CSSB 45(HSS): "An Act relating to insurance; relating to direct health care agreements; and relating to unfair trade practices."
00 CS FOR SENATE BILL NO. 45(HSS) 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 health care provider or 06 health care business and a patient or the representative of a patient may enter into a 07 direct health care agreement. A patient is not eligible to enter into a direct health care 08 agreement under this section if the patient is eligible to receive assistance under 09 AS 47.07 (Medical Assistance for Needy Persons) or AS 47.08 (Assistance for 10 Catastrophic Illness and Chronic or Acute Medical Conditions). 11 (b) A direct health care agreement must 12 (1) describe the health care services that the health care provider or 13 health care business makes available to the patient in exchange for payment of a 14 periodic fee and each location at which the health care services are available;
01 (2) specify 02 (A) the amount of the periodic fee a patient or the 03 representative of a patient pays in exchange for the health care services that the 04 health care provider or health care business makes available to the patient; 05 (B) the period covered by the periodic fee under (A) of this 06 paragraph; and 07 (C) additional fees that the health care provider or health care 08 business may charge in addition to the periodic fee, including cancellation 09 fees; 10 (3) identify and include contact information for a representative of the 11 health care provider or health care business that is responsible for receiving and 12 addressing 13 (A) a complaint made by a patient relating to the agreement; 14 and 15 (B) a request made by a patient to amend the agreement, 16 including a patient's request to change the name of the representative of the 17 patient or the patient's mailing address, physical address, telephone number, 18 electronic mail address, or other personal information; 19 (4) prominently state that the agreement is not health insurance and 20 does not meet an individual or other health insurance mandate that may be required by 21 federal law; and 22 (5) prominently state that the patient is not entitled to the protections 23 under AS 21.07 (Patient Protections Under Health Care Insurance Policies) or 24 AS 21.36 (Trade Practices and Frauds). 25 (c) A patient or the representative of a patient may terminate a direct health 26 care agreement in writing within 30 days after entering into the agreement. If a patient 27 or representative terminates an agreement under this subsection, the health care 28 provider or health care business shall, not later than 30 days after the patient or 29 representative terminates the agreement, refund to the patient or representative 30 payments made under the agreement, less payments made for services the health care 31 provider or health care business has already performed that are not included in the
01 periodic fee. 02 (d) A health care provider or health care business may immediately terminate 03 a direct health care agreement if 04 (1) a patient's behavior threatens the safety of the health care provider, 05 the staff of the health care provider or health care business, or other patients of the 06 health care provider or health care business; 07 (2) a patient engages in disrespectful, derogatory, or prejudiced 08 behavior that is within the patient's control and the patient does not stop the behavior 09 even after the health care provider or the staff of the health care provider or health care 10 business requests the patient to stop the behavior; or 11 (3) a patient or the representative of a patient breaches the terms of the 12 agreement. 13 (e) A patient or the representative of a patient may immediately terminate a 14 direct health care agreement if a health care provider or a health care business 15 breaches the terms of the agreement. 16 (f) A health care provider or health care business may not change the periodic 17 fee under the agreement more than once a year and shall provide at least 45 days' 18 written notice of a change in the periodic fee. If a health care provider or health care 19 business increases the amount of the periodic fee, a patient or the representative of a 20 patient may terminate the agreement by providing to the health care provider or health 21 care business written notice of the termination not later than the day before the date on 22 which the change to the periodic fee is scheduled to take effect. 23 (g) Except as otherwise provided in this section and in AS 45.45.915, a health 24 care provider, a health care business, a patient, or the representative of a patient may 25 terminate a direct health care agreement for any reason in writing after at least 30 26 days' notice. 27 (h) A health care provider or health care business may charge a termination 28 fee only for termination of an agreement by a patient or the representative of a patient 29 under (c) or (g) of this section. The termination fee may not exceed an amount equal to 30 one month's cost of the periodic fee. 31 (i) Upon termination of an agreement under (f) or (g) of this section, the
