Legislature(1999 - 2000)
03/03/2000 03:26 PM House L&C
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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-MANAGED HEALTH CARE INSURANCE CHAIRMAN ROKEBERG announced the first 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 0284 CHAIRMAN ROKEBERG informed members that the Senate and House Conference Committee on the national Patients Bill of Rights had met the previous day and was expected to have a bill ready this year, and that it will include provisions for allowing causative actions against providers. Number 0424 REPRESENTATIVE HALCRO moved to adopt Version I [1-LS0472\I, Ford, 2/24/00], as the working document before the committee. There being no objection, it was so ordered. JANET SEITZ, Staff to Representative Norman Rokeberg, Alaska State Legislature, explained the changes in Version I. On page 3, lines 3 and 4, a change was made to clarify confusing language; a clarifying change also was made on line 18. On page 5, line 6, after "currently offered," the phrase "or that may be offered in the future" was added. In the same section, provisions concerning the Division of Insurance and its overview were deleted. Ms. Seitz explained that the change had been made to lessen the involvement of the Division of Insurance, limiting it to a fiscal note. REPRESENTATIVE HALCRO asked whether there was a revised fiscal note. MS. SEITZ said that was not yet available. She continued with the explanation of Version I. On lines 25-30, in response to concerns about services being reasonably available in the community, the phrase "or that adequate referrals outside the community be available" was added. That allows a patient from a rural area to go to a major regional hospital for care that is not available in his home community, or to an Outside facility, such as the burn center in Seattle, for care that is not available in Alaska. MS. SEITZ reported that on page 6, line 22, the phrase "benefits relating to and restriction on non-participating provider services" was added. On page 7, lines 8-15, language was reinserted that allows a non-network option, such as a copayment or higher premium, if it is actuarially sound. Number 0650 CHAIRMAN ROKEBERG referred to the state attorney general's 1995 memorandum, copies of which had been sent to committee members. In a nutshell, the State of Alaska has a formal opinion mandating that any health care policy must include individuals' choice of providers, so the issue of a "point of service option" is moot in the eyes of state law. The memorandum goes on to say that a differential in charges can be made. There is nothing in this legislation [HB 211] that changes the attorney general's ruling. Number 0733 MS. SEITZ resumed her review of changes in Version I. On page 8, line 12, through page 9, line 1, an addition was made to language regarding continuing treatment of the terminally ill, defining "terminal" as "life expectancy of less than one year." On page 15, a change was made adding a reference to "religious, non- medical providers." The only other changes delete references to the Division of Insurance. Ms. Seitz concluded by saying that this is the shortened version, and there is an amendment concerning the research options which the committee was discussing. CHAIRMAN ROKEBERG told the committee that in addressing the major issue of confidentiality, it was decided not to include that in the proposed CS because comparable federal regulations [binding on Alaska] already are in place. That lowered the fiscal note substantially by saving the cost of developing state regulations. Number 0875 MS. SEITZ noted that the committee had requested a legal opinion from Mike Ford, Legislative Counsel [drafter of the bill], asking if anything in the bill prohibits a surcharge for nonemergency treatment provided at a hospital emergency room; Mr. Ford said he sees nothing in the bill that prohibits that. CHAIRMAN ROKEBERG said that would allow a small charge as a gatekeeping device to keep people from overusing the emergency room or to share in the costs of that emergency room. Number 0938 JIM JORDAN, Executive Director, Alaska State Medical Association, participated by teleconference. He said the revisions appear to accomplish what was needed, and that the amendments look fine to him as well. Number 0979 CHAIRMAN ROKEBERG asked Ms. Seitz to explain the three amendments before the committee. MS. SEITZ said Amendment 1 removes the Director of Insurance from some tasks that remained in Version I. Amendment 1 [1- LS0472\I.1, Ford, 2/25/00] read: Page 9, line 27: Delete "director shall" Insert "managed care entity shall provide" Page 9, line 28: Delete "require" Page 9, line 31: Delete "provide" Page 10, line 2: Delete "require by regulation" Page 13, line 16: Delete "is certified by the director as meeting" Insert "meets" CHAIRMAN ROKEBERG commented that this change was being made not just to lower the fiscal note, but also to streamline the whole bill. MS. SEITZ explained Amendment 2. It was requested by some companies that do medical research who felt that without the amendment, they could not get the information necessary to their research. Amendment 2 has been added to the confidentiality section, saying that no individual's identity can be disclosed without the written consent of that individual. Any information provided without that written consent must be provided in a form that assures that the identity of the individual cannot be ascertained. The intent is to keep from hampering medical and pharmaceutical research. Amendment 2 [1-LS0472\I.2, Ford, 2/26/00] read: Page 9, line 4, following "information.": Insert "(a)" Page 9, following line 7: Insert a new subsection to read: "(b) This section does not apply to medical information that is disclosed for research purposes if (1) the individual whose identity is disclosed gives written consent to the disclosure; or (2) the