Legislature(2017 - 2018)CAPITOL 106
03/08/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB358 | |
| HB351 | |
| HB193 | |
| HB336 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 358 | TELECONFERENCED | |
| += | HB 351 | TELECONFERENCED | |
| *+ | HB 193 | TELECONFERENCED | |
| += | HB 336 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 8, 2018
3:19 p.m.
MEMBERS PRESENT
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman (via teleconference)
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
Representative Matt Claman (alternate)
MEMBERS ABSENT
Representative Ivy Spohnholz, Chair
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
HOUSE BILL NO. 358
"An Act relating to insurance coverage for benefits provided
through telehealth; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 351
"An Act relating to care of juveniles and to juvenile justice;
relating to employment of juvenile probation officers by the
Department of Health and Social Services; relating to terms used
in juvenile justice; relating to mandatory reporters of child
abuse or neglect; relating to adjudication of minor delinquency
and the deoxyribonucleic acid identification registration
system; relating to sexual assault in the third degree; relating
to sexual assault in the fourth degree; repealing a requirement
for administrative revocation of a minor's driver's license,
permit, privilege to drive, or privilege to obtain a license for
consumption or possession of alcohol or drugs; and providing for
an effective date."
- MOVED CSHB 351(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 193
"An Act relating to insurance trade practices and frauds; and
relating to emergency services and balance billing."
- HEARD & HELD
HOUSE BILL NO. 336
"An Act relating to supported decision-making agreements to
provide for decision- making assistance; and amending Rule 402,
Alaska Rules of Evidence."
- MOVED CSHB 336(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 358
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/19/18 (H) READ THE FIRST TIME - REFERRALS
02/19/18 (H) HSS, L&C
03/08/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 351
SHORT TITLE: JUVENILES: JUSTICE,FACILITES,TREATMENT
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/16/18 (H) READ THE FIRST TIME - REFERRALS
02/16/18 (H) HSS, JUD
03/06/18 (H) HSS AT 3:00 PM CAPITOL 106
03/06/18 (H) Heard & Held
03/06/18 (H) MINUTE(HSS)
03/08/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 193
SHORT TITLE: HEALTH CARE; BALANCE BILLING
SPONSOR(s): REPRESENTATIVE(s) GRENN
03/24/17 (H) READ THE FIRST TIME - REFERRALS
03/24/17 (H) HSS, L&C
03/08/18 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 336
SHORT TITLE: SUPPORTIVE DECISION-MAKING AGREEMENTS
SPONSOR(s): REPRESENTATIVE(s) MILLETT
02/07/18 (H) READ THE FIRST TIME - REFERRALS
02/07/18 (H) HSS, JUD
03/01/18 (H) HSS AT 3:00 PM CAPITOL 106
03/01/18 (H) Heard & Held
03/01/18 (H) MINUTE(HSS)
03/08/18 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
BERNICE NISBETT, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 358 on behalf of the bill
sponsor, Representative Spohnholz.
ANNA LATHAM, Deputy Director
Juneau Division
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussions of HB
358 and HB 193.
MATT DAVIDSON, Social Services Program Officer
Division of Juvenile Justice
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
351.
REPRESENTATIVE JASON GRENN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 193 as the sponsor of the
bill.
RYAN JOHNSTON, Staff
Representative Jason Grenn
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the Sectional Analysis on behalf
of the bill sponsor, Representative Grenn.
MEGAN WALLACE, Attorney
Legislative Legal Counsel
Legislative Legal Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
193.
NATHAN PAIMANN, MD
Bartlett Regional Hospital
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 193.
HANS RODVIK, Staff
Representative Charisse Millett
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 336 on behalf of the bill
sponsor, Representative Millett.
ACTION NARRATIVE
3:19:41 PM
REPRESENTATIVE TARR called the House Health and Social Services
Standing Committee meeting to order at 3:19 p.m.
Representatives Tarr, Kito, Johnston, and Sullivan-Leonard were
present at the call to order. Representatives Edgmon and
Eastman (via teleconference) arrived as the meeting was in
progress.
HB 358-INSURANCE COVERAGE FOR TELEHEALTH
3:21:17 PM
REPRESENTATIVE TARR announced that the first order of business
would be HOUSE BILL NO. 358, "An Act relating to insurance
coverage for benefits provided through telehealth; and providing
for an effective date."
