CSSB 367(HES): "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; relating to the offense of operating a commercial motor vehicle while intoxicated and the offense of operating a motor vehicle, aircraft, or watercraft while intoxicated; relating to presumptions arising from the amount of alcohol in a person's breath or blood; relating 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."
00CS FOR SENATE BILL NO. 367(HES) 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; relating to the offense of operating a commercial motor vehicle while 06 intoxicated and the offense of operating a motor vehicle, aircraft, or watercraft 07 while intoxicated; relating to presumptions arising from the amount of alcohol in 08 a person's breath or blood; relating to the rate of interest on certain judgments 09 and decrees; to excise taxes on cigarettes; amending Alaska Rules of Civil 10 Procedure 26, 27, 68, 79, and 82 and Alaska Rules of Evidence 802, 803, and 11 804; repealing Alaska Rule of Civil Procedure 72.1; and providing for an effective 12 date." 13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 14 * Section 1. AS 08.64.326 is amended to read:
01 Sec. 08.64.326. GROUNDS FOR IMPOSITION OF DISCIPLINARY 02 SANCTIONS. (a) The board may impose a sanction if the board finds after a hearing 03 that a licensee 04 (1) secured a license through deceit, fraud, or intentional 05 misrepresentation; 06 (2) engaged in deceit, fraud, or intentional misrepresentation while 07 providing professional services or engaging in professional activities; 08 (3) advertised professional services in a false or misleading manner; 09 (4) has been convicted, including conviction based on a guilty plea or 10 plea of nolo contendere, of 11 (A) a felony or other crime if the felony or other crime is 12 substantially related to the qualifications, functions, or duties of the licensee; 13 or 14 (B) a crime involving the unlawful procurement, sale, 15 prescription, or dispensing of drugs; 16 (5) has procured, sold, prescribed, or dispensed drugs in violation of 17 a law, regardless of whether there has been a criminal action; 18 (6) intentionally or negligently permitted the performance of patient 19 care by persons under the licensee's supervision that does not conform to minimum 20 professional standards even if the patient was not injured; 21 (7) failed to comply with this chapter, a regulation adopted under this 22 chapter, or an order of the board; 23 (8) has demonstrated 24 (A) professional incompetence, gross negligence, or repeated 25 negligent conduct; the board may not base a finding of professional 26 incompetence solely on the basis that a licensee's practice is unconventional or 27 experimental in the absence of demonstrable physical harm to a patient; 28 (B) addiction to, severe dependency on, or habitual overuse of 29 alcohol or other drugs that impairs the licensee's ability to practice safely; 30 (C) unfitness because of physical or mental disability; 31 (9) engaged in unprofessional conduct or in lewd or immoral conduct
01 in connection with the delivery of professional services to patients; 02 (10) has violated AS 18.16.010; 03 (11) has violated any code of ethics adopted by regulation by the board; 04 or 05 (12) [HAS DENIED CARE OR TREATMENT TO A PATIENT OR 06 PERSON SEEKING ASSISTANCE FROM THE PHYSICIAN IF THE ONLY 07 REASON FOR THE DENIAL IS THE FAILURE OR REFUSAL OF THE PATIENT 08 TO AGREE TO ARBITRATE AS PROVIDED IN AS 09.55.535(a); OR 09 (13)] has had a license or certificate to practice medicine in another 10 state or territory of the United States, or a province or territory of Canada suspended 11 or revoked unless the suspension or revocation was caused by the failure of the 12 licensee to pay fees to that state, territory, or province. 13 (b) In a case involving (a)(12) [(a)(13)] of this section, the final findings of 14 fact, conclusions of law, and order of the authority that suspended or revoked a license 15 or certificate constitutes a prima facie case that the license or certificate was suspended 16 or revoked and the grounds under which the suspension or revocation was granted. 17 * Sec. 2. AS 08.68.270 is amended to read: 18 Sec. 08.68.270. GROUNDS FOR DENIAL, SUSPENSION, OR 19 REVOCATION. The board may deny, suspend, or revoke the license of a person who 20 (1) has obtained or attempted to obtain a license to practice nursing by 21 fraud or deceit; 22 (2) has been convicted of a felony or other crime if the felony or other 23 crime is substantially related to the qualifications, functions or duties of the licensee; 24 (3) habitually abuses alcoholic beverages, or illegally uses controlled 25 substances; 26 (4) has impersonated a registered or practical nurse; 27 (5) has intentionally or negligently engaged in conduct that has resulted 28 in a significant risk to the health or safety of a client or in injury to a client; 29 (6) practices or attempts to practice nursing while afflicted with 30 physical or mental illness, deterioration, or disability that interferes with the 31 individual's performance of nursing functions;
