00                             HOUSE BILL NO. 500                                                                          
01 "An Act relating to medical review organizations; and providing for an effective date."                                 
02 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
03    * Section 1.  AS 18.23.070(5) is amended to read:                                                                  
04                 (5)  "review organization" means                                                                        
05                      (A)  a hospital governing body or a committee whose                                                
06            membership is limited to health care providers and administrative staff, except                              
07            where otherwise provided for by state or federal law, and that is established by                             
08            a hospital, by a clinic, by one or more state or local associations of health care                           
09            providers, by an organization of health care providers from a particular area or                             
10            medical institution, or by a professional standards review organization                                      
11            established under 42 U.S.C. 1320c-1, to gather and review information relating                               
12            to the care and treatment of patients for the purposes of                                                    
13                           (i)  evaluating and improving the quality of health care                                      
14                 rendered in the area or medical institution;                                                            
15                           (ii)  reducing morbidity or mortality;                                                        
01                           (iii)  obtaining and disseminating statistics and                                             
02                 information relative to the treatment and prevention of diseases, illness,                              
03                 and injuries;                                                                                           
04                           (iv)  developing and publishing guidelines showing the                                        
05                 norms of health care in the area or medical institution;                                                
06                           (v)  developing and publishing guidelines designed to                                         
07                 keep the cost of health care within reasonable bounds;                                                  
08                           (vi)  reviewing the quality or cost of health care services                                   
09                 provided to enrollees of health maintenance organizations;                                              
10                           (vii)  acting as a professional standards review                                              
11                 organization under 42 U.S.C. 1320c;                                                                     
12                           (viii)  reviewing, ruling on, or advising on controversies,                                   
13                 disputes, or questions between a health insurance carrier or health                                     
14                 maintenance organization and one or more of its insured or enrollees;                                   
15                 between a professional licensing board, acting under its powers of                                      
16                 discipline or license revocation or suspension, and a health care                                       
17                 provider licensed by it when the matter is referred to a review                                         
18                 organization by the professional licensing board; between a health care                                 
19                 provider and the provider's patients concerning diagnosis, treatment, or                                
20                 care, or a charge or fee; between a health care provider and a health                                   
21                 insurance carrier or health maintenance organization concerning a                                       
22                 charge or fee for health care services provided to an insured or enrollee;                              
23                 or between a health care provider or the provider's patients and the                                    
24                 federal or a state or local government, or an agency of the federal or a                                
25                 state or local government;                                                                              
26                           (ix)  acting on the recommendation of a credential                                            
27                 review committee or a grievance committee;                                                              
28                      (B)  the State Medical Board established by AS 08.64.010;                                          
29                      (C)  a committee established by the commissioner of health and                                     
30            social services and approved by the State Medical Board to review public                                     
31            health issues regarding morbidity or mortality; at least 75 percent of the                                   
01            committee members must be health care providers;                                                         
02                      (D)  the Joint Commission on Accreditation of Healthcare                                       
03            Organizations (JCAHO).