3:21:34 PM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, paraphrased from the Sponsor Statement
[Included in members' packets] [original punctuation provided],
which read:
HB 358 will enhance access to health care services,
primarily mental health and primary care, for Alaskans
who have insurance plans with Moda, Premera Blue
Cross, United Healthcare, and Aetna Life Insurance, to
name a few. HB 358 does this by requiring the insurers
previously listed to provide insurance coverage for
health care services provided through telehealth.
Increasing access to health care services throughout
Alaska is crucial. Because of our unique geographical
landscape and our rural and aging communities spread
out across the state, telehealth can enhance access to
health care and improve clinical outcomes.
Here are some of the advantages of telehealth:
? Better access and privacy in rural, remote, and
urban areas of Alaska
? Early intervention which can lead to savings
? Greater access for referrals to providers who
specialize in treating specific health issues
? Better, and potentially quicker, access means a
potential reduction in suicides, domestic violence and
other serious events
? Zero impact on state budget
Under HB 358, telehealth benefits for all covered
health care services, including mental health
benefits, will be reimbursable for health care
providers licensed in the state without an initial in
person appointment. Depending on the patient's needs,
a telehealth appointment can provide education,
reviewing of prescriptions and checking symptoms, all
at a distance on a secure system.
Health care services delivered via telehealth is
happening all over the country, and Alaska is at the
forefront of providing telehealth services for urban,
rural, aging, and the underserved communities across
the state.
MS. NISBETT presented the definition of tele-health as it was
written in AS 47.05.27(e), and read:
the practice of health care delivery, evaluation,
diagnosis, consultation, or treatment using the
transfer of health care data through audio, visual, or
data communications performed over two or more
locations between providers who are physically
separated from the recipient or from each other or
between a provider and a recipient who are physically
separated from each other.
MS. NISBETT reported that prominent health care organizations in
Alaska had stated that tele-health can increase access, an issue
recommended by the Alaska Health Care Commission for the Alaska
State Legislature to address. She noted that the legislature
had passed Senate Bill 74 in 2016, which was primarily a
Medicaid reform bill with significant tele-health components.
She pointed out that the proposed bill would only impact
insurance plans regulated by the Division of Insurance.
3:24:49 PM
MS. NISBETT paraphrased from the Sectional Analysis [included in
members' packets], which read:
Section 1.
AS 21.42.422 has been amended to require insurance
coverage for benefits provided via telehealth.
Section 2.
AS 21.42.422 is a new subsection that defines health
care insurer as a person transacting the business of
health care insurance except for a nonfederal
governmental plan. It also adds the definition of
telehealth under 47.05.270(e) as the practice of
health care delivery, evaluation, diagnosis,
consultation, or treatment, using the transfer of
health care data through audio, visual, or data
communications, performed over two or more locations
between providers who are physically separated from
the recipient or from each other or between a provider
and a recipient who are physically separated from each
other.
Section 3
The changes to Section 1 of this bill applies to
health care insurance plans that are offered, issued,
delivered, or renewed on or after the effective date.
Section 4
The effective date is July 1, 2019.
3:26:12 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if a patient in a rural
area would need to see a primary physician prior to the use of
tele-health.
3:27:20 PM
ANNA LATHAM, Deputy Director, Juneau Division, Division of
Insurance, Department of Commerce, Community & Economic
Development, offered her belief that, although this had not been
addressed in the proposed bill, as the bill read, it was not
necessary for an in-person appointment prior to the use of tele-
health.
REPRESENTATIVE SULLIVAN-LEONARD opined that it was "really
important that we do have coverage for our tele-health process
and network for patients that don't have access to physicians."
She wanted to ensure there was not a gap in the process allowing
that someone did not receive the proper oversight from a
physician while in a rural area.
REPRESENTATIVE TARR noted that this had previously been limited
to mental health services, but, was now expanded for all
telehealth.
MS. LATHAM said that was correct.
3:29:07 PM
REPRESENTATIVE SULLIVAN-LEONARD asked to hear from a physician
or nurse practitioner for the effect of the proposed bill on
their practice.
MS. NISBETT, in response to Representative Sullivan-Leonard,
explained that providers primarily used telehealth for follow up
appointments, consultation, education, and review of
prescriptions. However, if a patient in rural Alaska had a
serious condition, it was suggested they travel to an urban area
to see a doctor. She declared that telehealth was not the
initial or primary service of care.