01 (7) is guilty of unprofessional conduct as defined by regulations 02 adopted by the board; 03 (8) has wilfully or repeatedly violated a provision of this chapter or 04 regulations adopted under it; 05 (9) is professionally incompetent [; 06 (10) DENIES CARE OR TREATMENT TO A PATIENT OR PERSON 07 SEEKING ASSISTANCE IF THE SOLE REASON FOR THE DENIAL IS THE 08 FAILURE OR REFUSAL OF THE PATIENT OR PERSON SEEKING ASSISTANCE 09 TO AGREE TO ARBITRATE AS PROVIDED IN AS 09.55.535(a)]. 10 * Sec. 3. AS 09.10 is amended by adding a new section to read: 11 Sec. 09.10.065. LIMITATION ON ACTIONS BY CERTAIN MINORS 12 AGAINST HEALTH CARE PROVIDERS. (a) Notwithstanding AS 09.10.140, an 13 action based on professional negligence may not be brought against a health care 14 provider by a person who is, on the date of the alleged negligent act or omission less 15 than two years of age, unless the action is brought before the person's eighth birthday. 16 (b) The limitation imposed under (a) of this section is tolled during any period 17 in which there exists 18 (1) fraud, including fraud or collusion by a parent, guardian, insurer, 19 or health care provider, resulting in the failure to bring an action on behalf of an 20 injured minor; 21 (2) intentional concealment; or 22 (3) the undiscovered presence of a foreign body, that has no therapeutic 23 or diagnostic purpose or effect, in the body of the injured person and the action is 24 based on the presence of the foreign body. 25 (c) In this section, 26 (1) "health care provider" has the meaning given in AS 21.58.400; 27 (2) "professional negligence" means a negligent act or omission by a 28 physician in rendering professional services; 29 (3) "professional services" means services provided by a health care 30 provider that are within the scope of services for which the health care provider is 31 licensed, and that are not prohibited under the health care provider's license or by a
01 hospital in which the health care provider practices. 02 * Sec. 4. AS 09.30.070(a) is amended to read: 03 (a) The rate of interest on judgments and decrees for the payment of money 04 is equal to the 12th Federal Reserve district discount rate as determined under 05 AS 45.45.010(b) [10.5 PERCENT A YEAR], except that a judgment or decree founded 06 on a contract in writing, providing for the payment of interest until paid at a specified 07 rate not exceeding the legal rate of interest for that type of contract, bears interest at 08 the rate specified in the contract if the interest rate is set out in the judgment or decree. 09 * Sec. 5. AS 09.55.535 is repealed and reenacted to read: 10 Sec. 09.55.535. MANDATORY ARBITRATION. (a) A person who files an 11 action for damages against a health care provider resulting from medical malpractice, 12 shall also submit the claim to the court for arbitration. 13 (b) When a claim is submitted as required by (a) of this section, the court shall 14 determine if the parties can agree on an arbitrator to review the claim. If the parties 15 agree on an arbitrator, the court shall appoint that person to review the claim. If 16 within 30 days after the filing of an answer to the complaint the parties have not 17 agreed on an arbitrator, the court shall appoint an arbitrator to review the claim. The 18 arbitrator appointed to review the claim shall interview the parties and examine all 19 records or materials relating to the claim and may compel the attendance of witnesses, 20 interview the parties, or consult with medical specialists. 21 (c) An arbitrator appointed under this section shall conduct a prehearing 22 settlement conference within 30 days after the appointment. The arbitrator shall 23 establish a period for discovery and a date for a hearing. The hearing date may not 24 be more than 120 days after the settlement conference. 25 (d) An arbitrator shall render a written decision within 30 days after hearing 26 a claim under (c) of this section. The decision must contain findings of fact and 27 conclusions of law. The decision of the arbitrator may be rejected by a party. 28 (e) If the decision of the arbitrator is rejected by a party, the action may 29 proceed in the appropriate court. The arbitrator's decision is admissible evidence in 30 that action and may be used by a party to support or oppose a claim of damages. 31 (f) A party that rejects the arbitrator's decision, proceeds in court as provided
01 under (e) of this section, and obtains a final judgment that is not more favorable to that 02 party than the arbitrator's decision, shall pay the opposing party's actual costs and 03 attorney fees incurred during the court proceeding and may not be awarded its own 04 costs or attorney fees. This subsection 05 (1) does not apply to costs or attorney fees incurred in an appeal of 06 a court decision; and 07 (2) applies notwithstanding a different result required by an Alaska 08 Rule of Civil Procedure relating to an offer of judgment. 09 (g) The provisions of AS 09.43.010 - 09.43.180 (Uniform Arbitration Act) 10 apply to an arbitration under this section, if the provisions do not conflict with the 11 provisions of this section. 12 * Sec. 6. AS 09.55.536 is amended to read: 13 Sec. 09.55.536. EXPERT ADVISOR [ADVISORY PANEL]. (a) In an action 14 for damages due to personal injury or death based upon the provision of professional 15 services by a health care provider [WHEN THE PARTIES HAVE NOT AGREED TO 16 ARBITRATION OF THE CLAIM UNDER AS 09.55.535,] the court shall appoint 17 within 20 days after filing of answer to a summons and complaint an expert medical 18 advisor [A THREE-PERSON EXPERT ADVISORY PANEL] unless the court decides 19 that an expert advisory opinion is not necessary for a decision in the case. When the 20 action is filed the court shall, by order, determine the specialty [PROFESSIONS OR 21 SPECIALTIES] to be represented by the medical expert [ON THE EXPERT 22 ADVISORY PANEL], giving the parties the opportunity to object or make 23 suggestions. 24 (b) The expert advisor [ADVISORY PANEL] may compel the attendance of 25 witnesses, interview the parties, physically examine the injured person if alive, consult 26 with the specialists or learned works they consider appropriate, and compel the 27 production of and examine all relevant hospital, medical, or other records or materials 28 relating to the health care in issue. The advisor [PANEL] may meet in camera, but 29 shall maintain a record of any testimony or oral statements of witnesses, and shall keep 30 copies of all written statements received [IT RECEIVES]. 31 (c) Not more than 30 days after selection of the advisor, the advisor [PANEL,
