HB 47: "An Act relating to insurance; relating to direct health care agreements; and relating to unfair trade practices."
00 HOUSE BILL NO. 47 01 "An Act relating to insurance; relating to direct health care agreements; and relating to 02 unfair trade practices." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 21.03 is amended by adding a new section to read: 05 Sec. 21.03.025. Direct health care agreements. (a) A direct health care 06 agreement is a written agreement between a health care provider or health care 07 business and a patient or the representative of a patient to provide health care services 08 in exchange for payment of a periodic fee. A patient is not eligible to enter into a 09 direct health care agreement under this section if the patient is eligible to receive 10 assistance under AS 47.07 (Medical Assistance for Needy Persons) or AS 47.08 11 (Assistance for Catastrophic Illness and Chronic or Acute Medical Conditions). 12 (b) A direct health care agreement must 13 (1) describe the health care services that the health care provider or 14 health care business makes available to the patient in exchange for payment of a
01 periodic fee and each location at which the health care services are available; 02 (2) specify 03 (A) the amount of the periodic fee a patient or the 04 representative of a patient pays in exchange for the health care services that the 05 health care provider or health care business makes available to the patient; 06 (B) the period covered by the periodic fee under (A) of this 07 paragraph; and 08 (C) additional fees that the health care provider or health care 09 business may charge in addition to the periodic fee, including cancellation 10 fees; 11 (3) identify and include contact information for a representative of the 12 health care provider or health care business that is responsible for receiving and 13 addressing a complaint made by a patient relating to the agreement; 14 (4) prominently state that the agreement is not health insurance and 15 does not meet an individual or other health insurance mandate that may be required by 16 federal law; and 17 (5) prominently state that the patient is not entitled to the protections 18 under AS 21.07 (Patient Protections Under Health Care Insurance Policies) or 19 AS 21.36 (Trade Practices and Frauds). 20 (c) A direct health care agreement must allow a patient or the representative of 21 a patient to terminate the agreement in writing within 30 days after entering into the 22 agreement. If a patient or representative terminates an agreement under this 23 subsection, the health care provider or health care business shall, not later than 30 days 24 after the patient or representative terminates the agreement, refund to the patient or 25 representative payments made under the agreement, less payments made for services 26 the health care provider or health care business has already performed that are not 27 included in the periodic fee. The health care provider or health care business may 28 charge a termination fee for termination of an agreement under this subsection, not to 29 exceed an amount equal to one month's cost of the periodic fee. 30 (d) A direct health care agreement must allow a health care provider, a health 31 care business, a patient, or the representative of a patient to terminate the agreement in
01 writing after at least 30 days' notice. The agreement must require that the patient pay 02 the health care provider or health care business the periodic fee, prorated through the 03 date of termination of the agreement, and that the patient pay any additional fees for 04 services the health care provider or health care business has already performed that are 05 not included in the periodic fee. The health care provider or health care business may 06 charge a termination fee for termination of an agreement under this subsection by a 07 patient or representative, not to exceed an amount equal to one month's cost of the 08 periodic fee. 09 (e) A health care provider or health care business may not change the periodic 10 fee under the agreement more than once a year and shall provide at least 45 days' 11 written notice of a change in the periodic fee. 12 (f) A health care provider or health care business may bill a patient or the 13 representative of a patient for the periodic fee only after the end of the period to which 14 the periodic fee applies. 15 (g) A patient's employer may pay the periodic fee and additional fees the 16 patient owes a health care provider or health care business under a direct health care 17 agreement. A payment by the employer under this subsection does not constitute 18 engaging in the business of insurance or underwriting in this state, and the employer is 19 not an insurer, a health maintenance organization, a health care insurer, or a medical 20 service corporation by virtue of the payment. 21 (h) A health care provider or health care business may immediately terminate 22 a direct health care agreement if 23 (1) a patient repeatedly fails to comply with the treatment plan for the 24 patient recommended by the health care provider or health care business; 25 (2) a patient's behavior threatens the safety of the health care provider, 26 the staff of the health care provider or health care business, or other patients of the 27 health care provider or health care business; or 28 (3) a patient engages in disrespectful, derogatory, or prejudiced 29 behavior that is within the patient's control and the patient does not stop the behavior 30 even after the health care provider or the staff of the health care provider or health care 31 business requests the patient to stop the behavior.
