HCS CSSB 45(2d L&C) am H(efd add H): "An Act relating to insurance; relating to direct health care agreements; relating to the duties of the director of the division of insurance in the Department of Commerce, Community, and Economic Development; and providing for an effective date."
00 HOUSE CS FOR CS FOR SENATE BILL NO. 45(2d L&C) am H(efd add H) 01 "An Act relating to insurance; relating to direct health care agreements; relating to the 02 duties of the director of the division of insurance in the Department of Commerce, 03 Community, and Economic Development; and providing for an effective date." 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. Health care services provided under a direct health care 09 agreement are limited to the type of health care services that a primary care provider 10 may provide to a patient. A patient is not eligible to enter into a direct health care 11 agreement under this section if the patient is eligible to receive assistance under 12 AS 47.07 (Medical Assistance for Needy Persons) or AS 47.08 (Assistance for 13 Catastrophic Illness and Chronic or Acute Medical Conditions). 14 (b) To be eligible to enter into a direct health care agreement under this
01 section, a health care provider or health care business must 02 (1) accept new patients who are enrolled in the Medicare program; or 03 (2) maintain a practice in which 20 percent or more of the patients 04 (A) are enrolled in the Medicare program; or 05 (B) do not have health insurance. 06 (c) A direct health care agreement must 07 (1) describe the health care services that the health care provider or 08 health care business makes available to the patient in exchange for payment of a 09 periodic fee and each location at which the health care services are available; 10 (2) specify 11 (A) the amount of the periodic fee a patient or the 12 representative of a patient pays in exchange for the health care services that the 13 health care provider or health care business makes available to the patient; 14 (B) the period covered by the periodic fee under (A) of this 15 paragraph; and 16 (C) additional fees that the health care provider or health care 17 business may charge in addition to the periodic fee, including cancellation 18 fees; 19 (3) identify and include contact information for a representative of the 20 health care provider or health care business that is responsible for receiving and 21 addressing 22 (A) a complaint made by a patient relating to the agreement; 23 and 24 (B) a request made by a patient to amend the agreement, 25 including a patient's request to change the name of the representative of the 26 patient or the patient's mailing address, physical address, telephone number, 27 electronic mail address, or other personal information; 28 (4) prominently state that the patient is not entitled to the protections 29 under AS 21.07 (Patient Protections Under Health Care Insurance Policies). 30 (d) A patient or the representative of a patient may terminate a direct health 31 care agreement in writing within 30 days after entering into the agreement. If a patient
01 or representative terminates an agreement under this subsection, the health care 02 provider or health care business shall, not later than 30 days after the patient or 03 representative terminates the agreement, refund to the patient or representative 04 payments made under the agreement, less payments made for services the health care 05 provider or health care business has already performed that are not included in the 06 periodic fee. 07 (e) A health care provider or health care business may immediately terminate 08 a direct health care agreement if 09 (1) a patient's behavior threatens the safety of the health care provider, 10 the staff of the health care provider or health care business, or other patients of the 11 health care provider or health care business; 12 (2) a patient engages in disrespectful, derogatory, or prejudiced 13 behavior that is within the patient's control and the patient does not stop the behavior 14 even after the health care provider or the staff of the health care provider or health care 15 business requests the patient to stop the behavior; or 16 (3) a patient or the representative of a patient breaches the terms of the 17 agreement. 18 (f) A patient or the representative of a patient may immediately terminate a 19 direct health care agreement if a health care provider or a health care business 20 breaches the terms of the agreement. 21 (g) A health care provider or health care business may not change the periodic 22 fee under the agreement more than once a year and shall provide at least 45 days' 23 written notice of a change in the periodic fee. If a health care provider or health care 24 business increases the amount of the periodic fee, a patient or the representative of a 25 patient may terminate the agreement by providing to the health care provider or health 26 care business written notice of the termination not later than the day before the date on 27 which the change to the periodic fee is scheduled to take effect. 28 (h) Except as otherwise provided in this section, a health care provider, a 29 health care business, a patient, or the representative of a patient may terminate a direct 30 health care agreement for any reason in writing after at least 30 days' notice. 31 (i) A health care provider or health care business may charge a termination fee