01 IT] shall make a written report to the parties and to the court, answering the following 02 questions and other questions submitted to the advisor [PANEL] by the court: 03 (1) What was the disorder for which the plaintiff came to medical care? 04 (2) What would have been the probable outcome without medical care? 05 (3) Was the treatment selected appropriate for the case? 06 (4) Did an injury arise from the medical care? 07 (5) What is the nature and extent of the medical injury? 08 (6) What specifically caused the medical injury? 09 (7) Was the medical injury caused by unskillful care? 10 (8) If a medical injury had not occurred, how would the plaintiff's 11 condition differ from the plaintiff's present condition? 12 (d) In any case in which the answer to one or more of the questions submitted 13 to the advisor [PANEL] depends upon the resolution of factual questions which are 14 not the proper subject of expert opinion, the report shall so state and may answer 15 questions based upon hypothetical facts that are fully set out in the opinion. The 16 report must [SHALL] include copies of all written statements, opinions, or records 17 relied upon by the advisor [PANEL] and either a transcription or other record of any 18 oral statements or opinions; must [SHALL] specify any medical or scientific authority 19 relied upon by the advisor [PANEL]; and must [SHALL] include the results of any 20 physical or mental examination performed on the plaintiff. The advisor [EACH 21 MEMBER] shall sign the report and the signature constitutes the advisor's 22 [MEMBER'S] adoption of all statements and opinions contained in it [; HOWEVER, 23 A MEMBER MAY, INSTEAD OF SIGNING THE REPORT, SUBMIT A 24 CONCURRING OR DISSENTING REPORT WHICH COMPLIES WITH THE 25 REQUIREMENTS OF THIS SUBSECTION]. An advisor [A MEMBER] may not 26 attest to any portion of the report as to which the advisor [MEMBER] is not qualified 27 to give expert testimony. 28 (e) The report of the advisor [PANEL WITH ANY DISSENTING OR 29 CONCURRING OPINION] is admissible in evidence to the same extent as though its 30 contents were orally testified to by the person or persons preparing it. The court shall 31 delete any portion that would not be admissible because of lack of foundation for
01 opinion testimony, or otherwise. Either party may submit testimony to support or refute 02 the report. The jury shall be instructed in general terms that the report shall be 03 considered and evaluated in the same manner as any other expert testimony. The 04 expert advisor [ANY MEMBER OF THE PANEL] may be called by any party and 05 may be cross-examined as to the contents of the report [OR OF THAT MEMBER'S 06 DISSENTING OR CONCURRING OPINION]. 07 (f) Discovery [NO DISCOVERY] may not be undertaken in a case until the 08 report of the expert advisor [ADVISORY PANEL] is received. However, the court 09 may relax this prohibition upon a showing of good cause by a [ANY] party. If the 10 advisor [PANEL] has not completed its report within the 30-day period prescribed in 11 (c) of this section, the court may, upon application, grant [IT] an additional 30 days. 12 (g) The expert advisor is [MEMBERS OF A PANEL ARE] entitled to a fee 13 of $500 and travel expenses and per diem in accordance with state law pertaining to 14 members of boards and commissions for all time spent in preparing its report. If an 15 advisor [A PANEL MEMBER] is called upon as a witness at trial or upon deposition, 16 the advisor [MEMBER] is entitled to payment of an expert witness fee, which may 17 not exceed $300 [$150] per day. All expenses incurred by the advisor [PANEL] shall 18 be paid by the court. However, in any case in which the court determines that a party 19 has made a patently frivolous claim or a patently frivolous denial of liability, it shall 20 order that all costs of the expert advisor [ADVISORY PANEL] be borne by the party 21 making that claim or denial. 22 (h) Parties to the case and their counsel may not initiate communication out 23 of court with an expert advisor [MEMBERS OF THE PANEL] on the subject matter 24 of its inquiry and report or cause or solicit others to do so, except through ordinary 25 discovery proceedings. 26 * Sec. 7. AS 21.51 is amended by adding a new section to read: 27 Sec. 21.51.350. PREMIUM RATES AND RATING FACTORS. (a) A 28 disability insurer 29 (1) shall file with the director rates or rating factors for disability 30 insurance at least 90 days before the intended effective date of the rate or rating factor; 31 and
01 (2) may not use a rate or rating factor that has not been filed with the 02 director as required under this subsection. 03 (b) A rate or rating factor not disapproved by the director before the intended 04 effective date of the rate or rating factor is considered approved by the director. 05 * Sec. 8. 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 periodically update a health 18 care data system. To the extent practicable, the data system base year shall be 19 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, including patient diagnosis, type of provider, 24 type of service, location and length of care, referral patterns, quality of care, and result 25 of care; 26 (4) billing and payment data; and 27 (5) public health data, including vital statistics and health status. 28 (b) The commissioner may, by regulation, require health care providers to 29 submit claims data and additional information necessary to develop or update the data 30 system required under (a) of this section. 31 (c) The commissioner may pursue waivers from applicable federal law or from
