Legislature(1993 - 1994)
03/30/1994 01:41 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 30, 1994
1:41 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
Senator Mike Miller
Senator Jim Duncan
COMMITTEE CALENDAR
SENATE BILL NO. 231
"An Act providing coverage under Medicaid for the services of
physician assistants; and reordering the priorities for Medicaid
services."
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 301
"An Act relating to the calculation of instructional units used in
determining state aid for education and increasing elementary and
secondary instructional units for certain school districts with 800
or fewer students in average daily membership; and providing for an
effective date."
SENATE BILL NO. 367
"An Act relating to health care and insurance for health care; to
review and approval of health insurance rates and rating factors;
relating to certain civil actions against health care providers; to
coordination of insurance benefits and to determination and
disclosure of fees paid to an insured or health care provider; to
the rate of interest on certain judgments and decrees; to excise
taxes on cigarettes; amending Alaska Rules of Civil Procedure 26,
27, 68, 79, and 82 and Alaska Rules of Evidence 802, 803, and 804;
repealing Alaska Rule of Civil Procedure 72.1; and providing for an
effective date."
PREVIOUS SENATE COMMITTEE ACTION
SB 231 - No previous action to record.
SB 301 - No previous action to record.
SB 367 - See Health, Education & Social Services minutes dated
3/28/94.
WITNESS REGISTER
Senator Taylor
Prime Sponsor
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Reviewed SB 301.
Duane Guiley, Director
School Finance
Department of Education
801 W. 10th Street, Suite 200
Juneau, Alaska 99801-1894
POSITION STATEMENT: Reviewed the "hold harmless" provision of
SB 301.
Gordan Evans
Health Insurance Association of America
318 4th Street
Juneau, Alaska
POSITION STATEMENT: Reviewed amendment to section 7 of SB 367.
David Walsh, Director
Division of Insurance
P.O. Box 110805
Juneau, Alaska 99811
POSITION STATEMENT: Preferred the prior approval of rates.
Reviewed the Division of Insurance's fiscal
note for SB 367.
Rick Urion
Alaska Employers' Coalition
POSITION STATEMENT: Reviewed SB 367.
Reed Stoops
AETNA Representative
Juneau, Alaska
POSITION STATEMENT: Reviewed AETNA's position on SB 367.
Dr. Rodman Wilson
800 M, NO 5W
Anchorage, Alaska 99501
POSITION STATEMENT: Reviewed SB 367.
Bonnie Nelson
Alaska Public Interest Research Group
20615 White Bird Road
Eagle River, Alaska 99567
POSITION STATEMENT: Reviewed SB 367.
Denny DeGross
2348 Leander Circle
Anchorage, Alaska 99515
POSITION STATEMENT: Reviewed SB 367.
Daryl Nelson
20615 White Birch
Eagle River, Alaska 99567
POSITION STATEMENT: Related personal experiences relevant to
SB 367.
Charles McKee
1508 W 43rd, NO 7
Anchorage, Alaska 99503
POSITION STATEMENT: Offered information.
Carol Carrol, Staff
Senator Kerttula
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Reviewed SB 231.
John Riley
Alaska Academy of Physician Assistant
6411 Italy Circle
Anchorage, Alaska 99516
POSITION STATEMENT: Reviewed SB 231.
Wendy Hladick
Physician Assistant
Registered Nurse
Galena, Alaska
POSITION STATEMENT: Reviewed SB 231.
ACTION NARRATIVE
TAPE 94-24, SIDE A
Number 004
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:41 p.m. He introduced
SB 301 (REVISE FOUNDATION FORMULA, SMALL SCHOOLS) as the first
order of business before the committee.
SENATOR TAYLOR, Prime Sponsor, explained that SB 301 addresses two
major concerns: a significant drop in the Sitka school district's
enrollment and funding for small single site school districts. He
read his sponsor statement. He commented on the continuing battle
over the single site issue. SB 301 amends the funding formula for
education in Alaska, which seems to be a big issue. He suggested
repairing the entire single site issue. He noted the various lists
of single site schools who need financial aid, B.A. Weinberg's list
should be reviewed. He anticipated an additional decrease of 100
students in the Sitka school district.
