HCS CSSB 45(2d L&C): "An Act relating to insurance; relating to direct health care agreements; and relating to the duties of the director of the division of insurance in the Department of Commerce, Community, and Economic Development."
00 HOUSE CS FOR CS FOR SENATE BILL NO. 45(2d L&C) 01 "An Act relating to insurance; relating to direct health care agreements; and relating to 02 the duties of the director of the division of insurance in the Department of Commerce, 03 Community, and Economic Development." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 21.03 is amended by adding a new section to read: 06 Sec. 21.03.025. Direct health care agreements. (a) A health care provider or 07 health care business and a patient or the representative of a patient may enter into a 08 direct health care agreement. A patient is not eligible to enter into a direct health care 09 agreement under this section if the patient is eligible to receive assistance under 10 AS 47.07 (Medical Assistance for Needy Persons) or AS 47.08 (Assistance for 11 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 14 (A) a complaint made by a patient relating to the agreement; 15 and 16 (B) a request made by a patient to amend the agreement, 17 including a patient's request to change the name of the representative of the 18 patient or the patient's mailing address, physical address, telephone number, 19 electronic mail address, or other personal information; 20 (4) prominently state that the agreement is not health insurance and 21 does not meet an individual or other health insurance mandate that may be required by 22 federal law; and 23 (5) prominently state that the patient is not entitled to the protections 24 under AS 21.07 (Patient Protections Under Health Care Insurance Policies) or 25 AS 21.36 (Trade Practices and Frauds). 26 (c) A patient or the representative of a patient may terminate a direct health 27 care agreement in writing within 30 days after entering into the agreement. If a patient 28 or representative terminates an agreement under this subsection, the health care 29 provider or health care business shall, not later than 30 days after the patient or 30 representative terminates the agreement, refund to the patient or representative 31 payments made under the agreement, less payments made for services the health care
01 provider or health care business has already performed that are not included in the 02 periodic fee. 03 (d) A health care provider or health care business may immediately terminate 04 a direct health care agreement if 05 (1) a patient's behavior threatens the safety of the health care provider, 06 the staff of the health care provider or health care business, or other patients of the 07 health care provider or health care business; 08 (2) a patient engages in disrespectful, derogatory, or prejudiced 09 behavior that is within the patient's control and the patient does not stop the behavior 10 even after the health care provider or the staff of the health care provider or health care 11 business requests the patient to stop the behavior; or 12 (3) a patient or the representative of a patient breaches the terms of the 13 agreement. 14 (e) A patient or the representative of a patient may immediately terminate a 15 direct health care agreement if a health care provider or a health care business 16 breaches the terms of the agreement. 17 (f) A health care provider or health care business may not change the periodic 18 fee under the agreement more than once a year and shall provide at least 45 days' 19 written notice of a change in the periodic fee. If a health care provider or health care 20 business increases the amount of the periodic fee, a patient or the representative of a 21 patient may terminate the agreement by providing to the health care provider or health 22 care business written notice of the termination not later than the day before the date on 23 which the change to the periodic fee is scheduled to take effect. 24 (g) Except as otherwise provided in this section and in AS 45.45.915, a health 25 care provider, a health care business, a patient, or the representative of a patient may 26 terminate a direct health care agreement for any reason in writing after at least 30 27 days' notice. 28 (h) A health care provider or health care business may charge a termination 29 fee only for termination of an agreement by a patient or the representative of a patient 30 under (c) or (g) of this section. The termination fee may not exceed an amount equal to 31 one month's cost of the periodic fee.
01 (i) Upon termination of an agreement under (f) or (g) of this section, the 02 patient shall pay the health care provider or health care business the periodic fee, 03 prorated through the date of termination of the agreement, and 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. 06 (j) A health care provider or health care business may bill a patient or the 07 representative of a patient for the periodic fee only after the end of the period to which 08 the periodic fee applies. 09 (k) A patient's employer may pay the periodic fee and additional fees the 10 patient owes a health care provider or health care business under a direct health care 11 agreement. A payment by the employer under this subsection does not constitute 12 engaging in the business of insurance or underwriting in this state, and the employer is 13 not an insurer, a health maintenance organization, a health care insurer, or a medical 14 service corporation by virtue of the payment. 15 (l) A direct health care agreement and health care services provided under a 16 direct health care agreement are not subject to AS 21.07 (Patient Protections Under 17 Health Care Insurance Policies) or AS 21.36 (Trade Practices and Frauds), but are 18 subject to other consumer protection statutes and regulations, including AS 45.45.915. 19 (m) Offering or executing a direct health care agreement does not constitute 20 engaging in the business of insurance or underwriting in this state, and, except as 21 provided in this section, a direct health care agreement and health care services 22 provided under a direct health care agreement are exempt from regulation by the 23 division under this title. A direct health care agreement is not insurance, health 24 insurance, health care insurance, or a health care insurance policy. A health care 25 provider or health care business is not an insurer, a health maintenance organization, a 26 health care insurer, or a medical service corporation by virtue of the offering or 27 execution of a direct health care agreement or the provision of health care services 28 under a direct health care agreement. A certificate of authority or license to market, 29 sell, or offer to sell a direct health care agreement or health care services under a direct 30 health care agreement is not required to offer or execute a direct health care agreement 31 or provide health care services under a direct health care agreement.
01 (n) In this section, 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 06 employs 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).