01 federal agencies to the extent necessary to maximize the collection and analysis of 02 health care data. 03 (d) Information and data obtained or produced by the director under this 04 section are subject to the disclosure requirements and exceptions of AS 09.25.110 and 05 09.25.120 and the regulations adopted under those statutes. Information or data 06 identifying a recipient of health care services is considered to be a medical and related 07 public health record subject to the exception to public inspection under AS 09.25.120 08 and, except as provided under (e) of this section, shall be kept confidential as a matter 09 of law. A person who wrongfully discloses or who uses or permits the use of 10 confidential information or data in violation of this subsection is guilty of a class B 11 misdemeanor. 12 (e) Information or data regarding health care services 13 (1) may be disclosed in an aggregate form that does not identify an 14 individual recipient; and 15 (2) that identify an individual recipient may be disclosed to a health 16 care provider, if the individual recipient has agreed to release the information or data. 17 Sec. 21.58.030. UNIFORM DATA AND PROCEDURES FOR HEALTH 18 CLAIMS. (a) The director shall adopt by regulation uniform claims forms, uniform 19 standards, and uniform procedures for the processing of data relating to billing for and 20 payment of health care services provided to residents of the state. A health insurance 21 company shall comply with the uniform claims forms, standards, and procedures 22 established under this section. 23 (b) The director shall ensure that other regulations adopted by the director 24 under this title that apply to a health insurer are not in conflict or inconsistent with 25 regulations adopted under (a) of this section. 26 Sec. 21.58.040. APPROPRIATIONS. The legislature may appropriate a 27 portion of the proceeds of the tax on insurance premiums collected under 28 AS 21.09.210 to pay the administrative costs of this chapter. 29 Sec. 21.58.400. DEFINITIONS. In this chapter, 30 (1) "commissioner" means the commissioner of commerce and 31 economic development;
01 (2) "health care provider" means an acupuncturist licensed under 02 AS 08.06; an audiologist licensed under AS 08.11; a chiropractor licensed under 03 AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under 04 AS 08.36; a marital or family therapist licensed under AS 08.63; a direct-entry 05 midwife certified under AS 08.65; a nurse licensed under AS 08.68; a dispensing 06 optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an 07 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical 08 therapist or occupational therapist licensed under AS 08.84; or a physician's assistant 09 certified under AS 08.64; a physician licensed under AS 08.64; a podiatrist; a 10 psychologist and a psychological associate licensed under AS 08.86; a clinical social 11 worker licensed under AS 08.95; an emergency medical technician certified under 12 AS 18.08.082; a mobile intensive care paramedic trained as required under 13 AS 18.08.082; a health maintenance organization as defined in AS 21.86.900; a 14 hospital or medical service corporation as defined in AS 21.87.330; a hospital as 15 defined in AS 18.20.130, including a governmentally owned or operated hospital; and 16 an employee of a health care provider acting within the course and scope of 17 employment; 18 (3) "health care services" means preventive, diagnostic, medical, 19 surgical, reproductive, psychiatric, psychologic, rehabilitative, health maintenance, 20 dental, podiatric, optometric, optical, audiologic, nutritive, and chiropractic care; 21 prescription drugs, laboratory and radiologic services, medical supplies, durable 22 medical equipment and devices; personal assistance services; inpatient and outpatient 23 care; home health care; hospice care; and long-term or institutional care; 24 (4) "health insurance" means an individual or group contract or other 25 plan providing coverage of health care services that is issued by the corporation or by 26 a health insurance company, a hospital service corporation, a medical service 27 corporation, or a health maintenance organization; "health insurance" includes disability 28 insurance under AS 21.12.050; 29 (5) "health insurance company" means an insurer that is authorized to 30 transact health insurance. 31 * Sec. 9. AS 21.86.070(g) is amended to read:
01 (g) The director may require that additional relevant material considered 02 necessary by the director be submitted in order to determine the acceptability of a 03 filing made under [EITHER] (b) [OR (e)] of this section. 04 * Sec. 10. AS 21.86 is amended by adding a new section to read: 05 Sec. 21.86.075. PREMIUM RATES AND CHARGES. (a) A health 06 maintenance organization 07 (1) shall file with the director rates, rating factors, premiums, fees for 08 services, and enrollee fees, including a change to a rate, rating factor, premium, or fee, 09 used in providing health care services to enrollees of the health maintenance 10 organization; a filing required under this paragraph must be made at least 90 days 11 before the intended effective date of the filing; and 12 (2) may not use a rate, rating factor, premium, or fee that has not been 13 filed with the director as required under this subsection. 14 (b) A filing under this section not disapproved by the director before its 15 intended effective date is considered approved by the director. 16 * Sec. 11. AS 21.86.260(a) is amended to read: 17 (a) Except as provided in AS 21.56, AS 21.89.100 - 21.89.120, and in this 18 chapter, this title does not apply to a health maintenance organization that obtains a 19 certificate of authority under this chapter. This subsection does not apply to an insurer 20 licensed under AS 21.09 or a hospital or medical service corporation licensed under 21 AS 21.87 except with respect to its health maintenance organization activities 22 authorized by and regulated under this chapter. 23 * Sec. 12. AS 21.87.190 is repealed and reenacted to read: 24 Sec. 21.87.190. RATES AND CHARGES. (a) A service corporation 25 (1) shall file with the director subscription rates, rating factors, fees, 26 and payment charges, including a change to a rate, rating factor, fee, or payment 27 charge, to be charged to or on account of the service corporation's subscribers; a filing 28 required under this paragraph must be made at least 90 days before the intended 29 effective date of the filing; and 30 (2) may not use a rate, rating factor, fee, or payment charge that has 31 not been filed with the director as required under this subsection.
