Legislature(2025 - 2026)DAVIS 106
04/03/2025 03:15 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB52 | |
| HB144 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 52 | TELECONFERENCED | |
| *+ | HB 144 | TELECONFERENCED | |
| *+ | HB 151 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 144-INSURANCE; PRIOR AUTHORIZATIONS
4:28:40 PM
CHAIR MINA announced that the next order of business would be
HOUSE BILL NO. 144, "An Act relating to prior authorization
requests for medical care covered by a health care insurer;
relating to a prior authorization application programming
interface; relating to step therapy; and providing for an
effective date."
4:28:50 PM
REPRESENTATIVE MEARS moved to adopt the proposed committee
substitute (CS) for HB 144, Version 34-LS0780\N, Wallace,
4/1/25, as the working document.
CHAIR MINA objected for the purpose of discussion.
4:29:25 PM
REPRESENTATIVE JUSTIN RUFFRIDGE, Alaska State Legislature, as
prime sponsor, presented HB 144. He said this issue has been
addressed in previous legislatures and addresses the issue of
prior authorization.
4:31:34 PM
BUD SEXTON, Staff, Representative Justin Ruffridge, on behalf of
Representative Ruffridge, prime sponsor, presented HB 144. He
described the process of prior authorization, which must be
reasonable and efficient. He said that under, HB 144, prior
authorization would be required within 72 hours for a standard
request and within 24 hours for an expedited request. He said
that HB 144 would benefit patients, especially those with
chronic conditions.
4:36:09 PM
REPRESENTATIVE FIELDS asked about HB 144 automatically renewing
coverage for those with chronic illnesses for an additional
year, rather than "additional periods," which would be more
subject to the medical condition at hand.
4:37:13 PM
JARED KOSIN, President and CEO, Alaska Hospital and Healthcare
Association, responded that the Division of Insurance interprets
the language of HB 144 as allowing renewals into perpetuity.
4:38:11 PM
REPRESENTATIVE FIELDS responded that he would like to hear
confirmation on this matter from Legislative Legal Services.
4:38:25 PM
MR. SEXTON continued the presentation of HB 144. On behalf of
Representative Ruffridge, prime sponsor, he read the sectional
analysis of HB 144 [hard copy included in the committee file].
Section 1. AS 21.07.080 is amended to make conforming
changes, preserving the original intent by citing AS
21.07.005-21.07.090 (the original chapter contents).
Section 2. AS 21.07 is amended by adding a new
section: Article 2. Prior Authorization.
Sec 21.07.100. Prior authorization requests.
(a) Requires that each health care insurer offering a
health plan, after January 1, 2027, shall designate a
prior authorization process that is reasonable,
efficient, and minimizes the administrative burden on
health care providers and facilities and that complies
with the standards for medical care and prescription
drugs.
(b) Requires that if a health care provider submits a
prior authorization request, the health care insurer
shall make a determination and notify the provider
within:
a. 72-hours after receiving a standard request
submitted by a method other than facsimile;
b. 72-hours, excluding weekends, after receiving a
standard request submitted by facsimile; or
c. 24-hours after receiving an expedited request.
(c) Provides, that when a prior authorization request
is submitted that does not contain the information
necessary to make a determination, the health care
insurer shall request specific additional information
within:
a. One calendar day after receiving an expedited
request;
b. Three calendar days after receiving a standard
request.
(d) Allows an insurer, in making a determination, that
if the submitted information is not sufficient to make
a determination the insurer may request additional
information with a due date of not less than five (5)
working days nor more than fourteen (14) working days.
(e) Mandates that after the submission of the prior
authorization request, the provider shall receive
confirmation that the request has been received with a
date and time of the receipt.
(f) Provides a prior authorization request is
considered approved if the health care insurer fails
to provide a written denial, approval or request for
additional information within the time specified
above.
Sec. 21.07.110.
(a) Provides that a health care insurer shall make its
most current prior authorization standards available,
on the health care insurer's website including
information or document needed to make a
determination. If the health care insurer provides a
portal, the prior authorization standards shall be
available on the portal.
