HB 402: "An Act revising the catastrophic illness assistance program; and providing for an effective date."
00 HOUSE BILL NO. 402 01 "An Act revising the catastrophic illness assistance program; and providing for an 02 effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 47.08.010(a) is amended to read: 05 (a) Under [SUBJECT TO (b) OF THIS SECTION, UNDER] AS 47.08.010 - 06 47.08.140, the Department of Health and Social Services may reimburse providers of 07 medical care for unpaid costs incurred in the treatment of a person suffering an illness 08 or accident that results in financial catastrophe to the person or the person's family. 09 * Sec. 2. AS 47.08.050 is amended to read: 10 Sec. 47.08.050. Services excluded [FROM COVERAGE]. Unpaid costs for 11 [ANNUALLY, THE COMMITTEE SHALL DETERMINE IN LIGHT OF 12 APPROPRIATED FUNDS AND EXPECTED NEED THE MEDICAL EXPENSES 13 REIMBURSABLE UNDER AS 47.08.010 - 47.08.140, EXCEPT THAT] the 14 following are not reimbursable:
01 (1) dentistry and optometry unless prescribed by a licensed dentist or 02 physician as medically necessary as the result of the injury or illness; 03 (2) elective medical or surgical procedures; 04 (3) drugs and medications not prescribed by a licensed physician; 05 (4) services received as a result of a pregnancy or birth without 06 unusual complications; 07 (5) private psychological or psychiatric treatment or private alcoholism 08 treatment, unless not available from public agencies or programs; 09 (6) chiropractic services and services provided by a person who 10 practices naturopathy; 11 (7) nonmedical care [SERVICES NOT OF A MEDICAL NATURE]; 12 (8) medical services currently provided to persons in the custody of the 13 Department of Corrections [; 14 (9) COSTS INCURRED BEFORE JULY 1976]. 15 * Sec. 3. AS 47.08.060(a) is amended to read: 16 (a) The [AS FREQUENTLY AS NECESSARY THE] committee shall adopt 17 [, IN LIGHT OF APPROPRIATED FUNDS AND EXPECTED NEED,] a formula to 18 determine an [BE USED IN DETERMINING THE] applicant's share of total medical 19 expenses incurred as a result of a catastrophic illness, based on the applicant's annual 20 gross income, number of dependents, amount of assets, and forthcoming third-party 21 payments [, ALL CONSIDERED IN LIGHT OF THE REQUIREMENT THAT THE 22 APPLICANT'S SHARE WILL BE PAID TO THE PROVIDER ON A PAYMENT 23 SCHEDULE COVERING A PERIOD OF AT LEAST THREE YEARS]. 24 * Sec. 4. AS 47.08.060(d) is amended to read: 25 (d) Assets received by an [THE] applicant as a custodian, guardian, 26 conservator, or trustee for another are not considered assets of the applicant 27 [CUSTODIAN, GUARDIAN, CONSERVATOR, OR TRUSTEE]. 28 * Sec. 5. AS 47.08.060(e) is amended to read: 29 (e) An [THE] applicant's share shall be reduced in the amount of any 30 premiums paid for health insurance or a prepaid medical plan up to $1,000 [$500] if 31 incurred in the 12-month period beginning with the occurrence of the injury or the
01 onset of the illness. 02 * Sec. 6. AS 47.08.070 is amended to read: 03 Sec. 47.08.070. Reimbursement [STANDARDS FOR 04 REIMBURSEMENT] to providers. (a) The amount that the committee may 05 reimburse [REIMBURSES] providers for the cost of medical services rendered to a 06 person who has suffered catastrophic illness 07 (1) may not exceed [BE GREATER THAN 100 PERCENT OF] the 08 total unpaid medical bills related to the catastrophic illness, not including interest or 09 penalties, reduced by the amount of the applicant's share under AS 47.08.060; 10 and 11 (2) may only include costs incurred for one year after the first 12 charge incurred because of the catastrophic illness or injury. 13 (b) The [AND SHALL BE DETERMINED BY THE FOLLOWING 14 STANDARDS: 15 (1) ONLY UNPAID MEDICAL EXPENSES FOR PERIODS NOT 16 TO EXCEED 12 MONTHS, AND RELATED TO CATASTROPHIC ILLNESS, 17 MAY BE CONSIDERED; THE INITIAL 12-MONTH PERIOD BEGINS WITH 18 THE DATE OF THE FIRST CHARGES INCURRED BECAUSE OF THE 19 ILLNESS; 20 (2) THE] committee may not reimburse a provider 21 (1) if an [THE] applicant's total medical expenses related to the 22 catastrophic illness are less than $1,000 [IN ANY PERIOD NOT EXCEEDING 12 23 MONTHS DESCRIBED IN (1) OF THIS SECTION] after all sources of third-party 24 payment have been exhausted by the applicant or by someone acting on behalf of the 25 applicant; 26 (2) [(3) THE COMMITTEE MAY NOT REIMBURSE A 27 PROVIDER] for the applicant's share of the total medical expenses unless the 28 provider agrees to accept payment of the applicant's share from the applicant 29 according to a payment schedule approved by the committee [; MOREOVER, A 30 REIMBURSEMENT TO THE PROVIDER SHALL BE CONDITIONED ON THE 31 PROVIDER'S AGREEMENT THAT THE PROVIDER ENTER INTO A PAYMENT
01 SCHEDULE WITH THE APPLICANT WHICH WILL RESULT IN FULL 02 LIQUIDATION OF THE APPLICANT'S SHARE; PAYMENT SCHEDULES MAY 03 NOT BE FOR A TERM OF LESS THAN THREE YEARS]. 04 * Sec. 7. AS 47.08.080 is amended to read: 05 Sec. 47.08.080. Reconsideration of decision by committee. The committee 06 shall promptly notify the [AN] applicant, in writing, of its decision. The notice must 07 include [WITH WRITTEN] reasons for the amount of the award or denial. An 08 applicant who is dissatisfied with a decision of the committee may apply to the 09 committee for reconsideration within 30 days of receipt of the decision. The request 10 for reconsideration must include a written statement of grounds for reconsideration 11 and any supporting documentation which was not available to the committee for its 12 original decision. Within 30 days after receipt of a request for reconsideration, the 13 committee shall affirm, amend, or reverse its original decision. The committee shall 14 promptly notify the applicant, in writing, of its decision upon reconsideration 15 including [WITH WRITTEN] reasons for its action. Information describing hearing 16 rights and procedures must be furnished with the notice [WRITTEN NOTIFICATION 17 OF DENIAL]. 18 * Sec. 8. AS 47.08.010(b) and 47.08.060(c)(8) are repealed. 19 * Sec. 9. This Act takes effect July 1, 2010.