01 (b) A filing under this section not disapproved by the director before its 02 intended effective date is considered approved by the director. 03 * Sec. 13. AS 21.87.340 is amended to read: 04 Sec. 21.87.340. OTHER PROVISIONS APPLICABLE. In addition to the 05 provisions contained or referred to previously in this chapter, the following chapters 06 and provisions of this title also apply with respect to service corporations to the extent 07 applicable and not in conflict with the express provisions of this chapter and the 08 reasonable implications of the express provisions, and for the purposes of the 09 application the corporations shall be considered to be mutual "insurers": 10 (1) AS 21.03; 11 (2) AS 21.06; 12 (3) AS 21.09, except AS 21.09.090; 13 (4) AS 21.18.010; 14 (5) AS 21.18.030; 15 (6) AS 21.18.040; 16 (7) AS 21.18.120; 17 (8) AS 21.21.321; 18 (9) AS 21.36; 19 (10) AS 21.42.345 - 21.42.365, 21.42.375, 21.42.380, and 21.42.385; 20 (11) AS 21.51.120; 21 (12) AS 21.53; 22 (13) AS 21.54.020; 23 (14) AS 21.56; 24 (15) AS 21.69.400; 25 (16) AS 21.69.520; 26 (17) AS 21.69.600, 21.69.620, and 21.69.630; 27 (18) AS 21.78; 28 (19) AS 21.89.040; 29 (20) AS 21.89.060 and 21.89.100 - 21.89.120; 30 (21) AS 21.90. 31 * Sec. 14. AS 21.89 is amended by adding new sections to read:
01 Sec. 21.89.100. REQUIRED PROVISIONS REGARDING COORDINATION 02 OF BENEFITS. (a) When an insured has coverage under two or more plans that 03 provide for coordination of benefits, the coverage from those plans must be 04 coordinated so that the insured receives the maximum allowable benefit from each 05 plan. The aggregate benefit should be more than that offered by any of the plans 06 individually, but the insured may not receive more than the total of the charges for the 07 health care services received. 08 (b) A plan that provides for coordination of benefits must contain a provision 09 that 10 (1) discloses that coordination of benefits applies when the insured has 11 health care coverage under more than one plan; 12 (2) states what benefits from the plan and other sources are recognized 13 under the coordinating provision and that indicates if one or more plan benefits are 14 exempt from the coordinating provision; 15 (3) states what health care expenses are allowable and what health care 16 expenses are excluded under the coordinating provision; 17 (4) states the claim period to be used in applying the coordinating 18 benefits provision; a claim period may not be less than 12 months, but may exclude 19 a period before coverage starts or after coverage ends; 20 (5) indicates the manner in which benefits are reduced by coordination; 21 a reduction in benefits is subject to the following order of benefit provisions: 22 (A) plan benefits applicable to an insured as an employee, 23 member, or subscriber, and also as a dependent, are first determined as benefits 24 applicable to the insured as employee, member, or subscriber; 25 (B) if a minor is eligible for benefits as a dependent of more 26 than one insured, the plan of the insured whose date of birth falls earlier in the 27 year is applied first, unless a different order of application is required by a 28 court; 29 (C) benefits not determined under this paragraph that are 30 applicable under more than one plan are determined under that plan applicable 31 to the insured for the longer period of time;
01 (D) when one of the plans is a medical plan and the other is a 02 dental plan, and a determination cannot be made under the provisions of (A) -(C) of this paragraph, the medical plan 03 shall be considered as the primary 04 coverage; 05 (E) if under the provisions of (A) - (D) of this paragraph the 06 plan is secondary to another source of benefits, the benefits of the plan may not 07 be reduced unless the sum of benefits payable for allowable expenses and the 08 benefits payable for allowable expenses under the other source exceed the 09 allowable expenses in a claim determination period; 10 (6) provides that the insurer has the right to receive and to release 11 information necessary to expedite a claim payment when coordinating benefits; 12 (7) allows the insurer to make a payment necessary to repay another 13 insurer for a payment that should have been made under the policy applicable to the 14 insured; and 15 (8) gives the insurer the right to recover excess payments from the 16 insured paid to another insurer providing benefits to the insured. 17 (c) In coordinating benefits from a plan that contractually reduces the fees for 18 services that participating health care providers accept as payment in full, the following 19 rules apply: 20 (1) when the reduced fee plan is the primary coverage and treatment 21 is provided by a participating health care provider, the reduced fee is that health care 22 provider's full fee; a secondary plan shall pay the lesser of its allowed benefit or the 23 difference between the primary plan's benefit and the reduced fee; 24 (2) when the reduced fee plan is the primary coverage and treatment 25 is provided by a nonparticipating health care provider, the reduced fee plan shall 26 provide its allowed amount for nonparticipating health care providers and the 27 secondary plan shall pay the lesser of 28 (A) its allowed benefit for the service; 29 (B) the difference between the primary plan's benefits for the 30 service and the health care provider's full fee; 31 (3) when a full fee plan is the primary coverage and a reduced fee plan
01 is secondary coverage, the full fee plan shall provide its allowed amount for the 02 service and the secondary plan shall pay the lesser of its allowed benefit for the service 03 or the difference between the primary plan's benefits and the health care provider's full 04 fee. 05 (d) In coordinating benefits between an indemnity and a capitation plan, the 06 following rules apply: 07 (1) when the capitation plan is the primary coverage, the capitation 08 payments to the treating health care provider remain the capitation plan's usual 09 benefits; the indemnity plan shall pay benefits for the patient's surcharges or 10 copayments up to the indemnity plan's allowable benefit; 11 (2) when the indemnity plan is the primary coverage and treatment is 12 received from a health care provider who is participating in a capitation plan, the 13 indemnity plan shall pay its allowable benefits; the capitation payments to the health 14 care provider are secondary coverage; 15 (3) when the indemnity plan or policy is the primary coverage, and 16 treatment is received from a health care provider who is not participating in a 17 capitation plan , the indemnity plan shall pay its allowable benefits; the capitation plan 18 shall pay benefits, in keeping with the capitation plan's allowed amount for treatment 19 by nonparticipating health care providers; 20 (4) a plan may not contractually direct a health care provider to charge 21 a secondary insurer for more than the amount that would be charged to the insured 22 absent secondary coverage. 23 (e) A certificate indicating insurance coverage must contain a summary of the 24 provisions in this section regarding coordination of benefits. 25 Sec. 21.89.110. DETERMINATION AND DISCLOSURE OF USUAL, 26 CUSTOMARY, AND REASONABLE FEES. An insurer who pays a claim under a 27 disability policy or an indemnity under a group or blanket disability insurance policy, 28 a health maintenance organization that adopts a schedule of charges, or a hospital or 29 medical service corporation that pays a subscriber or compensates a health care 30 provider on the basis of a usual, customary, or reasonable fee or charge shall 31 (1) maintain and use a statistically credible profile of fees of health care