REPRESENTATIVE SULLIVAN-LEONARD asked to ensure that everything
was covered by the providers.
3:31:39 PM
REPRESENTATIVE CLAMAN asked, as the proposed bill restricted
telehealth to providers licensed in Alaska, if it would be more
difficult to receive telehealth services from mental health
providers from out of state.
MS. NISBETT asked for clarification.
REPRESENTATIVE CLAMAN explained that there were instances in
which mental health providers worked with social workers in
Alaska to provide person to person counseling services, even
though the medication was managed by an out of state provider
who only communicated with the patient from afar. He asked if
the out of state provider would not receive an insurance payment
because they were not licensed in Alaska.
MS. NISBETT said that she would research this.
3:33:41 PM
REPRESENTATIVE JOHNSTON asked for clarification that there was
telemedicine through the Indian Health Service (IHS), and
whether this proposed bill would expand service to community
members in rural villages not covered by the Indian Health
Service.
MS. NISBETT replied that this was correct.
3:34:13 PM
MS. LATHAM stated that the proposed bill expanded telehealth and
removed it from solely mental health benefits, for the
individual and small group market, as those markets were
regulated by the Division of Insurance.
REPRESENTATIVE JOHNSTON asked if this was covered as a Medicaid
reimbursement, rather than the IHS.
MS. LATHAM offered her belief that, as the IHS was the payer of
last resort, a plan in the individual market would cover
telehealth benefits. She stated that she was not familiar with
the benefits covered under IHS, although her understanding was
that it would be covered under both scenarios.
3:35:28 PM
REPRESENTATIVE TARR asked if the proposed changes would impact
the benefits covered by Medicaid, noting that this proposed bill
was for private and group plans.
MS. LATHAM explained that the proposed bill only covered plans
regulated by the Division of Insurance, which included large
groups, small groups, and the individual market.
REPRESENTATIVE TARR referenced House Bill 234 in 2016 which did
not include a section regarding licensure by the state.
3:36:34 PM
REPRESENTATIVE TARR said that HB 358 would be held over.
HB 351-JUVENILES: JUSTICE,FACILITES,TREATMENT
3:36:52 PM
REPRESENTATIVE TARR announced that the next order of business
would be HOUSE BILL NO. 351, "An Act relating to care of
juveniles and to juvenile justice; relating to employment of
juvenile probation officers by the Department of Health and
Social Services; relating to terms used in juvenile justice;
relating to mandatory reporters of child abuse or neglect;
relating to adjudication of minor delinquency and the
deoxyribonucleic acid identification registration system;
relating to sexual assault in the third degree; relating to
sexual assault in the fourth degree; repealing a requirement for
administrative revocation of a minor's driver's license, permit,
privilege to drive, or privilege to obtain a license for
consumption or possession of alcohol or drugs; and providing for
an effective date."
3:37:39 PM
MATT DAVIDSON, Social Services Program Officer, Division of
Juvenile Justice, Department of Health and Social Services,
stated that the proposed bill was an update for the terms used
in the juvenile justice statute to describe the facilities and
staff. Most of the bill applied to conforming changes
throughout the statutes, and not for actual changes to meaning,
or changes to the powers or duties of the Division of Justice.
He listed some of the outdated terms used in statute, which
included juvenile work camps and detention homes, noting that
these were being updated with modern terms to describe the
facilities. He stated that the definition for juvenile
probation officer was being updated, as well as providing a
delineation between adult and juvenile probation officers in
statute. He pointed out that the proposed bill added juvenile
justice staff and probation officers as mandatory reporters of
child abuse and neglect in AS 47.17. He stated that this
reflected a role of the staff in working with kids, as they were
often disclosing this type of activity, which would be reported
to the Office of Children's Services.
REPRESENTATIVE TARR clarified that this was current policy and
was now being written into statute.
3:39:38 PM
REPRESENTATIVE TARR opened public testimony and after
ascertaining no one wished to testify, closed public testimony
on HB 351.
3:40:19 PM
REPRESENTATIVE TARR moved to adopt proposed Amendment 1, labeled
30-LS0416\R.1, Glover, 2/28/18, which read:
Page 13, lines 6 - 7:
Delete "the minor is not in sight or sound of
adult prisoners, and"
REPRESENTATIVE CLAMAN objected for discussion.