SENATOR ELLIS asked if Senator Randy Phillips' bill would be before
the HESS committee. CHAIRMAN RIEGER noted that Senator Phillips'
bill had just been passed out of the Community & Regional Affairs
(C&RA) committee, and would be before HESS.
CHAIRMAN RIEGER agreed that Sitka's problem was immediate. The
reason SB 301 would not be moved today was to allow further
consideration of section 2.
Number 122
SENATOR ELLIS asked if SB 301 was related to the "hold harmless"
provision regarding property value assessments. That "hold
harmless" provision would require the state to make up the
difference when property value assessments fall below a certain
level. The student would not feel the effects of the decrease in
property values. He thought that once property values increased
the state would continue to pay that increased amount of support.
DUANE GUILEY, Department of Education (DOE), informed the committee
that the "hold harmless" to which Senator Ellis referred has not
been adopted. The "hold harmless" in SB 301 exists in current
statutes. He explained that the "hold harmless" in SB 301 refers
to when a district has a 10 percent loss in K-12 units, which may
be the direct loss of students or the loss of students identified
in supplemental education categories. The "hold harmless" in SB
301 is not related to the one referred to by Senator Ellis. He
noted that the formula automatically annually adjusts for the
differences in assessed property value two years prior; as property
values go up in a community, state aid goes down. The basic need
stays the same, so the community would make up a greater share when
property values are high.
SENATOR SALO inquired as to the position of DOE on SB 301. DUANE
GUILEY noted support, contingent upon funding, from the State Board
of Education to the single site bill in the House. The department
nor the board has a position on a change to the "hold harmless."
Currently, only the Sitka school district would be effected by this
change due to its scheduled 7 percent reduction in K-12 units. Mr.
Guiley noted that three other districts would be eligible under the
10 percent: Adak, Aleutian Region, and Southeast Island.
SENATOR SHARP asked how many students are in Adak. DUANE GUILEY
stated that the projected enrollment for Adak next year is 150
students, which is down from 550 this year. The Navy predicts that
there would be no students at Adak by July 1.
SENATOR SHARP asked how much funding would Adak receive with 150
students under the 10 percent rule. DUANE GUILEY explained that
Adak would receive 75 percent of the revenue they would have
received with 550 students. The following year they would receive
50 percent of the revenue for 550 students, the next year they
would receive 25 percent of the revenue, and the fourth year they
would receive zero.
Number 215
SENATOR SHARP asked when that funding would end. DUANE GUILEY said
that under current statutes the school district would continue to
receive the money after there are no students. SENATOR SHARP
inquired as to the number of students of single site school
districts. DUANE GUILEY said that he would provide that
information for the committee. The "hold harmless" in statute is
based on the percentage change in K-12 units, which may come from
varying things such as the number of students or the profile of the
student body. Mr. Guiley clarified that in Sitka the 5 percent
reduction in K-12 units is actually a decrease in students.
SENATOR LEMAN expressed the need to consider a maximum trigger
which would make the three or four year phase out inappropriate.
DUANE GUILEY said he would review that situation. Mr. Guiley noted
that there had been discussion of creating a secondary "hold
harmless" where the loss is greater than 10 percent and the
district would receive less than 75 percent. Mr. Guiley pointed
out that contractual obligations are often more that 75 percent of
the budget; the timing of the circumstances is very important as to
whether the district could absorb the loss and adjust the program.
SENATOR SHARP requested the actual case history of Adak. DUANE
GUILEY said he would provide that to the committee.
SENATOR SALO thought that a maximum would be difficult to arrive at
because of the deadline information. She requested that Mr. Guiley
suggest other statutory ways that an Adak situation could be
handled while giving the department flexibility. Sending money to
places without students is absurd.
CHAIRMAN RIEGER held SB 301.
SENATOR ELLIS commented that he supported the change, but without
a comprehensive re-write of the formula his attitude changes. He
inquired as to the plan on the overall re-write. CHAIRMAN RIEGER
said that as of yet, there was not a plan.