01 providers in this state on which to base payment of the claim; the profile must (A) be 02 updated at least once every six months and may not contain fees for services 03 performed more than one year before the date of the most recent profile; (B) contain 04 fees for the geographic area in which a claimant might receive treatment; and (C) may 05 not include fees clearly marked "DO NOT PROFILE"; if statistically credible data for 06 a particular health care service in a certain geographic area does not exist, the insurer 07 may include in the profile a sufficient number of fees for that service from another 08 geographic area in order to establish a reliable data base; however, the final basis for 09 payment must be adjusted to reflect the general cost difference between the geographic 10 area where the service was performed and the other geographic area used in 11 establishing the statistically credible profile; the adjustment may be based upon the 12 Consumer Price Index, the medical care component of the Consumer Price Index, or 13 a reasonable basis stated in writing and determined acceptable by the director; 14 (2) respond within 15 working days after receiving a written request 15 from an insured, a health care provider with a valid assignment of payments, or a 16 health care provider engaged to provide services under a professional services contract, 17 with a full written disclosure of the methods employed under (1) of this section that 18 resulted in the difference between the amount paid on a claim for benefits and the 19 actual charges submitted; and 20 (3) disclose in a proposal for insurance, a policy of insurance, a 21 certificate of insurance, an employee benefit description or supplemental document, or 22 a professional service contract between an insurer and a health care provider 23 (A) the frequency with which the insurer determines the usual, 24 customary, and reasonable fee; 25 (B) a general description of the methodology used to determine 26 the usual, customary, and reasonable fee; 27 (C) the percentile of usual, customary, and reasonable fees at 28 which the insurer will reimburse the insured, or the contract health care 29 provider. 30 Sec. 21.89.120. DEFINITIONS FOR AS 21.89.100 - 21.89.120. In 31 AS 21.89.100 - 21.89.120,
01 (1) "health care provider" has the meaning given in AS 21.58.400; 02 (2) "health care service" has the meaning given in AS 21.87.330; 03 (3) "plan" means a group or blanket disability policy issued under 04 AS 21.54, small employer coverage issued under AS 21.56, evidence of coverage 05 issued under AS 21.86, or a subscriber contract issued under AS 21.87; 06 (4) "professional services contract" includes a contract for professional 07 services between a health care provider and insurer or health maintenance corporation, 08 and a service contract between a health care provider and a hospital or medical service 09 corporation; 10 (5) "service corporation" has the meaning given in AS 21.87.330. 11 * Sec. 15. AS 28.33.030(a) is amended to read: 12 (a) A person commits the crime of operating a commercial motor vehicle while 13 intoxicated if the person operates a commercial motor vehicle 14 (1) while under the influence of intoxicating liquor or any controlled 15 substance; 16 (2) when, as determined by a chemical test taken within four hours 17 after the alleged offense was committed, there is at the time the test is taken 0.04 18 percent or more by weight of alcohol in the person's blood or 40 milligrams or more 19 of alcohol per 100 milliliters of blood, or when there is 0.04 grams or more of alcohol 20 per 210 liters of the person's breath; or 21 (3) while under the combined influence of intoxicating liquor and a 22 controlled substance. 23 * Sec. 16. AS 28.35.030(a) is amended to read: 24 (a) A person commits the crime of driving while intoxicated if the person 25 operates or drives a motor vehicle or operates an aircraft or a watercraft 26 (1) while under the influence of intoxicating liquor, or any controlled 27 substance; 28 (2) when, as determined by a chemical test taken within four hours 29 after the alleged offense was committed, there is at the time the test is taken 0.08 30 [0.10] percent or more by weight of alcohol in the person's blood or 80 [100] 31 milligrams or more of alcohol per 100 milliliters of blood, or when there is 0.08 [0.10]
01 grams or more of alcohol per 210 liters of the person's breath; or 02 (3) while the person is under the combined influence of intoxicating 03 liquor and a controlled substance. 04 * Sec. 17. AS 28.35.033(a) is amended to read: 05 (a) Upon the trial of a civil or criminal action or proceeding arising out of acts 06 alleged to have been committed by a person while operating or driving a motor vehicle 07 or operating an aircraft or a watercraft while intoxicated, the amount of alcohol in the 08 person's blood or breath at the time alleged shall give rise to the following 09 presumptions: 10 (1) If there was 0.04 [0.05] percent or less by weight of alcohol in the 11 person's blood, or 40 [50] milligrams or less of alcohol per 100 milliliters of the 12 person's blood, or 0.04 [0.05] grams or less of alcohol per 210 liters of the person's 13 breath, it shall be presumed that the person was not under the influence of intoxicating 14 liquor. 15 (2) If there was in excess of 0.04 [0.05] percent but less than 0.08 16 [0.10] percent by weight of alcohol in the person's blood, or in excess of 40 [50] but 17 less than 80 [100] milligrams of alcohol per 100 milliliters of the person's blood, or 18 in excess of 0.04 [0.05] grams but less than 0.08 [0.10] grams of alcohol per 210 liters 19 of the person's breath, that fact does not give rise to any presumption that the person 20 was or was not under the influence of intoxicating liquor, but that fact may be 21 considered with other competent evidence in determining whether the person was 22 under the influence of intoxicating liquor. 23 (3) [REPEALED 24 (4)] If there was 0.08 [0.10] percent or more by weight of alcohol in 25 the person's blood, or 80 [100] milligrams or more of alcohol per 100 milliliters of the 26 person's blood, or 0.08 [0.10] grams or more of alcohol per 210 liters of the person's 27 breath, it shall be presumed that the person was under the influence of intoxicating 28 liquor. 29 * Sec. 18. AS 28.35.033(c) is amended to read: 30 (c) The provisions of (a) of this section 31 (1) may not be construed to limit the introduction of any other