01 only for termination of an agreement by a patient or the representative of a patient 02 under (d) or (h) of this section. The termination fee may not exceed an amount equal 03 to one month's cost of the periodic fee. 04 (j) Upon termination of an agreement under (g) or (h) of this section, the 05 patient shall pay the health care provider or health care business the periodic fee, 06 prorated through the date of termination of the agreement, and any additional fees for 07 services the health care provider or health care business has already performed that are 08 not included in the periodic fee. 09 (k) A health care provider or health care business may bill a patient or the 10 representative of a patient for the periodic fee only after the end of the period to which 11 the periodic fee applies. 12 (l) A patient's employer may pay the periodic fee and additional fees the 13 patient owes a health care provider or health care business under a direct health care 14 agreement. A payment by the employer under this subsection does not constitute 15 engaging in the business of insurance or underwriting in this state, and the employer is 16 not an insurer, a health maintenance organization, a health care insurer, or a medical 17 service corporation by virtue of the payment. 18 (m) A direct health care agreement and a health care provider or health care 19 business providing health care services under a direct health care agreement are 20 subject to AS 21.36 (Trade Practices and Frauds) to the extent applicable and when 21 not in conflict with the express provisions of this section. 22 (n) A health care provider or health care business may not decline to enter into 23 a direct health care agreement with a new patient or terminate a direct health care 24 agreement with an existing patient solely because of the patient's race, religion, color, 25 national origin, age, sex, physical or mental disability, marital status, change in marital 26 status, pregnancy, parenthood, or any other characteristic of a class of persons 27 protected by a state law that prohibits discrimination. 28 (o) A health care provider or health care business may decline to enter into a 29 direct health care agreement with a new patient if the health care provider or health 30 care business 31 (1) is unable to provide to the patient the health care services the
01 patient requires; or 02 (2) does not have the capacity to accept new patients. 03 (p) A health care provider or health care business may terminate a direct 04 health care agreement with an existing patient based on the patient's health status only 05 if the health care provider is unable to provide to the patient the health care services 06 the patient requires or in accordance with this section. 07 (q) A health care provider or health care business may not make, publish, 08 disseminate, circulate, broadcast, or place before the public, or cause, directly or 09 indirectly, to be made, published, disseminated, circulated, broadcast, or placed before 10 the public, in a newspaper, magazine, or other publication, or in the form of a notice, 11 circular, pamphlet, letter, or poster, or over a radio or television station, or in any other 12 way, an advertisement, announcement, or statement containing an assertion, 13 representation, or statement that is untrue, deceptive, or misleading with respect to 14 (1) the terms of or the benefits or advantages provided by a direct 15 health care agreement; 16 (2) the characterization of a direct health care agreement, including the 17 characterization of a direct health care agreement as health care insurance or an 18 alternative to health care insurance; 19 (3) the business of a direct health care agreement. 20 (r) In this section, 21 (1) "direct health care agreement" means a written agreement between 22 a health care provider or health care business and a patient or the representative of a 23 patient to provide health care services in exchange for payment of a periodic fee; 24 (2) "health care business" means a business licensed by the state that 25 employs health care providers; 26 (3) "health care insurance" has the meaning given in AS 21.12.050(b); 27 (4) "health care insurer" has the meaning given in AS 21.54.500; 28 (5) "health care provider" has the meaning given in AS 21.07.250; 29 (6) "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 (7) "health insurance" has the meaning given in AS 21.12.050; 06 (8) "health maintenance organization" has the meaning given in 07 AS 21.86.900; 08 (9) "medical service corporation" has the meaning given in 09 AS 21.87.330; 10 (10) "primary care provider" has the meaning given in AS 21.07.250. 11 * Sec. 2. This Act takes effect January 1, 2025.