REPRESENTATIVE TARR explained that proposed Amendment 1
addressed page 13, lines 6 - 7, of the proposed bill in which
youth could be detained in a temporary secure holding area. She
stated that removal of this language could be problematic for
these temporary secure holding areas.
3:41:40 PM
MR. DAVIDSON clarified that this section of the bill was in the
delinquency statute and, while drafting it, the separation of
sight and sound had been added to the wrong place. He explained
that currently this applied to youth in the custody of the
Department of Corrections, as explained in lines 18 and 21. He
stated that the intent of the bill was not for the Department of
Corrections to have sight and sound separation for those
individuals and that it was not required by law.
3:42:35 PM
REPRESENTATIVE CLAMAN removed his objection. There being no
further objection, Amendment 1 was adopted.
3:42:59 PM
REPRESENTATIVE EASTMAN moved to adopt proposed Amendment 2,
labeled 30-LS-0416\R.2, Laffen, 3/8/18, which read:
Page 18, line 21, through page 19, line 13:
Delete all material and insert:
"* Sec. 38. AS 47.17.020(a) is amended to read:
(a) The following persons who, in the
performance of their occupational duties or [,] their
appointed duties under (8) of this subsection, [OR
THEIR VOLUNTEER DUTIES UNDER (9) OF THIS SUBSECTION,]
have reasonable cause to suspect that a child has
suffered harm as a result of child abuse or neglect
shall immediately report the harm to the nearest
office of the department:
(1) practitioners of the healing arts;
(2) school teachers and school
administrative staff members, including athletic
coaches, of public and private schools;
(3) peace officers and officers of the
Department of Corrections;
(4) administrative officers of
institutions;
(5) child care providers;
(6) paid employees of domestic violence and
sexual assault programs, and crisis intervention and
prevention programs as defined in AS 18.66.990;
(7) paid employees of an organization that
provides counseling or treatment to individuals
seeking to control their use of drugs or alcohol;
(8) members of a child fatality review team
established under AS 12.65.015(e) or 12.65.120 or the
multidisciplinary child protection team created under
AS 47.14.300;
(9) juvenile probation officers, juvenile
probation office staff, and staff of juvenile
detention facilities and juvenile treatment
facilities, as those terms are defined in AS 47.12.990
[VOLUNTEERS WHO INTERACT WITH CHILDREN IN A PUBLIC OR
PRIVATE SCHOOL FOR MORE THAN FOUR HOURS A WEEK]."
Page 19, following line 13:
Insert a new bill section to read:
"* Sec. 39. AS 47.17.022(e) is amended to read:
(e) Each school district that provides training
under this section shall provide notice to public and
private schools located in the school district of the
availability of the training [AND INVITE VOLUNTEERS
WHO ARE REQUIRED TO REPORT ABUSE OR NEGLECT OF
CHILDREN UNDER AS 47.17.020 TO PARTICIPATE IN THE
TRAINING AT NO COST TO THE VOLUNTEER]."
Renumber the following bill sections accordingly.
Page 19, line 15:
Delete "and 47.14.990(9)"
Insert ", 47.14.990(9); and AS 47.17.020(j)"
Page 19, line 31:
Delete "Section 41"
Insert "Section 42"
REPRESENTATIVE TARR objected.
REPRESENTATIVE EASTMAN explained that proposed Amendment 2 would
protect the treatment of volunteers and recognize them as not
paid and not receiving direct benefits for their service. He
stated that the current proposal would allow that volunteers
were criminally liable for not reporting under the mandatory
reporter requirement. He said that the proposed amendment would
not limit a volunteer's ability to make a report. He stated
that making a volunteer criminally liable just for their
volunteer work would result in fewer volunteers.
3:44:59 PM
REPRESENTATIVE TARR shared a provision from House Bill 44 that
had been added to statute in 2015. She noted that there had
been a lot of discussion for this provision, and that the
provision had been added because of some very high-profile
incidences for individuals abusing children. She stated that
this was an attempt to create a better system, and it only
applied to those who volunteered for more than four hours each
week. She pointed out that it was important for these longer-
term volunteers to have the training as their behavior and their
recognition of other behavior would be enhanced. She shared
that, although she frequently received communication regarding
this bill, she had not heard of any issues with this provision.
She declared that she was not supportive of the proposed
amendment. She pointed out that the proposed bill was focused
on updates to the Division of Juvenile Justice statutes, and
that the mandatory reporter provisions were specific to juvenile
probation.
