SB 61: "An Act establishing an Alaska health care program to ensure insurance coverage for essential health services for residents of the state, the Alaska Health Care Board to administer the Alaska health care program and the Alaska health care fund, the Alaska health care clearinghouse to administer the Alaska health care program under the direction of the Alaska Health Care Board, and eligibility standards and premium assistance for health care coverage of persons with low incomes; creating the Alaska health care fund; providing for review of actions and reporting requirements related to the health care program; and providing for an effective date."
00 SENATE BILL NO. 61 01 "An Act establishing an Alaska health care program to ensure insurance coverage for 02 essential health services for residents of the state, the Alaska Health Care Board to 03 administer the Alaska health care program and the Alaska health care fund, the Alaska 04 health care clearinghouse to administer the Alaska health care program under the 05 direction of the Alaska Health Care Board, and eligibility standards and premium 06 assistance for health care coverage of persons with low incomes; creating the Alaska 07 health care fund; providing for review of actions and reporting requirements related to 08 the health care program; and providing for an effective date." 09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 10 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 11 to read: 12 FINDINGS; PURPOSE. (a) The legislature finds that
01 (1) the current health care system is unsustainable; 02 (2) improving and protecting the health of Alaskans must be a primary goal of 03 the state; 04 (3) all Alaskans should have access to essential health care services that are 05 affordable, that are based on publicly debated criteria, and that consider the well-being of 06 individuals across their life spans; 07 (4) Alaska has an economic interest in ensuring equitable financing of 08 essential health care for Alaskans who do not have access to basic health care; 09 (5) health care policies should emphasize public health and encourage the use 10 of quality service and evidence-based treatment that are appropriate and safe and that 11 discourage over-treatment; 12 (6) health care providers and informed patients must be the primary decision 13 makers who are accountable for an individual's health; 14 (7) health care funding should be explicit, predictable, and economically 15 sustainable; 16 (8) an economically sustainable health care system requires that providers 17 receive fair and adequate compensation; 18 (9) health care must be balanced with other programs that also affect health; 19 and 20 (10) health care must account for the allocation of resources and the human 21 consequences of funding decisions. 22 (b) The purpose of this Act is to address the findings and concerns listed in (a) of this 23 section by creating the Alaska health care program. 24 * Sec. 2. AS 21.54 is amended by adding new sections to read: 25 Article 2A. Alaska Health Care Program. 26 Sec. 21.54.200. Alaska health care program. The Alaska health care program 27 is established to 28 (1) ensure that residents of the state have access to affordable health 29 care insurance; 30 (2) require that residents of the state have, at a minimum, insurance 31 covering essential health care services;
01 (3) reduce unsustainable health care cost increases; 02 (4) establish a system of health care insurance that integrates public 03 involvement and oversight, consumer choice, and competition within the private 04 health care insurance market; 05 (5) use models of health care insurance benefits, service delivery, and 06 payments that control costs and overuse, emphasizing preventative care and chronic 07 disease management within a primary care environment; and 08 (6) provide services for humane and dignified end-of-life care. 09 Sec. 21.54.210. Alaska Health Care Board. (a) The Alaska Health Care 10 Board is established in the division to manage the Alaska health care program. 11 (b) The board shall consist of 13 members, including 12 members appointed 12 by the governor, subject to confirmation by the legislature, and the commissioner of 13 health and social services or the commissioner's designee, serving ex officio. The 14 members of the board appointed by the governor must include 15 (1) one representative who is a licensed insurance producer; 16 (2) one representative from a health insurance company licensed to 17 transact health care insurance in the state; 18 (3) two representatives of the business community other than health 19 care insurers, one representing large businesses, and one representing small 20 businesses; 21 (4) one representative each from two Alaska hospitals; 22 (5) one representative of a labor organization; 23 (6) two physicians licensed in Alaska; 24 (7) two health care consumer advocates; and 25 (8) one registered nurse. 26 (c) Except for the commissioner or the commissioner's designee, who serves 27 ex officio, each board member serves for a term of three years beginning on January 1 28 and until a successor has been appointed. A member is eligible for reappointment. 29 (d) If there is a vacancy, the governor shall make an appointment, effective 30 immediately, for the balance of the unexpired term. 31 (e) Members of the board are entitled to per diem and transportation costs
