sections would improve the bill. He suggested that Representative Rokeberg and Mr. Burgan meet to discuss these issues before the bill proceeds much farther. REPRESENTATIVE ROKEBERG reminded Mr. Etheridge that he himself considers this a patient's rights bill. MR. ETHERIDGE commented that he views this as a doctor's rights bill. REPRESENTATIVE CROFT interjected that he would like to hear from the other groups. Number 0608 JEFF BULLOCK (ph), Alaska State Medical Association and the Alaska Physicians & Surgeons, Inc., noted that the committee should have the aforementioned letter(s) from these groups. He clarified, "In the spirit of compromise, ..., we've come to the table and pulled out two of the key sections that was really the driving motivation behind the bill for the doctor's in the first place. We're willing to take those out in hopes that we can get a patient's bill of rights through this year...." He noted that next year "we" would be back to address the liability and medical necessity sections. CHAIRMAN KOTT asked Mr. Bullock if he is comfortable with the previous version. MR. BULLOCK answered, "Comfortable, no. But it's something ... that we feel that these are the two areas that have strong concern with the insurance industry and the unions." Furthermore, he said, there are other aspects to the bill that make it worthwhile legislation. REPRESENTATIVE MURKOWSKI pointed out that the effective date is July 1, 2001. She surmised that this legislation could pass out and next year the medical necessity and liability issue could be worked on; thus the latter portion could catch up with this legislation before the effective date. MR. BULLOCK remarked that he had not noticed the effective date, but commented that it worked for "us." REPRESENTATIVE ROKEBERG explained that there is a delay due to the (indisc.) contracts and things that need to work through the system. REPRESENTATIVE MURKOWSKI surmised that by that time, there may or may not be federal legislation. Number 0738 JERRY REINWAND, Lobbyist for Blue Cross, informed the committee that he has sent the latest version to his clients, from whom he has not yet heard from. He noted that "we" worked very closely with the unions on this legislation, and through that Mr. Burgan has pointed out a few issues that "our people" missed. REPRESENTATIVE ROKEBERG noted that the testimony he'd heard at the subcommittee meeting was in support of the version that came out of subcommittee. MR. REINWAND responded that the desire is to have a bill, although he did not believe they ever favored any particular version. He noted that the actual bill was not available until the other night. After the medical necessity language was taken out, he instructed them to put everything on hold. He said that he would forward any word as soon as he heard. CHAIRMAN KOTT commented that he believes the deletion of the medical necessity language would improve the comfort level of Blue Cross, AETNA, et cetera. REPRESENTATIVE ROKEBERG informed the committee that he has had contact with AETNA and Mr. Gordon Evans' organization, both of which have assured him that they are supporting the bill with that language removed. Representative Rokeberg characterized Mr. Reinwand's testimony as a "minor waffle." CHAIRMAN KOTT said that if it is the committee's will to remove the medical necessity language, there are a couple of ways to do so. REPRESENTATIVE ROKEBERG suggested the easiest way is to take up Version V and delete that section. Number 0884 REPRESENTATIVE ROKEBERG made a motion that the committee rescind its action in reporting CSHB 211(JUD), Version S as amended, out of committee. There being no objection, it was so ordered. Number 0933 REPRESENTATIVE JAMES made a motion that the committee adopt Version V [LS0472\V, Ford, 4/7/00] as the working document. There being no objection, it was so ordered and Version V was before the committee. REPRESENTATIVE ROKEBERG pointed out that on page 3, line 17, after the word "acts", the word "or conduct" should appear. [This was subsequently labeled technical Amendment 1.] Number 0962 REPRESENTATIVE ROKEBERG moved that the committee adopt the following, which was subsequently labeled Amendment 2. Page 3, line 25 through page 4, line 5, Delete subparagraph 2 Renumber accordingly. There being no objection, Amendment 2 was adopted. REPRESENTATIVE CROFT moved that the committee adopt Amendment 3, which read as follows: Page 1 Delete lines 4-7 REPRESENTATIVE CROFT commented that he does not believe that the bill, in its current form, should be entitled the Alaska patient's bill of rights. Representative Croft said he believes that technical work is being done. However, the major concerns of patients is being delayed and perhaps a future bill could be more appropriately entitled the Alaska patient's bill of rights. REPRESENTATIVE ROKEBERG objected and countered that this is a patient's bill of rights and would be a significant benefit to the citizens of this state. He specified that this bill allows a new emergency room standard, a choice of physician, requires and clarifies the external review process with peer review and provides the elements of medical necessity within the peer review. Furthermore, the bill clarifies numerous other situations and clarifies the relationships between the physician providers and the insurance companies. Those are the elements, besides liability, that are included in the national patient bill of rights. REPRESENTATIVE CROFT said he did not want to characterize this "watered-down" version as the Alaska patient's bill of rights. Upon a roll call vote, Representatives Croft, Kerttula and Kott voted in favor of Amendment 3 and Representatives Rokeberg, James and Murkowski voted against it. Therefore, Amendment 3 failed to be adopted with a vote of 3-3. Number 1206 REPRESENTATIVE JAMES moved to report the new CSHB 211, version LS0472\V, Ford, 4/7/00, as amended, out of committee with individual recommendations and the zero fiscal note. There being no objection, it was so ordered and the new CSHB 211(JUD) was reported from the House Judiciary Standing Committee.
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