01 (i) A health care provider or a health care business may immediately terminate 02 a direct health care agreement if a patient or the representative of a patient breaches 03 the terms of the agreement. A patient or representative may immediately terminate a 04 direct health care agreement if a health care provider or a health care business 05 breaches the terms of the agreement. 06 (j) A direct health care agreement and health care services provided under a 07 direct health care agreement are not subject to AS 21.07 (Patient Protections Under 08 Health Care Insurance Policies) or AS 21.36 (Trade Practices and Frauds), but are 09 subject to other consumer protection statutes and regulations, including AS 45.45.915. 10 (k) Offering or executing a direct health care agreement does not constitute 11 engaging in the business of insurance or underwriting in this state, and, except as 12 provided in this section, a direct health care agreement and health care services 13 provided under a direct health care agreement are exempt from regulation by the 14 division under this title. A direct health care agreement is not insurance, health 15 insurance, health care insurance, or a health care insurance policy. A health care 16 provider or health care business is not an insurer, a health maintenance organization, a 17 health care insurer, or a medical service corporation by virtue of the offering or 18 execution of a direct health care agreement or the provision of health care services 19 under a direct health care agreement. A certificate of authority or license to market, 20 sell, or offer to sell a direct health care agreement or health care services under a direct 21 health care agreement is not required to offer or execute a direct health care agreement 22 or provide health care services under a direct health care agreement. 23 (l) In this section, 24 (1) "health care business" means a business licensed by the state that is 25 entirely owned by health care providers; 26 (2) "health care insurance" has the meaning given in AS 21.12.050(b); 27 (3) "health care insurer" has the meaning given in AS 21.54.500; 28 (4) "health care provider" has the meaning given in AS 21.07.250; 29 (5) "health care service" 30 (A) means a health care service or procedure that is provided in 31 person or remotely by telemedicine or other means by a health care provider
01 for the care, prevention, diagnosis, or treatment of a physical or mental illness, 02 health condition, disease, or injury; 03 (B) does not include "emergency services" as defined in 04 AS 21.07.250; 05 (6) "health insurance" has the meaning given in AS 21.12.050; 06 (7) "health maintenance organization" has the meaning given in 07 AS 21.86.900; 08 (8) "medical service corporation" has the meaning given in 09 AS 21.87.330. 10 * Sec. 2. AS 45.45 is amended by adding a new section to read: 11 Sec. 45.45.915. Direct health care agreements. (a) A health care provider or 12 health care business may not decline to enter into a direct health care agreement with a 13 new patient or terminate a direct health care agreement with an existing patient solely 14 because of the patient's race, religion, color, national origin, age, sex, physical or 15 mental disability, marital status, change in marital status, pregnancy, parenthood, or 16 any other characteristic of a class of persons protected by a state law that prohibits 17 discrimination. 18 (b) A health care provider or health care business may decline to enter into a 19 direct health care agreement with a new patient if the health care provider or health 20 care business 21 (1) is unable to provide to the patient the health care services the 22 patient requires; or 23 (2) does not have the capacity to accept new patients. 24 (c) A health care provider or health care business may terminate a direct 25 health care agreement with an existing patient based on the patient's health status only 26 if the health care provider is unable to provide to the patient the health care services 27 the patient requires or in accordance with AS 21.03.025. 28 (d) In this section, 29 (1) "direct health care agreement" means an agreement described in 30 AS 21.03.025; 31 (2) "health care business" has the meaning given in AS 21.03.025(l);
01 (3) "health care provider" has the meaning given in AS 21.07.250; 02 (4) "health care service" has the meaning given in AS 21.03.025(l). 03 * Sec. 3. AS 45.50.471(b) is amended by adding a new paragraph to read: 04 (58) violating AS 45.45.915 (direct health care agreements).