SB 313 AM(EFD FLD): "An Act relating to the Comprehensive Health Insurance Association and to health insurance provided to residents of the state who are high risks; relating to health insurance fees, charges, premiums, rates, and rating factors; relating to disclosure of health care provider prices, a health care data system, and uniform data and procedures for health care billing and payment of claims; relating to coordination of insurance benefits and to determination and disclosure of fees paid to an insured or health care provider; establishing an advisory committee on a health care plan and an advisory committee on public health."
00SENATE BILL NO. 313 am(efd fld) 01 "An Act relating to the Comprehensive Health Insurance Association and to 02 health insurance provided to residents of the state who are high risks; relating 03 to health insurance fees, charges, premiums, rates, and rating factors; relating to 04 disclosure of health care provider prices, a health care data system, and uniform 05 data and procedures for health care billing and payment of claims; relating to 06 coordination of insurance benefits and to determination and disclosure of fees paid 07 to an insured or health care provider; establishing an advisory committee on a 08 health care plan and an advisory committee on public health." 09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 10 * Section 1. AS 21.51 is amended by adding a new section to read: 11 Sec. 21.51.350. PREMIUM RATES AND RATING FACTORS. A disability 12 insurer 13 (1) shall file with the director rates or rating factors for disability 14 insurance before the intended effective date of the rate or rating factor;
01 (2) may not use a rate or rating factor that has not been filed with the 02 director; and 03 (3) may file a new rate or rating factor at any time." 04 * Sec 2. AS 21.55.010 is amended to read: 05 Sec. 21.55.010. CREATION; MEMBERSHIP. There is established a nonprofit 06 incorporated legal entity to be known as the Comprehensive Health Insurance 07 Association. Membership consists of all licensed hospital or medical service 08 corporations in the state that offer subscriber contracts for major medical coverage, all 09 health maintenance organizations or other managed care arrangements approved 10 by the director, and all insurers licensed to transact health insurance in the state that 11 offer policies for major medical coverage on an expense incurred basis. All members 12 shall maintain membership in the association as a condition of doing health insurance 13 business, or being able to offer subscriber contracts or enrollment in a health 14 maintenance organization or managed care arrangement, in the state. 15 * Sec. 3. AS 21.55.100 is amended by adding a new subsection to read: 16 (d) The association may make available to residents who are high risks 17 coverage through a health maintenance organization or other managed care 18 arrangement as approved by the director. 19 * Sec. 4. AS 21.55.120(c) is amended to read: 20 (c) Except as provided in (e) of this section, the [THE] sum of the 21 deductible and copayments required in any calendar year under a plan may not exceed 22 a maximum limit of $2,000 per covered individual. Covered expenses incurred after 23 the applicable maximum limit has been reached shall be paid at the rate of 100 percent 24 of usual, customary, reasonable, or prevailing charges, except that expenses incurred 25 for treatment of mental and nervous conditions shall be paid at the rate of 50 percent. 26 The $2,000 maximum shall be adjusted yearly to correspond with the change in the 27 medical care component of the Consumer Price Index as adjusted by the director. 28 * Sec. 5. AS 21.55.120 is amended by adding a new subsection to read: 29 (e) In addition to the deductible, copayment, and applicable maximums 30 described in this section, other deductible, copayment, or maximum limits may be 31 offered if approved by the director.