3:47:34 PM
REPRESENTATIVE SULLIVAN-LEONARD asked whether volunteers were
already covered for liability.
MR. DAVIDSON explained that the volunteers referenced in the
proposed amendment were not specific to Juvenile Justice
volunteers. He noted that the proposed bill added juvenile
justice officers and juvenile probation staff to the mandatory
reporting requirement. He deferred to Representative Tarr for a
better understanding of the mandatory reporter statute. He
pointed out that the Office of Children's Services administered
the mandatory reporter training.
REPRESENTATIVE SULLIVAN-LEONARD stated her understanding that
there was liability coverage for volunteers and asked for a
comparison of the description beginning on page 18, line 22 of
the proposed bill with the proposed Amendment 2.
MR. DAVIDSON said that he was not familiar with liability
coverage for volunteers.
3:49:55 PM
REPRESENTATIVE TARR opined that volunteers were covered through
the school district and elsewhere.
3:50:17 PM
REPRESENTATIVE EASTMAN reported that, as a mandatory reporter in
his role as a firefighter for the Matanuska-Susitna Borough,
they regularly received this training. He stated that proposed
Amendment 2 recognized that volunteers should be treated
separately than those who were paid. He offered his belief that
"telling someone who's abusing a child that they need to report
the abuse of that child is not going to have much of an effect
on stopping that abuse. I think if someone already violating
the law ... probably isn't going to change much." He said that
it would impact those who were recruiting volunteers to work
with children, as many volunteers would not sign up under a
condition of liability. He pointed out that liability insurance
would protect against a civil suit, but proposed Amendment 2
would protect against criminal sanctions. He stated that this
amendment was not limiting the ability to report anything that
was of concern or limiting the training offered.
3:52:24 PM
REPRESENTATIVE TARR maintained her objection.
3:52:29 PM
A roll call vote was taken. Representative Eastman (via
teleconference) voted in favor of proposed Amendment 2.
Representatives Sullivan-Leonard, Claman (alternate), Kito,
Edgmon, Johnston, and Tarr voted against it. Therefore,
Amendment 2 failed by a vote of 1 yea - 6 nays.
3:53:29 PM
REPRESENTATIVE EDGMON moved to report HB 351, Version 30-
LS0416\R, as amended, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 351(HSS) was moved from the House Health and
Social Services Standing Committee.
3:54:09 PM
The committee took an at-ease from 3:54 p.m. to 3:56 p.m.
HB 193-HEALTH CARE; BALANCE BILLING
3:56:15 PM
REPRESENTATIVE TARR announced that the next order of business
would be HOUSE BILL NO. 193, "An Act relating to insurance trade
practices and frauds; and relating to emergency services and
balance billing."
3:56:39 PM
REPRESENTATIVE JASON GRENN, Alaska State Legislature,
paraphrased from the Sponsor Statement [included in members'
packets], which read:
House Bill 193 is focused on protecting Alaskans in
emergency situations from being surprised with
unexpected medical bills. The most common occurrence
for balance billing is during emergency situations
where patients are left without the option or
wherewithal to ensure they are treated by an in-
network provider. As a result, they find themselves on
the hook for hefty medical bills, despite having
proper health insurance. HB 193 would help Alaskans
already dealing with the turmoil of a medical
emergency by removing them from the billing side of
the equation. When a patient is already in a dire
situation, they should not be punished for the
inability of an in-network provider to respond to
their crisis.
HB 193 bans the practice of medical providers from
balance billing in emergency situations and requires
insurance providers to hold harmless their clients.
This covers emergency situations inside and outside of
hospitals. If a patient was transported to a hospital,
or an emergency arose during a medical procedure
requiring an out-of-network provider, this legislation
mandates the insurance and medical providers to
develop a fair and equitable payment agreement.
Instead of being left to handle the labyrinth of
medical billing on their own, the patient will be held
harmless in these situations.
Medical costs are a major concern in Alaska. HB 193 is
a part of a national movement to protect consumers
from unexpected costs in an already difficult
situation. Twenty-one states have a ban of some kind
on balance billing and more states are looking are
into the issue. Unexpected and excessive medical bills
from out-of-network providers contribute to the
growing problem of consumer medical debt, which
continues to be a significant cause of personal
bankruptcy. The goal of this legislation is to hold a
patient harmless while the medical and insurance
providers come to an agreement for the services
rendered.
