CSSB 74(FIN) am: "An Act relating to diagnosis, treatment, and prescription of drugs without a physical examination by a physician; relating to the delivery of services by a licensed professional counselor, marriage and family therapist, psychologist, psychological associate, and social worker by audio, video, or data communications; relating to the duties of the State Medical Board; relating to limitations of actions; establishing the Alaska Medical Assistance False Claim and Reporting Act; relating to medical assistance programs administered by the Department of Health and Social Services; relating to the controlled substance prescription database; relating to the duties of the Board of Pharmacy; relating to the duties of the Department of Commerce, Community, and Economic Development; relating to accounting for program receipts; relating to public record status of records related to the Alaska Medical Assistance False Claim and Reporting Act; establishing a telemedicine business registry; relating to competitive bidding for medical assistance products and services; relating to verification of eligibility for public assistance programs administered by the Department of Health and Social Services; relating to annual audits of state medical assistance providers; relating to reporting overpayments of medical assistance payments; establishing authority to assess civil penalties for violations of medical assistance program requirements; relating to seizure and forfeiture of property for medical assistance fraud; relating to the duties of the Department of Health and Social Services; establishing medical assistance demonstration projects; relating to Alaska Pioneers' Homes and Alaska Veterans' Homes; relating to the duties of the Department of Administration; relating to the Alaska Mental Health Trust Authority; relating to feasibility studies for the provision of specified state services; amending Rules 4, 5, 7, 12, 24, 26, 27, 41, 77, 79, 82, and 89, Alaska Rules of Civil Procedure, and Rule 37, Alaska Rules of Criminal Procedure; and providing for an effective date."
00 CS FOR SENATE BILL NO. 74(FIN) am 01 "An Act relating to diagnosis, treatment, and prescription of drugs without a physical 02 examination by a physician; relating to the delivery of services by a licensed professional 03 counselor, marriage and family therapist, psychologist, psychological associate, and 04 social worker by audio, video, or data communications; relating to the duties of the State 05 Medical Board; relating to limitations of actions; establishing the Alaska Medical 06 Assistance False Claim and Reporting Act; relating to medical assistance programs 07 administered by the Department of Health and Social Services; relating to the controlled 08 substance prescription database; relating to the duties of the Board of Pharmacy; 09 relating to the duties of the Department of Commerce, Community, and Economic 10 Development; relating to accounting for program receipts; relating to public record 11 status of records related to the Alaska Medical Assistance False Claim and Reporting 12 Act; establishing a telemedicine business registry; relating to competitive bidding for
01 medical assistance products and services; relating to verification of eligibility for public 02 assistance programs administered by the Department of Health and Social Services; 03 relating to annual audits of state medical assistance providers; relating to reporting 04 overpayments of medical assistance payments; establishing authority to assess civil 05 penalties for violations of medical assistance program requirements; relating to seizure 06 and forfeiture of property for medical assistance fraud; relating to the duties of the 07 Department of Health and Social Services; establishing medical assistance 08 demonstration projects; relating to Alaska Pioneers' Homes and Alaska Veterans' 09 Homes; relating to the duties of the Department of Administration; relating to the 10 Alaska Mental Health Trust Authority; relating to feasibility studies for the provision of 11 specified state services; amending Rules 4, 5, 7, 12, 24, 26, 27, 41, 77, 79, 82, and 89, 12 Alaska Rules of Civil Procedure, and Rule 37, Alaska Rules of Criminal Procedure; and 13 providing for an effective date." 14 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 15 * Section 1. AS 08.29.400 is amended by adding new subsections to read: 16 (b) The board may not impose disciplinary sanctions on a licensee for the 17 evaluation, diagnosis, or treatment of a person through audio, video, or data 18 communications when physically separated from the person if 19 (1) the licensee or another licensed health care provider is available to 20 provide follow-up care; 21 (2) the licensee requests that the person consent to sending a copy of 22 all records of the encounter to a primary care provider if the licensee is not the 23 person's primary care provider and, if the person consents, the licensee sends the 24 records to the person's primary care provider; and 25 (3) the licensee meets the requirements established by the board in 26 regulation.
01 (c) The board shall adopt regulations restricting the evaluation, diagnosis, 02 supervision, and treatment of a person as authorized under (b) of this section by 03 establishing standards of care, including standards for training, confidentiality, 04 supervision, practice, and related issues. 05 * Sec. 2. AS 08.63.210 is amended by adding new subsections to read: 06 (c) The board may not impose disciplinary sanctions on a licensee for the 07 evaluation, diagnosis, supervision, or treatment of a person through audio, video, or 08 data communications when physically separated from the person if 09 (1) the licensee or another licensed health care provider is available to 10 provide follow-up care; 11 (2) the licensee requests that the person consent to sending a copy of 12 all records of the encounter to a primary care provider if the licensee is not the 13 person's primary care provider and, if the person consents, the licensee sends the 14 records to the person's primary care provider; and 15 (3) the licensee meets the requirements established by the board in 16 regulation. 17 (d) The board shall adopt regulations restricting the evaluation, diagnosis, 18 supervision, and treatment of a person as authorized under (c) of this section by 19 establishing standards of care, including standards for training, confidentiality, 20 supervision, practice, and related issues. 21 * Sec. 3. AS 08.64.101 is amended to read: 22 Sec. 08.64.101. Duties. The board shall 23 (1) examine and issue licenses to applicants; 24 (2) develop written guidelines to ensure that licensing requirements are 25 not unreasonably burdensome and the issuance of licenses is not unreasonably 26 withheld or delayed; 27 (3) after a hearing, impose disciplinary sanctions on persons who 28 violate this chapter or the regulations or orders of the board; 29 (4) adopt regulations ensuring that renewal of licenses is contingent on 30 [UPON] proof of continued competency on the part of the licensee; and 31 (5) under regulations adopted by the board, contract with private
01 professional organizations to establish an impaired medical professionals program to 02 identify, confront, evaluate, and treat persons licensed under this chapter who abuse 03 alcohol, other drugs, or other substances or are mentally ill or cognitively impaired; 04 (6) adopt regulations that establish guidelines for a physician who 05 is rendering a diagnosis, providing treatment, or prescribing, dispensing, or 06 administering a prescription drug to a person without conducting a physical 07 examination under AS 08.64.364; the guidelines must include a nationally 08 recognized model policy for standards of care of a patient who is at a different 09 location than the physician. 10 * Sec. 4. AS 08.64.364(a) is amended to read: 11 (a) The board may not impose disciplinary sanctions on a physician for 12 rendering a diagnosis, providing treatment, or prescribing, dispensing, or 13 administering a prescription drug that is not a controlled substance to a person 14 without conducting a physical examination if 15 (1) [THE PRESCRIPTION DRUG IS 16 (A) NOT A CONTROLLED SUBSTANCE; OR 17 (B) A CONTROLLED SUBSTANCE AND IS PRESCRIBED, 18 DISPENSED, OR ADMINISTERED BY A PHYSICIAN WHEN AN 19 APPROPRIATE LICENSED HEALTH CARE PROVIDER IS PRESENT 20 WITH THE PATIENT TO ASSIST THE PHYSICIAN WITH 21 EXAMINATION, DIAGNOSIS, AND TREATMENT; 22 (2) THE PHYSICIAN IS LOCATED IN THIS STATE AND] the 23 physician or another licensed health care provider or physician in the physician's 24 group practice is available to provide follow-up care; and 25 (2) the physician requests that [(3)] the person consent 26 [CONSENTS] to sending a copy of all records of the encounter to the person's primary 27 care provider if the prescribing physician is not the person's primary care provider, 28 and, if the patient consents, the physician sends the records to the person's primary 29 care provider. 30 * Sec. 5. AS 08.64.364 is amended by adding new subsections to read: 31 (c) The board may not impose disciplinary sanctions on a physician for
01 prescribing, dispensing, or administering a prescription drug that is a controlled 02 substance or botulinum toxin if the requirements under (a) of this section are met and 03 the physician prescribes, dispenses, or administers the controlled substance or 04 botulinum toxin when an appropriate licensed health care provider is present with the 05 patient to assist the physician with examination, diagnosis, and treatment. 06 (d) Notwithstanding (a) and (c) of this section, a physician may not 07 (1) prescribe, dispense, or administer an abortion-inducing drug under 08 (a) of this section unless the physician complies with AS 18.16.010; or 09 (2) prescribe, dispense, or administer a prescription drug in response to 10 an Internet questionnaire or electronic mail message to a person with whom the 11 physician does not have a prior physician-patient relationship. 12 * Sec. 6. AS 08.86.204 is amended by adding new subsections to read: 13 (c) The board may not impose disciplinary sanctions on a licensee for the 14 evaluation, diagnosis, or treatment of a person through audio, video, or data 15 communications when physically separated from the person if 16 (1) the licensee or another licensed health care provider is available to 17 provide follow-up care; 18 (2) the licensee requests that the person consent to sending a copy of 19 all records of the encounter to a primary care provider if the licensee is not the 20 person's primary care provider and, if the person consents, the licensee sends the 21 records to the person's primary care provider; and 22 (3) the licensee meets the requirements established by the board in 23 regulation. 24 (d) The board shall adopt regulations restricting the evaluation, diagnosis, 25 supervision, and treatment of a person as authorized under (c) of this section by 26 establishing standards of care, including standards for training, confidentiality, 27 supervision, practice, and related issues. 28 * Sec. 7. AS 08.95.050 is amended by adding new subsections to read: 29 (b) The board may not impose disciplinary sanctions on a licensee for the 30 evaluation, diagnosis, or treatment of a person through audio, video, or data 31 communications when physically separated from the person if
01 (1) the licensee or another licensed health care provider is available to 02 provide follow-up care; 03 (2) the licensee requests that the person consent to sending a copy of 04 all records of the encounter to a primary care provider if the licensee is not the 05 person's primary care provider and, if the person consents, the licensee sends the 06 records to the person's primary care provider; and 07 (3) the licensee meets the requirements established by the board in 08 regulation. 09 (c) The board shall adopt regulations restricting the evaluation, diagnosis, 10 supervision, and treatment of a person as authorized under (b) of this section by 11 establishing standards of care, including standards for training, confidentiality, 12 supervision, practice, and related issues. 13 * Sec. 8. AS 09.10 is amended by adding a new section to read: 14 Sec. 09.10.075. Actions related to claims based on medical assistance 15 payment fraud. Except as provided in AS 09.58.070, a person may not bring an 16 action under AS 09.58.010 - 09.58.060, unless the action is commenced by the earlier 17 of (1) six years after the act or omission was committed, or (2) three years after the 18 date when facts material to the action were known, or reasonably should have been 19 known, by the attorney general or the Department of Health and Social Services, but 20 in no event more than 10 years after the date the violation under AS 09.58.010 21 occurred. 22 * Sec. 9. AS 09.10.120(a) is amended to read: 23 (a) Except as provided in AS 09.10.075, an [AN] action brought in the name 24 of or for the benefit of the state, any political subdivision, or public corporation may 25 be commenced only within six years after [OF] the date of accrual of the cause of 26 action. However, if the action is for relief on the ground of fraud, the limitation 27 commences from the time of discovery by the aggrieved party of the facts constituting 28 the fraud. 29 * Sec. 10. AS 09 is amended by adding a new chapter to read: 30 Chapter 58. Alaska Medical Assistance False Claim and Reporting Act. 31 Sec. 09.58.010. False claims for medical assistance; civil penalty. (a) A