01 * Sec. 6. AS 21.55.150(b) is amended to read: 02 (b) The association shall use separate scales of premium rates based on age 03 and geographic location of the insured. The association may use separate scales of 04 premium rates based on other factors, including use or nonuse of tobacco, if 05 approved by the director. 06 * Sec. 7. AS 21.55.300 is repealed and reenacted to read: 07 Sec. 21.55.300. ELIGIBILITY FOR STATE HEALTH INSURANCE. (a) 08 Except as provided in this section, a state resident who is a high risk is eligible to 09 enroll in a state plan described in AS 21.55.100. 10 (b) A person may not be covered by the state plan 11 (1) while covered by another health insurance policy or subscriber 12 contract; or 13 (2) if the person is eligible to be covered by a plan subject to the 14 requirements of AS 21.56.110 - 21.56.250. 15 (c) Upon ceasing to be a resident, a person is not eligible to purchase or renew 16 coverage under a state plan, but previously purchased coverage remains in effect for 17 the period covered by payments made while a resident. 18 (d) Additional eligibility requirements for enrollment in a state plan may be 19 imposed if approved by the director. 20 * Sec. 8. AS 21.55.310 is amended to read: 21 Sec. 21.55.310. ENROLLMENT BY AN ELIGIBLE PERSON. A person may 22 enroll in a state plan by applying to the writing carrier. The application must include 23 the following: 24 (1) name, address, age, and length of residency of the applicant; 25 (2) a designation of the plan desired, including deductible option 26 chosen; 27 (3) information relevant to whether the person is a high risk; and 28 (4) payment of the first premium. 29 * Sec. 9. AS 21.55.320 is amended to read: 30 Sec. 21.55.320. WRITING CARRIER'S RESPONSE. Within 30 days after 31 receiving the certificate described in AS 21.55.310, the writing carrier shall either
01 reject the application for failing to comply with the requirements of AS 21.55.300 and 02 21.55.310 or forward the eligible person a notice of acceptance [AND BILLING 03 INFORMATION]. 04 * Sec. 10. AS 21.55.400 is amended to read: 05 Sec. 21.55.400. DUTIES OF DIRECTOR. The director may 06 (1) approve the selection of the writing carrier by the association and 07 approve the association's contract with the writing carrier, including the coverages and 08 premiums to be charged; 09 (2) contract with the federal government or another unit of government 10 to ensure coordination of the state plans with other governmental assistance programs; 11 (3) undertake directly or through contracts with other persons studies 12 or demonstration programs to develop awareness of the benefits of this chapter; and 13 (4) formulate general policy, adopt regulations that are reasonably 14 necessary to administer this chapter. 15 * Sec. 11. AS 21.55 is amended by adding a new section to read: 16 Sec. 21.55.420. BOARD MEMBER CIVIL AND CRIMINAL IMMUNITY. 17 A member of the board of directors of the association may not be held civilly or 18 criminally liable for an act or omission if the act or omission was in good faith and 19 within the scope of the director's duties under this chapter. 20 * Sec. 12. AS 21.55.500(10) is amended to read: 21 (10) "residents who are high risks" means residents who 22 (A) have been rejected for medical reasons after applying for 23 a subscriber contract, a policy of health insurance, or a Medicare supplement 24 policy by at least two association members within the six months immediately 25 preceding the date of application for a state plan; medical reasons may include 26 preexisting medical conditions, a family history that predicts future medical 27 conditions, or an occupation that generates a frequency or severity of injury or 28 disease that results in coverage not being generally available; [OR] 29 (B) have had a restrictive rider placed on a subscriber contract, 30 a health insurance policy, or a Medicare supplement policy that substantially 31 reduces coverage; or
01 (C) meet other requirements adopted by regulation by the 02 director that are consistent with this chapter and that indicate that a 03 person is unable to obtain coverage substantially similar to that which may 04 be obtained by a person who is considered a standard risk; 05 * Sec. 13. AS 21 is amended by adding a new chapter to read: 06 CHAPTER 58. HEALTH CARE. 07 Sec. 21.58.010. REQUIRED AVAILABILITY OF PRICE LIST. A health care 08 provider shall prepare a list of the provider's prices that includes the dates during 09 which the prices will be applicable. The price list shall be made available either by 10 posting the price list in a conspicuous location in the health care provider's office or 11 by similarly posting a notice that the price list is available for review upon request. 12 The contents of the price list required under this section must include the provider's 13 40 most commonly provided health care services or those health care services provided 14 more than five times in a calendar year, whichever would result in a shorter price list 15 of health care services. 