Legislature(2001 - 2002)

02/21/2001 01:38 PM JUD

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Number 1599                                                                                                                     
                                                                                                                                
          SB 37-PHYSICIAN NEGOTIATIONS WITH HEALTH INSURE                                                                   
                                                                                                                                
MR. KRISTOPHER  KNAUSS, staff to Senator Pete Kelly,  said questions                                                            
from the  Department of Law  (DOL), Division  of Insurance,  and the                                                            
Nurse Practitioners  and Midwives  (NPM), in  the last hearing  have                                                            
been  answered.   NPM was  concerned that  their  services could  be                                                            
negotiated out of physician  contracts with healthcare plans.  As SB
37 is  written this  is not so.   It is in  statute that those  with                                                            
special occupational licenses  from health care plans or health care                                                            
in general cannot be discriminated  against - the new amendment also                                                            
clarifies this point.                                                                                                           
                                                                                                                                
Number 1698                                                                                                                     
                                                                                                                                
CHAIRMAN  TAYLOR  said  there  were  concerns   about  enough  state                                                            
involvement  within  the  process  so that  under  federal  law  the                                                            
constraints  of the  anti-trust legislation  could  be avoided.   He                                                            
asked if SB 37 was sufficient  for allowing the state to participate                                                            
in these negotiations.                                                                                                          
                                                                                                                                
MR. JAMES JORDAN,  Executive Director  for the Alaska State  Medical                                                            
Association,  testifying  via teleconference  from  Anchorage,  said                                                            
there is  sufficient regulatory  oversight in  SB 37 to provide  the                                                            
meeting  of the act  of oversight  test, not only  with the  various                                                            
guidelines  provided  for the  oversight agency  but  also the  AG's                                                            
office.                                                                                                                         
                                                                                                                                
MR. JORDAN said Texas enacted  a similar law in June of 1999 and has                                                            
been going  through  a process of  adopting regulations  to make  it                                                            
functional.   Washington  has a  law that allows  joint negotiation                                                             
under a state  action doctrine exception.   However, the  Washington                                                            
law did  not provide  for anything  more than  is currently  allowed                                                            
under new federal antitrust laws.                                                                                               
                                                                                                                                
Number 1880                                                                                                                     
                                                                                                                                
MR.  MICHAEL   HAUGEN,   Alaska  Physicians   and  Surgeons   (APS),                                                            
testifying via  teleconference from Anchorage, started  by answering                                                            
a  question  that  Senator Therriault   asked in  the  last  hearing                                                            
regarding  safe harbors.   APS has  talked with  the Alaska  Medical                                                            
Association's  (AMA) legal  department  and has done  its own  legal                                                            
analysis regarding  whether or not  SB 37 needs additional  language                                                            
to  protect  physicians  prior  to  active  negotiations  in  simply                                                            
getting together to discuss  the possibility of negotiation. Supreme                                                            
court cases  from the 1960's  say that provided  the applicants  are                                                            
working  in  good faith  to  apply  for state  protection  they  are                                                            
exempted  from any liability  under the Sherman  antitrust  laws and                                                            
the federal  antitrust rules.   The answer  to Senator Therriault's                                                             
question is  that provided the doctors  are acting in good  faith in                                                            
attempting to petition the AG to negotiate, they are protected.                                                                 
                                                                                                                                
MR. HAUGEN  said APS suggests  the AG issue  a "Dear Doctor"  letter                                                            
stating the "do's  and don'ts" of getting together,  before the safe                                                            
harbor provided  under SB  37 goes into effect,  to let the  doctors                                                            
know they have to be organizing  in good faith and that there may be                                                            
areas they  should not  discuss until  the green  light is given  to                                                            
negotiate.   APS  does not  think  additional language  would  offer                                                            
additional protection.                                                                                                          
                                                                                                                                
Number 2018                                                                                                                     
                                                                                                                                
MR.  CLYDE  SNIFFEN, JR.,  Attorney  General,  DOL,  testifying  via                                                            
teleconference  from Anchorage, said  he had not seen the  amendment                                                            
or any answers to the questions  referred to by Mr. Knauss.  He does                                                            
not know how  the concerns he raised  at the last hearing  have been                                                            
addressed and  therefore cannot comment  on them.  DOL continues  to                                                            
have serious  concerns  with SB  37.  The  only provision  in  SB 37                                                            
allowing DOL the authority  to adopt regulations is specific only to                                                            
fee issues.    DOL also  has concerns  about geographic  and  market                                                            
power issues, they are  not well defined or related to anything that                                                            
would suggest  the markets that SB  37 focuses on have an  impact on                                                            
the ability to set prices.                                                                                                      
                                                                                                                                