01 medical assistance provider or medical assistance recipient may not 02 (1) knowingly submit, authorize, or cause to be submitted to an officer 03 or employee of the state a false or fraudulent claim for payment or approval under the 04 medical assistance program; 05 (2) knowingly make, use, or cause to be made or used, directly or 06 indirectly, a false record or statement to get a false or fraudulent claim for payment 07 paid or approved by the state under the medical assistance program; 08 (3) conspire to defraud the state by getting a false or fraudulent claim 09 paid or approved under the medical assistance program; 10 (4) knowingly make, use, or cause to be made or used, a false record or 11 statement to conceal, avoid, increase, or decrease an obligation to pay or transmit 12 money or property to the medical assistance program; 13 (5) knowingly enter into an agreement, contract, or understanding with 14 an officer or employee of the state for approval or payment of a claim under the 15 medical assistance program knowing that the information in the agreement, contract, 16 or understanding is false or fraudulent. 17 (b) A beneficiary of an intentional or inadvertent submission of a false or 18 fraudulent claim under the medical assistance program who later discovers the claim is 19 false or fraudulent shall disclose the false or fraudulent claim to the state not later than 20 60 days after discovering the false claim. 21 (c) In addition to any criminal penalties or seizure or forfeiture of property 22 under AS 47.05, a medical assistance provider or medical assistance recipient who 23 violates (a) or (b) of this section shall be liable to the state in a civil action for 24 (1) a civil penalty of not less than $5,500 and not more than $11,000; 25 (2) three times the amount of actual damages sustained by the state; 26 and 27 (3) reasonable attorney fees and costs calculated under applicable court 28 rules. 29 (d) Liability for actual damages under (c) of this section may be reduced to not 30 less than twice the amount of actual damages that the state sustains if the court finds 31 that a person liable for an act under (a) or (b) of this section
01 (1) furnished the attorney general or the Department of Health and 02 Social Services with all information known to the person about the violation not later 03 than 30 days after the date the information was obtained; 04 (2) fully cooperated with the investigation of the violation under 05 AS 09.58.020; and 06 (3) at the time the person furnished the attorney general with the 07 information about the violation, no criminal prosecution, civil action, investigation, or 08 administrative action had been started in this state with respect to the violation, and the 09 person did not have actual knowledge of the existence of an investigation of the 10 violation. 11 (e) A corporation, partnership, or other individual is liable under this chapter 12 for acts of its agents if the agent acted with apparent authority, regardless of whether 13 the agent acted, in whole or in part, to benefit the principal and regardless of whether 14 the principal adopted or ratified the agent's claims, representations, statement, or other 15 action or conduct. 16 Sec. 09.58.015. Attorney general investigation; civil action. (a) The attorney 17 general or the Department of Health and Social Services may investigate an alleged 18 violation of AS 09.58.010. The attorney general may request assistance from the 19 Department of Health and Social Services in an investigation under this section. 20 (b) The attorney general may bring a civil action in superior court under 21 AS 09.58.010 - 09.58.060. 22 Sec. 09.58.020. Private plaintiff; civil action. (a) Notwithstanding 23 AS 09.58.015, a person may bring an action under this section for a violation of 24 AS 09.58.010 in the name of the person and the state. 25 (b) To bring an action under this section, a person shall file a complaint, in 26 camera and under seal, and serve on the attorney general 27 (1) a copy of the complaint; and 28 (2) written disclosure of substantially all material evidence and 29 information the person possesses that pertains to the claim. 30 (c) A complaint filed under this section must remain under seal for at least 60 31 days and may not be served on the defendant until the court so orders. The attorney
01 general may elect to intervene and proceed with the action within 60 days after the 02 attorney general receives both the complaint and the material evidence and the 03 information required under (b) of this section. The attorney general may, for good 04 cause shown, move the court, under seal, for an extension of the time during which the 05 complaint remains under seal under this subsection. 06 (d) Before the expiration of the 60-day period or an extension of time granted 07 under (c) of this section, the attorney general shall conduct an investigation and make 08 a written determination as to whether substantial evidence exists that a violation of 09 AS 09.58.010 has occurred. After the investigation and determination are complete, 10 the attorney general shall provide the person who brought the action and the 11 Department of Health and Social Services with a copy of the determination unless the 12 action has been referred to the division of the Department of Law that has 13 responsibility for criminal cases. 14 (e) Before the expiration of the 60-day period or an extension obtained under 15 (c) of this section, the attorney general shall 16 (1) intervene in the action and proceed with the action on behalf of the 17 state; 18 (2) notify the court that the attorney general declines to take over the 19 action, in which case the person bringing the action has the right to conduct the action; 20 or 21 (3) if the attorney general determines that substantial evidence does not 22 exist that a violation of AS 09.58.010 has occurred, or that the action is barred under 23 AS 09.58.050, the attorney general shall move the court to dismiss the action. 24 (f) The named defendant in a complaint filed under this section is not required 25 to respond to a complaint filed under this section until after the complaint is unsealed 26 by the court and a copy of the summons and complaint are served on the defendant 27 under the applicable Alaska Rules of Civil Procedure. 28 (g) When a person brings an action under this section, only the attorney 29 general may intervene or bring a related action based on similar facts to the underlying 30 action. 31 Sec. 09.58.025. Subpoenas. In conducting an investigation under
01 AS 09.58.015 or 09.58.020, the attorney general may issue subpoenas to compel the 02 production of books, papers, correspondence, memoranda, and other records in 03 connection with an investigation under or the administration of AS 09.58.010 - 04 09.58.060. If a medical assistance provider or a medical assistance recipient fails or 05 refuses, without just cause, to obey a subpoena issued under this subsection, the 06 superior court may, upon application by the attorney general, issue an order requiring 07 the medical assistance provider or medical assistance recipient to appear before the 08 attorney general to produce evidence. 09 Sec. 09.58.030. Rights in false or fraudulent claims actions. (a) If the 10 attorney general elects to intervene and proceed with an action under AS 09.58.020, 11 the attorney general has exclusive authority for prosecuting the action and is not bound 12 by an act of the person bringing the action. The person who brought the action has the 13 right to continue as a nominal party to the action, but does not have the right to 14 participate in the action except as a witness or as otherwise directed by the attorney 15 general. If the attorney general elects to intervene under AS 09.58.020, the attorney 16 general may file a new complaint or amend the complaint filed by the person who 17 brought the action under AS 09.58.020(b). 18 (b) Notwithstanding the objections of the person who brought the action, the 19 attorney general may 20 (1) move to dismiss the action at any time under this chapter if the 21 attorney general has notified the person who brought the action of the intent to seek 22 dismissal and the court has provided the person who brought the action with an 23 opportunity to respond to the motion; 24 (2) settle the action with the defendant at any time, if the court 25 determines, after a hearing, that the proposed settlement is fair, adequate, and 26 reasonable under all the circumstances; upon a showing of good cause, the hearing 27 described in this paragraph shall be held in camera. 28 (c) If the attorney general elects not to proceed under AS 09.58.020 with the 29 action, the person who brought the action has the right to proceed and conduct the 30 action. The attorney general may request at any time during the proceedings to be 31 served with copies of all documents related to the action, including pleadings,
01 motions, and discovery. The attorney general shall pay for the reasonable copying 02 charges for documents provided under this subsection. If the person who brought the 03 action proceeds with the action, the court, without limiting the status and rights of the 04 person who brought the action, shall allow the attorney general to intervene at any 05 time. 06 (d) Whether or not the attorney general proceeds with the action under this 07 chapter, on a showing by the attorney general that certain actions of discovery by the 08 person bringing the action would interfere with pending investigation or prosecution 09 of a criminal or civil proceeding arising out of the same matter, the court may stay the 10 discovery for not more than 90 days. The court may extend the 90-day period on a 11 further showing, in camera, that the state has pursued the criminal or civil 12 investigation or proceedings with reasonable diligence and that proposed discovery in 13 the civil action under AS 09.58.010 - 09.58.060 may interfere with the ongoing 14 criminal or civil investigation or proceedings. 15 Sec. 09.58.040. Award to false or fraudulent claim plaintiff. (a) If the 16 attorney general proceeds with an action brought by a person for a violation of 17 AS 09.58.010, the person who brought the action shall receive at least 15 percent but 18 not more than 25 percent of the proceeds of the action or settlement of the claim, 19 depending on the extent to which the person bringing the action contributed to the 20 prosecution of the action. The court order or settlement agreement shall state the 21 percentage and the amount to be received by the person who brought the action. A 22 payment under this subsection to the person who brought the action may only be paid 23 from proceeds received from a judgment or settlement under this section. 24 (b) If the attorney general does not proceed with an action brought under 25 AS 09.58.020, the person bringing the action to judgment or settlement by court order 26 shall receive an amount that the court decides is reasonable for collecting the civil 27 penalty and damages based on the person's effort to prosecute the action successfully. 28 The amount shall be at least 25 percent but not more than 30 percent of the proceeds 29 of the action or settlement of the claim. A payment under this subsection to the person 30 who brought the action may only be paid from proceeds received from a judgment or 31 settlement received under this section.