16 Sec. 21.58.020. HEALTH CARE DATA SYSTEM. (a) The Department of 17 Commerce and Economic Development shall develop and may, subject to 18 appropriation, periodically update a health care data system. To the extent practicable, 19 the data system base year shall be calendar year 1995 and the system may include 20 (1) health care expenditures, including capital expenditures associated 21 with receiving health care; 22 (2) demographic data; 23 (3) clinical information in a format that does not identify individual 24 patients, including diagnosis, type of provider, type of service, location and length of 25 care, referral patterns, quality of care, and result of care; 26 (4) billing and payment data in a format that does not identify 27 individual patients; and 28 (5) public health data, including vital statistics and health status. 29 (b) The commissioner may request health care data necessary to develop or 30 update the data system required under (a) of this section from a health care provider 31 or insurer. A health care provider or insurer who receives a request from the
01 commissioner under this subsection may, but is not required to, comply with the 02 request. 03 (c) Information and data obtained or produced by the director under this 04 section, except as provided under (d) of this section, shall be kept confidential as a 05 matter of law. A person who wrongfully discloses or who uses or permits the use of 06 confidential information or data in violation of this subsection is guilty of a class B 07 misdemeanor. 08 (d) Information or data regarding health care services 09 (1) may be disclosed in an aggregate form that does not identify an 10 individual recipient or health care provider; and 11 (2) that identify an individual recipient may be disclosed to a health 12 care provider, if the individual recipient has agreed to release the information or data. 13 Sec. 21.58.030. UNIFORM DATA AND PROCEDURES FOR HEALTH 14 CLAIMS. (a) The director shall adopt by regulation uniform claims forms, uniform 15 standards, and uniform procedures for the processing of data relating to billing for and 16 payment of health care services provided to residents of the state. A health insurance 17 company shall comply with the uniform claims forms, standards, and procedures 18 established under this section. 19 (b) The director shall ensure that other regulations adopted by the director 20 under this title that apply to a health insurer are not in conflict or inconsistent with 21 regulations adopted under (a) of this section. 22 Sec. 21.58.040. APPROPRIATIONS. The legislature may appropriate a 23 portion of the proceeds of the tax on insurance premiums collected under 24 AS 21.09.210 to pay the administrative costs of this chapter. 25 Sec. 21.58.400. DEFINITIONS. In this chapter, 26 (1) "commissioner" means the commissioner of commerce and 27 economic development; 28 (2) "health care provider" means an acupuncturist licensed under 29 AS 08.06; an audiologist licensed under AS 08.11; a chiropractor licensed under 30 AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under 31 AS 08.36; a marital or family therapist licensed under AS 08.63; a direct-entry
01 midwife certified under AS 08.65; a nurse licensed under AS 08.68; a dispensing 02 optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an 03 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical 04 therapist or occupational therapist licensed under AS 08.84; or a physician's assistant 05 certified under AS 08.64; a physician licensed under AS 08.64; a podiatrist; a 06 psychologist and a psychological associate licensed under AS 08.86; a clinical social 07 worker licensed under AS 08.95; an emergency medical technician certified under 08 AS 18.08.082; a mobile intensive care paramedic trained as required under 09 AS 18.08.082; a health maintenance organization as defined in AS 21.86.900; a 10 hospital or medical service corporation as defined in AS 21.87.330; a hospital as 11 defined in AS 18.20.130, including a governmentally owned or operated hospital; and 12 an employee of a health care provider acting within the course and scope of 13 employment; 14 (3) "health care services" means preventive, diagnostic, medical, 15 surgical, reproductive, psychiatric, psychologic, rehabilitative, health maintenance, 16 dental, podiatric, optometric, optical, audiologic, nutritive, and chiropractic care; 17 prescription drugs, laboratory and radiologic services, medical supplies, durable 18 medical equipment and devices; personal assistance services; inpatient and outpatient 19 care; home health care; hospice care; and long-term or institutional care; 20 (4) "health insurance" means an individual or group contract or other 21 plan providing coverage of health care services that is issued by the corporation or by 22 a health insurance company, a hospital service corporation, a medical service 23 corporation, or a health maintenance organization; "health insurance" includes disability 24 insurance under AS 21.12.050; 25 (5) "health insurance company" means an insurer that is authorized to 26 transact health insurance. 27 * Sec. 14. AS 21.86.070(g) is amended to read: 28 (g) The director may require that additional relevant material considered 29 necessary by the director be submitted in order to determine the acceptability of a 30 filing made under [EITHER] (b) [OR (e)] of this section. 31 * Sec. 15. AS 21.86 is amended by adding a new section to read:
