04/16/2025 03:15 PM House LABOR & COMMERCE

             HB 144-INSURANCE; PRIOR AUTHORIZATIONS                                                                         
                                                                                                                                
5:23:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS 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." [Before the committee was CSHB 144(HSS).]                                                                      
                                                                                                                                
5:23:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JUSTIN RUFFRIDGE,  Alaska  State Legislature,  as                                                               
prime sponsor, presented CSHB 144(HSS).   He explained that prior                                                               
authorization  (PA) was  a requirement  for  health services  and                                                               
medications  to  be  approved  by  the  payer  before  a  patient                                                               
receives  said services  or  medications.   He  noted that  prior                                                               
authorization has been  a barrier to receiving  healthcare due to                                                               
both technology and old equipment.   He stated that CSHB 144(HSS)                                                               
was  a collaborative  effort to  address prior  authorizations in                                                               
Alaska,  adapt  timelines for  access  to  care, particularly  in                                                               
urgent or  emergency situations, update access  for chronic care,                                                               
and update  requirements for  response time.   He  concluded that                                                               
CSHB  144(HSS)  was  designed  to be  "good  for  patients,"  and                                                               
improve access to healthcare.                                                                                                   
                                                                                                                                
5:26:10 PM                                                                                                                    
                                                                                                                                
BUD SEXTON, Staff, Representative  Justin Ruffridge, Alaska State                                                               
Legislature,  on   behalf  of  Representative   Ruffridge,  prime                                                               
sponsor  of CSHB  144(HSS), began  on slide  2 of  the PowerPoint                                                               
[included in the committee file],  and outlined problems that the                                                               
proposed  legislation was  meant to  address.   Slide  2 read  as                                                               
follows [original punctuation provided]:                                                                                        
                                                                                                                                
     • Need for Prior Authorization (PA) before obtaining                                                                       
     services.                                                                                                                  
     • Time                                                                                                                     
     • Individuals with Chronic Conditions.                                                                                     
       • Crafting a solution that takes into account the                                                                        
     needs                                                                                                                      
     and protocols for all parties.                                                                                             
                                                                                                                                
MR.  SEXTON moved  to slide  3,  giving an  overview of  the                                                                    
collaborative efforts  put into  crafting CSHB  144(HSS) and                                                                    
outlined the  goals of the proposed  legislation, which read                                                                    
as follows [original punctuation provided]:                                                                                     
                                                                                                                                
     • Over the past year, numerous meetings between                                                                            
     stakeholders.                                                                                                              
     • Easy to understand process.                                                                                              
     • Establish timelines                                                                                                      
     • Enforcement                                                                                                              
                                                                                                                                
MR. SEXTON clarified that CSHB 144(HSS) would establish                                                                         
mechanisms of enforcement for the Division of Insurance.                                                                        
                                                                                                                                
MR. SEXTON gave an overview of the timelines expected under                                                                     
CSHB 144(HSS), shown on slide 4, which read as follows                                                                          
[original punctuation provided]:                                                                                                
                                                                                                                                
        • Easy to understand by patients and healthcare                                                                         
     providers.                                                                                                                 
     • Process must be reasonable and efficient.                                                                                
     • Determination with 72 hours for standard request.                                                                        
     • 24 hours for an expedited request.                                                                                       
     • Prior Authorization request is approved if timeline                                                                      
     is not met under the updated process.                                                                                      
                                                                                                                                
MR.  SEXTON gave  a summary  of  the proposed  process for  prior                                                               
authorizations  with incomplete  information, shown  on slide  5,                                                               
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
           • If more information is needed to make a                                                                            
     determination,                                                                                                             
      the insurer shall send a request within one calendar                                                                      
     day                                                                                                                        
     for an expedited request and three calendar days for a                                                                     
     standard request.                                                                                                          
      • Information due to the insurer between five to 14                                                                       
     days.                                                                                                                      
                                                                                                                                
MR. SEXTON moved to slide 6 of the PowerPoint, and gave a                                                                       
summary of improvements to the prior authorization process,                                                                     
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
       • PA standards listed on the health care insurer's                                                                       
     website                                                                                                                    
     or portal (both locations if available).                                                                                   
     • PA criteria based on peer-reviewed, evidenced-based                                                                      
     clinical review criteria.                                                                                                  
     • Consistently applied by all sources including                                                                            
     Utilization Review Organizations.                                                                                          
                                                                                                                                