01 competent evidence bearing upon the question of whether the person was or was not 02 under the influence of intoxicating liquor; and 03 (2) do not apply to a civil action permitted under AS 04.21.020. 04 * Sec. 19. AS 43.50.190(a) is amended to read: 05 (a) There is levied an excise tax of 17 [12] mills on each cigarette imported 06 or acquired in this state. 07 * Sec. 20. Section 7, ch. 39, SLA 1993, is amended to read: 08 Sec. 7. AS 21.86.260(a) is repealed and reenacted to read: 09 (a) Except as provided in AS 21.89.100 - 21.89.120 and this chapter, this title 10 does not apply to a health maintenance organization that obtains a certificate of 11 authority under this chapter. This subsection does not apply to an insurer licensed 12 under AS 21.09 or a hospital or medical service corporation licensed under AS 21.87 13 except with respect to its health maintenance organization activities authorized by and 14 regulated under this chapter. 15 * Sec. 21. Section 9, ch. 39, SLA 1993, is amended to read: 16 Sec. 9. AS 21.87.340 is repealed and reenacted to read: 17 Sec. 21.87.340. OTHER PROVISIONS APPLICABLE. In addition to the 18 provisions contained or referred to previously in this chapter, the following chapters 19 and provisions of this title also apply with respect to service corporations to the extent 20 applicable and not in conflict with the express provisions of this chapter and the 21 reasonable implications of the express provisions, and for the purposes of the 22 application the corporations shall be considered to be mutual "insurers": 23 (1) AS 21.03 24 (2) AS 21.06 25 (3) AS 21.09, except AS 21.09.090 26 (4) AS 21.18.010 27 (5) AS 21.18.030 28 (6) AS 21.18.040 29 (7) AS 21.18.120 30 (8) AS 21.21.321 31 (9) AS 21.36
01 (10) AS 21.42.345 - 21.42.365, 21.42.375, 21.42.380, and 21.42.385 02 (11) AS 21.51.120 03 (12) AS 21.53 04 (13) AS 21.54.020 05 (14) AS 21.69.400 06 (15) AS 21.69.520 07 (16) AS 21.69.600, 21.69.620, and 21.69.630 08 (17) AS 21.78 09 (18) AS 21.89.040 10 (19) AS 21.89.060 and 21.89.100 - 21.89.120 11 (20) AS 21.90. 12 * Sec. 22. APPLICABILITY. Sections 11, 13, and 14 of this Act apply to a policy of 13 insurance, evidence of coverage under AS 21.86, or a service agreement or subscriber's 14 contract under AS 21.87, issued or renewed on or after the effective date of this Act. 15 * Sec. 23. HEALTH CARE PLAN ADVISORY COMMITTEE. (a) The legislature finds 16 that it is necessary to have reliable information on the specific content and cost of any 17 proposed mandatory health care plan, before it can be taken to the public for review. The 18 legislature further finds that questions of a single payer system versus a multi payer system 19 for any mandatory coverage, and questions regarding inclusion or exclusion of certain groups 20 of Alaskans who are covered by other federal health insurance, are not prejudiced by the 21 direction given to the advisory committee created in this section. 22 (b) The Health Care Plan Advisory Committee is established in the Office of the 23 Governor. The committee consists of seven members who are appointed by the governor as 24 follows: 25 (1) one person with experience in providing health care services on an inpatient 26 basis; 27 (2) one person with experience in providing health care services on an 28 outpatient basis; 29 (3) one person with experience as a health care provider; 30 (4) one person who is an accountant who has experience in health care 31 insurance;
01 (5) one person who has experience in health care insurance; and 02 (6) two persons who represent the public. 03 (c) Notwithstanding any other provision of law, a committee member is subject to the 04 provisions of AS 39.50 as if the committee member were a member of a state commission or 05 board described under AS 39.50.200(b). 06 (d) A committee member is entitled to receive compensation at the rate of $400 a day 07 for each day spent in performing duties as a committee member and to travel and per diem 08 expenses authorized by law for boards and commissions under AS 39.20.180. 09 (e) The committee may 10 (1) establish subcommittees; 11 (2) conduct hearings; 12 (3) employ personnel necessary to complete assigned duties; 13 (4) enter into contracts; 14 (5) subject to appropriation, expend money. 15 (f) By December 15, 1994, the committee shall report to the legislature on the scope 16 of the health care insurance coverage and the cost of providing health care insurance if health 17 care insurance were to be offered under the following conditions: 18 (1) participation is mandatory by all state residents; coverage shall include a 19 spouse and dependent children; 20 (2) health care services that are covered must include preventive care and 21 immunizations, prenatal care, children's health care, and catastrophic medical expense 22 coverage; 23 (3) coverage shall be designed to impose a family deductible of $3,000 for all 24 covered health care services other than prenatal care, preventive care, and immunizations, and 25 to allow reimbursement in a calendar year at not more than 80 percent for all covered health 26 care services, other than prenatal care, preventive care, and immunizations, after the first 27 $3,000 in covered expenses; prenatal care, preventive care, and immunizations may be 28 reimbursed at more than 80 percent for a covered expense; coverage for health care services 29 that are offered on an outpatient basis shall provide reimbursement for outpatient health care 30 services at a rate equal to or higher than the rate for inpatient services; 31 (4) premiums shall be set at a single rate for all covered individuals, except