01 Sec. 21.86.075. PREMIUM RATES AND CHARGES. A health maintenance 02 organization 03 (1) shall file with the director rates, rating factors, premiums, fees for 04 services, and enrollee fees, including a change to a rate, rating factor, premium, or fee, 05 used in providing health care services to enrollees of the health maintenance 06 organization; 07 (2) may not use a rate, rating factor, premium, or fee that has not been 08 filed with the director; and 09 (3) may use a new rate, rating factor, premium, or fee at any time. 10 * Sec. 16. AS 21.86.260(a) is amended to read: 11 (a) Except as provided in AS 21.56, AS 21.89.100 - 21.89.120, and in this 12 chapter, this title does not apply to a health maintenance organization that obtains a 13 certificate of authority under this chapter. This subsection does not apply to an insurer 14 licensed under AS 21.09 or a hospital or medical service corporation licensed under 15 AS 21.87 except with respect to its health maintenance organization activities 16 authorized by and regulated under this chapter. 17 * Sec. 17. AS 21.87.190 is repealed and reenacted to read: 18 Sec. 21.87.190. RATES AND CHARGES. A service corporation 19 (1) shall file with the director subscription rates, rating factors, fees, 20 and payment charges, including a change to a rate, rating factor, fee, or payment 21 charge, to be charged to or on account of the service corporation's subscribers; 22 (2) may not use a rate, rating factor, fee, or payment charge that has 23 not been filed with the director; and 24 (3) may file a new rate, rating factor, fee, or payment charge at any 25 time. 26 * Sec. 18. AS 21.87.340 is amended to read: 27 Sec. 21.87.340. OTHER PROVISIONS APPLICABLE. In addition to the 28 provisions contained or referred to previously in this chapter, the following chapters 29 and provisions of this title also apply with respect to service corporations to the extent 30 applicable and not in conflict with the express provisions of this chapter and the 31 reasonable implications of the express provisions, and for the purposes of the
01 application the corporations shall be considered to be mutual "insurers": 02 (1) AS 21.03; 03 (2) AS 21.06; 04 (3) AS 21.09, except AS 21.09.090; 05 (4) AS 21.18.010; 06 (5) AS 21.18.030; 07 (6) AS 21.18.040; 08 (7) AS 21.18.120; 09 (8) AS 21.21.321; 10 (9) AS 21.36; 11 (10) AS 21.42.345 - 21.42.365, 21.42.375, 21.42.380, and 21.42.385; 12 (11) AS 21.51.120; 13 (12) AS 21.53; 14 (13) AS 21.54.020; 15 (14) AS 21.56; 16 (15) AS 21.69.400; 17 (16) AS 21.69.520; 18 (17) AS 21.69.600, 21.69.620, and 21.69.630; 19 (18) AS 21.78; 20 (19) AS 21.89.040; 21 (20) AS 21.89.060 and 21.89.100 - 21.89.120; 22 (21) AS 21.90. 23 * Sec. 19. AS 21.89 is amended by adding new sections to read: 24 Sec. 21.89.100. REQUIRED PROVISIONS REGARDING COORDINATION 25 OF BENEFITS. (a) When an insured has coverage under two or more plans that 26 provide for coordination of benefits, the coverage from those plans must be 27 coordinated so that the insured receives the maximum allowable benefit from each 28 plan. The aggregate benefit should be more than that offered by any of the plans 29 individually, but the insured may not receive more than the total of the charges for the 30 health care services received. 31 (b) A plan that provides for coordination of benefits must contain a provision
01 that 02 (1) discloses that coordination of benefits applies when the insured has 03 health care coverage under more than one plan; 04 (2) states what benefits from the plan and other sources are recognized 05 under the coordinating provision and that indicates if one or more plan benefits are 06 exempt from the coordinating provision; 07 (3) states what health care expenses are allowable and what health care 08 expenses are excluded under the coordinating provision; 09 (4) states the claim period to be used in applying the coordinating 10 benefits provision; a claim period may not be less than 12 months, but may exclude 11 a period before coverage starts or after coverage ends; 12 (5) indicates the manner in which benefits are reduced by coordination; 13 a reduction in benefits is subject to the following order of benefit provisions: 14 (A) plan benefits applicable to an insured as an employee, 15 member, or subscriber, and also as a dependent, are first determined as benefits 16 applicable to the insured as employee, member, or subscriber; 17 (B) if a minor is eligible for benefits as a dependent of more 18 than one insured, the plan of the insured whose date of birth falls earlier in the 19 year is applied first, unless a different order of application is required by a 20 court; 21 (C) benefits not determined under this paragraph that are 22 applicable under more than one plan are determined under that plan applicable 23 to the insured for the longer period of time; 24 (D) when one of the plans is a medical plan and the other is a 25 dental plan, and a determination cannot be made under the provisions of (A) -(C) of this paragraph, the medical plan 26 shall be considered as the primary 27 coverage; 28 (E) if under the provisions of (A) - (D) of this paragraph the 29 plan is secondary to another source of benefits, the benefits of the plan may not 30 be reduced unless the sum of benefits payable for allowable expenses and the 31 benefits payable for allowable expenses under the other source exceed the
