SB 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."
00SENATE BILL NO. 367 01 "An Act relating to health care and insurance for health care; to review and 02 approval of health insurance rates and rating factors; relating to certain civil 03 actions against health care providers; to coordination of insurance benefits and 04 to determination and disclosure of fees paid to an insured or health care 05 provider; to the rate of interest on certain judgments and decrees; to excise taxes 06 on cigarettes; amending Alaska Rules of Civil Procedure 26, 27, 68, 79, and 82 07 and Alaska Rules of Evidence 802, 803, and 804; repealing Alaska Rule of Civil 08 Procedure 72.1; and providing for an effective date." 09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 10 * Section 1. AS 08.64.326 is amended to read: 11 Sec. 08.64.326. GROUNDS FOR IMPOSITION OF DISCIPLINARY 12 SANCTIONS. (a) The board may impose a sanction if the board finds after a hearing 13 that a licensee 14 (1) secured a license through deceit, fraud, or intentional
01 misrepresentation; 02 (2) engaged in deceit, fraud, or intentional misrepresentation while 03 providing professional services or engaging in professional activities; 04 (3) advertised professional services in a false or misleading manner; 05 (4) has been convicted, including conviction based on a guilty plea or 06 plea of nolo contendere, of 07 (A) a felony or other crime if the felony or other crime is 08 substantially related to the qualifications, functions, or duties of the licensee; 09 or 10 (B) a crime involving the unlawful procurement, sale, 11 prescription, or dispensing of drugs; 12 (5) has procured, sold, prescribed, or dispensed drugs in violation of 13 a law, regardless of whether there has been a criminal action; 14 (6) intentionally or negligently permitted the performance of patient 15 care by persons under the licensee's supervision that does not conform to minimum 16 professional standards even if the patient was not injured; 17 (7) failed to comply with this chapter, a regulation adopted under this 18 chapter, or an order of the board; 19 (8) has demonstrated 20 (A) professional incompetence, gross negligence, or repeated 21 negligent conduct; the board may not base a finding of professional 22 incompetence solely on the basis that a licensee's practice is unconventional or 23 experimental in the absence of demonstrable physical harm to a patient; 24 (B) addiction to, severe dependency on, or habitual overuse of 25 alcohol or other drugs that impairs the licensee's ability to practice safely; 26 (C) unfitness because of physical or mental disability; 27 (9) engaged in unprofessional conduct or in lewd or immoral conduct 28 in connection with the delivery of professional services to patients; 29 (10) has violated AS 18.16.010; 30 (11) has violated any code of ethics adopted by regulation by the board; 31 or
01 (12) [HAS DENIED CARE OR TREATMENT TO A PATIENT OR 02 PERSON SEEKING ASSISTANCE FROM THE PHYSICIAN IF THE ONLY 03 REASON FOR THE DENIAL IS THE FAILURE OR REFUSAL OF THE PATIENT 04 TO AGREE TO ARBITRATE AS PROVIDED IN AS 09.55.535(a); OR 05 (13)] has had a license or certificate to practice medicine in another 06 state or territory of the United States, or a province or territory of Canada suspended 07 or revoked unless the suspension or revocation was caused by the failure of the 08 licensee to pay fees to that state, territory, or province. 09 (b) In a case involving (a)(12) [(a)(13)] of this section, the final findings of 10 fact, conclusions of law, and order of the authority that suspended or revoked a license 11 or certificate constitutes a prima facie case that the license or certificate was suspended 12 or revoked and the grounds under which the suspension or revocation was granted. 13 * Sec. 2. AS 08.68.270 is amended to read: 14 Sec. 08.68.270. GROUNDS FOR DENIAL, SUSPENSION, OR 15 REVOCATION. The board may deny, suspend, or revoke the license of a person who 16 (1) has obtained or attempted to obtain a license to practice nursing by 17 fraud or deceit; 18 (2) has been convicted of a felony or other crime if the felony or other 19 crime is substantially related to the qualifications, functions or duties of the licensee; 20 (3) habitually abuses alcoholic beverages, or illegally uses controlled 21 substances; 22 (4) has impersonated a registered or practical nurse; 23 (5) has intentionally or negligently engaged in conduct that has resulted 24 in a significant risk to the health or safety of a client or in injury to a client; 25 (6) practices or attempts to practice nursing while afflicted with 26 physical or mental illness, deterioration, or disability that interferes with the 27 individual's performance of nursing functions; 28 (7) is guilty of unprofessional conduct as defined by regulations 29 adopted by the board; 30 (8) has wilfully or repeatedly violated a provision of this chapter or 31 regulations adopted under it;