01 (c) Whether or not the attorney general participates in the action, if the court 02 finds that the action was brought by a person who planned or initiated the violation 03 alleged in the action brought under AS 09.58.020, the court may, to the extent the 04 court considers appropriate, reduce the share of the proceeds of the action that the 05 person would otherwise receive under (a) or (b) of this section, taking into account the 06 role of that person in advancing the case to litigation and any relevant circumstances 07 pertaining to the violation. If the person bringing the action is convicted of criminal 08 conduct arising from the person's role in the violation of AS 09.58.010, the court shall 09 dismiss the person from the civil action and the person may not receive any share of 10 the proceeds of the action or settlement. A dismissal under this subsection does not 11 prejudice the right of the attorney general to continue the action. 12 (d) In this section, "proceeds of the action or settlement" 13 (1) includes damages, civil penalties, payment for cost of compliance, 14 and other economic benefits realized by the state as a result of a civil action brought 15 under AS 09.58.010 - 09.58.060; 16 (2) does not include attorney fees and costs awarded to the state. 17 Sec. 09.58.050. Certain actions barred. A person may not bring an action 18 under AS 09.58.020 if the action is 19 (1) based on evidence or information known to the state when the 20 action was brought; 21 (2) based on allegations or transactions that are the subject of a civil or 22 criminal action or an administrative proceeding in which the state is already a party; 23 (3) based on the public disclosure of allegations or actions in a 24 criminal or civil action or an administrative hearing, or from the news media, unless 25 the action is brought by the attorney general or the person bringing the action is an 26 original source of the information that was publicly disclosed; in this paragraph, a 27 person is an original source of the information that was publicly disclosed if the 28 person has independent knowledge, including knowledge based on personal 29 investigation of the defendant's conduct, of the information on which the allegations 30 are based, and has voluntarily provided or verified the information on which the 31 allegations are based or voluntarily provided the information to the attorney general
01 before filing an action under AS 09.58.020 that is based on the information; or 02 (4) against the state or current or former state employees. 03 Sec. 09.58.060. State not liable for attorney fees, costs, and other expenses. 04 The state, its agencies, current or former officers, and current or former employees, are 05 not liable for attorney fees, costs, and other expenses that a person incurs in bringing 06 an action under AS 09.58.020. 07 Sec. 09.58.070. Employee protection for retaliation. (a) An employee of a 08 medical assistance provider who is discharged, demoted, suspended, threatened, 09 harassed, or discriminated against in the terms and conditions of employment by the 10 employee's employer because of lawful acts done by the employee on behalf of the 11 employee or others in furtherance of an action under AS 09.58.010 - 09.58.060, 12 including investigation for, initiation of, testimony for or assistance in an action filed 13 or to be filed under AS 09.58.010 - 09.58.060, is entitled to the same relief authorized 14 under AS 39.90.120. 15 (b) Notwithstanding (a) of this section, a state employee who is discharged, 16 demoted, suspended, threatened, harassed, or discriminated against in the terms and 17 conditions of employment because of lawful acts done by the employee on behalf of 18 the employee or a person who brings an action under AS 09.58.020 or in furtherance 19 of an action under AS 09.58.010 - 09.58.060, including investigation, initiation of, 20 testimony for or assistance in an action filed or to be filed under AS 09.58.010 - 21 09.58.060, is entitled to relief under AS 39.90.100 - 39.90.150 (Alaska Whistleblower 22 Act). 23 (c) A person may not bring an action under this section unless the action is 24 commenced not later than three years after the date the employee was subject to 25 retaliation under (a) or (b) of this section. 26 Sec. 09.58.080. Regulations. The attorney general may adopt regulations 27 under AS 44.62 as necessary to carry out the purposes of this chapter. 28 Sec. 09.58.090. Special provisions. (a) This chapter does not apply to any 29 controversy involving damages to the state of less than $5,500 in value. 30 (b) No punitive damages may be awarded in an action brought under 31 AS 09.58.010 - 09.58.060.
01 Sec. 09.58.100. Definitions. In this chapter, 02 (1) "attorney general" includes a designee of the attorney general; 03 (2) "claim" means a request for payment of health care services or 04 equipment, whether made to a contractor, grantee, or other person, when the state 05 provides, directly or indirectly, a portion of the money, property, or services requested 06 or demanded, or when the state will, directly or indirectly, reimburse the contractor, 07 grantee, or other recipient for a portion of the money, property, or services requested 08 or demanded; 09 (3) "controversy" means the aggregate of one or more false claims 10 submitted by the same medical assistance provider or medical assistance recipient 11 under this chapter; 12 (4) "knowingly" means that a person, with or without specific intent to 13 defraud, 14 (A) has actual knowledge of the information; 15 (B) acts in deliberate ignorance of the truth or falsity of the 16 information; or 17 (C) acts in reckless disregard of the truth or falsity of the 18 information; 19 (5) "medical assistance program" means the federal-state program 20 administered by the Department of Health and Social Services under AS 47.05 and 21 AS 47.07 and regulations adopted under AS 47.05 and AS 47.07; 22 (6) "medical assistance provider" has the meaning given under 23 AS 47.05.290; 24 (7) "medical assistance recipient" has the meaning given under 25 AS 47.05.290; 26 (8) "obligation" means an established duty, whether or not fixed, 27 arising from 28 (A) an express or implied contractual grantor or grantee or 29 licensor or licensee relationship; 30 (B) a fee-based or similar relationship; 31 (C) a statute or regulation; or
01 (D) the retention of any overpayment. 02 Sec. 09.58.110. Short title. This chapter may be cited as the Alaska Medical 03 Assistance False Claim and Reporting Act. 04 * Sec. 11. AS 09.58.025, added by sec. 10 of this Act, is amended to read: 05 Sec. 09.58.025. Subpoenas. In conducting an investigation under 06 AS 09.58.015 [OR 09.58.020], the attorney general may issue subpoenas to compel 07 the production of books, papers, correspondence, memoranda, and other records in 08 connection with an investigation under or the administration of AS 09.58.010 - 09 09.58.060. If a medical assistance provider or a medical assistance recipient fails or 10 refuses, without just cause, to obey a subpoena issued under this subsection, the 11 superior court may, upon application by the attorney general, issue an order requiring 12 the medical assistance provider or medical assistance recipient to appear before the 13 attorney general to produce evidence. 14 * Sec. 12. AS 09.58.070(b), added by sec. 10 of this Act, is amended to read: 15 (b) Notwithstanding (a) of this section, a state employee who is discharged, 16 demoted, suspended, threatened, harassed, or discriminated against in the terms and 17 conditions of employment because of lawful acts done by the employee on behalf of 18 the employee [OR A PERSON WHO BRINGS AN ACTION UNDER AS 09.58.020] 19 or in furtherance of an action under AS 09.58.010 - 09.58.060, including investigation, 20 initiation of, testimony for or assistance in an action filed or to be filed under 21 AS 09.58.010 - 09.58.060, is entitled to relief under AS 39.90.100 - 39.90.150 (Alaska 22 Whistleblower Act). 23 * Sec. 13. AS 17.30.200(a) is amended to read: 24 (a) The controlled substance prescription database is established in the Board 25 of Pharmacy. The purpose of the database is to contain data as described in this 26 section regarding every prescription for a schedule [IA, IIA, IIIA, IVA, OR VA 27 CONTROLLED SUBSTANCE UNDER STATE LAW OR A SCHEDULE I,] II, III, 28 or IV [, OR V] controlled substance under federal law dispensed in the state to a 29 person other than those administered to a patient at a health care facility. The 30 Department of Commerce, Community, and Economic Development shall assist the 31 board and provide necessary staff and equipment to implement this section.