01 allowable expenses in a claim determination period; 02 (6) provides that the insurer has the right to receive and to release 03 information necessary to expedite a claim payment when coordinating benefits; 04 (7) allows the insurer to make a payment necessary to repay another 05 insurer for a payment that should have been made under the policy applicable to the 06 insured; and 07 (8) gives the insurer the right to recover excess payments from the 08 insured paid to another insurer providing benefits to the insured. 09 (c) In coordinating benefits from a plan that contractually reduces the fees for 10 services that participating health care providers accept as payment in full, the following 11 rules apply: 12 (1) when the reduced fee plan is the primary coverage and treatment 13 is provided by a participating health care provider, the reduced fee is that health care 14 provider's full fee; a secondary plan shall pay the lesser of its allowed benefit or the 15 difference between the primary plan's benefit and the reduced fee; 16 (2) when the reduced fee plan is the primary coverage and treatment 17 is provided by a nonparticipating health care provider, the reduced fee plan shall 18 provide its allowed amount for nonparticipating health care providers and the 19 secondary plan shall pay the lesser of 20 (A) its allowed benefit for the service; 21 (B) the difference between the primary plan's benefits for the 22 service and the health care provider's full fee; 23 (3) when a full fee plan is the primary coverage and a reduced fee plan 24 is secondary coverage, the full fee plan shall provide its allowed amount for the 25 service and the secondary plan shall pay the lesser of its allowed benefit for the service 26 or the difference between the primary plan's benefits and the health care provider's full 27 fee. 28 (d) In coordinating benefits between an indemnity and a capitation plan, the 29 following rules apply: 30 (1) when the capitation plan is the primary coverage, the capitation 31 payments to the treating health care provider remain the capitation plan's usual
01 benefits; the indemnity plan shall pay benefits for the patient's surcharges or 02 copayments up to the indemnity plan's allowable benefit; 03 (2) when the indemnity plan is the primary coverage and treatment is 04 received from a health care provider who is participating in a capitation plan, the 05 indemnity plan shall pay its allowable benefits; the capitation payments to the health 06 care provider are secondary coverage; 07 (3) when the indemnity plan or policy is the primary coverage, and 08 treatment is received from a health care provider who is not participating in a 09 capitation plan , the indemnity plan shall pay its allowable benefits; the capitation plan 10 shall pay benefits, in keeping with the capitation plan's allowed amount for treatment 11 by nonparticipating health care providers; 12 (4) a plan may not contractually direct a health care provider to charge 13 a secondary insurer for more than the amount that would be charged to the insured 14 absent secondary coverage. 15 (e) A certificate indicating insurance coverage must contain a summary of the 16 provisions in this section regarding coordination of benefits. 17 Sec. 21.89.110. DETERMINATION AND DISCLOSURE OF USUAL, 18 CUSTOMARY, AND REASONABLE FEES. An insurer who pays a claim under a 19 disability policy or an indemnity under a group or blanket disability insurance policy, 20 a health maintenance organization that adopts a schedule of charges, or a hospital or 21 medical service corporation that pays a subscriber or compensates a health care 22 provider on the basis of a usual, customary, or reasonable fee or charge shall 23 (1) maintain and use a statistically credible profile of fees of health care 24 providers in this state on which to base payment of the claim; the profile must (A) be 25 updated at least once every six months and may not contain fees for services 26 performed more than one year before the date of the most recent profile; (B) contain 27 fees for the geographic area in which a claimant might receive treatment; and (C) may 28 not include fees clearly marked "DO NOT PROFILE"; if statistically credible data for 29 a particular health care service in a certain geographic area does not exist, the insurer 30 may include in the profile a sufficient number of fees for that service from another 31 geographic area in order to establish a reliable data base; however, the final basis for