01 (9) is professionally incompetent [; 02 (10) DENIES CARE OR TREATMENT TO A PATIENT OR PERSON 03 SEEKING ASSISTANCE IF THE SOLE REASON FOR THE DENIAL IS THE 04 FAILURE OR REFUSAL OF THE PATIENT OR PERSON SEEKING ASSISTANCE 05 TO AGREE TO ARBITRATE AS PROVIDED IN AS 09.55.535(a)]. 06 * Sec. 3. AS 09.10 is amended by adding a new section to read: 07 Sec. 09.10.065. LIMITATION ON ACTIONS BY CERTAIN MINORS 08 AGAINST HEALTH CARE PROVIDERS. (a) Notwithstanding AS 09.10.140, an 09 action based on professional negligence may not be brought against a health care 10 provider by a person who is, on the date of the alleged negligent act or omission less 11 than two years of age, unless the action is brought before the person's eighth birthday. 12 (b) The limitation imposed under (a) of this section is tolled during any period 13 in which there exists 14 (1) fraud, including fraud or collusion by a parent, guardian, insurer, 15 or health care provider, resulting in the failure to bring an action on behalf of an 16 injured minor; 17 (2) intentional concealment; or 18 (3) the undiscovered presence of a foreign body, that has no therapeutic 19 or diagnostic purpose or effect, in the body of the injured person and the action is 20 based on the presence of the foreign body. 21 (c) In this section, 22 (1) "health care provider" has the meaning given in AS 21.58.400; 23 (2) "professional negligence" means a negligent act or omission by a 24 physician in rendering professional services; 25 (3) "professional services" means services provided by a health care 26 provider that are within the scope of services for which the health care provider is 27 licensed, and that are not prohibited under the health care provider's license or by a 28 hospital in which the health care provider practices. 29 * Sec. 4. AS 09.30.070(a) is amended to read: 30 (a) The rate of interest on judgments and decrees for the payment of money 31 is equal to the 12th Federal Reserve district discount rate as determined under
01 AS 45.45.010(b) [10.5 PERCENT A YEAR], except that a judgment or decree founded 02 on a contract in writing, providing for the payment of interest until paid at a specified 03 rate not exceeding the legal rate of interest for that type of contract, bears interest at 04 the rate specified in the contract if the interest rate is set out in the judgment or decree. 05 * Sec. 5. AS 09.55.535 is repealed and reenacted to read: 06 Sec. 09.55.535. MANDATORY ARBITRATION. (a) A person who files an 07 action for damages against a health care provider resulting from medical malpractice, 08 shall also submit the claim to the court for arbitration. 09 (b) When a claim is submitted as required by (a) of this section, the court shall 10 appoint an arbitrator to review the claim. The arbitrator appointed to review the claim 11 shall interview the parties and examine all records or materials relating to the claim 12 and may compel the attendance of witnesses, interview the parties, or consult with 13 medical specialists. 14 (c) An arbitrator appointed under this section shall conduct a prehearing 15 settlement conference within 30 days after the appointment. The arbitrator shall 16 establish a period for discovery and a date for a hearing. The hearing date may not 17 be more than 120 days after the settlement conference. 18 (d) An arbitrator shall render a decision within 30 days after hearing a claim 19 under (c) of this section. The decision must contain findings of fact and conclusions 20 of law. The decision of the arbitrator may be rejected by a party. 21 (e) If the decision of the arbitrator is rejected by a party, the action may 22 proceed in the appropriate court. The arbitrator's decision is admissible evidence in 23 that action and may be used by a party to support or oppose a claim of damages. 24 (f) A party that rejects the arbitrator's decision, proceeds in court as provided 25 under (e) of this section, and obtains a final judgment that is not more favorable to that 26 party than the arbitrator's decision, shall pay the opposing party's actual costs and 27 attorney fees incurred during the court proceeding and may not be awarded its own 28 costs or attorney fees. This subsection 29 (1) does not apply to costs or attorney fees incurred in an appeal of 30 a court decision; and 31 (2) applies notwithstanding a different result required by an Alaska
01 Rule of Civil Procedure relating to an offer of judgment. 02 (g) The provisions of AS 09.43.010 - 09.43.180 (Uniform Arbitration Act) 03 apply to an arbitration under this section, if the provisions do not conflict with the 04 provisions of this section. 05 * Sec. 6. AS 09.55.536 is amended to read: 06 Sec. 09.55.536. EXPERT ADVISOR [ADVISORY PANEL]. (a) In an action 07 for damages due to personal injury or death based upon the provision of professional 08 services by a health care provider [WHEN THE PARTIES HAVE NOT AGREED TO 09 ARBITRATION OF THE CLAIM UNDER AS 09.55.535,] the court shall appoint 10 within 20 days after filing of answer to a summons and complaint an expert medical 11 advisor [A THREE-PERSON EXPERT ADVISORY PANEL] unless the court decides 12 that an expert advisory opinion is not necessary for a decision in the case. When the 13 action is filed the court shall, by order, determine the professions or specialties to be 14 represented by the medical expert [ON THE EXPERT ADVISORY PANEL], giving 15 the parties the opportunity to object or make suggestions. 16 (b) The expert advisor [ADVISORY PANEL] may compel the attendance of 17 witnesses, interview the parties, physically examine the injured person if alive, consult 18 with the specialists or learned works they consider appropriate, and compel the 19 production of and examine all relevant hospital, medical, or other records or materials 20 relating to the health care in issue. The advisor [PANEL] may meet in camera, but 21 shall maintain a record of any testimony or oral statements of witnesses, and shall keep 22 copies of all written statements received [IT RECEIVES]. 23 (c) Not more than 30 days after selection of the advisor, the advisor [PANEL, 24 IT] shall make a written report to the parties and to the court, answering the following 25 questions and other questions submitted to the advisor [PANEL] by the court: 26 (1) What was the disorder for which the plaintiff came to medical care? 27 (2) What would have been the probable outcome without medical care? 28 (3) Was the treatment selected appropriate for the case? 29 (4) Did an injury arise from the medical care? 30 (5) What is the nature and extent of the medical injury? 31 (6) What specifically caused the medical injury?