Number 290
CHAIRMAN RIEGER introduced SB 367 (HEALTH CARE REFORM COMMITTEES)
as the next order of business before the committee.
GORDAN EVANS, representing the Health Insurance Agency of America
(HIAA), said that he would be speaking to section 7 of SB 367.
This section applies to the review and approval of premium rates
and rating factors. The proposed amendment would change the
mandatory prior approval of rates to a file and use approach. He
suggested that the amendment should have additional language
applying to AS 21.86 and 21.87. He informed the committee that the
National Association of Insurance Commissioners' statistics show
that eight states, including Alaska, do not make any provisions for
filing or approval of health insurance premiums or rates. Nine
states, mostly in the east and the south, require prior approval as
this bill would. The file and use system is used in thirty-two
states. Only one state requires use and file system. He said that
the proposed amendment would place Alaska in with the majority of
states requiring the file and use system. He pointed out that this
amendment was approved in the House in the Governor's health care
legislation. He stated that Commissioner Usera had indicated that
the change they were seeking would still require filing of rates.
This would decrease costs related to rate review, allow collection
of data in an aggregate form, and place the review in the Division
of Insurance.
SENATOR LEMAN asked if nine states have prior approval. GORDAN
EVANS said yes.
CHAIRMAN RIEGER inquired as to the other portion of Mr. Evan's
suggestion regarding what the Division of Insurance does. GORDAN
EVANS clarified that a rate or rating factor must be filed with the
director and a rate not yet filed cannot be used. The division is
not given the ability to disapprove a rate. He reiterated the need
to add similar language to AS 21.86 and 21.87.
Number 372
DAVID WALSH, Director of the Division of Insurance, stated that for
many years the division has wanted rate authority for health rates.
In theory, he preferred prior approval. He acknowledged that prior
approval could have problems if a regulatory authority does not do
its job, a company could wait anywhere from 30 days up to 180 days.
He said that such long waiting does not happen in Alaska.
Consumers would best be protected with a prior approval statute.
He thought that the amendment would be better than nothing;
however, the Division of Insurance prefers prior approval.
CHAIRMAN RIEGER asked what the difference was between prior
approval and file and use with a deemer clause. DAVID WALSH said
that they were similar. From a management perspective, prior
approval is less likely to let something slip through; the division
must make an affirmative decision. Mr. Walsh reiterated that the
timeliness issue should not be a problem in Alaska. Prior approval
provides quicker scrutiny.
RICK URION, Alaska Employer's Coalition, stated that the Alaska
Employer's Coalition is a group of Alaska employers who provide
health insurance for their employees, both union and non-union. He
indicated that the increasing cost of health care could be
contributed to high tech medicine and increased utilization. He
questioned the need to develop an entirely new system since most
people are being served by the current health care system. He
supported any reforms making health care more efficient, easier to
obtain, and less costly. Increased governmental control would not
produce any of those. He opposed the single payer system, employer
mandates, and a community rating system. He supported:
(1) allowing employers to put together their own health care plans,
which are successful in serving many Alaskans;
(2) expanding access to cover high risk individuals such as those
with pre-existing conditions;
(3) eliminating the waiting period;
(4) pooling and subsidizing systems for those unable to afford
coverage;
(5) requiring health care providers to list their fees; and
(6) malpractice reforms allowing health care providers to work in
an atmosphere that does not necessitate wasteful, defensive
medicine or expensive legal fees.
Mr. Urion appreciated the efforts to address some of the problems.
He liked the proposed method of obtaining data in SB 367. He said
that they have a problem with section 11 on page 13 regarding the
required provisions of the coordination of benefits. He opposed
double dipping and did not see such language here, but 100 percent
coverage is mandated under two policies. He preferred the option
of allowing maximum coverage of the dominant policy. He did not
oppose 100 percent coverage, but he did not want that to be
mandated. He approved of the health care advisory committee and
expressed the desire to participate in that committee; however, the
direction of the committee is limited. He implied that the
committee was heading in the direction of a single payer system due
to the large pool with mandatory participation, community rating,
and employer mandates. He expressed the need to take care of those
who are not covered with little effect on those who are covered.
