Legislature(2017 - 2018)BELTZ 105 (TSBldg)
04/19/2018 09:00 AM Senate JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| SB81 | |
| HB355 | |
| HB208 | |
| HB123 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 355 | TELECONFERENCED | |
| += | SB 81 | TELECONFERENCED | |
| += | HB 208 | TELECONFERENCED | |
| += | HB 123 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 123-DISCLOSURE OF HEALTH CARE COSTS
10:16:45 AM
CHAIR COGHILL announced the consideration of HB 123. [SCS CSHB
123(HSS) was before the committee.]
10:17:11 AM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 123, said this bill is a first step in the
marathon to address health care costs in Alaska. The first
health insurance in the U.S. was created in 1930 and Medicare
and Medicaid were added in 1965. She said no one measure will
resolve the complex problem of paying for health care, but HB
123 is a first bite at the apple that gives more power to
consumers. She continued to introduce HB 123 speaking to the
following sponsor statement:
HB 123 empowers consumers to make informed decisions
about their health care options by ensuring accessible
information on medical pricing. The bill will require
health care providers to publish health care price
information in public spaces and on their websites and
to submit that price information to the Department of
Health and Social Services. Individual providers must
disclose the total undiscounted costs of their 25 most
commonly provided health care services and procedures.
Larger medical facilities would provide the same price
information for their 50 most common health care
services and procedures.
Alaska has the second most expensive health care costs
per person in the nation as a result of a small
insurance market with limited provider competition.
Health care spending in Alaska increases faster than
the rate of inflation despite the fact that Alaska's
use of health care services is lower than the
nationwide average.) Because of the murkiness around
health care prices, consumers have little power to
influence the cost of desperately needed medical
services.
Medical price transparency across the nation could
2
save the U.S. $36 billion in health care spending.
More than 30 states are pursuing legislation to
increase price transparency across the nation;
however, Alaska currently has no price transparency
law in place. Price transparency can allow consumers
to take financial control of their health care and
exercise more choice in their providers. Transparency
can also begin the public dialogue between
stakeholders in the health care industry regarding the
variation of health care costs within Alaska.
HB 123 provides a simple approach to comprehensive,
consumer-friendly health care price information for
consumers. It may also help reduce the price of health
care spending and increase the accessibility to
quality health care, while being unburdensome to
health care providers and facilities. Empowering
consumers with price information allows patients to
compare providers and "shop" for high-value, cost-
effective care. While health care prices are
negotiable, health care is not. Alaskans deserve to
know what health care services and procedures will
cost before they step into the doctor's office.
REPRESENTATIVE SPOHNHOLZ advised that during the Interim they
made some changes to the bill that passed the House. Originally
the bill required only undiscounted prices (rack rate) to be
posted. Doctors pointed out that most consumers do not pay that
rate and the Senate Health and Social Services amended the bill
to list Medicaid rates so a range of prices are described. The
bill now also allows a disclaimer that says the actual rate may
be different than the listed rates. The billing office or
insurance company would have the complete information. She noted
that health care providers have broad discretion in what the
disclaimer says.
Another new provision is for a good faith estimate that is
similar to the Municipality of Anchorage ordinance. This would
be given to consumers on request. One difference is that
inpatient and emergency departments are not required to
immediately provide an estimate. The good faith estimate may
also be provided verbally if it meets the patient's needs.
Efforts were made to come up with something that is practical
and easy to implement. The list of most frequently offered
services will only need to be run once a year and posted by
January 30.
REPRESENTATIVE SPOHNHOLZ said HB 123 is not a silver bullet. It
will not bend the cost curve in health care this year, but it is
a good place to start.
10:24:35 AM
CHAIR COGHILL said he was flagging the use of Medicaid to
describe the range of prices for discussion at the next hearing.
10:25:21 AM
SENATOR WIELECHOWSKI said he believes the bill is a good step
forward but wonders about the next step.
10:25:44 AM
REPRESENTATIVE SPOHNHOLZ explained that the bill is designed to
put information into the community about health care costs to
hopefully incentivize further price transparency and the way
care is paid for. Health care in the U.S. isn't really an
option. Rather, it's sick care. Health care providers are paid
to give care when consumers are sick. Helping people to get and
stay healthy isn't incentivized. She noted that she and other
legislators are looking at ways to explore value-based
compensation so health care providers are incentivized to help
people get healthier.
CHAIR COGHILL said his first response to the bill was more
negative than positive because he questioned the value to the
consumer. He acknowledged that he was coming around. He asked
for sectional review.
REPRESENTATIVE SPOHNHOLZ said she appreciates the time he has
taken to learn about the bill. Health care is a very complex
subject.
10:29:13 AM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, Juneau, Alaska, reviewed the following
sectional analysis for HB 123, version 30-LS0380\B:
Section 1
AS 18.15.360.
Subsection (a) (p. 1, line 14, p. 2, line 1): has been
amended to authorize the Department of Health and
Social Services (DHSS) to collect, analyze, and
maintain databases of information related to health
care services and price information collected under AS
18.23.400.
Section 2
AS 18.23.400.
(p. 2, line 4): this is a new section that mandates
the disclosure and reporting of health care services
and price information.
Subsection (a) (p. 2, lines 7-16): providers will
compile a list of the 25 most commonly performed
health care services from the previous year and for
each of the services state the procedure code, the
undiscounted price, facility fees, and the payment
rates for Medicaid.
Subsection (b) (p. 2, lines 17-25): facilities will
compile a list of the 50 most commonly performed
health care services from the previous year and for
each of the services state the procedure code, the
undiscounted price, facility fees, and the payment
rates for Medicaid.