01 (7) Was the medical injury caused by unskillful care? 02 (8) If a medical injury had not occurred, how would the plaintiff's 03 condition differ from the plaintiff's present condition? 04 (d) In any case in which the answer to one or more of the questions submitted 05 to the advisor [PANEL] depends upon the resolution of factual questions which are 06 not the proper subject of expert opinion, the report shall so state and may answer 07 questions based upon hypothetical facts that are fully set out in the opinion. The 08 report must [SHALL] include copies of all written statements, opinions, or records 09 relied upon by the advisor [PANEL] and either a transcription or other record of any 10 oral statements or opinions; must [SHALL] specify any medical or scientific authority 11 relied upon by the advisor [PANEL]; and must [SHALL] include the results of any 12 physical or mental examination performed on the plaintiff. The advisor [EACH 13 MEMBER] shall sign the report and the signature constitutes the advisor's 14 [MEMBER'S] adoption of all statements and opinions contained in it [; HOWEVER, 15 A MEMBER MAY, INSTEAD OF SIGNING THE REPORT, SUBMIT A 16 CONCURRING OR DISSENTING REPORT WHICH COMPLIES WITH THE 17 REQUIREMENTS OF THIS SUBSECTION]. An advisor [A MEMBER] may not 18 attest to any portion of the report as to which the advisor [MEMBER] is not qualified 19 to give expert testimony. 20 (e) The report of the advisor [PANEL WITH ANY DISSENTING OR 21 CONCURRING OPINION] is admissible in evidence to the same extent as though its 22 contents were orally testified to by the person or persons preparing it. The court shall 23 delete any portion that would not be admissible because of lack of foundation for 24 opinion testimony, or otherwise. Either party may submit testimony to support or refute 25 the report. The jury shall be instructed in general terms that the report shall be 26 considered and evaluated in the same manner as any other expert testimony. The 27 expert advisor [ANY MEMBER OF THE PANEL] may be called by any party and 28 may be cross-examined as to the contents of the report [OR OF THAT MEMBER'S 29 DISSENTING OR CONCURRING OPINION]. 30 (f) Discovery [NO DISCOVERY] may not be undertaken in a case until the 31 report of the expert advisor [ADVISORY PANEL] is received. However, the court
01 may relax this prohibition upon a showing of good cause by a [ANY] party. If the 02 advisor [PANEL] has not completed its report within the 30-day period prescribed in 03 (c) of this section, the court may, upon application, grant [IT] an additional 30 days. 04 (g) The expert advisor is [MEMBERS OF A PANEL ARE] entitled to travel 05 expenses and per diem in accordance with state law pertaining to members of boards 06 and commissions for all time spent in preparing its report. If an advisor [A PANEL 07 MEMBER] is called upon as a witness at trial or upon deposition, the advisor 08 [MEMBER] is entitled to payment of an expert witness fee, which may not exceed 09 $300 [$150] per day. All expenses incurred by the advisor [PANEL] shall be paid by 10 the court. However, in any case in which the court determines that a party has made 11 a patently frivolous claim or a patently frivolous denial of liability, it shall order that 12 all costs of the expert advisor [ADVISORY PANEL] be borne by the party making 13 that claim or denial. 14 (h) Parties to the case and their counsel may not initiate communication out 15 of court with an expert advisor [MEMBERS OF THE PANEL] on the subject matter 16 of its inquiry and report or cause or solicit others to do so, except through ordinary 17 discovery proceedings. 18 * Sec. 7. AS 21.51 is amended by adding new sections to read: 19 Sec. 21.51.350. REVIEW AND APPROVAL OF RATES AND RATING 20 FACTORS. (a) A disability insurer shall file with the director rates or rating factors 21 for disability insurance, including a change to a disability rate or factor. The filing 22 must include detailed information that allows the director to evaluate the 23 appropriateness of the proposed rate or rating factor. A disability insurer may furnish 24 the following information in support of a filing: 25 (1) actuarial judgment; 26 (2) interpretation of the statistical data relied upon by the disability 27 insurer; 28 (3) the loss and expense experience of the policy or plan or a similar 29 policy or plan; 30 (4) other information or data requested by the director. 31 (b) A filing must be made at least 75 days before the intended effective date
01 of the rate or rating factor and is subject to the approval of the director. 02 * Sec. 8. AS 21 is amended by adding a new chapter to read: 03 CHAPTER 58. HEALTH CARE. 04 Sec. 21.58.010. REQUIRED AVAILABILITY OF PRICE LIST. A health care 05 provider shall prepare a list of the provider's prices that includes the dates during 06 which the prices will be applicable. The price list shall be made available either by 07 posting the price list in a conspicuous location in the health care provider's office or 08 by similarly posting a notice that the price list is available for review upon request. 09 The contents of the price list required under this section must include the provider's 10 40 most commonly provided health care services or those health care services provided 11 more than five times in a calendar year, whichever would result in a shorter price list 12 of health care services. 