01 payment must be adjusted to reflect the general cost difference between the geographic 02 area where the service was performed and the other geographic area used in 03 establishing the statistically credible profile; the adjustment may be based upon the 04 Consumer Price Index, the medical care component of the Consumer Price Index, or 05 a reasonable basis stated in writing and determined acceptable by the director; 06 (2) respond within 15 working days after receiving a written request 07 from an insured, a health care provider with a valid assignment of payments, or a 08 health care provider engaged to provide services under a professional services contract, 09 with a full written disclosure of the methods employed under (1) of this section that 10 resulted in the difference between the amount paid on a claim for benefits and the 11 actual charges submitted; and 12 (3) disclose in a proposal for insurance, a policy of insurance, a 13 certificate of insurance, an employee benefit description or supplemental document, or 14 a professional service contract between an insurer and a health care provider 15 (A) the frequency with which the insurer determines the usual, 16 customary, and reasonable fee; 17 (B) a general description of the methodology used to determine 18 the usual, customary, and reasonable fee; 19 (C) the percentile of usual, customary, and reasonable fees at 20 which the insurer will reimburse the insured, or the contract health care 21 provider. 22 Sec. 21.89.120. DEFINITIONS FOR AS 21.89.100 - 21.89.120. In 23 AS 21.89.100 - 21.89.120, 24 (1) "health care provider" has the meaning given in AS 21.58.400; 25 (2) "health care service" has the meaning given in AS 21.87.330; 26 (3) "plan" means a group or blanket disability policy issued under 27 AS 21.54, small employer coverage issued under AS 21.56, evidence of coverage 28 issued under AS 21.86, or a subscriber contract issued under AS 21.87; 29 (4) "professional services contract" includes a contract for professional 30 services between a health care provider and insurer or health maintenance corporation, 31 and a service contract between a health care provider and a hospital or medical service
01 corporation; 02 (5) "service corporation" has the meaning given in AS 21.87.330. 03 * Sec. 20. Section 7, ch. 39, SLA 1993, is amended to read: 04 Sec. 7. AS 21.86.260(a) is repealed and reenacted to read: 05 (a) Except as provided in AS 21.89.100 - 21.89.120 and this chapter, this title 06 does not apply to a health maintenance organization that obtains a certificate of 07 authority under this chapter. This subsection does not apply to an insurer licensed 08 under AS 21.09 or a hospital or medical service corporation licensed under AS 21.87 09 except with respect to its health maintenance organization activities authorized by and 10 regulated under this chapter. 11 * Sec. 21. Section 9, ch. 39, SLA 1993, is amended to read: 12 Sec. 9. AS 21.87.340 is repealed and reenacted to read: 13 Sec. 21.87.340. OTHER PROVISIONS APPLICABLE. In addition to the 14 provisions contained or referred to previously in this chapter, the following chapters 15 and provisions of this title also apply with respect to service corporations to the extent 16 applicable and not in conflict with the express provisions of this chapter and the 17 reasonable implications of the express provisions, and for the purposes of the 18 application the corporations shall be considered to be mutual "insurers": 19 (1) AS 21.03 20 (2) AS 21.06 21 (3) AS 21.09, except AS 21.09.090 22 (4) AS 21.18.010 23 (5) AS 21.18.030 24 (6) AS 21.18.040 25 (7) AS 21.18.120 26 (8) AS 21.21.321 27 (9) AS 21.36 28 (10) AS 21.42.345 - 21.42.365, 21.42.375, 21.42.380, and 21.42.385 29 (11) AS 21.51.120 30 (12) AS 21.53 31 (13) AS 21.54.020
01 (14) AS 21.69.400 02 (15) AS 21.69.520 03 (16) AS 21.69.600, 21.69.620, and 21.69.630 04 (17) AS 21.78 05 (18) AS 21.89.040 06 (19) AS 21.89.060 and 21.89.100 - 21.89.120 07 (20) AS 21.90. 08 * Sec. 22. AS 21.86.070(e) and 21.86.070(f) are repealed. 09 * Sec. 23. APPLICABILITY. Sections 16, 18, and 19 of this Act apply to a policy of 10 insurance, evidence of coverage under AS 21.86, or a service agreement or subscriber's 11 contract under AS 21.87, issued or renewed on or after the effective date of this Act. 12 * Sec. 24. HEALTH CARE PLAN ADVISORY COMMITTEE. (a) The legislature finds 13 that it is necessary to have reliable information on the specific content and cost of any 14 proposed mandatory health care plan, before it can be taken to the public for review. The 15 legislature further finds that questions of a single payer system versus a multi payer system 16 for any mandatory coverage, and questions regarding inclusion or exclusion of certain groups 17 of Alaskans who are covered by other federal health insurance, are not prejudiced by the 18 direction given to the advisory committee created in this section. 19 (b) The Health Care Plan Advisory Committee is established in the Office of the 20 Governor. The committee consists of seven members who are appointed by the governor as 21 follows: 22 (1) one person with experience in providing health care services on an inpatient 23 basis; 24 (2) one person with experience in providing health care services on an 25 outpatient basis; 26 (3) one person with experience as a health care provider; 27 (4) one person who has experience in health care insurance; and 28 (5) three persons who represent the public. 29 (c) Notwithstanding any other provision of law, a committee member is subject to the 30 provisions of AS 39.50 as if the committee member were a member of a state commission or 31 board described under AS 39.50.200(b).