MR. SEXTON moved  to slide 7 and asserted that  CSHB 144(HSS) was                                                               
intended to  be favorable to  the patients.   He gave  the bullet                                                               
points of  slide 7, which  read as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     • Patients benefit?if the standards by the insurer and                                                                     
     the                                                                                                                        
     utilization review organization are different.                                                                             
     • For each service, the insurer must list:                                                                                 
     • If a prior authorization process is necessary.                                                                           
     • Date the requirement became effective                                                                                    
                                                                                                                                
MR. SEXTON moved to slide 8 and gave an overview of changes                                                                     
to care regarding chronic conditions, which read [original                                                                      
punctuation provided]:                                                                                                          
                                                                                                                                
     • PA is valid for not less than 12 months.                                                                                 
     • Automatic renewal if condition remains unchanged.                                                                        
     • Stage 4 metastatic cancer/Step therapy.                                                                                  
                                                                                                                                
MR. SEXTON moved to slide 9 and gave an overview of                                                                             
accountability and compliance under CSHB 144(HSS), which                                                                        
read [original punctuation provided]:                                                                                           
                                                                                                                                
     • Dept of Insurance Director shall monitor compliance.                                                                     
      • Examination of health care insurers at least every                                                                      
     two years:                                                                                                                 
     • PA response times and adherence to timeframes.                                                                           
     • Accuracy and completeness of PA requirements.                                                                            
      • Consistency of PA practices by Utilization Review                                                                       
     Organizations and Third-Party Administrators.                                                                              
                                                                                                                                
MR. SEXTON moved to slide 10 and gave an overview of                                                                            
enforcement mechanisms under CSHB 144(HSS), which read as                                                                       
follows [original punctuation provided]:                                                                                        
                                                                                                                                
     • The director may impose penalties                                                                                        
          • May impose a penalty for each instance of                                                                           
     noncompliance                                                                                                              
         • Persistent or severe violations may warrant                                                                          
    suspension   or   revocation    of   health   insurer's                                                                     
     certificate of authority                                                                                                   
                                                                                                                                
5:30:50 PM                                                                                                                    
                                                                                                                                
JARED  KOSIN, President  & CEO,  gave invited  testimony on  CSHB
(HSS).  He stated that  AHHA strongly supported CSHB 144(HSS).                                                               
He asserted that,  while prior authorization is  a useful process                                                               
for reviewing  appropriateness of medical  care, it was  a deeply                                                               
flawed  process that  has, in  past,  led to  critical delays  in                                                               
patient care.   He stated that CSHB 144(HSS)  was a collaboration                                                               
among providers,  insurers, regulators to improve  the PA process                                                               
for  patients.   He highlighted  improvements for  patients under                                                               
CSHB  144(HSS),  including:     long-term  approval  for  chronic                                                               
conditions,  decreasing turnaround  times  from five  days to  72                                                               
hours, no  restrictions on  key therapies  for stage  IV cancers,                                                               
and requiring an exception process  to step therapy protocol.  He                                                               
asserted  that  the  proposed  legislation  creates  transparency                                                               
around  "the processes  that  are used,  how  they're used,  when                                                               
they're  effective,  who  [is]   doing  these  reviews,  ...  how                                                               
accountability is going to be applied,  and ... how bill is being                                                               
enforced."   He concluded by  asserting that CSHB 144(HSS)  was a                                                               
comprehensive  bill with  strong support  from both  insurers and                                                               
hospitals in Alaska and invited questions from the committee.                                                                   
                                                                                                                                
5:33:25 PM                                                                                                                    
                                                                                                                                
GARY  STRANNIGAN,  Vice  President, Congressional  &  Legislative                                                               
Affairs,  Premera  Blue Cross,  gave  invited  testimony on  CSHB
(HSS).  He  stated that Premera Blue Cross  has been providing                                                               
services  to residents  in Alaska  before statehood.   He  stated                                                               
that  Premera  Blue  Cross  supported   efforts  to  promote  the                                                               
affordability  of their  products in  continued service  of their                                                               
customers.  He  asserted that affordability has  become a gateway                                                               
in  restricting   access  to   care.     He  stated   that  prior                                                               
authorization was  important to  affordability in  helping ensure                                                               
that members  are getting the  "right care  at the right  time in                                                               
the right  setting at the  right price."   He asserted  that CSHB
(HSS)  was representative  of a  reasonable compromise  by all                                                               
parties and encouraged the passage of CSHB 144(HSS).                                                                            
                                                                                                                                
[CSHB 144(HSS) was held over.]