Subsection (c) (p. 2, line 26-31): if a provider or
facility has fewer than 25 or 50 health care services
performed, respectively, the provider or facility will
compile a list of all health care services performed
with the procedure code, undiscounted price, facility
fees, and the payment rates for Medicaid.
Subsection (d) (p. 3, lines 1-7): a provider in a
group practice is not required to compile and publish
a price information list if the group practice
compiles and publishes a list, and the prices and fees
that the provider charges are reflected in the list
published by the group practice.
10:30:59 AM
CHAIR COGHILL said he looks for some modification of that
provision.
10:31:06 AM
MS. NISBETT continued.
Subsection (e) (p. 3, lines 8-30): providers and
facilities will publish their list each year by
January 31stand submit the list to DHSS along with
their name and location. The lists will be posted in
font size no smaller than 20, in a public area with
the DHSS website address listed, and a statement
explaining that the price posted may be higher or
lower than the amount paid by the patient. The list
will also include a statement that says the patient
will be provided an estimate upon request, and the
provider or facilities' in-network preferred provider.
Lastly, the lists will be posted on the website of the
facility or provider if they have one.
10:31:49 AM
CHAIR COGHILL asked if it will also list an in-network.
MS. NISBETT answered yes; it will list the in-network preferred
provider for the facility or provider. Responding to a further
question she agreed that in a hospital the posting could list
multiple providers.
MS. NISBETT continued.
Subsection (f) (p. 3, line 31, p. 4, lines 1-4): once
a year, DHSS will gather the compiled lists from the
health care providers and facilities and post the
information on their website. The lists will also be
entered into the DHSS database under AS 18.15.360(a).
Subsection (g) (p. 4, lines 5-25): when a patient
requests a good faith estimate (GFE) of nonemergency
health care services, the provider, facility, or
insurer will have 10 days to provide the GFE verbally,
in writing, or by electronic means. If the GFE is
received verbally, the provider, facility, or insurer
will keep a record of that GFE. The provider,
facility, or insurer is not required to disclose the
total charges for the anticipated course of treatment
but should provide a portion of the total charges of
the course of treatment, or a range of the charges for
the anticipated service if the provider or facility
cannot reasonably assess what the services should be.
Subsection (h) (p. 4, lines 26-31, p. 5, lines 1-17):
a GFE must include a brief description in plain
language of the health care services, products,
procedures, and supplies, the in-network preferred
providers, the procedure code, facility fees, and the
suspected identity of others that may charges for a
service, product, procedure or supply in connection
with the nonemergent health care service, along with
an explanation of whether the charges are included are
in the GFE.
Subsection (i) (p. 5, lines 18-21): a provider,
facility, or insurer that provides an GFE will not be
liable for damages if the GFE is different from the
amount charged to the patient.
Subsection (j) (p. 5, lines 22-25): a facility that is
an emergency department will not be required to
provide a GRE or post that they will provide GFE upon
request.
Subsection (k) (p. 5, lines 26-31, p. 6 lines 1-2):
Civil penalties for providers and facilities that do
not comply with posting the price information in
subsections (a) through (e) will be $100 a day after
March 31st. This amount will not exceed $10,000. Civil
penalties for providers, facilities, or insurers who
do not provide a GFE upon request in subsections (g)
and (h) after 10 business days will be $100 a day but
will not exceed $10,000.
Subsection (l) (p.6, lines 3-5): providers and
facilities that are penalized are entitled to a
hearing conducted by the office of administrative
hearings.
Subsection (m) (p. 6, lines 6-8): municipalities may
not enforce an ordinance that imposes health care
price disclosure requirements inconsistent with the
regulations in Section 2.
CHAIR COGHILL offered his understanding that this is fairly
close to the Municipality of Anchorage ordinance.
REPRESENTATIVE SPOHNHOLZ confirmed that this was modeled on that
ordinance.
MS. NISBETT continued.
Subsection (n) (p. 6, lines 9-31, p. 7, lines 1-21):
health care facility excludes the Alaska Pioneers'
Home, the Alaska Veterans' Home, an assisted living
home, a long-term care nursing facility licensed by
the department, a hospital operated by the United
States Department of Veterans Affairs, the United
States Department of Defense, or any other federal
institution are described. Department, facility fee,
health care facility, health care insurer, health care
provider, health care service, nonemergency health
care service, patient, third party, and undiscounted
price are also defined.
Section 3
(p. 7, lines 22-26): An individual who has health
insurance can request a GFE of nonemergency health
care services and receive the same information listed
in subsection (g) and (h).
Section 4
(p. 7, lines 27-31, p. 8 line 1): The DHSS can adopt
regulations to implement the changes in this Act.
Section 5
(p. 8, line 2): Section 4 of this Act will take effect
immediately.
Section 6
(p. 8, line 3): Except for Section 5 of this Act, the
effective date is January 1, 2019.
10:38:00 AM
CHAIR COGHILL outlined the path for the next hearing and held HB
123 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 123 - Explanation of changes (ver. O to ver. B).pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Letters of Opposition.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Letter of Support - Fairbanks Chamber.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Letters of Support.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Sectional Analysis (ver. B).pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Sponsor Statement.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Supporting Document - ADN Article.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Supporting Document - Health Care Price Transparency Laws.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |
| HB 123 - Supporting Document - How Price Transparency Can Control the Cost of Health Care.pdf |
SJUD 4/19/2018 9:00:00 AM |
HB 123 |