00                             HOUSE BILL NO. 92                                                                          
01 "An Act exempting direct health care agreements from regulation as insurance;                                           
02 establishing a direct care payment program for medical assistance recipients; and                                       
03 providing for an effective date."                                                                                       
04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
05    * Section 1. AS 21.03.021 is amended by adding new subsections to read:                                            
06            (l)  This title does not apply to a written health care agreement for direct care                            
07       between a health care provider and an individual patient or the patient's representative                          
08       that                                                                                                              
09                 (1)  describes the health care services to be provided by the health care                               
10       provider to the patient in exchange for payment of a periodic fee;                                                
11                 (2)  allows the health care provider or the patient to terminate the                                    
12       agreement in writing, without penalty or payment of a termination fee, at any time or                             
13       after notice of not more than 60 days, as specified in the agreement;                                             
14                 (3)  specifies the periodic fee the patient must pay for the health care                                

01       services and any additional fee that the health care provider may charge; the                                     
02       agreement may allow an individual who is not the patient to pay the periodic fee or                               
03       additional fees;                                                                                                  
04                 (4)  conspicuously states that the agreement is not health insurance and                                
05       does not meet an individual or other health insurance mandate that may be required by                             
06       federal or state law; and                                                                                         
07                 (5)  prohibits the health care provider from charging or receiving                                      
08       compensation in addition to the fees described in this subsection for the health care                             
09       services included in the agreement.                                                                               
10            (m)  In (l) of this section,                                                                                 
11 (1)  "health care" means care, treatment, a service, or a procedure to                                                  
12 maintain, diagnose, detect, manage, or promote an individual's physical or mental                                       
13       condition;                                                                                                        
14 (2)  "health care provider" means a person who is licensed, registered,                                                 
15 or otherwise authorized under AS 08 to provide health care services or an individual                                    
16 who is an employee of the person and acting within the course and scope of                                              
17       employment.                                                                                                       
18    * Sec. 2. AS 21.03.021(l), enacted by sec. 1 of this Act, is amended to read:                                      
19 (l)  This title does not apply to a written health care agreement for direct care                                       
20 between a health care provider and an individual patient or the patient's representative                                
21       if the                                                                                                        
22                 (1)  health care provider                                                                           
23 (A)  accepts new patients who are medical assistance or                                                             
24            Medicare recipients; or                                                                                  
25 (B)  maintains a practice in which 20 percent or more of the                                                        
26            patients are medical assistance or Medicare recipients; and                                              
27                 (2)  written health care agreement for direct care                                                  
28 (A) [THAT (1)] describes the health care services to be                                                             
29 provided by the health care provider to the patient in exchange for payment of                                          
30            a periodic fee;                                                                                              
31 (B) [(2)] allows the health care provider or the patient to                                                         

01 terminate the agreement in writing, without penalty or payment of a                                                     
02 termination fee, at any time or after notice of not more than 60 days, as                                               
03            specified in the agreement;                                                                                  
04 (C) [(3)] specifies the periodic fee the patient must pay for the                                                   
05 health care services and any additional fee that the health care provider may                                           
06 charge; the agreement may allow an individual who is not the patient to pay                                             
07            the periodic fee or additional fees;                                                                         
08 (D) [(4)] conspicuously states that the agreement is not health                                                     
09 insurance and does not meet an individual or other health insurance mandate                                             
10            that may be required by federal or state law; and                                                            
11 (E) [(5)] prohibits the health care provider from charging or                                                       
12 receiving compensation in addition to the fees described in this subsection for                                         
13            the health care services included in the agreement.                                                          
14    * Sec. 3. AS 47.07.036 is amended by adding a new subsection to read:                                              
15 (h)  The department shall establish and implement a direct care program for                                             
16 payment to health care providers for services to medical assistance recipients. Under                                   
17 the program, the department may contract directly with health care providers to                                         
18 provide specified health care services covered under AS 47.07.030 to recipients for a                                   
19       periodic fee paid by the department. The program must                                                             
20 (1)  establish criteria for a health care provider's participation in the                                               
21       program;                                                                                                          
22                 (2)  allow a recipient to                                                                               
23                      (A)  enroll voluntarily in the direct care program; and                                            
24 (B)  select a participating health care provider as the recipient's                                                     
25            primary source for health care services;                                                                     
26 (3)  describe the health care services to be provided to a recipient by the                                             
27       health care provider; and                                                                                         
28 (4)  establish periodic fees that the department may pay to a health care                                               
29       provider under the program.                                                                                       
30    * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to                          
31 read:                                                                                                                   

01 MEDICAID STATE PLAN; FEDERAL APPROVAL; NOTICE TO REVISOR OF                                                             
02 STATUTES. The Department of Health and Social Services shall immediately amend and                                      
03 submit for federal approval the state Medicaid plan to authorize direct care payments under                             
04 AS 47.07.036(h), enacted by sec. 3 of this Act. The Department of Health and Social Services                            
05 shall apply to the United States Department of Health and Human Services for any waivers                                
06 necessary to implement AS 47.07.036(h), enacted by sec. 3 of this Act. The commissioner of                              
07 health and social services shall notify the revisor of statutes in writing if the United States                         
08 Department of Health and Human Services approves a state Medicaid plan to authorize direct                              
09 care payments under AS 47.07.036(h), enacted by sec. 3 of this Act.                                                     
10    * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to                          
11 read:                                                                                                                   
12 CONDITIONAL EFFECT. AS 21.03.021(l), as amended by sec. 2 of this Act, and                                              
13 AS 47.07.036(h), enacted by sec. 3 of this Act, take effect only if the commissioner of health                          
14 and social services notifies the revisor of statutes in writing under sec. 4 of this Act, on or                         
15 before October 1, 2021, that the United States Department of Health and Human Services has                              
16 approved a state Medicaid plan to authorize direct care payments under AS 47.07.036(h).                                 
17    * Sec. 6. If, under sec. 5 of this Act, sec. 3 of this Act takes effect, it takes effect on the day                
18 after the date the commissioner of health and social services notifies the revisor of statutes                          
19 under sec. 4 of this Act.                                                                                               
20    * Sec. 7. If, under sec. 5 of this Act, sec. 2 of this Act takes effect, it takes effect 180 days                  
21 after the date the commissioner of health and social services notifies the revisor of statutes                          
22 under sec. 4 of this Act.