01 * Sec. 14. AS 17.30.200(b) is amended to read: 02 (b) The pharmacist-in-charge of each licensed or registered pharmacy, 03 regarding each schedule [IA, IIA, IIIA, IVA, OR VA CONTROLLED SUBSTANCE 04 UNDER STATE LAW OR A SCHEDULE I,] II, III, or IV [, OR V] controlled 05 substance under federal law dispensed by a pharmacist under the supervision of the 06 pharmacist-in-charge, and each practitioner who directly dispenses a schedule [IA, 07 IIA, IIIA, IVA, OR VA CONTROLLED SUBSTANCE UNDER STATE LAW OR A 08 SCHEDULE I,] II, III, or IV [, OR V] controlled substance under federal law other 09 than those administered to a patient at a health care facility, shall submit to the board, 10 by a procedure and in a format established by the board, the following information for 11 inclusion in the database on at least a weekly basis: 12 (1) the name of the prescribing practitioner and the practitioner's 13 federal Drug Enforcement Administration registration number or other appropriate 14 identifier; 15 (2) the date of the prescription; 16 (3) the date the prescription was filled and the method of payment; this 17 paragraph does not authorize the board to include individual credit card or other 18 account numbers in the database; 19 (4) the name, address, and date of birth of the person for whom the 20 prescription was written; 21 (5) the name and national drug code of the controlled substance; 22 (6) the quantity and strength of the controlled substance dispensed; 23 (7) the name of the drug outlet dispensing the controlled substance; 24 and 25 (8) the name of the pharmacist or practitioner dispensing the controlled 26 substance and other appropriate identifying information. 27 * Sec. 15. AS 17.30.200(d) is amended to read: 28 (d) The database and the information contained within the database are 29 confidential, are not public records, and are not subject to public disclosure. The board 30 shall undertake to ensure the security and confidentiality of the database and the 31 information contained within the database. The board may allow access to the
01 database only to the following persons, and in accordance with the limitations 02 provided and regulations of the board: 03 (1) personnel of the board regarding inquiries concerning licensees or 04 registrants of the board or personnel of another board or agency concerning a 05 practitioner under a search warrant, subpoena, or order issued by an administrative law 06 judge or a court; 07 (2) authorized board personnel or contractors as required for 08 operational and review purposes; 09 (3) a licensed practitioner having authority to prescribe controlled 10 substances or an agent or employee of the practitioner whom the practitioner has 11 authorized to access the database on the practitioner's behalf, to the extent the 12 information relates specifically to a current patient of the practitioner to whom the 13 practitioner is prescribing or considering prescribing a controlled substance; 14 (4) a licensed or registered pharmacist having authority to dispense 15 controlled substances or an agent or employee of the pharmacist whom the 16 pharmacist has authorized to access the database on the pharmacist's behalf, to 17 the extent the information relates specifically to a current patient to whom the 18 pharmacist is dispensing or considering dispensing a controlled substance; 19 (5) federal, state, and local law enforcement authorities may receive 20 printouts of information contained in the database under a search warrant, subpoena, 21 or order issued by a court establishing probable cause for the access and use of the 22 information; [AND] 23 (6) an individual who is the recipient of a controlled substance 24 prescription entered into the database may receive information contained in the 25 database concerning the individual on providing evidence satisfactory to the board that 26 the individual requesting the information is in fact the person about whom the data 27 entry was made and on payment of a fee set by the board under AS 37.10.050 that 28 does not exceed $10; 29 (7) a licensed pharmacist employed by the Department of Health 30 and Social Services who is responsible for administering prescription drug 31 coverage for the medical assistance program under AS 47.07, to the extent that
01 the information relates specifically to prescription drug coverage under the 02 program; 03 (8) a licensed pharmacist, licensed practitioner, or authorized 04 employee of the Department of Health and Social Services responsible for 05 utilization review of prescription drugs for the medical assistance program under 06 AS 47.07, to the extent that the information relates specifically to utilization 07 review of prescription drugs provided to recipients of medical assistance; 08 (9) the state medical examiner, to the extent that the information 09 relates specifically to investigating the cause and manner of a person's death; and 10 (10) an authorized employee of the Department of Health and 11 Social Services may receive information from the database that does not disclose 12 the identity of a patient, prescriber, dispenser, or dispenser location, for the 13 purpose of identifying and monitoring public health issues in the state; however, 14 the information provided under this paragraph may include the region of the 15 state in which a patient, prescriber, and dispenser are located and the specialty of 16 the prescriber. 17 * Sec. 16. AS 17.30.200(e) is amended to read: 18 (e) The failure of a pharmacist-in-charge, pharmacist, or practitioner to 19 register or submit information to the database as required under this section is 20 grounds for the board to take disciplinary action against the license or registration of 21 the pharmacy or pharmacist or for another licensing board to take disciplinary action 22 against a practitioner. 23 * Sec. 17. AS 17.30.200(h) is amended to read: 24 (h) An individual who has submitted information to the database in 25 accordance with this section may not be held civilly liable for having submitted the 26 information. [NOTHING IN THIS SECTION REQUIRES OR OBLIGATES A 27 DISPENSER OR PRACTITIONER TO ACCESS OR CHECK THE DATABASE 28 BEFORE DISPENSING, PRESCRIBING, OR ADMINISTERING A 29 MEDICATION, OR PROVIDING MEDICAL CARE TO A PERSON.] Dispensers or 30 practitioners may not be held civilly liable for damages for accessing or failing to 31 access the information in the database.
01 * Sec. 18. AS 17.30.200(k) is amended to read: 02 (k) In the regulations adopted under this section, the board shall provide 03 (1) that prescription information in the database [SHALL] be purged 04 from the database after two years have elapsed from the date the prescription was 05 dispensed; 06 (2) a method for an individual to challenge information in the database 07 about the individual that the person believes is incorrect or was incorrectly entered by 08 a dispenser; 09 (3) a procedure and time frame for registration with the database; 10 (4) that a pharmacist or practitioner review the information in the 11 database to check a patient's prescription records before dispensing, prescribing, 12 or administering a controlled substance to the patient; the regulations must 13 provide that a pharmacist or practitioner is not required to review the 14 information in the database before dispensing, prescribing, or administering a 15 controlled substance to a person who is receiving treatment 16 (A) in an inpatient setting; 17 (B) at the scene of an emergency or in an ambulance; in this 18 subparagraph, "ambulance" has the meaning given in AS 18.08.200; 19 (C) in an emergency room; or 20 (D) immediately before, during, or within the first 24 hours 21 after surgery. 22 * Sec. 19. AS 17.30.200 is amended by adding new subsections to read: 23 (o) A pharmacist who dispenses or a practitioner who prescribes, administers, 24 or directly dispenses a schedule II, III, or IV controlled substance under federal law 25 shall register with the database by a procedure and in a format established by the 26 board. 27 (p) The board shall promptly notify the State Medical Board, the Board of 28 Nursing, the Board of Dental Examiners, and the Board of Examiners in Optometry 29 when a practitioner registers with the database under (o) of this section. 30 (q) The board is authorized to provide unsolicited notification to a pharmacist 31 or practitioner if a patient has received one or more prescriptions for controlled
01 substances in quantities or with a frequency inconsistent with generally recognized 02 standards of safe practice. 03 (r) The board shall update the database on at least a weekly basis with the 04 information submitted to the board under (b) of this section. 05 * Sec. 20. AS 37.05.146(c) is amended by adding a new paragraph to read: 06 (88) monetary recoveries under AS 09.58 (Alaska Medical Assistance 07 False Claim and Reporting Act). 08 * Sec. 21. AS 40.25.120(a) is amended by adding a new paragraph to read: 09 (15) records relating to proceedings under AS 09.58 (Alaska Medical 10 Assistance False Claim and Reporting Act). 11 * Sec. 22. AS 44.33 is amended by adding a new section to read: 12 Article 5A. Telemedicine Business Registry. 13 Sec. 44.33.381. Telemedicine business registry. (a) The department shall 14 adopt regulations for establishing and maintaining a registry of businesses performing 15 telemedicine services in the state. 16 (b) The department shall maintain the registry of businesses performing 17 telemedicine services in the state. The registry must include the name, address, and 18 contact information of businesses performing telemedicine services in the state. 19 (c) In this section, 20 (1) "department" means the Department of Commerce, Community, 21 and Economic Development; 22 (2) "telemedicine services" means the delivery of health care services 23 using the transfer of medical data through audio, visual, or data communications that 24 are performed over two or more locations by a provider who is physically separated 25 from the recipient of the health care services. 26 * Sec. 23. AS 47.05.015 is amended by adding a new subsection to read: 27 (e) Notwithstanding (c) of this section, the department may enter into a 28 contract through the competitive bidding process under AS 36.30 (State Procurement 29 Code) for medical assistance products and services offered under AS 47.07.030 if the 30 contract is for durable medical equipment or specific medical services that can be 31 delivered on a statewide basis.