(b) Provides that a health care insurer's prior
authorization standards must include prior
authorization requirements used by the insurer and by
the insurer's utilization review organization. The
requirements must be based on peer-reviewed, evidence-
based clinical review criteria and be consistently
applied by all sources.
(c) Provides that if the prior authorization standards
published by the health care insurer differ from those
published by their utilization review organization,
the standard most favorable to the covered person
shall be used.
(d) Provides that a health care insurer shall indicate
on its website, for each service subject to prior
authorization,
(1) Whether a standardized electronic prior
authorization request transaction is available; and
(2) The date the prior authorization requirement
became effective and was published on their website.
(e) Provides that if the prior authorization
requirement is terminated, the health care insurer
shall indicate on its website the date the requirement
was removed.
Sec. 21.07.120. Peer review of prior authorization
requests.
(a) Provides that an insurer shall establish a process
for the health care provider to request a clinical
peer review of a prior authorization request.
(b) The peer reviewer must have relevant clinical
expertise in the specialty area or be an equivalent
specialty of the provider submitting the prior
authorization request.
(c) Provides that a heath care insurer shall provide
to the health care provider upon request, the
qualifications of a peer reviewer issuing an adverse
decision.
Sec. 21.07.130. Period of validity of prior
authorization.
(a) Requires that a prior authorization request, for a
chronic condition, must be valid for not less than
twelve (12) months while the covered person is covered
by the insurer's policy. Also addresses how the prior
authorization may be renewed.
(b) Provides that, except for (a) above, a prior
authorization request shall be valid for ninety (90)
calendar days or a duration that is clinically
appropriate, whichever is longer.
Sec. 21.07.140. Adverse determinations.
Provides that if a health care insurer makes an
adverse determination, the insurer shall notify the
covered person and their health care provider and
provide each
(1) A clear explanation of the adverse determination,
(2) A statement of the covered person's right of
appeal; and
(3) Instructions on how to file the appeal.
Sec. 21.07.150. Prior authorization application
programming interface. States that each insurer shall
maintain a prior authorization application programming
interface that automates the prior authorization
process for providers to determine whether a prior
authorization is required for medical care, identify
prior authorization information and documentation
requirements, and facilitate the exchange of prior
authorization requests and determinations from its
electronic health records or practice management
system. The application programming interface must be
consistent with the technical standards and
implementation dates established in the Centers for
Medicare and Medicaid Services rules on
interoperability and patient access.
Sec 21.07.160. Step therapy restrictions and
exception.
(a) Requires that an insurer that provides coverage
under a policy for the treatment of Stage 4 advanced
metastatic cancer shall not limit or exclude coverage
for a drug that is approved by the Federal Drug
Administration (FDA) and that is on the insurer's
prescription drug formulary by mandating that a
covered person with Stage 4 advanced metastatic cancer
undergo step therapy.
(b) Provides that if coverage of a prescription drug
for treatment of any medical condition is restricted
by the insurer, or their utilization review
organization because of a step therapy protocol, the
health care insurer or utilization review organization
must provide a covered person, and his/her provider,
with access to a clear, convenient, and readily
accessible process to request a step therapy exception
determination.
(c) A step therapy exception determination shall be
granted if the covered person has tried the step
therapy required prescription drugs while under a
current or previous health insurance policy.
(d) The insurer, or utilization review organization,
may request relevant documentation from the covered
person or provider to support the exception request.
(e) States that this section shall not be construed to
prevent:
(1) An insurer, or utilization review organization,
from requiring a covered person to try a generic
equivalent or other brand name drug prior to providing
coverage for the requested prescription drug; or
(2) A provider from prescribing a prescription drug he
or she determines is medically appropriate.
Sec 21.07.170. Annual report.
Health care insurers shall submit annual reports, on a
form prescribed by the director, detailing their
adherence to AS 21.07.100 through AS 21.07.180.
Sec 21.07.180. Compliance and enforcement
(a) Requires that the director shall monitor
compliance with the provision of AS 21.07.100 AS
21.07.180.
(b) States that the examination of an insurer's prior
authorization practices shall be consistent with AS
21.06.120 through AS 21.06.230. Examinations shall be
performed at least every two years
(c) Provides that if an insurer is found to be non-
compliant with the provisions of AS 21.07.100 through
AS 21.07.180, the director may impose penalties
including fines for each instance of non-compliance,
orders to rectify deficiencies within a specified time
frame or for suspension or revocation of the insurer's
certificate of authority for persistent or severe
violations.
