Legislature(2005 - 2006)BUTROVICH 205
04/26/2006 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES
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|Overview: Obesity Prevention – American Heart Association|
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
CSHB 393(HES)-INSURANCE FOR COLORECTAL CANCER SCREENING CHAIR DYSON announced CSHB 393(HES) to be up for consideration. HEATH HILYARD, Staff to Representative Anderson, said that a blank committee substitute (CS) for the bill was submitted to the committee. He remarked that he would like to explain the changes within the CS. CHAIR DYSON moved to adopt SCS CSHB 393(HES), version L of as the committee's working document. He objected for the purpose of discussion. MR. HILYARD said that the only substantial difference between version L and the previous version could be found on page 2, beginning on line 21. The change clarifies that notification is the responsibility of the employer, not the insurance company, unless the policy is being purchased directly by an individual from the company, in which case the standard notification process is in place. He said that colorectal cancer is the second leading cause of cancer deaths in Alaska and Alaska Natives have the highest rates of colorectal cancer in the country. He added that the survival rate for colorectal cancer when caught at the localized stage through routine screening is over 90 percent but, if it progresses to advanced stages, the survival rate is only about 10 percent. MR. HILYARD said that colonoscopies are over 90 percent effective at detecting colon cancer and can remove precancerous polyps. Screening is cost effective and national studies confirm that the cost of these screenings is minimal when spread across the insured population. SENATOR OLSON asked what is the incidence of complications for colonoscopies. MR. HILYARD replied that he could not answer that question. SENATOR ELTON asked whether this bill allows the insurer to choose a particular screening method. 3:01:11 PM MR. HILYARD replied that language in the original bill specifying the four available methods for colorectal screening was removed in the CS. He added that page 2 of the CS references the use of the test recommended in the American Cancer Society (ACS) guidelines for colorectal screening. He remarked that many of the major insurance providers recognize this test as the gold standard for the procedure. SENATOR ELTON asked if he is correct in his understanding that passage of the bill would require insurance companies to cover any one of the four procedures. MR. HILYARD replied yes. CHAIR DYSON asked Ms. Millhorn whether the administration has taken a position on the bill. MELANIE MILLHORN, Director, Division of Retirement and Benefits, replied that her division has not taken a policy position on the bill. CHAIR DYSON asked whether this legislation would affect the state's retirement system. MS. MILLHORN replied that her division has concluded that the bill would have no impact on the state's active and retiree plans because those plans are not regulated under AS.21.42. 3:04:25 PM CHAIR DYSON asked whether the state has adopted the mandates that it has placed on the insurance industry. MS. MILLHORN remarked that only the Commissioner of the Department of Administration has the authority to make changes to the state's active and retiree plans. She said that the State has voluntarily adopted some of the mandated coverage it has imposed such as mammograms, pap smears, and prostate specific antigen testing. CHAIR DYSON asked whether the administration considered amending section 39, as well as 42. MR. HILYARD replied that they had not made that consideration. SENATOR ELTON asked whether the commissioner could exclude a benefit from a plan once it had been adopted. MS. MILLHORN replied that might be considered a diminishment of benefits. The Alaska Supreme Court ruled that the advantages and disadvantages of changes to the retiree health plan must offset one another. She added that colorectal screening is covered under the State's active plan so long as a provider requests it and it occurs within 30 days of the employee's annual exam, but that preventative colorectal screening is not available under the retiree plan except for retirees with a related diagnosis. 3:08:25 PM SENATOR ELTON asked whether the bill requires insurance companies to pay the entire cost of colorectal cancer screening. MR. HILYARD replied that on page 2, beginning on lines 1 and 2, the bill states that the standard policy provisions and the deductible and copayment provisions shall stay in place. He added that the sponsor had not considered a specific percentage structure for additional costs. SENATOR ELTON remarked that his provider recommended that he have his procedure performed in Seattle because it is significantly cheaper there than in Juneau. He asked whether the bill takes prevailing costs into account. MR. HILLARD replied that is not addressed in the bill. CHAIR DYSON remarked that his wife's procedure cost nearly $5,000, which was outrageous. He asked whether there is anything the legislature could do to address excessive billing from providers. 3:12:08 PM MS. MILLHORN replied that that the state could advertise cost differences in their news breaks. She added that there are ways that the third party administrator could negotiate some charges through network savings and similar measures on an individual basis. 3:13:15 PM CHAIR DYSON remarked that someone ought to review the medical invoices of State employees to ensure that all of the billed expenses are legitimate. MS. MILLHORN replied that the division looks into some of those areas, and added that the state is adopting another third party administrator from which it expects to receive some benefits that will save the state money. She said that the division is considering making changes to its plan configuration to cover air travel to places that offer procedures at significantly lower rates. 3:15:46 PM CHAIR DYSON asked whether any representatives from the insurance industry were scheduled to testify on this bill. MR. HILYARD replied no. CHAIR DYSON asked whether any representatives from the insurance industry had testified on the bill in previous hearings. MR. HILYARD replied that representatives from the industry were present at several of the House committee meetings where the bill was discussed. He said Mr. Reed Stoops of AETNA testified that his organization had concerns about a section that has since been changed in the CS. He said that other than that they did not have any opposition to the bill. He remarked that AETNA and Blue Cross already provide coverage for the screening in their standard policies. 3:17:02 PM CHAIR DYSON remarked that he hates putting mandates on the private sector, and that if spending the money on the test is going to provide better health outcomes for patient-client policyholders, and save the insurance company money in the long term, all responsible insurance companies should be doing it. He related a conversation he had with insurance representatives five or six years ago when dealing with this issue. They admitted that the screening is good for them and their clients, but wanted to be sure that everyone would be required to cover it so that they would not be at a cost disadvantage. MR. HILYARD said that a number of members in the other body expressed the same philosophical approach. The sponsor's office has worked with members of the insurance industry to satisfy any concerns with minimal impact, yet benefit the public health. He restated that while he has not received comment from small private insurers, the two major providers in this state have expressed their satisfaction with the bill. 3:19:15 PM CHAIR DYSON asked whether Linda Hall, Director of the Division of Insurance (DOI), has commented on this bill. MR. HILYARD replied that DOI believes this bill would have no fiscal impact. He said that she did not offer a policy position on the bill. SENATOR ELTON referenced a statement from Blue Cross/Blue Shield of Alaska that it currently covers colorectal screening on all of its plans. He asked whether this benefit would extend to retirees without the Commissioner's acceptance of colorectal coverage, if the state adopts Blue Cross/Blue Shield as its third party administrator. MR. HILYARD replied that active members are currently covered for this screening, but retirees are not. SENATOR ELTON said he understood that active state members are only covered if a physician asks for the screening but this legislation would provide that they would be covered regardless of whether or not a physician requests the procedure. MR. HILYARD replied that is correct. 3:22:23 PM MOLLY McCAMMON, Juneau resident, testified in support of HB 393, saying that she is living proof that screening saves lives. DARYL McCLENDON, MD, testified in support of HB 393. He said that coverage for colorectal screening is financially and medically prudent since the lifetime risk of colorectal cancer is high, one in twenty, and the incidence of survival is much higher when it is caught in the early stages of its development. CHAIR DYSON said that the cost of the screening seems to be inordinately expensive in Anchorage and asked whether quality testing is available in other locations. DR. McCLENDON replied that he did not know how the costs in Anchorage compare to costs in other areas. CHAIR DYSON thanked the witness for his work in Alaska and announced that the bill would be held in committee.