01 * Sec. 24. AS 47.05 is amended by adding a new section to article 1 to read: 02 Sec. 47.05.105. Enhanced computerized eligibility verification system. (a) 03 The department shall establish an enhanced computerized income, asset, and identity 04 eligibility verification system for the purposes of verifying eligibility, eliminating 05 duplication of public assistance payments, and deterring waste and fraud in public 06 assistance programs administered by the department under AS 47.05.010. Nothing in 07 this section prohibits the department from verifying eligibility for public assistance 08 through additional procedures or authorizes the department or a third-party vendor to 09 use data to verify eligibility for a federal program if the use of that data is prohibited 10 by federal law. 11 (b) The department shall enter into a competitively bid contract with a third- 12 party vendor for the purpose of developing a system under this section to prevent 13 fraud, misrepresentation, and inadequate documentation when determining an 14 applicant's eligibility for public assistance before the payment of benefits and for 15 periodically verifying eligibility between eligibility redeterminations and during 16 eligibility redeterminations and reviews under AS 47.05.110 - 47.05.120. The 17 department may also contract with a third-party vendor to provide information to 18 facilitate reviews of recipient eligibility and income verification. 19 (c) The annual savings to the state resulting from the use of the system under 20 this section must exceed the cost of implementing the system. A contract under this 21 section must require the third-party vendor to report annual savings to the state 22 realized from implementing the system. Payment to the third-party vendor may be 23 based on a fee for each applicant and may include incentives for achieving a rate of 24 success established by the department for identifying duplication, waste, and fraud in 25 public assistance programs. 26 (d) To avoid a conflict of interest, the department may not award a contract to 27 provide services for the enrollment of public assistance providers or applicants under 28 this title to a vendor that is awarded a contract under this section. 29 * Sec. 25. AS 47.05.200(a) is amended to read: 30 (a) The department shall annually contract for independent audits of a 31 statewide sample of all medical assistance providers in order to identify overpayments
01 and violations of criminal statutes. The audits conducted under this section may not be 02 conducted by the department or employees of the department. The number of audits 03 under this section may not be less than 50 each year [, AS A TOTAL FOR THE 04 MEDICAL ASSISTANCE PROGRAMS UNDER AS 47.07 AND AS 47.08, SHALL 05 BE 0.75 PERCENT OF ALL ENROLLED PROVIDERS UNDER THE 06 PROGRAMS, ADJUSTED ANNUALLY ON JULY 1, AS DETERMINED BY THE 07 DEPARTMENT, EXCEPT THAT THE NUMBER OF AUDITS UNDER THIS 08 SECTION MAY NOT BE LESS THAN 75]. The audits under this section must 09 include both on-site audits and desk audits and must be of a variety of provider types. 10 The department may not award a contract under this subsection to an organization that 11 does not retain persons with a significant level of expertise and recent professional 12 practice in the general areas of standard accounting principles and financial auditing 13 and in the specific areas of medical records review, investigative research, and Alaska 14 health care criminal law. The contractor, in consultation with the commissioner, shall 15 select the providers to be audited and decide the ratio of desk audits and on-site audits 16 to the total number selected. In identifying providers who are subject to an audit 17 under this chapter, the department shall attempt to minimize concurrent state or 18 federal audits. 19 * Sec. 26. AS 47.05.200(b) is amended to read: 20 (b) Within 90 days after receiving each audit report from an audit conducted 21 under this section, the department shall begin administrative procedures to recoup 22 overpayments identified in the audits and shall allocate the reasonable and necessary 23 financial and human resources to ensure prompt recovery of overpayments unless the 24 attorney general has advised the commissioner in writing that a criminal investigation 25 of an audited provider has been or is about to be undertaken, in which case, the 26 commissioner shall hold the administrative procedure in abeyance until a final 27 charging decision by the attorney general has been made. The commissioner shall 28 provide copies of all audit reports to the attorney general so that the reports can be 29 screened for the purpose of bringing criminal charges. The department may assess 30 interest and penalties on any identified overpayment. Interest under this 31 subsection shall be calculated using the statutory rates for postjudgment interest
01 accruing from the date of the issuance of the final agency decision to recoup 02 overpayments identified in the audit. In this subsection, the date of issuance of 03 the final agency decision is the later of the date of 04 (1) the department's written notification of the decision and the 05 provider's appeal rights; or 06 (2) if timely appealed by the provider, a final agency decision 07 under AS 44.64.060. 08 * Sec. 27. AS 47.05 is amended by adding a new section to read: 09 Sec. 47.05.235. Duty to identify and repay self-identified overpayments. (a) 10 Unless a provider is being audited under AS 47.05.200(a), an enrolled medical 11 assistance provider shall conduct a biennial review or audit of a statistically valid 12 sample of claims submitted to the department for reimbursement. If overpayments are 13 identified, the medical assistance provider shall report the overpayment to the 14 department not later than 10 business days after identification of the overpayment. The 15 report must also identify how the medical assistance provider intends to repay the 16 department. After the department receives the report, the medical assistance provider 17 and the department shall enter into an agreement establishing a schedule for 18 repayment of the identified overpayment. The agreement may authorize repayment in 19 a lump sum, a payment plan, or by offsetting future billings as approved by the 20 department. 21 (b) The department may not assess interest or penalties on an overpayment 22 identified and repaid by a medical assistance provider under this section. 23 * Sec. 28. AS 47.05 is amended by adding new sections to read: 24 Sec. 47.05.250. Civil penalties. (a) The department may assess a civil penalty 25 against a provider who violates this chapter, AS 47.07, or regulations adopted under 26 this chapter or AS 47.07. 27 (b) The department shall adopt regulations establishing a range of civil 28 penalties that the department may assess against a provider under this section. In 29 establishing the range of civil penalties, the department shall take into account 30 appropriate factors, including the seriousness of the violation, the service provided by 31 the provider, and the severity of the penalty. The regulations may not provide for a
01 civil penalty of less than $100 or more than $25,000 for each violation. 02 (c) The provisions of this section are in addition to any other remedies 03 available under this chapter, AS 47.07, or regulations adopted under this chapter or 04 AS 47.07. 05 (d) A provider against whom a civil penalty of less than $2,500 is assessed 06 may appeal the decision assessing the penalty to the commissioner or the 07 commissioner's designee. The commissioner shall, by regulation, establish time limits 08 and procedures for an appeal under this subsection. The decision of the commissioner 09 or the commissioner's designee may be appealed to the office of administrative 10 hearings established under AS 44.64. 11 (e) A provider against whom a civil penalty of $2,500 or more is assessed may 12 appeal the decision assessing the penalty to the office of administrative hearings 13 established under AS 44.64. 14 Sec. 47.05.260. Seizure and forfeiture of real or personal property in 15 medical assistance fraud cases. (a) Upon written application by the attorney general 16 establishing probable cause that a medical assistance provider has committed or is 17 committing medical assistance fraud under AS 47.05.210, the court may authorize the 18 seizure of real or personal property listed in (e) of this section to cover the cost of the 19 alleged fraud. The application may be made ex parte if the attorney general establishes 20 sufficient facts to show that notice to the owner of the property would lead to the 21 waste or dissipation of assets subject to seizure. If the attorney general does not 22 establish sufficient facts to show that notice to the owner would lead to the waste or 23 dissipation of assets subject to seizure, the application for seizure must be served on 24 the owners of the property. 25 (b) Upon issuance of the court order authorizing seizure, the owners of the 26 property may not take any action to dispose of the property through transfer of title or 27 sale of the property without written permission from the court. However, an innocent 28 purchaser may not be required to forfeit property purchased in good faith. The 29 purchaser bears the burden of proof to establish that the property was purchased 30 innocently and in good faith. 31 (c) If a medical assistance provider is convicted of medical assistance fraud
01 under AS 47.05.210 after property is seized under this section, the court may order 02 that the property be forfeited to the state and disposed of as directed by the court. If 03 the property has been sold, the proceeds of the sale shall be transmitted to the proper 04 state officer or employee for deposit into the general fund. The attorney general shall 05 return to the owner of the property any property seized under this section that the court 06 does not order to be forfeited as soon as practicable after the court issues a final 07 judgment in the medical assistance fraud proceeding under AS 47.05.210 and the 08 medical assistance provider pays any fine or restitution ordered by the court. 09 (d) An action for forfeiture under this section may be joined with a civil or 10 criminal action brought by the state to recover damages resulting from alleged medical 11 assistance fraud. 12 (e) Property that may be seized under this chapter includes bank accounts, 13 automobiles, boats, airplanes, stocks, bonds, the medical assistance provider's business 14 inventory, and other real or personal property owned and used to conduct the medical 15 assistance provider's business. 16 Sec. 47.05.270. Medical assistance reform program. (a) The department 17 shall adopt regulations to design and implement a program for reforming the state 18 medical assistance program under AS 47.07. The reform program must include 19 (1) referrals to community and social support services, including career 20 and education training services available through the Department of Labor and 21 Workforce Development under AS 23.15, the University of Alaska, or other sources; 22 (2) electronic distribution of an explanation of medical assistance 23 benefits to recipients for health care services received under the program; 24 (3) expanding the use of telehealth for primary care, behavioral health, 25 and urgent care; 26 (4) enhancing fraud prevention, detection, and enforcement; 27 (5) reducing the cost of behavioral health, senior, and disabilities 28 services provided to recipients of medical assistance under the state's home and 29 community-based services waiver under AS 47.07.045; 30 (6) pharmacy initiatives; 31 (7) enhanced care management;
01 (8) redesigning the payment process by implementing fee agreements 02 that include one or more of the following: 03 (A) premium payments for centers of excellence; 04 (B) penalties for hospital-acquired infections, readmissions, 05 and outcome failures; 06 (C) bundled payments for specific episodes of care; or 07 (D) global payments for contracted payers, primary care 08 managers, and case managers for a recipient or for care related to a specific 09 diagnosis; 10 (9) stakeholder involvement in setting annual targets for quality and 11 cost-effectiveness; 12 (10) to the extent consistent with federal law, reducing travel costs by 13 requiring a recipient to obtain medical services in the recipient's home community, to 14 the extent appropriate services are available in the recipient's home community; 15 (11) guidelines for health care providers to develop health care 16 delivery models supported by evidence-based practices that encourage wellness and 17 disease prevention. 18 (b) The department shall, in coordination with the Alaska Mental Health Trust 19 Authority, efficiently manage a comprehensive and integrated behavioral health 20 program that uses evidence-based, data-driven practices to achieve positive outcomes 21 for people with mental health or substance abuse disorders and children with severe 22 emotional disturbances. The goal of the program is to assist recipients of services 23 under the program to recover by achieving the highest level of autonomy with the least 24 dependence on state-funded services possible for each person. The program must 25 include 26 (1) a plan for providing a continuum of community-based services to 27 address housing, employment, criminal justice, and other relevant issues; 28 (2) services from a wide array of providers and disciplines, including 29 licensed or certified mental health and primary care professionals; and 30 (3) efforts to reduce operational barriers that fragment services, 31 minimize administrative burdens, and reduce the effectiveness and efficiency of the