(d) Provides that the director shall adopt regulations
establishing penalties for noncompliance.
Section 3. Sec 21.07.250 is amended to
Add definitions for:
(15) Chronic Condition
(16) Covered person
(17) Expedited request
(18) Prior Authorization
(19) Standard request
(20) Step-therapy protocol
(21) Utilization review organization
Section 4. The uncodified laws of the State of Alaksa
are amended by adding a new section to read:
Transition Regulations providing that the director may
adopt regulations necessary to implement this Act.
Section 5. Provides that Section 4 takes effect
immediately.
Section 6. Provides that except as provided in Sec 5,
this act takes effects on January 1, 2027.
4:43:24 PM
REPRESENTATIVE FIELDS, [referring to page 5, line 16, in Section
2 of HB 144], pointed to the language "Adverse determinations"
and asked if it would be necessary to add "answered by a human"
to add clarity.
4:44:12 PM
REPRESENTATIVE RUFFRIDGE responded that some other sections of
HB 144 detail how to avoid an adverse determination. He said
that there are options before a telephone conversation with a
human would be necessary.
4:45:48 PM
REPRESENTATIVE FIELDS asked why stage 4 metastatic breast
cancer, as opposed to other types or stages of cancer, is
distinguished in HB 144.
REPRESENTATIVE RUFFRIDGE responded with an explanation of step
therapy. He said that stage 4 metastatic breast cancer is not
exclusive under HB 144.
4:48:18 PM
CHAIR MINA removed her objection to the motion to adopt the
proposed CS for HB 144, Version 34-LS0780\N, Wallace, 4/1/25, as
the working document. There being no further objection, Version
N was before the committee.
4:48:43 PM
CHAIR MINA announced invited testimony.
4:48:51 PM
MR. KOSIN begin his invited testimony on HB 144, Version N, by
explaining that at stage 4 of any cancer, one typically starts
exploring trials and alternative treatments. He said that the
Alaska Hospital and Healthcare Association strongly supports HB
144 and the effort to reform prior authorization. He said that
HB 144, Version N, would address the delays in urgent care
needed by patients and would have an immediate, positive impact
on patients. He emphasized the importance of transparency that
would be added to prior authorization under the proposed
legislation.
4:53:25 PM
GARY STRANNIGAN, Vice President, Congressional and Legislative
Affairs, Premera Blue Cross Blue Shield of Alaska, began his
invited testimony in support of HB 144, Version N. He said that
prior authorization is an important component to making
healthcare affordable. He said he thinks the proposed
legislation would improve prior authorization and increase its
efficiency by increasing automation of the process.
4:56:21 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, began her invited testimony in support of HB 144,
Version N. She said that the Alaska State Medical Association
strongly supports the proposed legislation. She said that the
process of prior authorization has become cumbersome and harmful
to patients, but HB 144, Version N, would address those issues
very well.
4:58:31 PM
REPRESENTATIVE GRAY raised concern that HB 144, Version N, would
not actually reduce costs.
REPRESENTATIVE RUFFRIDGE responded that in states that have
passed similar legislation, there have been direct correlations
to reduce costs. He added that HB 144, Version N, would
simplify the process of prior authorization and the number of
employees required to complete the process.
REPRESENTATIVE GRAY explained that often, due to drug
advertising, patients will ask a physician to prescribe
specific, name-brand drugs, rather than the generic drug of the
same kind. He said that doing so requires prior authorization,
even in situations where physicians may not have the time to
process a prior authorization. He asked for feedback on these
cases.
REPRESENTATIVE RUFFRIDGE responded that prior authorization does
help with cost containment and that HB 144, Version N, would
improve the ability to provide step therapy, as well as help
uphold patient safety.
REPRESENTATIVE GRAY suggested that one way to expand access to
care and lower costs would be to allow pharmacists to prescribe
medications.
REPRESENTATIVE RUFFRIDGE responded that pharmacists are awesome,
and he supports Representative Gray's support of their work.
[HB 144, Version N, was held over.]