01 under AS 39.20.180. 02 (f) The board shall select a member to serve as chair and a member to serve as 03 vice-chair for a term and with duties and powers necessary to perform their functions. 04 (g) A majority of the board constitutes a quorum for transacting business. 05 Sec. 21.54.220. Powers and duties of the Alaska Health Care Board. (a) 06 The Alaska Health Care Board shall 07 (1) administer, as a fiduciary, the Alaska health care fund established 08 under AS 21.54.280 in accordance with the Alaska health care program established by 09 AS 21.54.200 - 21.54.310; 10 (2) establish types or categories of health care insurance plans offered 11 through the Alaska health care clearinghouse; 12 (3) classify each plan offered through the clearinghouse as a 13 comprehensive or basic health care insurance plan, based on criteria including the 14 financial cost of the plan, including premium cost, deductible costs, and co-pay 15 provisions; 16 (4) establish criteria for participation by residents and insurers in the 17 Alaska health care program; 18 (5) establish an Alaska health care voucher system that provides health 19 care insurance to each individual who meets the needs-based participation criteria set 20 out in AS 21.54.240 or who is the beneficiary of contributions made to the fund that 21 specify the individual as the beneficiary under AS 21.54.280(b); 22 (6) ensure that eligible individuals are enrolled in a health care 23 insurance plan that provides essential health care services; 24 (7) prescribe the method for determining individual income for the 25 purpose of the Alaska health care program; 26 (8) establish procedures for enrolling a participant in the Alaska health 27 care program, including enrollment procedures describing when an individual may 28 enroll or select a different health insurance plan offered through the Alaska health care 29 clearinghouse; the procedures established under this paragraph must allow an 30 individual insured by a health care insurance plan offered through the Alaska health 31 care clearinghouse to select a different health care insurance plan from the plans
01 offered through the clearinghouse and to make that selection at least annually; 02 (9) require that participants receive complete information regarding the 03 cost of obtaining health care insurance; 04 (10) establish procedures for notice and hearings for a person 05 aggrieved by a decision of the board or the Alaska health care clearinghouse; and 06 (11) ensure that every Alaskan who is required to participate in the 07 Alaska health care program is offered health care insurance that protects the insured 08 from severe financial hardship caused by the cost of receiving medical care. 09 (b) The board may hold regular and special meetings as the board considers 10 necessary; board meetings may be held by teleconference; meetings shall be recorded 11 and made available on request. 12 Sec. 21.54.230. Alaska health care clearinghouse. (a) The Alaska health care 13 clearinghouse is established in the division. 14 (b) The clearinghouse shall be administered by the director. 15 (c) The clearinghouse shall 16 (1) administer the Alaska health care program under the direction of 17 the Alaska Health Care Board; 18 (2) disseminate information about health care insurance products 19 available through the clearinghouse; and 20 (3) provide assistance in the enrollment process for a small business or 21 an individual. 22 Sec. 21.54.240. Essential health care services; eligibility. (a) Every resident 23 of the state shall participate in the Alaska health care program except a resident who 24 (1) is a beneficiary of a health care plan that provides health care 25 benefits that meet or exceed the benefits for essential health care services; 26 (2) is enrolled in a publicly funded medical assistance program 27 providing services that meet or exceed the benefits required as essential health care 28 services; 29 (3) is enrolled in Medicaid or Medicare; 30 (4) is receiving health care benefits under a health benefit plan 31 regulated by 29 U.S.C. 1001 - 1461 (Employee Retirement Income Security Act of