01 program. 02 (c) The department shall identify the areas of the state where improvements in 03 access to telehealth would be most effective in reducing the costs of medical 04 assistance and improving access to health care services for medical assistance 05 recipients. The department shall make efforts to improve access to telehealth for 06 recipients in those locations. The department may enter into agreements with Indian 07 Health Service providers, if necessary, to improve access by medical assistance 08 recipients to telehealth facilities and equipment. 09 (d) On or before November 15 of each year, the department shall prepare a 10 report and submit the report to the senate secretary and the chief clerk of the house of 11 representatives and notify the legislature that the report is available. The report must 12 include 13 (1) realized cost savings related to reform efforts under this section; 14 (2) realized cost savings related to medical assistance reform efforts 15 undertaken by the department other than the reform efforts described in this Act; 16 (3) a statement of whether the department has met annual targets for 17 quality and cost-effectiveness; 18 (4) recommendations for legislative or budgetary changes related to 19 medical assistance reforms during the next fiscal year; 20 (5) changes in federal laws that the department expects will result in a 21 cost or savings to the state of more than $1,000,000; 22 (6) a description of any medical assistance grants, options, or waivers 23 the department applied for in the previous fiscal year; 24 (7) the results of demonstration projects the department has 25 implemented; 26 (8) legal and technological barriers to the expanded use of telehealth, 27 improvements in the use of telehealth in the state, and recommendations for changes 28 or investments that would allow cost-effective expansion of telehealth; 29 (9) the percentage decrease in costs of travel for medical assistance 30 recipients compared to the previous fiscal year; 31 (10) the percentage decrease in the number of medical assistance
01 recipients identified as frequent users of emergency departments compared to the 02 previous fiscal year; 03 (11) the percentage increase or decrease in the number of hospital 04 readmissions within 30 days after a hospital stay for medical assistance recipients 05 compared to the previous fiscal year; 06 (12) the percentage increase or decrease in state general fund spending 07 for the average medical assistance recipient compared to the previous fiscal year; 08 (13) the percentage increase or decrease in uncompensated care costs 09 incurred by medical assistance providers compared to the percentage change in private 10 health insurance premiums for individual and small group health insurance; 11 (14) the cost, in state and federal funds, for providing optional services 12 under AS 47.07.030(b). 13 (e) In this section, "telehealth" means the practice of health care delivery, 14 evaluation, diagnosis, consultation, or treatment, using the transfer of health care data 15 through audio, visual, or data communications, performed over two or more locations 16 between providers who are physically separated from the recipient or from each other 17 or between a provider and a recipient who are physically separated from each other. 18 * Sec. 29. AS 47.07.030(d) is amended to read: 19 (d) The department shall [MAY] establish as optional services a primary care 20 case management system or a managed care organization contract in which certain 21 eligible individuals are required to enroll and seek approval from a case manager or 22 the managed care organization before receiving certain services. The purpose of a 23 primary care case management system or managed care organization contract is 24 to increase the use of appropriate primary and preventive care by medical 25 assistance recipients, while decreasing the unnecessary use of specialty care and 26 hospital emergency department services. The department shall 27 (1) establish enrollment criteria and determine eligibility for services 28 consistent with federal and state law; the department shall require recipients with 29 multiple hospitalizations to enroll in a primary care case management system or 30 with a managed care organization under this subsection, except that the 31 department may exempt recipients with chronic, acute, or terminal medical
01 conditions from the requirement under this paragraph; 02 (2) define the coordinated care services and provider types eligible 03 to participate as primary care providers; 04 (3) create a performance and quality reporting system; and 05 (4) integrate the coordinated care demonstration projects 06 described under AS 47.07.039 and the demonstration projects described under 07 AS 47.07.036(e) with the primary care case management system or managed care 08 organization contract established under this subsection. 09 * Sec. 30. AS 47.07.036 is amended by adding new subsections to read: 10 (d) Notwithstanding (a) - (c) of this section, the department may 11 (1) apply for a section 1915(i) option under 42 U.S.C. 1396n to 12 improve services and care through home and community-based services to obtain a 50 13 percent federal match; 14 (2) apply for a section 1915(k) option under 42 U.S.C. 1396n to 15 provide home and community-based services and support to increase the federal match 16 for these programs from 50 percent to 56 percent; 17 (3) apply for a section 1945 option under 42 U.S.C. 1396w-4 to 18 provide coordinated care through health homes for individuals with chronic conditions 19 and to increase the federal match for the services to 90 percent for the first eight 20 quarters the required state plan amendment is in effect; 21 (4) evaluate and seek permission from the United States Department of 22 Health and Human Services Centers for Medicare and Medicaid Services to participate 23 in various demonstration projects, including payment reform, care management 24 programs, workforce development and innovation, and innovative services delivery 25 models; and 26 (5) provide incentives for telehealth, including increasing the 27 capability for and reimbursement of telehealth for recipients. 28 (e) Notwithstanding (a) - (c) of this section, and in addition to the projects and 29 services described under (d) and (f) of this section, the department shall apply for a 30 section 1115 waiver under 42 U.S.C. 1315(a) to establish one or more demonstration 31 projects focused on innovative payment models for one or more groups of medical
01 assistance recipients in one or more specific geographic areas. The demonstration 02 project or projects may include 03 (1) managed care organizations as described under 42 U.S.C. 1396u-2; 04 (2) community care organizations; 05 (3) patient-centered medical homes as described under 42 U.S.C. 256a- 06 1; or 07 (4) other innovative payment models that ensure access to health care 08 without reducing the quality of care. 09 (f) Notwithstanding (a) - (c) of this section, and in addition to the projects and 10 services described under (d) and (e) of this section, the department shall apply for a 11 section 1115 waiver under 42 U.S.C. 1315(a) to establish one or more demonstration 12 projects focused on improving the state's behavioral health system for medical 13 assistance recipients. The department shall engage stakeholders and the community in 14 the development of a project or projects under this subsection. The demonstration 15 project or projects must be consistent with the comprehensive and integrated 16 behavioral health program described under AS 47.05.270(b). 17 (g) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 18 * Sec. 31. AS 47.07 is amended by adding new sections to read: 19 Sec. 47.07.038. Collaborative, hospital-based project to reduce use of 20 emergency department services. (a) On or before December 1, 2016, the department 21 shall collaborate with a statewide professional hospital association to establish a 22 hospital-based project to reduce the use of emergency department services by medical 23 assistance recipients. The statewide professional hospital association shall operate the 24 project. The project may include shared savings for participating hospitals. The project 25 must include 26 (1) an interdisciplinary process for defining, identifying, and 27 minimizing the number of frequent users of emergency department services; 28 (2) to the extent consistent with federal law, a system for real-time 29 electronic exchange of patient information, including recent emergency department 30 visits, hospital care plans for frequent users of emergency departments, and data from 31 the controlled substance prescription database;
01 (3) a procedure for educating patients about the use of emergency 02 departments and appropriate alternative services and facilities for nonurgent care; 03 (4) a process for assisting users of emergency departments in making 04 appointments with primary care or behavioral health providers within 96 hours after 05 an emergency department visit; 06 (5) a collaborative process between the department and the statewide 07 professional hospital association to establish uniform statewide guidelines for 08 prescribing narcotics in an emergency department; and 09 (6) designation of health care personnel to review successes and 10 challenges regarding appropriate emergency department use. 11 (b) The department shall adopt regulations necessary to implement this 12 section, request technical assistance from the United States Department of Health and 13 Human Services, and apply to the United States Department of Health and Human 14 Services for waivers or amendments to the state plan as necessary to implement the 15 projects under this section. 16 Sec. 47.07.039. Coordinated care demonstration projects. (a) The 17 department shall contract with one or more third parties to implement one or more 18 coordinated care demonstration projects for recipients of medical assistance identified 19 by the department. The purpose of a demonstration project under this section is to 20 assess the efficacy of a proposed health care delivery model with respect to cost for, 21 access to, and quality of care for medical assistance recipients. The department may 22 contract for separate demonstration projects to coordinate care for different groups of 23 medical assistance recipients to achieve more effective care for recipients at greater 24 cost savings for the medical assistance program. The department shall request 25 proposals for at least one project under this section on or before December 31, 2016, 26 and may annually request proposals for additional projects under this section 27 thereafter. The department may use an innovative procurement process as described 28 under AS 36.30.308 to award a contract for a project under this section. A proposal for 29 a demonstration project under this section must be submitted to the committee 30 established under (b) of this section and must include three or more of the following 31 elements:
01 (1) comprehensive primary-care-based management for medical 02 assistance services, including behavioral health services and coordination of long-term 03 services and support; 04 (2) care coordination, including the assignment of a primary care 05 provider located in the local geographic area of the recipient, to the extent practical; 06 (3) health promotion; 07 (4) comprehensive transitional care and follow-up care after inpatient 08 treatment; 09 (5) referral to community and social support services, including career 10 and education training services available through the Department of Labor and 11 Workforce Development under AS 23.15, the University of Alaska, or other sources; 12 (6) sustainability and the ability to achieve similar results in other 13 regions of the state; 14 (7) integration and coordination of benefits, services, and utilization 15 management; 16 (8) local accountability for health and resource allocation. 17 (b) A project review committee is established in the department for the 18 purpose of reviewing proposals for demonstration projects under this section. The 19 project review committee consists of 20 (1) the commissioner of the department, or the commissioner's 21 designee; 22 (2) the commissioner of administration, or the commissioner's 23 designee; 24 (3) the chief executive officer of the Alaska Mental Health Trust 25 Authority, or the chief executive officer's designee; 26 (4) two representatives of stakeholder groups, appointed by the 27 governor for staggered three-year terms; 28 (5) a nonvoting member who is a member of the senate, appointed by 29 the president of the senate; and 30 (6) a nonvoting member who is a member of the house of 31 representatives, appointed by the speaker of the house of representatives.
