Legislature(2021 - 2022)DAVIS 106
05/05/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB132 | |
| SB98 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 132 | TELECONFERENCED | |
| += | SB 98 | TELECONFERENCED | |
| + | HB 176 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 176-DIRECT HEALTH AGREEMENT: NOT INSURANCE
4:31:26 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 176, "An Act relating to insurance;
relating to direct health care agreements; and relating to
unfair trade practices."
4:31:44 PM
CRYSTAL KOENEMAN, Staff, Representative Sara Rasmussen, Alaska
State Legislature, on behalf of Representative Rasmussen, prime
sponsor, gave a sectional analysis of HB 176. She stated that
HB 176 would establish direct health care agreements for medical
providers to provide Direct Primary Care (DPC) to patients. She
explained that DPC would be a membership based alternative
payment model where patients, employers, or health plans pay
primary care providers flat, simple periodic fees directly, in
exchange for access to a broad range of primary care services.
She reported that the previous committee of referral had done
quite a bit of work on the proposed legislation, and it
suggested going through the sectional analysis to better
understand all the many intricate parts of the bill.
CO-CHAIR ZULKOSKY requested a reading of the sectional analysis.
MS. KOENEMAN gave a sectional analysis of HB 176 [copy included
in the committee packet], which read as follows [original
punctuation provided]:
Section 1: AS 21.03.025 Direct health care
agreements. Adds a new section to AS 21.03 creating
direct health care agreements.
Subsection (a) outlines that a direct health care
agreement is between a health care provider and a
government entity, individual patient, employer of a
patient, or a representative of a patient.
Subsection (b) states the provider shall disclose the
services provided under the agreement and establish an
annual fee comparable to other agreements.
Subsection (c) The health care agreement must be
legible and in language an individual with no medical
training can understand. It must: Describe the
services to be provided by the health care provider;
Specify the annual fees associated with the agreement;
Prominently state that the agreement is not health
insurance and that it does not meet health insurance
mandates that may be required by federal law; Include
contact information for the person receiving and
addressing complaints; State the annual fee under the
agreement; and Specify the number of patients the
health care provider has the capacity to serve and the
number they are currently serving.
Subsection (d) allows for the policy to be terminated
within 30 days of entering into the agreement from the
patient.
Subsection (e) allows for the policy to be terminated
after a 30-day written notice from either party.
Subsection (f) allows for the policy to be terminated
in accordance with the agreement.
Subsection (g) allows for policy modification
Subsection (h) States that the services and agreements
are subject to consumer protection laws
Subsection (i) specifies that the offering or
execution of an agreement is not engaging in the
business of insurance or underwriting in the state.
Subsection (j) [states that a person may not make,
publish or disseminate an assertation that is untrue
or deceptive.]
Subsection (k) providers that enter into agreements
shall file a report with the Division of Insurance on
or before September 1 each year.
Subsection (l) defines the terms "health care
practice", "health care provider", and "health care
service"
Section 2: AS 45.45.915 Direct health care
agreements. Adds a new section under Trade Practices.
Subsection (a) prevents health care providers from
declining or terminating direct health care agreements
based on a patient's protected class under federal or
state law that prohibits discrimination.
Subsection (b) provides that a provider may decline or
terminate a direct health care agreement if the
provider is unable to provide the level or type of
care the patient requires. The provider shall ensure
the patient is referred to a health care provider who
is able to provide the level or type of care required
and agrees to provide said care.
Subsection (c) allows for a provider to decline to
enter into an agreement if they do not have the
capacity to accept new patients.
Subsection (d) defines the terms "direct health care
agreement" and "health care provider."
Section 3: AS 45.50.471(b) Unlawful acts and
practices. Updates definitions for "unfair methods of
competition" and "unfair or deceptive acts or
practices" to include violating direct health
agreements under AS 45.45.915.
Section 4: Amends uncodified law for the Division of
Insurance to adopt regulations.
Section 5: provides an immediate effective date for
Section 4.
Section 6: provides for a January 1, 2023, effective
date.
4:37:48 PM
REPRESENTATIVE PRAX pointed out that the proposed legislation
provides that DPC would not be insurance. He questioned why the
Division of Insurance would regulate DPC.
MS. KOENEMAN explained that the proposed legislation is similar
to the laws for air ambulance service. She stated that this
service is also not insurance; however, it does fall under Title
21, which allows for a regulatory authority to oversee the
agreements. She stated that other options were discussed, such
as placing the bill under Title 8 as a medical statute or giving
the Department of Health and Social Services oversight. She
reported that the Division of Insurance was chosen as this would
increase consumer protection, as the providers would be required
to provide documentation to the division.
4:39:23 PM
REPRESENTATIVE SPOHNHOLZ pointed out that the decision to put
the DPC under the Division of Insurance was made in the House
Labor and Commerce Standing Committee, which she co-chairs. She
explained that the choice was made based on the Division of
Insurance having the expertise to prioritize consumer protection
while implementing this novel way to access health care.
4:40:28 PM
REPRESENTATIVE FIELDS added that the House Labor and Commerce
Standing Committee, which he also co-chairs, wrote the "not
insurance, consumer protection" regulation language with the
director of the Division of Insurance. Instead of any problem
requiring a new bill, he expressed the need to allow for timely
resolutions to implementation issues. He stated that as a new
healthcare vehicle, it was decided the division would be the
best to have regulatory oversight. He cited the director of the
division's institutional knowledge and expertise in consumer
protection.
4:41:18 PM
CO-CHAIR ZULKOSKY asked whether similar types of agreements
between businesses and consumers existed in Alaska. She
questioned whether the framework would be a similar to other
agreements. She suggested that the proposed legislation could
create a brand-new consumer dynamic.
MS. KOENEMAN explained that because statute does not explicitly
prohibit these types of agreements, there are providers already
using them. She stated that it would be advantageous for the
state to create a regulatory system for these agreements based
on the framework which already exists. This way providers and
patients would have any future disputes addressed.
4:43:06 PM
REPRESENTATIVE PRAX referred to language in Section 2 which
addresses price discrimination. He expressed the understanding
that often life insurance costs less for women, while health
insurance costs more. He questioned whether this would be the
type of discrimination the language is trying to prevent.
MS. KOENEMAN explained that the intent of the legislation is to
facilitate fair and equitable agreements, which would allow
anyone to enter a DPC agreement without fear of discrimination.
MS. KOENEMAN, in response to a follow-up question, reiterated
that the intent is for there to be no price discrimination. She
reported that in states where DCP agreements have been legalized
there are set rates for individuals, families, adults, and
children, but there were no rates based on gender.
4:45:40 PM
REPRESENTATIVE FIELDS recollected that the language was written
to include "age bands" with different rates, but discrimination
between genders within these age bands would not be allowed. He
requested confirmation of this from the director of the
division.
CO-CHAIR ZULKOSKY explained that the committee would follow up
with the director outside of the meeting.
4:46:12 PM
CO-CHAIR ZULKOSKY announced that HB 176 was held over.