01 1974) that meet or exceed the benefits for essential health care services; 02 (5) is an individual insured under an individual state plan of health 03 insurance under the Comprehensive Health Insurance Association under AS 21.55; 04 (6) is receiving health care benefits under a medical care program of 05 the Indian Health Service; however, a person receiving health care benefits under a 06 medical care plan of the Indian Health Service may elect to participate in the Alaska 07 health care program; 08 (7) has resided in the state for less than one year; however, a person 09 who has resided in the state for less than one year may receive services provided by 10 the Alaska health care clearinghouse under AS 21.54.230; or 11 (8) demonstrates satisfactorily to the board, under criteria established 12 by the board, that the person has deeply held religious beliefs contrary to the Alaska 13 health care program and the requirement to purchase health care insurance for 14 essential health care services. 15 (b) Except as provided in (g) of this section, the Alaska Health Care Board 16 shall provide a voucher to a resident with an income that is not more than 450 percent 17 of the most recent federal poverty guidelines, updated periodically in the Federal 18 Register by the United States Department of Health and Human Services under the 19 authority of 42 U.S.C. 9902(2), and who is only eligible for coverage through the 20 Comprehensive Health Insurance Association (AS 21.55). A voucher authorized by 21 this subsection must equalize the cost of insurance under the Comprehensive Health 22 Insurance Association with the cost of purchasing a health care insurance plan that 23 provides substantially equivalent benefits through the Alaska health care 24 clearinghouse. For purposes of cost comparison under this subsection, the board shall 25 determine whether a plan provided under the Comprehensive Health Insurance 26 Association provides substantially equivalent benefits to a health care insurance plan 27 offered through the clearinghouse. 28 (c) Except as provided in (g) of this section, a resident with an income that is 29 not more than the most recent federal poverty guidelines, updated periodically in the 30 Federal Register by the United States Department of Health and Human Services 31 under the authority of 42 U.S.C. 9902(2), who is required to participate in the Alaska
01 health care program shall receive private health care insurance coverage for essential 02 health care services at no cost, paid from the fund. 03 (d) Except as provided in (g) of this section, a resident with an income 04 between 100 percent and not more than 300 percent of the most recent federal poverty 05 guidelines, updated periodically in the Federal Register by the United States 06 Department of Health and Human Services under the authority of 42 U.S.C. 9902(2), 07 who is required to participate in the Alaska health care program shall pay premiums 08 for health care insurance for essential health care services on a sliding scale 09 established by the board. 10 (e) A resident with an income of 300 percent or more of the most recent 11 federal poverty guidelines, updated periodically in the Federal Register by the United 12 States Department of Health and Human Services under the authority of 42 U.S.C. 13 9902(2), who is required to participate in the Alaska health care program shall pay the 14 premium for health care insurance for essential health care services. 15 (f) A person who is an alien is not eligible for assistance under AS 21.54.200 - 16 21.54.310 unless the person is a qualified alien, as defined under 8 U.S.C. 1641, or an 17 alien excepted under 8 U.S.C. 1612(b). However, a qualified alien may only be 18 eligible for assistance under AS 21.54.200 - 21.54.310 if the person is not precluded 19 by the limited eligibility provision of 8 U.S.C. 1613. 20 (g) A person who is exempt from being required to participate in the Alaska 21 health care program under 22 (1) (a)(1) - (5) of this section, but who is eligible to participate in a 23 program identified in (a)(1) - (5) of this section, may not receive benefits under (b) - 24 (d) of this section. 25 (2) (a)(7) of this section may not receive benefits under (b) - (d) of this 26 section until the person has resided in the state for one year or more. 27 Sec. 21.54.250. Essential health care services. For purposes of AS 21.54.200 28 - 21.54.310, essential health care services means medical services performed for an 29 individual covered by a health care plan for the diagnosis or treatment of 30 nonoccupational disease or nonoccupational injury. The medical services that must be 31 performed for an individual covered by a health care plan include, as a minimum,
01 (1) preventative and primary care; 02 (2) emergency services; 03 (3) inpatient services and hospital treatment; 04 (4) ambulatory patient services; 05 (5) prescription drug coverage; and 06 (6) mental health services. 07 Sec. 21.54.260. Alternative or additional health care services. (a) An 08 employer may offer health insurance coverage that meets or exceeds coverage for 09 essential health care services. 10 (b) An individual or employer may purchase health care insurance for health 11 care services in addition to the essential health care services required under 12 AS 21.54.200 - 21.54.310. 