Number 453
CHAIRMAN RIEGER noted that SB 201 did have a limit of 100 percent
so as to eliminate someone profiting from having two claims. He
did not believe it would be good policy to have total reimbursement
for any claim in excess of 80 percent. He was open regarding the
coordination of benefits. RICK URION said if an employer is buying
those policies, then they could say that nothing would cover more
than the dominant policy no matter how you split it between the two
policies.
SENATOR SHARP explained that he maintained two policies from a
previous employer due to a pre-existing condition. With the
premiums he paid, he expected 100 percent paid on his claims. He
believed that if the individual pays one of the premiums, then
receiving 100 percent would be acceptable. RICK URION agreed. Mr.
Urion said that if someone else pays the premium, then there is a
problem.
SENATOR SALO did not understand why there would be a problem when
they are receiving two premiums. RICK URION clarified that the
insurance companies are getting the premiums.
SENATOR SALO felt that if an individual pays two premiums, then it
would seem to be appropriate to have more coverage than the
dominant policy. RICK URION said that he would assume that the
premium would be less if the coverage does not exceed the dominant
policy.
SENATOR LEMAN concluded that it would be better to allow the
employer the option to choose the 100 percent coverage and pay the
additional amount or the employer could choose the dominant policy
which could result in cost savings.
SENATOR SALO asked if under the current state health insurance, an
individual can choose not to take the health insurance. She noted
her personal experience when she was appointed to the House; she
was told that she had to take the state's health insurance.
SENATOR SHARP said that he had been told the same. SENATOR SALO
suggested that should be changed.
Number 502
CHAIRMAN RIEGER inquired as to Mr. Urion's comment regarding the
nature of the committee. RICK URION explained that on page 19,
line 23 creates a mandatory system for everyone and page 4, line 20
refers to community rating. Mr. Urion also pointed out that page
20, line 27 specifies that the premium payment would be paid by a
payroll deduction, employer contribution, or a combination of both
which seems to indicate an employer mandate.
CHAIRMAN RIEGER stated that SB 367 attempts to reveal a
representation of mandatory participation, but not mandating
participation. This would provide information that would allow
better informed decisions. Chairman Rieger addressed single
rating. He pointed out the exception to single rating on page 20,
lines 10 and 11. This allows rates to vary dependent upon
individual responsibility. He agreed that it could be administered
through the payroll system if one was employed; however, the bill
does not specify that the employer or the employee would pay.
Chairman Rieger concluded that SB 367 attempts to set some
guidelines while not writing the health care bill.
RICK URION said that he did not oppose revealing what may occur,
but it had made him nervous.
SENATOR LEMAN inquired as to where the support for subsidies would
come. RICK URION explained that support for subsidies should come
from a broad base community. Mr. Urion opposed an employer
mandate.
DAVID WALSH stated that Commissioner Usera had informed him that
the administration had not taken a position on SB 367. He noted
that the Division of Insurance's fiscal note was not complete.
There are other components such as the committee, the public
involvement process and others that are being done in the fiscal
note for DHSS. He explained that many of the numbers in SB 367
were taken from portions of SB 367 which mirror portions of
previous bills. He pointed out that the capital expenditure figure
represents a direct transfer of the contracted out services for the
functions contained in this fiscal note. The Division of
Insurance's portion is reasonable, accurate, and reflects the
functions SB 367 places in the Division of Insurance. He felt that
the coordination of benefits was an important goal. He related an
example regarding double dipping.
TAPE 94-24, SIDE B
Mr. Walsh commented that SB 367 and SB 201 would provide all the
legal tools necessary to solve the problem of double dipping.
Number 584
CHAIRMAN RIEGER asked if there was something in SB 201 that was not
present in SB 367. DAVID WALSH said no.
SENATOR ELLIS inquired of the missing portions of the fiscal note
of the administration besides the Governor's office submission.
DAVID WALSH indicated that a data collection portion of the fiscal
note was being worked on by DHSS. SENATOR ELLIS clarified that two
portions of the fiscal note are coming. CHAIRMAN RIEGER noted that
there was also a fiscal note from the Department of Revenue.