CHAIRMAN TAYLOR  asked if DOL had  prepared amendments to  take care                                                            
of these concerns.                                                                                                              
                                                                                                                                
MR. SNIFFEN replied no.                                                                                                         
                                                                                                                                
Number 2187                                                                                                                     
                                                                                                                                
MS.  SANDY PERRY-PROVOST,  Alaska  Nurse Practitioners  Association                                                             
said she could not comment  on the amendment because the nurses have                                                            
not seen it yet.  She pointed  out that there is not an (o) under AS                                                            
23.50.020 in the amendment.                                                                                                     
                                                                                                                                
SENATOR  THERRIAULT  asked  if  Chairman  Taylor  would  afford  the                                                            
drafter latitude in changing the language.                                                                                      
                                                                                                                                
CHAIRMAN TAYLOR said the amendment is only conceptual.                                                                          
                                                                                                                                
TAPE 01-4, SIDE B                                                                                                             
                                                                                                                                
Number 2334                                                                                                                     
                                                                                                                                
SENATOR  ELLIS  said  there  had been  a  request  from  the  Alaska                                                            
Optometric Association  (AOA) as well.  AOA supports SB 37 but wants                                                            
an amendment that would  encompass all the groups that have problems                                                            
with the bill.                                                                                                                  
                                                                                                                                
CHAIRMAN  TAYLOR  said the  wording of  SB 37  is  to encompass  all                                                            
groups  that   would  be  defined   within  that  category   -  "the                                                            
performance  of  services   that  are  within  the  scope  of  their                                                            
occupational license."   The amendment was structured  to accomplish                                                            
this without listing each group.                                                                                                
                                                                                                                                
CHAIRMAN  TAYLOR moved  to adopt  the conceptual  amendment.   There                                                            
being no objection, the motion carried.                                                                                         
                                                                                                                                
SENATOR  COWDERY moved  to pass CSSB  37 (JUD)  from committee  with                                                            
individual recommendations.                                                                                                     
                                                                                                                                
SENATOR ELLIS objected.                                                                                                         
                                                                                                                                
SENATOR ELLIS  said there were still too many concerns  that had not                                                            
been addressed.                                                                                                                 
                                                                                                                                
CHAIRMAN TAYLOR said he  shared some of the same concerns as Senator                                                            
Ellis about  the questions  on antitrust.   He  said he hoped  these                                                            
issues  would be  resolved before  SB 37  goes to the  Floor of  the                                                            
Senate.    Chairman  Taylor  said  the antitrust  issue  has  to  be                                                            
resolved or SB 37 will not have the desired effect.                                                                             
                                                                                                                                
SENATOR  ELLIS noted  there is  a significant  fiscal  note and  the                                                            
discomfort  level would go up dramatically  if the fiscal  note were                                                            
to be  significantly  reduced  or wiped  out allowing  no  oversight                                                            
through the  AG's office.  He does  not object to the amendment  but                                                            
wondered  if there would  be restrictions  in other  parts of  SB 37                                                            
that would cause  concern that doctors would constrain  trade of the                                                            
concerned groups.                                                                                                               
                                                                                                                                
CHAIRMAN TAYLOR said the  first section is just legislative findings                                                            
and the only real substance to the bill is the amended section.                                                                 
                                                                                                                                
SENATOR  ELLIS  said, with  all  respect  to  the Chairman,  if  the                                                            
committee were  to move SB 37 he would have a hard  time feeling the                                                            
committee had done a full job.                                                                                                  
                                                                                                                                
CHAIRMAN  TAYLOR  said  he shared  many  of those  concerns  and  he                                                            
assured Senator  Ellis that  if these issues  were not resolved,  he                                                            
would request SB 37 back to the Judiciary Committee.                                                                            
                                                                                                                                
A roll  call was taken.   Senator Donley,  Senator Cowdery,  Senator                                                            
Therriault  and Chairman Taylor  voted "yea."   Senator Ellis  voted                                                            
"nay."    The  motion  carried  and CSSB  37  (JUD)  passed  out  of                                                            
committee with individual recommendations.                                                                                      

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