13 (c) If an employer does not provide a health care insurance plan for all 14 employees or provides a health care insurance plan that meets or exceeds coverage for 15 essential health care services but does not enroll at least 25 percent of the employer's 16 employees in the plan or does not offer to pay at least 33 percent of the premium for 17 health care insurance under the plan, the employer shall pay the department as 18 follows: 19 (1) if an employer's annual gross payroll paid to employees who are 20 required to participate in the Alaska health care plan under AS 21.54.240 is $500,000 21 or less, no payment is required; 22 (2) if an employer's annual gross payroll paid to employees who are 23 required to participate in the Alaska health care plan under AS 21.54.240 is greater 24 than $500,000 but less than $1,000,000, the employer shall pay one percent of the 25 gross payroll; or 26 (3) if an employer's annual gross payroll paid to employees who are 27 required to participate in the Alaska health care program under AS 21.54.240 is 28 $1,000,000 or greater, the employer shall pay two percent of the gross payroll. 29 (d) An employer that establishes a cafeteria plan under 26 U.S.C. 125 (Internal 30 Revenue Code) that offers employees the option to elect health care insurance 31 coverage that meets or exceeds essential health care services is not subject to the
01 payment requirements under (c) of this section, regardless of whether an employee 02 elects to receive the offered health care insurance. 03 (e) In this section, "essential health care services" means those services set out 04 in AS 21.54.250. 05 Sec. 21.54.270. Health care insurance plan; children's coverage. (a) A 06 health care insurance plan that is approved by the director that provides coverage for 07 essential health care services under AS 21.54.200 - 21.54.310 and meets the other 08 requirements established under this title may be offered through the Alaska health care 09 clearinghouse. 10 (b) A health care insurance plan offered through the Alaska health care 11 clearinghouse may not deny enrollment to an eligible individual. 12 (c) A health care insurance plan offered through the Alaska health care 13 clearinghouse may include 14 (1) different benefits for network or out-of-network providers; 15 (2) varied levels of copayment, coinsurance, deductable amounts, out- 16 of-pocket maximums; 17 (3) high deductible health plans as defined by 26 U.S.C. 223(c)(2) 18 (Internal Revenue Code); and 19 (4) special insurance terms applicable only to individuals between 18 20 and 30 years of age. 21 (d) A health care insurance plan offered through the Alaska health care 22 clearinghouse that covers children must provide that the coverage will continue until 23 the earlier of the child's reaching 25 years of age or two years after the child no longer 24 resides with the family. 25 (e) Notwithstanding AS 21.54.110(a), a health care insurance plan offered 26 through the Alaska health care clearinghouse may not exclude coverage for a 27 preexisting condition that 28 (1) relates to a condition, regardless of cause, for which medical 29 advice, diagnosis, care, or treatment was recommended or received more than two 30 years before the enrollment date; 31 (2) considers genetic information as a condition for which a
01 preexisting exclusion may be imposed in the absence of a diagnosis of the condition 02 related to the genetic information; 03 (3) extends more than 12 months after the enrollment date; or 04 (4) excludes a condition relating to pregnancy. 05 (f) A period of a preexisting condition exclusion permissible under (e) of this 06 section must be reduced by the aggregate periods of creditable coverage, if any, as 07 determined under AS 21.54.120, including creditable coverage resulting from 08 participation in a plan offered through the Alaska health care clearinghouse, or a plan 09 described in AS 21.54.240(a)(1) - (6). The aggregate of periods of creditable coverage 10 is determined by adding all periods of creditable coverage before the enrollment date, 11 excluding periods of creditable coverage before a continuous break in coverage of 12 more than 90 days. This subsection does not apply if an individual's most recent 13 period of creditable coverage ended on a date more than 90 days before the enrollment 14 date. This subsection does not preclude application of a waiting period to all new 15 enrollees under a health care insurance plan. 16 Sec. 21.54.280. Alaska health care fund. (a) The Alaska health care fund is 17 established as a separate trust fund of the state. The fund consists of 18 (1) state money appropriated to the fund; 19 (2) federal money appropriated to the fund; 20 (3) private employer and employee health care contributions or fees 21 received by the department and appropriated to the fund; 22 (4) health care premiums received by the department and appropriated 23 to the fund; 24 (5) other appropriations by the legislature; 25 (6) contributions appropriated to the fund from the United States 26 government and its agencies or from any other source, public or private, provided for 27 purposes that are consistent with the goals of the Alaska health care program; and 28 (7) interest earnings from investments of the fund appropriated to the 29 fund. 30 (b) Contributions may be made to the fund by an employer, employers, or an 31 individual that is specified for a particular beneficiary. If a contribution is made to the