SENATOR ELLIS asked Mr. Walsh to explain the $100,000 cost for
legal representation regarding the federal waiver process. DAVID
WALSH stated that there would be a number of stages and waivers no
matter the type of health reform that takes effect. Mr. Walsh said
that he had heard two different federal views on the waiver issue:
one view is that the waivers would be automatic, while another view
is that it would be similar to the Medicare supplement regulations
with federal mandates. The $100,000 amount is an estimate and a
very speculative amount since the waiver process has not been
decided.
SENATOR ELLIS asked which portion of SB 367 requires the federal
waivers. DAVID WALSH explained that anything that the state does
would require a series of federal waivers depending upon the
position at the federal level. There would also be a federal
oversight role which would review each time the state adds a new
service or changes the program in order to assure fulfillment of
the federal requirements. He reiterated that without any federal
guidelines, the process and its cost are only guesses.
SENATOR LEMAN inquired as to Mr. Walsh's reaction to removing the
option of an employer to provide up to the maximum of the dominant
plan. DAVID WALSH stated that it would be a policy call that the
legislature and the Governor should decide how far the mandates go
and if there should be exceptions. Personally, Mr. Walsh said that
there must be strong triggers within the system in order to assure
participation. He expressed concern "that the more wiggle room
there is in terms of participation, the greater the opportunity for
mischief."
CHAIRMAN RIEGER asked for a clarification on the data collection
portion of the fiscal note regarding DHSS. DAVID WALSH said that
he had been incorrect, it was not data collection.
Number 520
REED STOOPS, AETNA representative, concurred with Mr. Evans'
testimony on rate regulations in section 7; he also preferred the
file and use system over the prior approval system. He pointed out
that a prior approval system would create problems: there are no
time limits on the rate approval, the Norman & Roberts study
illustrates that prior approval in other states resulted in less
competition of insurers, and rate regulations for insurers is not
effective in decreasing health costs because most money received
through premiums goes back to providers. SB 367 does not address
regulating provider rates. He indicated that they support the
adopted House version.
Mr. Stoops stated that pages 19 and 20 appear to charge the
advisory committee with pricing a pool on the assumption that all
Alaskans would be in the same pool. Perhaps, that is only for the
purpose of pricing, but they prefer that the advisory committee be
charged with reviewing those now insured for pricing. He suggested
that subsection (d), paragraph (1) on page 19 be clarified. If the
intention of that section is to put everyone in a single pool, then
they recommend that the pool be limited.
Mr. Stoops appreciated the committee allowing written testimony by
Mr. Steve LeBrun on SB 201 be submitted at this hearing. He
expressed concern with the provision of SB 201 which would change
the coordination of benefits, therefore, requiring that a 100
percent claim be paid when two policies cover the same claim. He
agreed that an employer should have the option to choose the 100
percent plan or the less restrictive model. The 100 percent option
is clearly more expensive. He suggested a comparison by the
Division of Insurance regarding the current regulations to the new
regulations provided under SB 201; this would provide a better idea
of the reasoning behind the suggested changes to the system.
SENATOR ELLIS asked if rate approval in other states had ever lead
to withdrawal of AETNA. REED STOOPS said that he would provide
that information at the next hearing.
SENATOR LEMAN asked what would be the general difference in cost
between a 100 percent coverage policy or a dominant policy coverage
if section 11 was adopted. STEVE LEBRUN thought that it would not
have a significant impact. Perhaps, a couple percent of the total
health care. Mr. LeBrun noted that when an employer pays benefits,
any lesser payments made on a secondary plan would be reflected in
their claim experience resulting in adjusted rates. A plan
requiring contributions would provide information to the individual
so that they would know if the additional coverage was worth the
contribution.
CHAIRMAN RIEGER asked if a couple percent would be around $5 to
$10. STEVE LEBRUN agreed with that estimate. An average family
premium with $500 would be around the $10 or $20 range.