13 Sec. 21.58.020. HEALTH CARE DATA SYSTEM. (a) The Department of 14 Commerce and Economic Development shall develop and periodically update a health 15 care data system. To the extent practicable, the data system base year shall be 16 calendar year 1995 and the system may include 17 (1) health care expenditures, including capital expenditures associated 18 with receiving health care; 19 (2) demographic data; 20 (3) clinical information, including patient diagnosis, type of provider, 21 type of service, location and length of care, referral patterns, quality of care, and result 22 of care; 23 (4) billing and payment data; and 24 (5) public health data, including vital statistics and health status. 25 (b) The commissioner may, by regulation, require health care providers to 26 submit claims data and additional information necessary to develop or update the data 27 system required under (a) of this section. 28 (c) The commissioner may pursue waivers from applicable federal law or from 29 federal agencies to the extent necessary to maximize the collection and analysis of 30 health care data. 31 (d) Information and data obtained or produced by the director under this
01 section are subject to the disclosure requirements and exceptions of AS 09.25.110 and 02 09.25.120 and the regulations adopted under those statutes. Information or data 03 identifying a recipient of health care services is considered to be a medical and related 04 public health record subject to the exception to public inspection under AS 09.25.120 05 and, except as provided under (e) of this section, shall be kept confidential as a matter 06 of law. A person who wrongfully discloses or who uses or permits the use of 07 confidential information or data in violation of this subsection is guilty of a class B 08 misdemeanor. 09 (e) Information or data regarding health care services 10 (1) may be disclosed in an aggregate form that does not identify an 11 individual recipient; and 12 (2) that identify an individual recipient may be disclosed to a health 13 care provider, if the individual recipient has agreed to release the information or data. 14 Sec. 21.58.030. UNIFORM DATA AND PROCEDURES FOR HEALTH 15 CLAIMS. (a) The director shall adopt by regulation uniform claims forms, uniform 16 standards, and uniform procedures for the processing of data relating to billing for and 17 payment of health care services provided to residents of the state. A health insurance 18 company shall comply with the uniform claims forms, standards, and procedures 19 established under this section. 20 (b) The director shall ensure that other regulations adopted by the director 21 under this title that apply to a health insurer are not in conflict or inconsistent with 22 regulations adopted under (a) of this section. 23 Sec. 21.58.040. APPROPRIATIONS. The legislature may appropriate a 24 portion of the proceeds of the tax on insurance premiums collected under 25 AS 21.09.210 to pay the administrative costs of this chapter. 26 Sec. 21.58.400. DEFINITIONS. In this chapter, 27 (1) "commissioner" means the commissioner of commerce and 28 economic development; 29 (2) "health care provider" means an acupuncturist licensed under 30 AS 08.06; an audiologist licensed under AS 08.11; a chiropractor licensed under 31 AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under
01 AS 08.36; a marital or family therapist licensed under AS 08.63; a direct-entry 02 midwife certified under AS 08.65; a nurse licensed under AS 08.68; a dispensing 03 optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an 04 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical 05 therapist or occupational therapist licensed under AS 08.84; or a physician's assistant 06 certified under AS 08.64; a physician licensed under AS 08.64; a podiatrist; a 07 psychologist and a psychological associate licensed under AS 08.86; a clinical social 08 worker licensed under AS 08.95; an emergency medical technician certified under 09 AS 18.08.082; a mobile intensive care paramedic trained as required under 10 AS 18.08.082; a health maintenance organization as defined in AS 21.86.900; a 11 hospital or medical service corporation as defined in AS 21.87.330; a hospital as 12 defined in AS 18.20.130, including a governmentally owned or operated hospital; and 13 an employee of a health care provider acting within the course and scope of 14 employment; 15 (3) "health care services" means preventive, diagnostic, medical, 16 surgical, reproductive, psychiatric, psychologic, rehabilitative, health maintenance, 17 dental, podiatric, optometric, optical, audiologic, nutritive, and chiropractic care; 18 prescription drugs, laboratory and radiologic services, medical supplies, durable 19 medical equipment and devices; personal assistance services; inpatient and outpatient 20 care; home health care; hospice care; and long-term or institutional care; 21 (4) "health insurance" means an individual or group contract or other 22 plan providing coverage of health care services that is issued by the corporation or by 23 a health insurance company, a hospital service corporation, a medical service 24 corporation, or a health maintenance organization; "health insurance" includes disability 25 insurance under AS 21.12.050; 26 (5) "health insurance company" means an insurer that is authorized to 27 transact health insurance. 28 * Sec. 9. AS 21.86.260(a) is amended to read: 29 (a) Except as provided in AS 21.56, AS 21.89.100 - 21.89.120, and in this 30 chapter, this title does not apply to a health maintenance organization that obtains a 31 certificate of authority under this chapter. This subsection does not apply to an insurer