01 (d) A committee member is entitled to receive compensation at the rate of $250 a day 02 for each day spent in performing duties as a committee member and to travel and per diem 03 expenses authorized by law for boards and commissions under AS 39.20.180. 04 (e) The committee may 05 (1) establish subcommittees; 06 (2) conduct hearings; 07 (3) employ personnel necessary to complete assigned duties; 08 (4) enter into contracts; 09 (5) subject to appropriation, expend money. 10 (f) By December 15, 1994, the committee shall report to the legislature on the scope 11 of the health care insurance coverage and the cost of providing health care insurance if health 12 care insurance were to be offered under the following conditions: 13 (1) participation is mandatory by all state residents; coverage shall include a 14 spouse and dependent children; 15 (2) health care services that are covered must include preventive care and 16 immunizations, prenatal care, children's health care, and catastrophic medical expense 17 coverage; 18 (3) coverage shall be designed to impose a family deductible of $3,000 for all 19 covered health care services other than prenatal care, preventive care, and immunizations, and 20 to allow reimbursement in a calendar year at not more than 80 percent for all covered health 21 care services, other than prenatal care, preventive care, and immunizations, after the first 22 $3,000 in covered expenses; prenatal care, preventive care, and immunizations may be 23 reimbursed at more than 80 percent for a covered expense; coverage for health care services 24 that are offered on an outpatient basis shall provide reimbursement for outpatient health care 25 services at a rate equal to or higher than the rate for inpatient services; 26 (4) premiums shall be set at a single rate for all covered individuals, except 27 (A) a surcharge for coverage of each dependent child or spouse may 28 be imposed; a surcharge may not exceed 50 percent of the individual premium; it is 29 the intent of the legislature that the premium be set at a rate that does not exceed $100 30 per month or 14 percent of the individual's monthly gross income, whichever is lower; 31 (B) premium rates are allowed to vary depending on whether the
01 individual smokes or any other factors within the control of an individual, and 02 depending on whether the individual is less than 30 years of age; a premium may not 03 vary under a community rating system, other than as specified in this section; 04 (5) a one-year exclusion for preexisting conditions for new enrollees is 05 imposed; this paragraph does not apply to a person who has resided in the state for at least 06 one year, or who is less than one year old and was born in this state. 07 (g) By December 15, 1995, the committee shall report to the legislature on 08 (1) the cost of providing health insurance coverage under the following 09 conditions: 10 (A) coverage shall meet the conditions set out under (f)(1) - (5) of this 11 section; 12 (B) additional medical benefits are included as recommended by the 13 committee; 14 (C) it is the intent of the legislature that the premium be set at a rate 15 that does not exceed $150 per month or 14 percent of the individual's monthly gross 16 income, whichever is lower; 17 (2) the effect of the following conditions assuming that insurance coverage as 18 specified under (f) of this section is provided: 19 (A) premium payment is by payroll deduction, employer contribution, 20 or a combination of employer contribution and payroll deduction; 21 (B) premium payment by an unemployed or self-employed person is 22 by direct payment; 23 (3) assuming that the state requires all residents to participate in a state health 24 insurance plan, changes necessary in existing provisions of law to 25 (A) allow integration of optional health insurance plans with the 26 mandatory insurance plan; the integration should allow an individual or group to 27 purchase supplemental insurance coverage without duplication of coverage; and 28 (B) discourage health insurance that reimburses covered benefits at a 29 rate greater than 80 percent of the cost of the benefits; 30 (4) recommended legislation regarding public health issues; 31 (5) recommended legislation to simplify health care administration;