SENATOR LEMAN asked if an employee would be allowed to pay the
additional cost for the added coverage if the coordination of
benefits was not mandated. STEVE LEBRUN said that it would create
administrative complexity to offer those dual options. Mr. LeBrun
felt that it should be done on an "either or" basis at the employer
policy level.
CHAIRMAN RIEGER informed the committee that staff was inquiring of
the Division of Insurance's explanation of the difference between
statutory provisions in SB 367 and current regulations. He
encouraged the committee to think about the policy issues. He
noted the presence of amendments to SB 367.
Number 390
SENATOR LEMAN offered the first amendment.
AMENDMENT 1
Page 19, line 26:
Delete "prematernal"
Insert "prenatal"
Page 19, line 29:
Delete "prematernal"
Insert "prenatal"
Page 19, line 30:
Delete "prematernal"
Insert "prenatal"
SENATOR LEMAN moved Amendment 1. SENATOR ELLIS objected.
SENATOR ELLIS inquired as to the intentions or implications of the
change. SENATOR LEMAN said that he had never seen the term
"prematernal" nor had others in the medical profession, no one
could explain that term. After discussing it with Chairman Rieger,
they agreed that it was meant to mean "prenatal" which resulted in
the change. CHAIRMAN RIEGER agreed that the intention was to use
the term "prenatal."
SENATOR ELLIS requested that the drafter be asked why the term
"prematernal" was used instead of "prenatal."
SENATOR LEMAN withdrew Amendment 1 with the consent of the
committee. He offered Amendment 2 following the offering of
Amendment 1.
AMENDMENT 2
Page 19, after line 27:
Insert a new paragraph to read"
"(3) health care services that may not be covered include
elective abortions;"
DR. RODMAN WILSON stated that overall SB 367 is a great improvement
over the Administration's bills, SB 270 or HB 414. SB 367 needs
some improvements. He noted that he had sent the committee a list
of suggestions to SB 367. He discussed aspects of SB 367 which he
felt were commendable. He recommended reviewing the price listing
of providers; hospitals are not covered. He suggested that the
provider be required to submit their prices to the Department of
Commerce and Economic Development which could act as a restraint on
the providers. He commended the section on health care data
collection as well as the cigarette tax. He requested that the
committee review the advisory committee. The advisory committee
seems weak and its functions are not well worded. He suggested
that a subcommittee could do those functions.
Number 297
BONNIE NELSON, Alaska Public Interest Research Group (AKPIRG), said
that SB 367 was an incremental step forward which clearly specifies
what would be studied. The definitions of the benefits package is
one of the most important items as well as single pooling. She
supported mandatory participation and community rating which should
be the most cost effective while providing the best quality and
equality of health care. The majority of people would pay less as
well as the employers. She expressed the importance of eliminating
the pre-existing conditions clause which SB 367 addresses. She
indicated opposition to experience ratings and the Tort Reform
portions of the bill. She blamed the high liability insurance
rates on outside insurance companies; therefore, reform that
reviews that issue should be looked over.
SENATOR ELLIS asked if Ms. Nelson had a comment on the make-up of
the advisory committee in the office of the Governor contained in
SB 367. BONNIE NELSON stated that AKPIRG was opposed to having
provider expert control. The make-up of the advisory committee
should be of reasonable and intelligent people such as architects
and accountants. Health care providers and malpractice attorneys
would not be neutral, they would have a conflict of interest. Ms.
Nelson did not oppose a retired industry worker, a retired nurse or
physician, who would not have a monetary gain. Ms. Nelson
supported rate approval within the Division of Insurance, but she
expressed the need for more public involvement in that process.
Rate approval of health care providers in hospitals is also
necessary. Ms. Nelson felt that there would be greater individual
choice with more government regulations rather than outside
insurance industries. AKPIRG supports neutral negotiations between
providers and consumers and policy-makers.
DENNY DEGROSS agreed with Dr. Wilson that SB 367 is a step forward
from the Governor's bill. He expressed concerns with SB 367:
organizations would not be able to respond in a timely manner, and
the location of the data gathering and manipulation functions. He
discussed the resulting problems when Environmental Health was
taken out of DHSS. He was concerned with moving the data portion
of the bill out of DHSS, the state's primary protection for public
health. Most industrial countries have a better ratio of dollars
spent in their health system to health status than does the U.S.