01 licensed under AS 21.09 or a hospital or medical service corporation licensed under 02 AS 21.87 except with respect to its health maintenance organization activities 03 authorized by and regulated under this chapter. 04 * Sec. 10. AS 21.87.340 is amended to read: 05 Sec. 21.87.340. OTHER PROVISIONS APPLICABLE. In addition to the 06 provisions contained or referred to previously in this chapter, the following chapters 07 and provisions of this title also apply with respect to service corporations to the extent 08 applicable and not in conflict with the express provisions of this chapter and the 09 reasonable implications of the express provisions, and for the purposes of the 10 application the corporations shall be considered to be mutual "insurers": 11 (1) AS 21.03; 12 (2) AS 21.06; 13 (3) AS 21.09, except AS 21.09.090; 14 (4) AS 21.18.010; 15 (5) AS 21.18.030; 16 (6) AS 21.18.040; 17 (7) AS 21.18.120; 18 (8) AS 21.21.321; 19 (9) AS 21.36; 20 (10) AS 21.42.345 - 21.42.365, 21.42.375, 21.42.380, and 21.42.385; 21 (11) AS 21.51.120; 22 (12) AS 21.53; 23 (13) AS 21.54.020; 24 (14) AS 21.56; 25 (15) AS 21.69.400; 26 (16) AS 21.69.520; 27 (17) AS 21.69.600, 21.69.620, and 21.69.630; 28 (18) AS 21.78; 29 (19) AS 21.89.040; 30 (20) AS 21.89.060 and 21.89.100 - 21.89.120; 31 (21) AS 21.90.
01 * Sec. 11. AS 21.89 is amended by adding new sections to read: 02 Sec. 21.89.100. REQUIRED PROVISIONS REGARDING COORDINATION 03 OF BENEFITS. (a) When an insured has coverage under two or more plans that 04 provide for coordination of benefits, the coverage from those plans must be 05 coordinated so that the insured receives the maximum allowable benefit from each 06 plan. The aggregate benefit should be more than that offered by any of the plans 07 individually, but the insured may not receive more than the total of the charges for the 08 health care services received. 09 (b) A plan that provides for coordination of benefits must contain a provision 10 that 11 (1) discloses that coordination of benefits applies when the insured has 12 health care coverage under more than one plan; 13 (2) states what benefits from the plan and other sources are recognized 14 under the coordinating provision and that indicates if one or more plan benefits are 15 exempt from the coordinating provision; 16 (3) states what health care expenses are allowable and what health care 17 expenses are excluded under the coordinating provision; 18 (4) states the claim period to be used in applying the coordinating 19 benefits provision; a claim period may not be less than 12 months, but may exclude 20 a period before coverage starts or after coverage ends; 21 (5) indicates the manner in which benefits are reduced by coordination; 22 a reduction in benefits is subject to the following order of benefit provisions: 23 (A) plan benefits applicable to an insured as an employee, 24 member, or subscriber, and also as a dependent, are first determined as benefits 25 applicable to the insured as employee, member, or subscriber; 26 (B) if a minor is eligible for benefits as a dependent of more 27 than one insured, the plan of the insured whose date of birth falls earlier in the 28 year is applied first, unless a different order of application is required by a 29 court; 30 (C) benefits not determined under this paragraph that are 31 applicable under more than one plan are determined under that plan applicable
01 to the insured for the longer period of time; 02 (D) when one of the plans is a medical plan and the other is a 03 dental plan, and a determination cannot be made under the provisions of (A) - (C) of this paragraph, the medical plan 04 shall be considered as the primary 05 coverage; 06 (E) if under the provisions of (A) - (D) of this paragraph the 07 plan is secondary to another source of benefits, the benefits of the plan may not 08 be reduced unless the sum of benefits payable for allowable expenses and the 09 benefits payable for allowable expenses under the other source exceed the 10 allowable expenses in a claim determination period; 11 (6) provides that the insurer has the right to receive and to release 12 information necessary to expedite a claim payment when coordinating benefits; 13 (7) allows the insurer to make a payment necessary to repay another 14 insurer for a payment that should have been made under the policy applicable to the 15 insured; and 16 (8) gives the insurer the right to recover excess payments from the 17 insured paid to another insurer providing benefits to the insured. 18 (c) In coordinating benefits from a plan that contractually reduces the fees for 19 services that participating health care providers accept as payment in full, the following 20 rules apply: 21 (1) when the reduced fee plan is the primary coverage and treatment 22 is provided by a participating health care provider, the reduced fee is that health care 23 provider's full fee; a secondary plan shall pay the lesser of its allowed benefit or the 24 difference between the primary plan's benefit and the reduced fee; 25 (2) when the reduced fee plan is the primary coverage and treatment 26 is provided by a nonparticipating health care provider, the reduced fee plan shall 27 provide its allowed amount for nonparticipating health care providers and the 28 secondary plan shall pay the lesser of 29 (A) its allowed benefit for the service; 30 (B) the difference between the primary plan's benefits for the 31 service and the health care provider's full fee;