01 (A) a surcharge for coverage of each dependent child or spouse may 02 be imposed; a surcharge may not exceed 50 percent of the individual premium; it is 03 the intent of the legislature that the premium be set at a rate that does not exceed $100 04 per month or 14 percent of the individual's monthly gross income, whichever is lower; 05 (B) premium rates are allowed to vary depending on whether the 06 individual smokes or any other factors within the control of an individual, and 07 depending on whether the individual is less than 30 years of age; a premium may not 08 vary under a community rating system, other than as specified in this section; 09 (5) a one-year exclusion for preexisting conditions for new enrollees is 10 imposed; this paragraph does not apply to a person who has resided in the state for at least 11 one year, or who is less than one year old and was born in this state. 12 (g) By December 15, 1995, the committee shall report to the legislature on 13 (1) the cost of providing health insurance coverage under the following 14 conditions: 15 (A) coverage shall meet the conditions set out under (f)(1) - (5) of this 16 section; 17 (B) additional medical benefits are included as recommended by the 18 committee; 19 (C) the premium for a single person may not exceed $150 per month; 20 (2) the effect of the following conditions assuming that insurance coverage as 21 specified under (f) of this section is provided: 22 (A) premium payment is by payroll deduction, employer contribution, 23 or a combination of employer contribution and payroll deduction; 24 (B) premium payment by an unemployed or self-employed person is 25 by direct payment; 26 (3) assuming that the state requires all residents to participate in a state health 27 insurance plan, changes necessary in existing provisions of law to 28 (A) allow integration of optional health insurance plans with the 29 mandatory insurance plan; the integration should allow an individual or group to 30 purchase supplemental insurance coverage without duplication of coverage; and 31 (B) discourage health insurance that reimburses covered benefits at a
01 rate greater than 80 percent of the cost of the benefits; 02 (4) recommended legislation regarding public health issues; 03 (5) recommended legislation to simplify health care administration; 04 (6) recommended legislation regarding antitrust changes necessary to allow the 05 use of pooled purchasing to reduce the cost of health care if required under federal law; 06 (7) recommended legislation to enact tort reform measures intended to reduce 07 the cost of health care, including changes to statutes of limitation, contingent fee agreements, 08 and to the Alaska Rules of Civil Procedure; 09 (8) recommended legislation regarding long-term health care, including 10 methods to encourage individual savings for the cost of long-term health care; 11 (9) recommended legislation regarding how the state should educate residents 12 on health care, including how to be a prudent consumer, increasing awareness of provider 13 charges, and a curriculum that should be used in public schools in the state. 14 (h) By December 15, 1995, the committee shall recommend to the legislature 15 legislation necessary to improve data collection used to control health care expenditures or to 16 improve the efficiency of the health care system in the state. 17 (i) In this section, "health care provider" has the meaning given in AS 21.58.400. 18 * Sec. 24. MEDICAL PRACTICE ADVISORY COMMITTEE. (a) The Medical Practice 19 Advisory Committee is established in the Office of the Governor. The committee consists of 20 four members who are appointed by the governor as follows: 21 (1) two persons licensed under AS 08.64; 22 (2) one person who is a health care provider licensed under AS 08 but who 23 is not licensed under AS 08.64; and 24 (3) one person who is a health care provider licensed under AS 08 and who 25 practices in a rural area of the state. 26 (b) Notwithstanding any other provision of law, a committee member is subject to the 27 provisions of AS 39.50 as if the committee member were a member of a state commission or 28 board described under AS 39.50.200(b). 29 (c) A committee member is entitled to receive compensation at the rate of $400 a day 30 for each day spent in performing duties as a committee member and to travel and per diem 31 expenses authorized by law for boards and commissions under AS 39.20.180.
01 (d) The committee may 02 (1) establish subcommittees; 03 (2) conduct hearings; 04 (3) employ personnel necessary to complete assigned duties; 05 (4) enter into contracts; 06 (5) subject to appropriation, expend money. 07 (e) By December 15 of each year, the committee shall provide recommendations for 08 necessary health care reform legislation to the legislature on the following: 09 (1) training necessary for primary health care providers regarding proper 10 referral of cases; 11 (2) medical practice parameters intended to reduce or eliminate medical 12 malpractice claims; 13 (3) required additions or changes in the authority given to health care providers 14 in order to prudently maximize a health care provider's scope of practice; 15 (4) obstacles that may arise from federal antitrust laws in allowing health care 16 providers to join in a peer review process, share price information, or share equipment or 17 facilities; 18 (5) recommendations to facilitate the use of video teleconferencing or other 19 long-distance communications that allow health care providers with special skills to extend 20 their practice to remote areas of the state; 21 (6) the creation of peer review boards to sanction health care providers, to 22 require approval of certain medical procedures, and to recommend practice incentives. 23 (f) In this section, "health care provider" has the meaning given in AS 21.58.400. 24 * Sec. 25. Alaska Rule of Civil Procedure 72.1 is repealed. 25 * Sec. 26. AS 21.86.070(e) and 21.86.070(f) are repealed. 26 * Sec. 27. AS 09.55.535(f), as enacted in sec. 5 of this Act, has the effect of amending 27 Alaska Rules of Civil Procedure 68, 79, and 82 by providing that a party that rejects an 28 arbitration decision and receives a judgment that is not more favorable than the decision 29 obtained in arbitration is required to pay the opposing party's actual costs and attorney fees 30 incurred in the court proceeding, and by providing that the provisions of AS 09.55.535(f) 31 apply notwithstanding a different result required under an Alaska Rule of Civil Procedure
01 relating to an offer of judgment. 02 * Sec. 28. AS 09.55.536(f), amended by sec. 6 of this Act, amends Alaska Rules of Civil 03 Procedure 26 and 27 by providing that discovery may not be undertaken until the expert 04 advisor's report is received. 05 * Sec. 29. AS 09.55.536(e), amended by sec. 6 of this Act, amends Alaska Rules of 06 Evidence 802, 803, and 804 by providing that the expert advisor's report is admissible in 07 evidence to the same extent as though its contents were orally testified to by the advisor. 08 * Sec. 30. Section 25 of this Act takes effect July 1, 1994, only if that section receives the 09 two-thirds majority vote of each house required by art. IV, sec. 15, Constitution of the State 10 of Alaska. 11 * Sec. 31. Sections 23 and 24 of this Act are repealed June 30, 1996. 12 * Sec. 32. This Act takes effect July 1, 1994.