He indicated that the U.S., unlike those countries, separates
medicine and public health. He suggested more emphasis on public
health in SB 367.
Number 119
DARYL NELSON related his own personal experience with these issues.
He did not believe that insurance companies should make choices for
him regarding the care he received. He expressed concern with the
Tort Reform statements of this bill. A large amount of parents
with children who are effected, did not or will not know about the
law. He did not believe that Tort Reform would help the majority
of the people with health care.
CHARLES MCKEE noted that he was presenting information given to him
by a security officer in the United States Airforce. He said that
the information referred to line 25 on page 10, line 21 on page 8,
line 17 on page 10, and page 18.
TAPE 94-25, SIDE A
CHARLES MCKEE said that the committee was not aware of the crimes
of counterfeiting, forgery, and accepting claims as well as
actuaries making appropriations to doctors and the medical
community.
Number 036
CHAIRMAN RIEGER closed the public hearing on SB 367 after inquiring
of others desiring to testify. He informed the committee that the
definition of "prematernal" was more open ended, going back prior
to motherhood. "Prenatal" generally deals with the period from
conception to delivery. He said that the drafter explained that
"prematernal" was used due to its presence in earlier drafts.
Chairman Rieger stated that "prenatal" was the intention in the
wording of the bill.
SENATOR LEMAN moved to adopt Amendment 1. Hearing no objection,
Amendment 1 was adopted. Senator Leman said that he would offer
Amendment 2 at the next hearing of SB 367.
CHAIRMAN RIEGER noted the presence of two more amendments in the
committee's packets and suggested that there may be other
amendments. He held SB 367 until Wednesday, April 6, 1994.
Number 068
CHAIRMAN RIEGER introduced SB 231 (PAY PHYSICIAN ASSTS UNDER
MEDICAID) as the last order of business before the committee.
CAROL CARROL, Staff to Senator Kerttula, explained that SB 231
would add physician assistants to the optional services reimbursed
under Medicaid. She discussed the current problems regarding
billing and physician assistants. Medicaid requires that the
physician must see each patient billed under their number at least
once. SB 231 would allow physician assistants to bill Medicaid for
services they provided to patients in their local areas. She noted
the presence of a fiscal note from DHSS.
CHAIRMAN RIEGER said that he intended to have SB 231 at the same
time as a bill regarding Medicaid in Senate Finance where the
fiscal note could be addressed. He said that he would hear
testimony on the fiscal note if anyone wished to testify.
SENATOR SALO stated that the fiscal note seemed inflated and would
be best handled in Senate Finance.
SENATOR SHARP inquired as to the numbering of the list on page 2 of
SB 231. CAROL CARROL explained that as funds run short, numbers 1-
4 would be removed. From numbers 5 and up, the groups become a
higher priority when removing money from Medicaid. CHAIRMAN RIEGER
agreed with Senator Sharp that there seemed to be a drafting error
in the numbering.
Number 140
SENATOR LEMAN stated that the situation which brought this problem
to Senator Kerttula's attention had been resolved due to
designating the entity as a rural health clinic. He asked if
adoption of SB 231 would create disparities in billing for Medicaid
services and other billings by physician assistants who have to use
the collaborating doctor's number for all other billings.
CAROL CARROL clarified that a physician assistant in a physician's
office on location bills under the physician's number. SB 231
addresses a physician assistant collaborating with a physician at
a remote location where the physician does not see every Medicaid
patient. The physician assistant cannot bill Medicaid for those
services because the collaborating physician does not see the
patient at a remote site. She concluded that SB 231 deals with
physician assistants at remote sites, but it would allow a
physician assistant to set up their own site with a collaborating
physician and see patients. She said that most physician
assistants currently, are located in a physician's office in their
location.