01 (3) when a full fee plan is the primary coverage and a reduced fee plan 02 is secondary coverage, the full fee plan shall provide its allowed amount for the 03 service and the secondary plan shall pay the lesser of its allowed benefit for the service 04 or the difference between the primary plan's benefits and the health care provider's full 05 fee. 06 (d) In coordinating benefits between an indemnity and a capitation plan, the 07 following rules apply: 08 (1) when the capitation plan is the primary coverage, the capitation 09 payments to the treating health care provider remain the capitation plan's usual 10 benefits; the indemnity plan shall pay benefits for the patient's surcharges or 11 copayments up to the indemnity plan's allowable benefit; 12 (2) when the indemnity plan is the primary coverage and treatment is 13 received from a health care provider who is participating in a capitation plan, the 14 indemnity plan shall pay its allowable benefits; the capitation payments to the health 15 care provider are secondary coverage; 16 (3) when the indemnity plan or policy is the primary coverage, and 17 treatment is received from a health care provider who is not participating in a 18 capitation plan , the indemnity plan shall pay its allowable benefits; the capitation plan 19 shall pay benefits, in keeping with the capitation plan's allowed amount for treatment 20 by nonparticipating health care providers; 21 (4) a plan may not contractually direct a health care provider to charge 22 a secondary insurer for more than the amount that would be charged to the insured 23 absent secondary coverage. 24 (e) A certificate indicating insurance coverage must contain a summary of the 25 provisions in this section regarding coordination of benefits. 26 Sec. 21.89.110. DETERMINATION AND DISCLOSURE OF USUAL, 27 CUSTOMARY, AND REASONABLE FEES. An insurer who pays a claim under a 28 disability policy or an indemnity under a group or blanket disability insurance policy, 29 a health maintenance organization that adopts a schedule of charges, or a hospital or 30 medical service corporation that pays a subscriber or compensates a health care 31 provider on the basis of a usual, customary, or reasonable fee or charge shall
01 (1) maintain and use a statistically credible profile of fees of health care 02 providers in this state on which to base payment of the claim; the profile must (A) be 03 updated at least once every six months and may not contain fees for services 04 performed more than one year before the date of the most recent profile; (B) contain 05 fees for the geographic area in which a claimant might receive treatment; and (C) may 06 not include fees clearly marked "DO NOT PROFILE"; if statistically credible data for 07 a particular health care service in a certain geographic area does not exist, the insurer 08 may include in the profile a sufficient number of fees for that service from another 09 geographic area in order to establish a reliable data base; however, the final basis for 10 payment must be adjusted to reflect the general cost difference between the geographic 11 area where the service was performed and the other geographic area used in 12 establishing the statistically credible profile; the adjustment may be based upon the 13 Consumer Price Index, the medical care component of the Consumer Price Index, or 14 a reasonable basis stated in writing and determined acceptable by the director; 15 (2) respond within 15 working days after receiving a written request 16 from an insured, a health care provider with a valid assignment of payments, or a 17 health care provider engaged to provide services under a professional services contract, 18 with a full written disclosure of the methods employed under (1) of this section that 19 resulted in the difference between the amount paid on a claim for benefits and the 20 actual charges submitted; and 21 (3) disclose in a proposal for insurance, a policy of insurance, a 22 certificate of insurance, an employee benefit description or supplemental document, or 23 a professional service contract between an insurer and a health care provider 24 (A) the frequency with which the insurer determines the usual, 25 customary, and reasonable fee; 26 (B) a general description of the methodology used to determine 27 the usual, customary, and reasonable fee; 28 (C) the percentile of usual, customary, and reasonable fees at 29 which the insurer will reimburse the insured, or the contract health care 30 provider. 31 Sec. 21.89.120. DEFINITIONS FOR AS 21.89.100 - 21.89.120. In
01 AS 21.89.100 - 21.89.120, 02 (1) "health care provider" has the meaning given in AS 21.58.400; 03 (2) "health care service" has the meaning given in AS 21.87.330; 04 (3) "plan" means a group or blanket disability policy issued under 05 AS 21.54, small employer coverage issued under AS 21.56, evidence of coverage 06 issued under AS 21.86, or a subscriber contract issued under AS 21.87; 07 (4) "professional services contract" includes a contract for professional 08 services between a health care provider and insurer or health maintenance corporation, 09 and a service contract between a health care provider and a hospital or medical service 10 corporation; 11 (5) "service corporation" has the meaning given in AS 21.87.330. 12 * Sec. 12. AS 43.50.190(a) is amended to read: 13 (a) There is levied an excise tax of 17 [12] mills on each cigarette imported 14 or acquired in this state. 15 * Sec. 13. Section 7, ch. 39, SLA 1993, is amended to read: 16 Sec. 7. AS 21.86.260(a) is repealed and reenacted to read: 17 (a) Except as provided in AS 21.89.100 - 21.89.120 and this chapter, this title 18 does not apply to a health maintenance organization that obtains a certificate of 19 authority under this chapter. This subsection does not apply to an insurer licensed 20 under AS 21.09 or a hospital or medical service corporation licensed under AS 21.87 21 except with respect to its health maintenance organization activities authorized by and 22 regulated under this chapter. 23 * Sec. 14. Section 9, ch. 39, SLA 1993, is amended to read: 24 Sec. 9. AS 21.87.340 is repealed and reenacted to read: 25 Sec. 21.87.340. OTHER PROVISIONS APPLICABLE. In addition to the 26 provisions contained or referred to previously in this chapter, the following chapters 27 and provisions of this title also apply with respect to service corporations to the extent 28 applicable and not in conflict with the express provisions of this chapter and the 29 reasonable implications of the express provisions, and for the purposes of the 30 application the corporations shall be considered to be mutual "insurers": 31 (1) AS 21.03