information is released in a form that does not reveal the identity of an individual." CHAIRMAN ROKEBERG commented that this will assure the privacy of individuals participating in clinical trials of experimental drugs. MS. SEITZ explained Amendment 3. It makes some changes regarding the Division of Insurance's oversight. It deletes, for example, the requirement that the standard provisions of a contract have to be submitted to the division and approved by the director [which otherwise would mean that 1,000-2,000 forms would have to be reviewed]. It also deletes some references to the director, the regulations, and to certification by the director. There is also an addition in Amendment 3 related to unfair trade practices. Amendment 3 [1-LS0472\I.3, Ford, 3/3/00] read: Page 5, lines 15 - 17: Delete all material. Page 13, line 20, following ";": Insert "and" Page 13, line 23: Delete "; and" Insert "." Page 13, line 24, through page 14, line 9: Delete all material. Reletter the following subsections accordingly. Page 14, line 20: Delete "as determined under any regulations that the director may prescribe" Page 18, following line 8: Insert a new bill section to read: "* Sec. 4. AS 21.36.125 is amended by adding a new paragraph to read: (16) violate a provision contained in AS 21.07." Renumber the following bill sections accordingly. Page 19, line 7: Delete "sec. 6" Insert "sec. 7" [End of Amendment 3] Number 1248 BOB LOHR, Director, Division of Insurance, testified by teleconference from Anchorage, noting that he had been asked to comment. He said he had not seen Version I, but the Division of Insurance had been happy to work with Chairman Rokeberg and Miss Seitz to make specific suggestions for streamlining the bill, reducing the bureaucratic involvement, the need for regulation. He said he believes the bill is significantly improved in that regard, both from the point of view of operation of the bill and the cost of it. MR. LOHR said that originally the Division of Insurance had significantly underestimated the fiscal impact of the contract review provisions. In redetermining that, the division "tried to squeeze out any kind of regulatory responsibilities that could be handled in a different fashion." The bottom line is this: It will be possible to reduce the fiscal note. Mr. Lohr asked latitude to thoroughly review Version I, with the amendments, over the weekend and to provide a revised fiscal note on Monday [March 20]. Number 1413 CHAIRMAN ROKEBERG said he didn't mind moving it [HB 211] with the existing fiscal note and providing for a revision of the fiscal note down the pike. He requested confirmation that the fiscal note would be substantially reduced. MR. LOHR affirmed that it will be reduced. Number 1438 REPRESENTATIVE HALCRO made a motion to adopt Amendment 1, 1- LS0472\I.1,, Ford, 3/3/00 [text provided previously]. There being no objection, Amendment 1 was adopted. REPRESENTATIVE HALCRO made a motion to adopt Amendment 2, 1- LS0472\I.2, Ford, 3/3/00 [text provided previously]. REPRESENTATIVE BRICE objected. He expressed concern about the possibility that information about people and their illnesses might be passed beyond a research organization and potentially used against the person in future health insurance coverage or otherwise. What happens if information goes beyond the arena of research? Number 1570 MR. JORDAN said he thought "we are talking about two different things." He said that paragraph A is referring to medical information already in the possession of the insurance company. It can only be used for the purpose of the claim. under Paragraph B, an entity such as a pharmaceutical manufacturer [could access that]. REPRESENTATIVE BRICE withdrew his objection. [There were no further objections to Amendment 2.] Number 1695 REPRESENTATIVE HALCRO made a motion to adopt Amendment 3, 1- LS0472\I.3, Ford, 3/3/00 [text provided previously]. There being no objection, Amendment 3 was adopted. Number 1707 REPRESENTATIVE HALCRO expressed concern about the impact of HB 211 on small business in Alaska. He said he would vote to move it out of committee, but was not sure he was ready to support the bill in its entirety until it is a finished product. Number 1743 RICHARD L. BLOCK, Christian Science Committee on Publications for the State of Alaska, testified by teleconference from Anchorage. He said he had reviewed Version I and was pleased with it and the amendments. Number 1757 REPRESENTATIVE HARRIS said he still has some concerns, and believes he has received assurances from Chairman Rokeberg that this bill is still in progress. He said he would vote to move it out of committee with the understanding that Chairman Rokeberg is still working with various groups that have very serious concerns about this. He would reserve his support on the floor until comfortable that those concerns have been met. CHAIRMAN ROKEBERG said he is pleased that groups that have expressed opposition to this type of legislation in the past have now changed their positions. He predicted that this version, with the amendments, will win the support of those who have opposed [the bill] in the past. He assured Representative Halcro that he shares his concerns that there not be a negative impact on individual and small business insurance in this state. Number 1865 REPRESENTATIVE HALCRO made a motion to move the CS for HB 211, Version I [1-LS0472\I, Ford, 3/3/00], as amended, out of committee with individual recommendations and the accompanying fiscal note, with a revision to that fiscal note pending. REPRESENTATIVE BRICE objected. Number 1905 Upon a roll call vote, Representatives Murkowski, Harris, Halcro, and Rokeberg voted in favor of moving the bill out of committee; Representatives Cissna and Brice voted against it. Therefore, CSHB 211(L&C) was moved out of the House Labor and Commerce Standing Committee by a vote of 4-2.
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