JOHN RILEY, Alaska Academy of Physician Assistants, reiterated that
the primary purpose of SB 231 was to allow reimbursement of
physician assistants working in remote sites. He noted that
previously, physician assistants billed through their collaborating
physician's Medicaid number or through a clinic's Medicaid number,
in certain designated rural health clinics. He acknowledged that
there are some physician assistants in remote areas who do bill
under their physician's number although the physician is not on
site, which DHSS says is not allowable. In communities where a
physician assistant is the only health care provider, this issue
would be a clear barrier to care for Medicaid recipients. He
informed the committee of an October 1993 study that found that
about half of the physician assistants are located in rural areas
outside of Anchorage, Fairbanks, and Juneau.
Mr. Riley stated that the fiscal note seems higher than it should
be. The fiscal note would be more accurate if it represented a
parallel number to the fees generated for Medicaid by currently
practicing nurses practitioners. This is a $200,000 cost to the
state. He assumed that the reimbursement rate for physician
assistants would be similar to that of nurse practitioners, 80
percent. That would result in a decreased billing rate to Medicaid
which would lead to cost shifting.
Number 249
WENDY HLADICK, Physician Assistant and Registered Nurse in Galena,
said that she was speaking for the rural areas of Galena,
Telkeetna, Healey, McGrath, Pelican, Skagway, and Seward. She
informed the committee that non-physician providers, physician
assistants and nurse practitioners, are able to diagnosis and treat
80 percent of their patient's problems. She stated that non-
physician providers are less expensive to train than physicians and
have a proven track record comparable to physicians. SB 231 would
remove some of the inequalities in practice between nurse
practitioners and physician assistants. She did not believe that
current regulations adequately or fairly reimburse physician
assistants. SB 231 would help educate insurance companies of
physician assistants. Physician assistants offer affordable,
quality health care. She said that passage of SB 231 would
recognize physician assistants as health care providers worthy of
reimbursement just as nurse practitioners, and recognize the need
for uniform percentile reimbursement by all insurance carriers for
physician assistants.
SENATOR ELLIS moved to adopt Senator Kerttula's amendment which
adds physician assistants to the list of non-discriminatory groups.
AMENDMENT
Page 1, line 1, after " Act ":
Insert " relating to physician assistants "
Page 1, line 4, after " Section 1. ":
Insert new material to read:
"AS 21,36.090(d) is amended to read:
(d) Except to the extent necessary to comply with AS
21.42.365 and AS 21.56, a person may not practice or permit
unfair discrimination against a person who provides a service
covered under a group disability policy that extends coverage
on an expense incurred basis, or under a group service or
indemnity type contract issued by a nonprofit corporation, if
the service is within the scope of the provider's occupational
license. In this subsection, "provider" means a state
licensed physician, physician assistant, dentist, osteopath,
optometrist, chiropractor, nurse midwife, advanced nurse
practitioner, naturopath, physical therapist, occupational
therapist, psychologist, psychological associate, [OR]
licensed clinical social worker, or certified direct-entry
midwife.
*Sec. 2. AS 23,30.265(24) is amended to read:
(24) "physician" includes doctors of medicine,
surgeons, physician assistants, chiropractors, osteopaths,
dentists, and optometrists;
*Sec. 3. "
CHAIRMAN RIEGER objected. He explained that there was a similar
bill, Family & Marital Therapist, in the Labor & Commerce committee
which had not moved. He preferred that this amendment be offered
in Finance in order to have Senator Kerttula, the prime sponsor, as
well as Senator Kelly, the chairman of Labor & Commerce, would be
present to discuss their views. Chairman Rieger stated that he
tended to support the amendment.
SENATOR SALO believed that the amendment did not move out of Labor
& Commerce because another amendment was offered adding
acupuncturists. That seemed to complicate the issue.
CHAIRMAN RIEGER removed his objection.
CAROL CARROL stated that this allows physician assistants to be
covered under workman's compensation for any services they fund or
under third party payers insurance companies.
Hearing no objection, the amendment was adopted.
SENATOR ELLIS moved SB 231 out of committee with individual
recommendations. Hearing no objections, it was so ordered.
There being no further business before the committee, the meeting
was adjourned at 3:36 p.m.
| Document Name | Date/Time | Subjects |
|---|