01 (6) recommended legislation regarding antitrust changes necessary to allow the 02 use of pooled purchasing to reduce the cost of health care if required under federal law; 03 (7) recommended legislation to enact tort reform measures intended to reduce 04 the cost of health care, including changes to statutes of limitation, contingent fee agreements, 05 and to the Alaska Rules of Civil Procedure; 06 (8) recommended legislation regarding long-term health care, including 07 methods to encourage individual savings for the cost of long-term health care; 08 (9) recommended legislation regarding how the state should educate residents 09 on health care, including how to be a prudent consumer, increasing awareness of provider 10 charges, and a curriculum that should be used in public schools in the state. 11 (h) By December 15, 1995, the committee shall recommend to the legislature 12 legislation necessary to improve data collection used to control health care expenditures or to 13 improve the efficiency of the health care system in the state. 14 (i) In this section, "health care provider" has the meaning given in AS 21.58.400. 15 * Sec. 25. PUBLIC HEALTH ADVISORY COMMITTEE. (a) The Public Health 16 Advisory Committee is established in the Office of the Governor. The committee consists of 17 nine members with significant public health expertise who are appointed by the governor. The 18 governor shall consider public and private health care professionals, labor organizations, 19 businesses, the education system, the Alaska Public Health Association, the Alaska Mental 20 Health Board, and the Alaska Native Health Board for service on the Public Health Advisory 21 Committee, as well as recognizing the need for geographic, ethnic, and cultural diversity. 22 (b) A committee member is entitled to travel and per diem expenses authorized by law 23 for boards and commissions under AS 39.20.180. 24 (c) The committee may 25 (1) establish subcommittees; 26 (2) conduct hearings; 27 (3) employ personnel necessary to complete assigned duties; 28 (4) enter into contracts; 29 (5) subject to appropriation, expend money. 30 (d) The committee shall 31 (1) advise the commissioner of health and social services, the commissioner
01 of administration, and the commissioner of commerce and economic development on public 02 health matters; 03 (2) develop a public health improvement plan as described under (e) of this 04 section. 05 (e) The plan developed by the committee may 06 (1) recognize the need for 07 (A) community involvement in health care planning and delivery; 08 (B) attention to local needs that may vary from place to place; 09 (C) accountability for the use of public funds; 10 (D) equity and stability in the distribution of public funds; 11 (E) shared responsibility of all levels of government for administering 12 and financing public health care delivery; and 13 (F) coordination of basic public health services; and 14 (2) include 15 (A) an analysis of the health status of the residents of the state; 16 (B) an assessment of the most appropriate role for various levels of 17 government to play in addressing the health care needs of the residents of the state; 18 (C) a delineation of the standards that should be used in assessment, 19 policy development, and quality assurance in the delivery of public health services; 20 (D) documentation of the extent to which the current public health 21 system implements or achieves the standards identified under (C) of this paragraph; 22 (E) identification of interjurisdictional issues involved in health care 23 access and delivery; 24 (F) recommendations, including recommendations for specific 25 legislative action when necessary, pertaining to the following: 26 (i) strategies, time lines, financial needs, and specific sources 27 of stable revenue for bringing the state public health care system up to 28 standards identified by the committee; 29 (ii) appropriate sharing of the responsibility of local, regional, 30 state, and federal government entities to deliver public health care services 31 efficiently and effectively, including recommendations for organization within
01 state government; 02 (iii) integration of the public health care system with state and 03 national health care reform efforts; 04 (iv) the committee's estimate of the optimal share that public 05 health should represent in the total health care delivery system of the state, 06 expressed in terms of a percentage of health care dollars spent or in terms of 07 public dollars per state resident; 08 (v) a program designed to give incentives to a primary health 09 care provider to practice in the state, especially in rural and underserved areas 10 of the state. 11 (f) In this section, "health care provider" has the meaning given in AS 21.58.400. 12 * Sec. 26. Sections 24 and 25 of this Act are repealed June 30, 1996.