01 (2) AS 21.06 02 (3) AS 21.09, except AS 21.09.090 03 (4) AS 21.18.010 04 (5) AS 21.18.030 05 (6) AS 21.18.040 06 (7) AS 21.18.120 07 (8) AS 21.21.321 08 (9) AS 21.36 09 (10) AS 21.42.345 - 21.42.365, 21.42.375, 21.42.380, and 21.42.385 10 (11) AS 21.51.120 11 (12) AS 21.53 12 (13) AS 21.54.020 13 (14) AS 21.69.400 14 (15) AS 21.69.520 15 (16) AS 21.69.600, 21.69.620, and 21.69.630 16 (17) AS 21.78 17 (18) AS 21.89.040 18 (19) AS 21.89.060 and 21.89.100 - 21.89.120 19 (20) AS 21.90. 20 * Sec. 15. APPLICABILITY. Sections 9, 10, and 11 of this Act apply to a policy of 21 insurance, evidence of coverage under AS 21.86, or a service agreement or subscriber's 22 contract under AS 21.87, issued or renewed on or after the effective date of this Act. 23 * Sec. 16. HEALTH CARE PLAN ADVISORY COMMITTEE. (a) The legislature finds 24 that it is necessary to have reliable information on the specific content and cost of any 25 proposed mandatory health care plan, before it can be taken to the public for review. The 26 legislature further finds that questions of a single payer system versus a multi payer system 27 for any mandatory coverage, and questions regarding inclusion or exclusion of certain groups 28 of Alaskans who are covered by other federal health insurance, are not prejudiced by the 29 direction given to the advisory committee created in this section. 30 (b) The Health Care Plan Advisory Committee is established in the Office of the 31 Governor. The committee consists of seven members who are appointed by the governor as
01 follows: 02 (1) one person who is employed in providing health care services on an 03 inpatient basis; 04 (2) one person who is employed in providing health care services on an 05 outpatient basis; 06 (3) one person who is a health care provider; 07 (4) one person who is an accountant who has experience in health care 08 insurance; 09 (5) one person who is an actuary who has experience in health care insurance; 10 and 11 (6) two persons who represent the public. 12 (c) The committee may 13 (1) establish subcommittees; 14 (2) conduct hearings; 15 (3) employ personnel necessary to complete assigned duties; 16 (4) enter into contracts; 17 (5) subject to appropriation, expend money. 18 (d) By December 15, 1994, the committee shall report to the legislature on the scope 19 of the health care insurance coverage and the cost of providing health care insurance if health 20 care insurance were to be offered under the following conditions: 21 (1) participation is mandatory by all state residents; coverage shall include a 22 spouse and dependent children; 23 (2) health care services that are covered must include preventive care and 24 immunizations, prematernal care, children's health care, and catastrophic medical expense 25 coverage; 26 (3) coverage shall be designed to allow reimbursement in a calendar year at 27 not more than 80 percent for all covered health care services, other than prematernal care, 28 preventive care, and immunizations, after the first $3,000 in covered expenses; prematernal 29 care, preventive care, and immunizations may be reimbursed at more than 80 percent for a 30 covered expense; coverage for health care services that are offered on an outpatient basis shall 31 provide reimbursement for outpatient health care services at a rate equal to or higher than the
01 rate for inpatient services; 02 (4) premiums shall be set at a single rate for all covered individuals, except 03 (A) a surcharge for coverage of each dependent child or spouse may 04 be imposed; a surcharge may not exceed 50 percent of the individual premium; it is 05 the intent of the legislature that the premium be set at a rate that does not exceed $100 06 per month or 14 percent of the individual's monthly gross income, whichever is 07 higher; 08 (B) premium rates are allowed to vary depending on whether the 09 individual smokes or any other factors within the control of an individual, and 10 depending on whether the individual is less than 30 years of age; a premium may not 11 vary under a community rating system, other than as specified in this section; 12 (5) a one-year exclusion for preexisting conditions for new enrollees is 13 imposed; this paragraph does not apply to a person who has resided in the state for at least 14 one year, or who is less than one year old and was born in this state. 15 (e) By December 15, 1995, the committee shall report to the legislature on 16 (1) the cost of providing health insurance coverage under the following 17 conditions: 18 (A) coverage shall meet the conditions set out under (d)(1) - (5) of this 19 section; 20 (B) additional medical benefits are included as recommended by the 21 committee; 22 (C) the premium for a single person may not exceed $150 per month; 23 (2) the effect of the following conditions assuming that insurance coverage as 24 specified under (d) of this section is provided: 25 (A) premium payment is by payroll deduction, employer contribution, 26 or a combination of employer contribution and payroll deduction; 27 (B) premium payment by an unemployed or self-employed person is 28 by direct payment; 29 (3) assuming that the state requires all residents to participate in a state health 30 insurance plan, changes necessary in existing provisions of law to 31 (A) allow integration of optional health insurance plans with the