3:58:50 PM
REPRESENTATIVE EDGMON moved to adopt the proposed committee
substitute (CS) for HB 193, labeled 30-LS0466\T, Wallace,
3/6/18, as the working draft.
3:59:01 PM
REPRESENTATIVE TARR objected for discussion.
3:59:08 PM
RYAN JOHNSTON, Staff, Representative Jason Grenn, Alaska State
Legislature, paraphrased from the Sectional Analysis, which
read:
Section 1: Establishes a "Hold Harmless" standard for
insurance providers in the situation where a covered
person receives medical care from an out-of-network
medical provider in an emergency. An insurance
provider will hold a covered person harmless to ensure
that the covered person only pay what would have been
paid if the medical provider was an in-network
provider.
Outlines the standards to establish the situations
where a medical provider cannot balance bill a covered
person. An insurance provider shall pay a non-network
health care provider if the health care provider
renders to a covered person;
emergency services or treats an emergency medical
condition
services at an in-network facility
services for which a referral was made by an in-
network health care provider to an out of-network
health care provider without the explicit written
consent of the covered person.
The covered person is still required to pay the in-
network rates for the deductible, coinsurance and
copayment. The amount paid by the covered person is
required to be counted towards the covered persons
deductible.
The final payment determined for the medical provider
will subtract any amount paid by the covered person.
The insurance provider is to pay the greater of three
possible amounts;
the median negotiated contract rate generated
using the in-network health care providers for the
service provided;
That is equal to the 80th percentile of charges
for the services calculated using a method that
establishes a statistically credible profile that
reflects the general cost differences between the
geographical area where the service was preformed and
the other geographical areas when performed by a
health care provider in the same or similar specialty;
or
That would be paid under Medicare for the service
provided.
Medical providers are required to send all bills to
the insurance provider, except for the deductible,
coinsurance and copayment.
Contains a clause that if a covered person knowingly
elects to use an out-of-network medical provider then
they can be balanced billed for the services.
4:01:41 PM
REPRESENTATIVE KITO asked for clarification regarding the
determination of the calculations.
MR. JOHNSTON explained that the greater of three possible
amounts model was taken from an [PP]ACA [Patient Protection and
Affordable Care Act] regulation that was adopted at the time of
its federal adoption. He stated that the 80th percentile, the
usual and customary rate, had been used as the standard by the
State of Alaska, a precedent had already been set for its use.
4:02:41 PM
MR. JOHNSTON continued to paraphrase from the Sectional
Analysis, which read:
Section 2: Health care insurance plans obtained under
AS 39.30.090 or provided under AS 39.30.091 will be
subject to the requirements of secs. 21.36.512 and
21.36.513.
Section 3: Bans the practice of "Balance Billing" by a
medical provider under the criteria of section 1 of
the bill. Stipulates that the medical provider can
still bill for the deductible, coinsurance and
copayment.
States that a medical provider will be paid according
to section 1 of the bill.
Section 4: Establishes the punishment for medical
providers under the Unfair Trade Practices and
Consumer Protection.
4:03:36 PM
REPRESENTATIVE TARR mused that Version T of the proposed bill
did not have an effective date.
REPRESENTATIVE KITO asked whether the consumer was responsible
for the balance billing.
MR. JOHNSTON replied that the patient would not be responsible
for balance billing, and that the patient would only be required
to pay the co-insurance co-payment and deductible at the in-
network rates. The insurance provider, after providing the
three possible amounts, would choose the greater, which would be
the reimbursement amount for the medical provider.
REPRESENTATIVE SULLIVAN-LEONARD offered her belief that the
insurance through the State of Alaska already covered patients
for emergency room treatment. She asked if the care for many
patients was not being covered in the emergency room.
4:05:10 PM
REPRESENTATIVE GRENN explained that initially the proposed
legislation had been suggested by a constituent who had this
experience with another insurance provider in Alaska. He said
that insurance for State of Alaska employees was still under
investigation, although statements from the Department of
Administration indicated that the state did not balance bill in
emergency situations as those focused on by the proposed bill.
4:06:01 PM
REPRESENTATIVE SULLIVAN-LEONARD asked for additional information
to those statistics for non-coverage of emergency situations by
insurance companies in Alaska as well as other states.