01 patient shall pay the health care provider or health care business the periodic fee, 02 prorated through the date of termination of the agreement, and any additional fees for 03 services the health care provider or health care business has already performed that are 04 not included in the periodic fee. 05 (j) A health care provider or health care business may bill a patient or the 06 representative of a patient for the periodic fee only after the end of the period to which 07 the periodic fee applies. 08 (k) A patient's employer may pay the periodic fee and additional fees the 09 patient owes a health care provider or health care business under a direct health care 10 agreement. A payment by the employer under this subsection does not constitute 11 engaging in the business of insurance or underwriting in this state, and the employer is 12 not an insurer, a health maintenance organization, a health care insurer, or a medical 13 service corporation by virtue of the payment. 14 (l) A direct health care agreement and health care services provided under a 15 direct health care agreement are not subject to AS 21.07 (Patient Protections Under 16 Health Care Insurance Policies) or AS 21.36 (Trade Practices and Frauds), but are 17 subject to other consumer protection statutes and regulations, including AS 45.45.915. 18 (m) Offering or executing a direct health care agreement does not constitute 19 engaging in the business of insurance or underwriting in this state, and, except as 20 provided in this section, a direct health care agreement and health care services 21 provided under a direct health care agreement are exempt from regulation by the 22 division under this title. A direct health care agreement is not insurance, health 23 insurance, health care insurance, or a health care insurance policy. A health care 24 provider or health care business is not an insurer, a health maintenance organization, a 25 health care insurer, or a medical service corporation by virtue of the offering or 26 execution of a direct health care agreement or the provision of health care services 27 under a direct health care agreement. A certificate of authority or license to market, 28 sell, or offer to sell a direct health care agreement or health care services under a direct 29 health care agreement is not required to offer or execute a direct health care agreement 30 or provide health care services under a direct health care agreement. 31 (n) In this section,
01 02 (1) "direct health care agreement" means a written agreement between 03 a health care provider or health care business and a patient or the representative of a 04 patient to provide health care services in exchange for payment of a periodic fee; 05 (2) "health care business" means a business licensed by the state that is 06 entirely owned by health care providers; 07 (3) "health care insurance" has the meaning given in AS 21.12.050(b); 08 (4) "health care insurer" has the meaning given in AS 21.54.500; 09 (5) "health care provider" has the meaning given in AS 21.07.250; 10 (6) "health care service" 11 (A) means a health care service or procedure that is provided in 12 person or remotely by telemedicine or other means by a health care provider 13 for the care, prevention, diagnosis, or treatment of a physical or mental illness, 14 health condition, disease, or injury; 15 (B) does not include "emergency services" as defined in 16 AS 21.07.250; 17 (7) "health insurance" has the meaning given in AS 21.12.050; 18 (8) "health maintenance organization" has the meaning given in 19 AS 21.86.900; 20 (9) "medical service corporation" has the meaning given in 21 AS 21.87.330. 22 * Sec. 2. AS 45.45 is amended by adding a new section to read: 23 Sec. 45.45.915. Direct health care agreements. (a) A health care provider or 24 health care business may not decline to enter into a direct health care agreement with a 25 new patient or terminate a direct health care agreement with an existing patient solely 26 because of the patient's race, religion, color, national origin, age, sex, physical or 27 mental disability, marital status, change in marital status, pregnancy, parenthood, or 28 any other characteristic of a class of persons protected by a state law that prohibits 29 discrimination. 30 (b) A health care provider or health care business may decline to enter into a 31 direct health care agreement with a new patient if the health care provider or health
01 care business 02 (1) is unable to provide to the patient the health care services the 03 patient requires; or 04 (2) does not have the capacity to accept new patients. 05 (c) A health care provider or health care business may terminate a direct 06 health care agreement with an existing patient based on the patient's health status only 07 if the health care provider is unable to provide to the patient the health care services 08 the patient requires or in accordance with AS 21.03.025. 09 (d) A health care provider or health care business may not make, publish, 10 disseminate, circulate, broadcast, or place before the public, or cause, directly or 11 indirectly, to be made, published, disseminated, circulated, broadcast, or placed before 12 the public, in a newspaper, magazine, or other publication, or in the form of a notice, 13 circular, pamphlet, letter, or poster, or over a radio or television station, or in any other 14 way, an advertisement, announcement, or statement containing an assertion, 15 representation, or statement that is untrue, deceptive, or misleading with respect to 16 (1) the terms of or the benefits or advantages provided by a direct 17 health care agreement; 18 (2) the characterization of a direct health care agreement, including the 19 characterization of a direct health care agreement as health insurance or an alternative 20 to health insurance; 21 (3) the business of a direct health care agreement. 22 (e) In this section, 23 (1) "direct health care agreement" has the meaning given in 24 AS 21.03.025(n); 25 (2) "health care business" has the meaning given in AS 21.03.025(n); 26 (3) "health care provider" has the meaning given in AS 21.07.250; 27 (4) "health care service" has the meaning given in AS 21.03.025(n); 28 (5) "health insurance" has the meaning given in AS 21.12.050. 29 * Sec. 3. AS 45.50.471(b) is amended by adding a new paragraph to read: 30 (58) violating AS 45.45.915 (direct health care agreements).