01 (c) The department may contract with a managed care organization, primary 02 care case manager, accountable care organization, prepaid ambulatory health plan, or 03 provider-led entity to implement a demonstration project under this section. The fee 04 structure for a contract under this subsection may include global payments, bundled 05 payments, capitated payments, shared savings and risk, or other payment structures. 06 The department shall work with the division of insurance, Department of Commerce, 07 Community, and Economic Development, to streamline the application process for a 08 company to obtain a certificate of authority required under AS 21.09.010 as necessary 09 to participate in a demonstration project under this section. 10 (d) A proposal for a demonstration project under this section must include, in 11 addition to the elements required under (a) of this section, information demonstrating 12 how the project will implement additional cost-saving measures including innovations 13 to reduce the cost of care for medical assistance recipients through the expanded use 14 of telehealth for primary care, urgent care, and behavioral health services. The 15 department shall identify legal or cost barriers preventing the expanded use of 16 telehealth and shall recommend remedies for identified barriers. 17 (e) The department shall contract with a third-party actuary to review 18 demonstration projects established under this section. The actuary shall review each 19 demonstration project after one year of implementation and make recommendations 20 for the implementation of a similar project on a statewide basis. The actuary shall 21 evaluate each project based on cost savings for the medical assistance program, health 22 outcomes for participants in the project, and the ability to achieve similar results on a 23 statewide basis. On or before December 31 of each year starting in 2018, the actuary 24 shall submit a final report to the department regarding any demonstration project that 25 has been in operation for at least one year. 26 (f) The department shall prepare a plan regarding regional or statewide 27 implementation of a coordinated care project based on the results of the demonstration 28 projects under this section. On or before November 15, 2019, the department shall 29 submit the plan to the senate secretary and the chief clerk of the house of 30 representatives and notify the legislature that the plan is available. On or before 31 November 15 of each year thereafter, the department shall submit a report regarding
01 any changes or recommendations regarding the plan developed under this subsection 02 to the senate secretary and the chief clerk of the house of representatives and notify the 03 legislature that the report is available. 04 (g) In this section, "telehealth" has the meaning given in AS 47.05.270(e). 05 * Sec. 32. AS 47.07 is amended by adding a new section to read: 06 Sec. 47.07.076. Report to legislature. (a) The department and the attorney 07 general shall annually prepare a report relating to the medical assistance program 08 under AS 47.07. The report must include the following information: 09 (1) the amount and source of funds used to prevent or prosecute fraud, 10 abuse, payment errors, and errors in eligibility determinations for the previous fiscal 11 year; 12 (2) actions taken to address fraud, abuse, payment errors, and errors in 13 eligibility determinations during the previous fiscal year; 14 (3) specific examples of fraud or abuse that were prevented or 15 prosecuted; 16 (4) identification of vulnerabilities in the medical assistance program, 17 including any vulnerabilities identified by independent auditors with whom the 18 department contracts under AS 47.05.200; 19 (5) initiatives the department has taken to prevent fraud or abuse; 20 (6) recommendations to increase effectiveness in preventing and 21 prosecuting fraud and abuse; 22 (7) the return to the state for every dollar expended by the department 23 and the attorney general to prevent and prosecute fraud and abuse; 24 (8) the most recent payment error rate measurement report for the 25 medical assistance program, including fee for service programs and pilot or 26 demonstration projects; the report must also explain the reasons for the payment errors 27 and the total amount of state and federal funds paid in error during the reporting period 28 and not recovered by the department at the time of the report; 29 (9) results from the Medicaid Eligibility Quality Control program. 30 (b) On or before November 15 of each year, the department shall submit the 31 report required under this section to the senate secretary and the chief clerk of the
01 house of representatives and notify the legislature that the report is available. 02 * Sec. 33. AS 47.07.900(4) is amended to read: 03 (4) "clinic services" means services provided by state-approved 04 outpatient community mental health clinics [THAT RECEIVE GRANTS UNDER 05 AS 47.30.520 - 47.30.620], state-operated community mental health clinics, outpatient 06 surgical care centers, and physician clinics; 07 * Sec. 34. AS 47.07.900(17) is amended to read: 08 (17) "rehabilitative services" means services for substance abusers and 09 emotionally disturbed or chronically mentally ill adults provided by 10 (A) a drug or alcohol treatment center [THAT IS FUNDED 11 WITH A GRANT UNDER AS 47.30.475]; or 12 (B) an outpatient community mental health clinic [THAT HAS 13 A CONTRACT TO PROVIDE COMMUNITY MENTAL HEALTH 14 SERVICES UNDER AS 47.30.520 - 47.30.620]; 15 * Sec. 35. AS 47.55.020(e) is amended to read: 16 (e) As a condition for receipt of payment assistance under (d) of this section, 17 the department, under regulations adopted by the department, shall [MAY] require a 18 person to 19 (1) apply for other state or federally sponsored programs that may 20 reduce the amount of the payment assistance; and 21 (2) submit to the department a copy of the person's application for 22 medical assistance coverage under AS 47.07 and the decision letter the person 23 receives regarding the application. 24 * Sec. 36. AS 09.58.020, 09.58.030, 09.58.040, 09.58.050, and 09.58.060 are repealed 25 July 1, 2019. 26 * Sec. 37. The uncodified law of the State of Alaska is amended by adding a new section to 27 read: 28 INDIRECT COURT RULE AMENDMENTS. (a) AS 09.58.020, added by sec. 10 of 29 this Act, and repealed by sec. 36 of this Act, has the effect of amending the following court 30 rules in the manner specified from the effective date of sec. 10 of this Act until July 1, 2019: 31 (1) Rules 4, 5, 7, and 12, Alaska Rules of Civil Procedure, by requiring that a
01 complaint under AS 09.58 be filed in camera and under seal and may not be served on the 02 defendant until unsealed and that a copy of the complaint be served on the attorney general; 03 (2) Rules 41 and 77, Alaska Rules of Civil Procedure, by authorizing the 04 attorney general to move for dismissal of a complaint filed by another person under 05 AS 09.58.020, added by sec. 10 of this Act and repealed by sec. 36 of this Act, and requiring 06 court approval for dismissal of the action. 07 (b) AS 09.58.025, added by sec. 10 of this Act, and amended by sec. 11 of this Act, 08 has the effect of amending Rule 27, Alaska Rules of Civil Procedure, by authorizing the 09 attorney general to issue subpoenas as part of an investigation 10 (1) under AS 09.58.015, added by sec. 10 of this Act, from the effective date 11 of sec. 10 of this Act; and 12 (2) under AS 09.58.020, added by sec. 10 of this Act, from the effective date 13 of sec. 10 of this Act until July 1, 2019. 14 (c) AS 09.58.030, added by sec. 10 of this Act, and repealed by sec. 36 of this Act, 15 has the effect of amending the following court rules in the manner specified from the effective 16 date of sec. 10 of this Act until July 1, 2019: 17 (1) Rule 24, Alaska Rules of Civil Procedure, by authorizing the attorney 18 general to intervene in a civil action filed by another person under AS 09.58.020 added by 19 sec. 10 of this Act, and repealed by sec. 36 of this Act, and limiting the participation of a party 20 to the litigation; 21 (2) Rules 26 and 27, Alaska Rules of Civil Procedure, by authorizing the 22 attorney general to request that the court issue a stay of discovery for a 90-day period, or 23 longer upon a showing by the attorney general. 24 (d) AS 09.58.040, added by sec. 10 of this Act, and repealed by sec. 36 of this Act, 25 has the effect of amending Rules 79 and 82, Alaska Rules of Civil Procedure, from the 26 effective date of sec. 10 of this Act until July 1, 2019, by giving a person who brings an action 27 under AS 09.58.020, added by sec. 10 of this Act, and repealed by sec. 36 of this Act, the 28 right to reasonable attorney fees and costs in an action prosecuted by the attorney general. 29 (e) AS 47.05.260, added by sec. 28 of this Act, has the effect of amending Rule 89, 30 Alaska Rules of Civil Procedure, and Rule 37, Alaska Rules of Criminal Procedure, by 31 authorizing the attorney general to apply to the court for authorization to seize property in
01 conjunction with an action filed under AS 47.05.210. 02 * Sec. 38. The uncodified law of the State of Alaska is amended by adding a new section to 03 read: 04 IMPLEMENT FEDERAL POLICY ON TRIBAL MEDICAID REIMBURSEMENT. 05 (a) The Department of Health and Social Services shall collaborate with Alaska tribal health 06 organizations and the United States Department of Health and Human Services to fully 07 implement changes in federal policy that authorize 100 percent federal funding for services 08 provided to American Indian and Alaska Native individuals eligible for Medicaid. 09 (b) Within 30 days after the date the Centers for Medicare and Medicaid Services 10 issues a final policy regarding the circumstances in which 100 percent federal funding is 11 available for medical assistance services received through the United States Indian Health 12 Service or tribal health facilities, the Department of Health and Social Services shall notify 13 and submit a report to the co-chairs of the house and senate finance committees of the Alaska 14 State Legislature that includes an estimate of the savings to the state resulting from the final 15 policy. Within six months after the date the Centers for Medicare and Medicaid Services 16 issues the final policy, the Department of Health and Social Services shall fully implement the 17 policy in the state. 18 (c) In this section, "Alaska tribal health organization" means an organization 19 recognized by the United States Indian Health Service to provide health-related services. 20 * Sec. 39. The uncodified law of the State of Alaska is amended by adding a new section to 21 read: 22 HEALTH INFORMATION INFRASTRUCTURE PLAN. (a) The Department of 23 Health and Social Services shall develop a health information infrastructure plan to strengthen 24 the health information infrastructure, including health data analytics capability. The purpose 25 of the health information infrastructure plan is to transform the health care system in the state 26 by providing 27 (1) data required by health care providers for care coordination and quality 28 improvement; and 29 (2) the information support required by the Department of Health and Social 30 Services and health care providers to enable development and implementation of the other 31 provisions of this Act.