01 mandatory insurance plan; the integration should allow an individual or group to 02 purchase supplemental insurance coverage without duplication of coverage; and 03 (B) discourage health insurance that reimburses covered benefits at a 04 rate greater than 80 percent of the cost of the benefits; 05 (4) recommended legislation regarding public health issues; 06 (5) recommended legislation to simplify health care administration; 07 (6) recommended legislation regarding antitrust changes necessary to allow the 08 use of pooled purchasing to reduce the cost of health care if required under federal law; 09 (7) recommended legislation to enact tort reform measures intended to reduce 10 the cost of health care, including changes to statutes of limitation, contingent fee agreements, 11 and to the Alaska Rules of Civil Procedure; 12 (8) recommended legislation regarding long-term health care, including 13 methods to encourage individual savings for the cost of long-term health care; 14 (9) recommended legislation regarding how the state should educate residents 15 on health care, including how to be a prudent consumer, increasing awareness of provider 16 charges, and a curriculum that should be used in public schools in the state. 17 (f) By December 15, 1995, the committee shall recommend to the legislature 18 legislation necessary to improve data collection used to control health care expenditures or to 19 improve the efficiency of the health care system in the state. 20 (g) In this section, "health care provider" has the meaning given in AS 21.58.400. 21 * Sec. 17. MEDICAL PRACTICE ADVISORY COMMITTEE. (a) The Medical Practice 22 Advisory Committee is established in the Office of the Governor. The committee consists of 23 four members who are appointed by the governor as follows: 24 (1) one person who is a doctor of medicine licensed under AS 08.64; 25 (2) one person who is a doctor of osteopathy licensed under AS 08.64; 26 (3) one person who is a health care provider licensed under AS 08 but who 27 is not licensed under AS 08.64; and 28 (4) one person who is a health care provider licensed under AS 08 and who 29 practices in a rural area of the state. 30 (b) The committee may 31 (1) establish subcommittees;
01 (2) conduct hearings; 02 (3) employ personnel necessary to complete assigned duties; 03 (4) enter into contracts; 04 (5) subject to appropriation, expend money. 05 (c) By December 15 of each year, the committee shall provide recommendations for 06 necessary health care reform legislation to the legislature on the following: 07 (1) training necessary for primary health care providers regarding proper 08 referral of cases; 09 (2) medical practice parameters intended to reduce or eliminate medical 10 malpractice claims; 11 (3) required additions or changes in the authority given to health care providers 12 in order to prudently maximize a health care provider's scope of practice; 13 (4) obstacles that may arise from federal antitrust laws in allowing health care 14 providers to join in a peer review process, share price information, or share equipment or 15 facilities; 16 (5) recommendations to facilitate the use of video teleconferencing or other 17 long-distance communications that allow health care providers with special skills to extend 18 their practice to remote areas of the state; 19 (6) the creation of peer review boards to sanction health care providers, to 20 require approval of certain medical procedures, and to recommend practice incentives. 21 (d) In this section, "health care provider" has the meaning given in AS 21.58.400. 22 * Sec. 18. Alaska Rule of Civil Procedure 72.1 is repealed. 23 * Sec. 19. AS 09.55.535(f), as enacted in sec. 5 of this Act, has the effect of amending 24 Alaska Rules of Civil Procedure 68, 79, and 82 by providing that a party that rejects an 25 arbitration decision and receives a judgment that is not more favorable than the decision 26 obtained in arbitration is required to pay the opposing party's actual costs and attorney fees 27 incurred in the court proceeding, and by providing that the provisions of AS 09.55.535(f) 28 apply notwithstanding a different result required under an Alaska Rule of Civil Procedure 29 relating to an offer of judgment. 30 * Sec. 20. AS 09.55.536(g), amended by sec. 6 of this Act, amends Alaska Rules of Civil 31 Procedure 26 and 27 by providing that discovery may not be undertaken until the expert
01 advisor's report is received. 02 * Sec. 21. AS 09.55.536(e), amended by sec. 6 of this Act, amends Alaska Rules of 03 Evidence 802, 803, and 804 by providing that the expert advisor's report is admissible in 04 evidence to the same extent as though its contents were orally testified to by the advisor. 05 * Sec. 22. Section 18 of this Act takes effect July 1, 1994, only if that section receives the 06 two-thirds majority vote of each house required by art. IV, sec. 15, Constitution of the State 07 of Alaska. 08 * Sec. 23. Sections 16 and 17 of this Act are repealed June 30, 1996. 09 * Sec. 24. This Act takes effect July 1, 1994.