01 fund for the benefit of a particular beneficiary, the beneficiary shall receive a health 02 care voucher in the amount of the contribution that may be used to purchase a health 03 care insurance plan. Money collected under AS 21.54.260(c) is not considered made 04 for the benefit of a particular beneficiary. 05 (c) The board may use the fund for the purpose of administering the Alaska 06 health care program consistent with AS 21.54.200 - 21.54.310. 07 Sec. 21.54.290. Disputes and appeals. A person is entitled to notice and an 08 opportunity for a hearing under regulations adopted by the Alaska Health Care Board 09 if 10 (1) the board or the Alaska health care clearinghouse denies enrollment 11 to the person; 12 (2) an accountable health care plan refuses to enroll an individual or 13 fails to provide essential health care services; or 14 (3) the person is adversely affected or aggrieved by a decision of the 15 board or the clearinghouse. 16 Sec. 21.54.300. Reporting. The Alaska Health Care Board shall submit a 17 written report on the operation of the Alaska health care program to the commissioner 18 and to the legislature by January 1 of each year. The report must include 19 (1) the number of individuals enrolled in the Alaska health care 20 program; 21 (2) the cost savings to the state, to employers, and to health care 22 providers; 23 (3) a measure of patient satisfaction; 24 (4) an assessment of patient access to essential health care services; 25 (5) a description of the changes or adjustments made to the program 26 during the period covered by the report; 27 (6) a discussion of the state agencies delivering redundant services, if 28 any, relating to health care benefits; 29 (7) an evaluation of state programs that regulate or deliver health care 30 benefits; 31 (8) recommendations for legislative changes necessary to meet the
01 goals of the program; 02 (9) an evaluation of and recommendations on the following topics: 03 (A) the use of electronic health records; 04 (B) children's health insurance programs; 05 (C) the effectiveness of Medicaid and the potential expansion 06 of the Alaska Medicaid program, including a comparison between the costs of 07 expanding the Alaska Medicaid program and the cost of providing benefits 08 through the Alaska health care program; 09 (D) the effect of mandated benefits; 10 (E) prescription drug bargaining; 11 (F) evidence-based treatment procedures including a 12 comparison of the use of evidence-based treatment in other states; 13 (G) the recruitment and retention of medical professionals in 14 the state; 15 (H) expanding offerings of the University of Alaska in medical 16 fields; 17 (I) maximizing federal funding to implement the program; 18 (J) innovations that could produce health care cost savings, 19 including waivers under 42 U.S.C. 1315 (sec. 1115, Social Security Act), 20 which allows experimental, pilot, or demonstration projects likely to assist in 21 promoting the objectives of the Medicaid statute. 22 Sec. 21.54.310. Regulations. The Alaska Health Care Board shall adopt 23 regulations under AS 44.62 (Administrative Procedure Act) consistent with 24 AS 21.54.200 - 21.54.310. 25 * Sec. 3. AS 21.54.500 is amended by adding new paragraphs to read: 26 (30) "alien" means a person who is not a citizen or national of the 27 United States; 28 (31) "board" means the Alaska Health Care Board; 29 (32) "fund" means the Alaska health care fund; 30 (33) "resident" has the meaning given in AS 01.10.055. 31 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to
01 read: 02 TRANSITIONAL PROVISIONS. Notwithstanding AS 21.54.210, enacted by sec. 2 03 of this Act, the initial terms for members of the Alaska Health Care Board, except for the 04 commissioner of health of social services who serves ex officio, are as follows: 05 (1) four members shall be appointed to serve for a term ending December 31, 06 2010; 07 (2) four members shall be appointed to serve for a term ending December 31, 08 2011; and 09 (3) the remaining members shall be appointed to serve for a term ending 10 December 31, 2012. 11 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 12 read: 13 TRANSITIONAL PROVISIONS: REGULATIONS. The Alaska Health Care Board 14 established under AS 21.54.210, enacted by sec. 2 of this Act, may proceed to adopt 15 regulations necessary to implement this Act under AS 21.54.310, enacted by sec. 2 of this 16 Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not 17 before the effective date of the statutory changes. 18 * Sec. 6. AS 21.54.210, 21.54.220, and 21.54.230, enacted by sec. 2 of this Act, and sec. 5 19 of this Act take effect immediately under AS 01.10.070(c). 20 * Sec. 7. Except as provided in sec. 6 of this Act, this Act takes effect January 1, 2010.