4:06:27 PM
MR. JOHNSTON said that he would provide that information.
4:06:36 PM
REPRESENTATIVE JOHNSTON asked, as there were insurance companies
which did cover balance billing, whether this would "level the
field for everybody."
4:07:10 PM
MR. JOHNSTON replied that the proposed bill only covered private
insurers and would "not catch all the plans like self-funded
plans." He stated that this would be the standard for out of
network plans with billings for emergency situations.
REPRESENTATIVE JOHNSTON suggested to expand the breadth of the
proposed bill. She mused that, as 21 states were currently
offering this, it would be good to have those benchmarks, how
long they had been offering this program, and if there had been
any cause and effect. She asked about the proposed 80th
percentile, which she deemed was "very different than the
current 80th percentile, cause you're using a geographic
region." She offered her belief that this was a business
geographic region, and asked how this would change if there were
certain fees. She shared that past problems with this 80th
percentile had arisen as, although the policy and the purpose
was very good, it had caused a "hockey stick" in a
representative chart of medical costs. She suggested to take
some emergency fees and see what would happen.
4:09:49 PM
MR. JOHNSTON replied that he had been reviewing various
databases and that his experimentation for the geographical
area, using FAIR Health, had revealed a similar rate. He
acknowledged that "the geographical area has been an interesting
part of this conversation."
4:10:44 PM
REPRESENTATIVE JOHNSTON acknowledged that the database he had
used, FAIR Health, was an excellent source, except that it was
voluntary. She stated that an advantage for only using the
Municipality of Anchorage was that a local ordinance allowed
someone to ask a medical facility about a procedure and then
"get the rack rate."
4:11:12 PM
REPRESENTATIVE CLAMAN asked about the lack of a definition for
balance billing in the proposed bill, as it was not necessarily
a term that was easily understood.
MR. JOHNSTON offered his belief that, as the proposed bill
focused on the emergency situations, balance billing was what
was stipulated in the bill, and the bill itself was "kind of the
definition." He acknowledged that balance billing was a much
broader term.
4:12:16 PM
MEGAN WALLACE, Attorney, Legislative Legal Counsel, Legislative
Legal Services, reiterated that the bill described the instance
of balance billing, and she opined:
because the explanation in Section 3 of the bill that
talks, that uses the term balance bill, specifically
states that the balance bill cannot result in charges
that are more than those out of pocket expenses that
the covered person would incur in an in-network
facility or being treated by an in-network health care
provider. That the bill is sufficiently clear to
articulate what the balance bill would be for.
4:13:15 PM
REPRESENTATIVE TARR mused that, as some insurers covered
Providence [Alaska Medical Center] and some covered Alaska
Regional [Hospital], a person would be taken to the closest
hospital in an emergency. The proposed bill would eliminate the
possibility that a person would pay extra charges even though
they had not been taken to the hospital covered by their
insurance.
4:14:17 PM
REPRESENTATIVE GRENN expressed his agreement with her
explanation for the intent of the proposed bill, pointing out
that this was only for emergency situations as it was not always
possible to indicate which hospital.
4:14:55 PM
REPRESENTATIVE TARR removed her objection. There being no
further objection, Version T was adopted.
4:16:34 PM
NATHAN PAIMANN, MD, Bartlett Regional Hospital, in response to
Representative Tarr, explained that some physicians staffing at
hospitals were independent, and had to independently contract
with the network to be in-network providers. Although the
hospital could be in-network, the providers may not be an in-
network provider. He stated that the proposed bill "would
change this so you had no surprise insurance gap billing,
outside of what your usual and customary charges would be."
4:18:17 PM
REPRESENTATIVE KITO shared some anecdotes of hospital situations
for physicians not in-network which resulted in surprise
billings for the patients.
4:19:04 PM
MS. LATHAM, in response to Representative Sullivan-Leonard,
stated that there was an 80th percentile regulation already in
effect, which had been adopted to include the treatment of
emergency services and services at an in-network hospital or
ambulatory surgical center, as explained on page 2, lines 4 - 6
of the proposed bill. She added that the proposed bill "does
broaden the scope of coverage services to services for which a
referral was made by an in-network health care provider to the
non-network health care providers without written consent of the
covered person." She declared that this did strengthen
provisions for consumers. She directed attention to page 4,
line 27, which created a violation of the [Alaska] Unfair Trade
Practices and Consumer Protection Act. She expressed concern
that, as the Division of Insurance had never regulated state
health plans, Section 2 of the proposed bill [page 4, line 5]
moved AS 39 under AS 21, which she deemed to be "unusual."