01 (b) To the greatest extent practicable, the health information infrastructure plan will 02 leverage existing resources, including the health information exchange, and will identify 03 opportunities for integrating and streamlining health data systems administered by the state. 04 * Sec. 40. The uncodified law of the State of Alaska is amended by adding a new section to 05 read: 06 FEASIBILITY STUDIES FOR THE PROVISION OF SPECIFIED STATE 07 SERVICES. (a) The Department of Health and Social Services shall procure a study 08 analyzing the feasibility of privatizing services delivered at Alaska Pioneers' Homes and 09 select facilities of the division of juvenile justice. The Department of Health and Social 10 Services shall deliver a report summarizing the conclusions of the Department of Health and 11 Social Services to the senate secretary and the chief clerk of the house of representatives and 12 notify the legislature that the report is available within 10 days after the convening of the First 13 Regular Session of the Thirtieth Alaska State Legislature. 14 (b) The Department of Health and Social Services, in conjunction with the Alaska 15 Mental Health Trust Authority, shall procure a study analyzing the feasibility of privatizing 16 services delivered at the Alaska Psychiatric Institute. The Department of Health and Social 17 Services and the Alaska Mental Health Trust Authority shall deliver a joint report 18 summarizing the conclusions of the Department of Health and Social Services and the Alaska 19 Mental Health Trust Authority to the senate secretary and the chief clerk of the house of 20 representatives and notify the legislature that the report is available within 10 days after the 21 convening of the First Regular Session of the Thirtieth Alaska State Legislature. 22 (c) The Department of Administration shall, in collaboration with the house and 23 senate finance committees, procure a study to be completed on or before June 30, 2017, to 24 determine the feasibility of creating a health care authority to coordinate health care plans and 25 consolidate purchasing effectiveness for all state employees, retired state employees, retired 26 teachers, medical assistance recipients, University of Alaska employees, employees of state 27 corporations, and school district employees and to develop appropriate benefit sets, rules, 28 cost-sharing, and payment structures for all employees and individuals whose health care 29 benefits are funded directly or indirectly by the state, with the goal of achieving the greatest 30 possible savings to the state through a coordinated approach administered by a single entity. 31 In developing the study, the Department of Administration shall seek input from the
01 Department of Health and Social Services, administrators familiar with managing government 02 employee health plans, and human resource professionals familiar with self-insured health 03 care plans. The study must 04 (1) identify cost-saving strategies that a health care authority could implement; 05 (2) analyze local government participation in the authority; 06 (3) analyze a phased approach to adding groups to the health care plans 07 coordinated by the health care authority; 08 (4) consider previous studies procured by the Department of Administration 09 and the legislature; 10 (5) assess the use of community-related health insurance risk pools and the use 11 of the private marketplace; 12 (6) identify organizational models for a health care authority, including private 13 for-profit, private nonprofit, government, and state corporations; and 14 (7) include a public review and comment opportunity for employers, 15 employees, medical assistance recipients, retirees, and health care providers. 16 (d) In this section, "school district" has the meaning given in AS 14.30.350. 17 * Sec. 41. The uncodified law of the State of Alaska is amended by adding a new section to 18 read: 19 MEDICAID STATE PLAN; WAIVERS; INSTRUCTIONS; NOTICE TO REVISOR 20 OF STATUTES. The Department of Health and Social Services shall amend and submit for 21 federal approval a state plan for medical assistance coverage consistent with this Act. The 22 Department of Health and Social Services shall apply to the United States Department of 23 Health and Human Services for any waivers necessary to implement this Act. The 24 commissioner of health and social services shall certify to the revisor of statutes if the 25 provisions of AS 47.05.270(a)(5), (8), and (10), added by sec. 28 of this Act, and the 26 provisions of AS 47.07.038, added by sec. 31 of this Act, are approved by the United States 27 Department of Health and Human Services. 28 * Sec. 42. The uncodified law of the State of Alaska is amended by adding a new section to 29 read: 30 TRANSITION: REGULATIONS. (a) The Department of Health and Social Services 31 may adopt regulations necessary to implement the changes made by this Act. The regulations
01 take effect under AS 44.62 (Administrative Procedure Act), but not before the effective date 02 of the relevant provision of this Act implemented by the regulation. 03 (b) The Board of Pharmacy may adopt regulations necessary to implement the 04 changes made by secs. 13 - 19 of this Act. The regulations take effect under AS 44.62 05 (Administrative Procedure Act), but not before the effective date of the relevant provision of 06 secs. 13 - 19 of this Act implemented by the regulation. 07 * Sec. 43. The uncodified law of the State of Alaska is amended by adding a new section to 08 read: 09 CONDITIONAL EFFECT. (a) AS 47.05.270(a)(5), enacted by sec. 28 of this Act, 10 takes effect only if the commissioner of health and social services certifies to the revisor of 11 statutes under sec. 41 of this Act, on or before October 1, 2017, that all of the provisions 12 added by AS 47.05.270(a)(5) have been approved by the United States Department of Health 13 and Human Services. 14 (b) AS 47.05.270(a)(8), enacted by sec. 28 of this Act, takes effect only if the 15 commissioner of health and social services certifies to the revisor of statutes under sec. 41 of 16 this Act, on or before October 1, 2017, that all of the provisions added by AS 47.05.270(a)(8) 17 have been approved by the United States Department of Health and Human Services. 18 (c) AS 47.05.270(a)(10), enacted by sec. 28 of this Act, takes effect only if the 19 commissioner of health and social services certifies to the revisor of statutes under sec. 41 of 20 this Act, on or before October 1, 2017, that all of the provisions added by 21 AS 47.05.270(a)(10) have been approved by the United States Department of Health and 22 Human Services. 23 (d) AS 47.07.038, enacted by sec. 31 of this Act, takes effect only if the commissioner 24 of health and social services certifies to the revisor of statutes under sec. 41 of this Act, on or 25 before October 1, 2017, that all of the provisions added by AS 47.07.038 have been approved 26 by the United States Department of Health and Human Services. 27 (e) AS 09.58.020, added by sec. 10 of this Act, AS 09.58.025, added by sec. 10 of this 28 Act and amended by sec. 11 of this Act, AS 09.58.030, added by sec. 10 of this Act and 29 repealed by sec. 36 of this Act, AS 09.58.040, added by sec. 10 of this Act, and AS 47.05.260, 30 added by sec. 28 of this Act, take effect only if sec. 37 of this Act receives the two-thirds 31 majority vote of each house required by art. IV, sec. 15, Constitution of the State of Alaska.
01 * Sec. 44. If AS 47.05.270(a)(5), enacted by sec. 28 of this Act, takes effect, it takes effect 02 on the day after the date the commissioner of health and social services makes a certification 03 to the revisor of statutes under secs. 41 and 43(a) of this Act. 04 * Sec. 45. If AS 47.05.270(a)(8), enacted by sec. 28 of this Act, takes effect, it takes effect 05 on the day after the date the commissioner of health and social services makes a certification 06 to the revisor of statutes under secs. 41 and 43(b) of this Act. 07 * Sec. 46. If AS 47.05.270(a)(10), enacted by sec. 28 of this Act, takes effect, it takes effect 08 on the day after the date the commissioner of health and social services makes a certification 09 to the revisor of statutes under secs. 41 and 43(c) of this Act. 10 * Sec. 47. If AS 47.07.038, enacted by sec. 31 of this Act, takes effect, it takes effect on the 11 day after the date the commissioner of health and social services makes a certification to the 12 revisor of statutes under secs. 41 and 43(d) of this Act. 13 * Sec. 48. Sections 40, 41, 42(a), and 43 of this Act take effect immediately under 14 AS 01.10.070(c). 15 * Sec. 49. Sections 13 - 19 of this Act take effect January 1, 2017. 16 * Sec. 50. Section 42(b) of this Act takes effect July 1, 2016. 17 * Sec. 51. Sections 11 and 12 of this Act take effect July 1, 2019.