4:21:23 PM
REPRESENTATIVE SULLIVAN-LEONARD expressed that she had concerns
with the application and possible outcome because of Section 4
[page 4, lines 27 - 29].
MS. LATHAM replied that, as this was enforced by the Department
of Law, it offered "very, very strong consumer protections."
4:22:01 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if the bill sponsor could
review that section.
REPRESENTATIVE JOHNSTON asked if the concern for Section 2 [page
4, lines 6 - 11] was because it was an additional
responsibility, and whether it was for the possibility of
"opening up a door that might go beyond this."
MS. LATHAM said that this was similar to House Bill 25, a
contraceptive coverage bill, as this proposed bill also just
included the state self-insured, non-federal health plans, which
had never been under the jurisdiction of AS 21 and was
unprecedented.
4:23:05 PM
REPRESENTATIVE KITO asked if she was referencing the state
employee plans.
MS. LATHAM said, "that's exactly what I'm referencing."
4:23:36 PM
REPRESENTATIVE TARR said that HB 193 would be held over.
HB 336-SUPPORTIVE DECISION-MAKING AGREEMENTS
4:23:47 PM
REPRESENTATIVE TARR announced that the final order of business
would be HOUSE BILL NO. 336, "An Act relating to supported
decision-making agreements to provide for decision- making
assistance; and amending Rule 402, Alaska Rules of Evidence."
4:24:21 PM
HANS RODVIK, Staff, Representative Charisse Millett, Alaska
State Legislature, paraphrased from the Sponsor Statement
[Included in members' packets], which read:
With over 100 wards per public guardian Alaska has one
of the highest rates of full guardianship in the
nation. Studies concerning individuals under full
guardianship have found that such individuals were
significantly less likely to have any kind of paid
employment and are less likely to be integrated into
their community, than people provided less restrictive
options to full guardianship.
Policy makers should engage in efforts to provide
adults with intellectual and developmental
disabilities (IDD) the needed tools to experience
lives with the most autonomy, freedom and independence
as possible. The Supported Decision-Making Agreements
Act does just that.
Designed as a mechanism to enable adults with IDD to
enter into newly created legal structures called
supported decision-making agreements (SDMA), House
Bill 336 will provide a less restrictive alternative
to full guardianship for adults with IDD. Guided by
the experience of other states, HB 336 will enable
adults with disabilities to maintain their rights to
make decisions currently being taken away from them by
guardianship orders.
The philosophy underpinning HB 336 contends that
adults with IDD do have and should retain their
constitutional and civil rights to live as freely and
autonomously as possible. HB 336 will help change the
current system in which one person tends makes every
decision for adults with IDD, even though those adults
have capacity to make many decisions on their own; to
a system where adults who can make life decisions with
support from others no longer have the right to make
those decisions taken away from them by the
government.
HB 336 will enable OPA to focus its efforts on adults
who truly need full guardianship, while providing
Alaskans experiencing varying levels of IDD an avenue
to live happier and healthier lives.
MR. RODVIK pointed out that the proposed bill had been written
in conjunction with the Governor's Council on Disabilities and
Special Education to address these issues and allow people to
live more self-guided lives.
4:25:21 PM
REPRESENTATIVE TARR reminded that public testimony had remained
open.
4:26:11 PM
REPRESENTATIVE TARR closed public testimony on HB 336.
4:26:29 PM
REPRESENTATIVE JOHNSTON stated her support of the proposed bill
and pointed to a cost savings.
4:26:42 PM
REPRESENTATIVE CLAMAN stated his support of the proposed bill.
4:27:05 PM
REPRESENTATIVE KITO stated that the proposed bill was a key tool
to enable support of family members.
4:27:38 PM
REPRESENTATIVE SULLIVAN-LEONARD expressed her support and
offered a personal anecdote.
4:28:18 PM
REPRESENTATIVE TARR stated her support of the proposed bill.
4:28:50 PM
REPRESENTATIVE EDGMON moved to report CSHB 336, Version 30-
LS1239\J, Bannister, 2/26/18, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 336(HSS) was moved from the House Health and
Social Services Standing Committee.
4:30:56 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:30 p.m.