Legislature(2023 - 2024)DAVIS 106
03/14/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Board of Direct Entry Midwives | |
| HB363 | |
| HB187 | |
| HB205 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 187 | TELECONFERENCED | |
| *+ | HB 363 | TELECONFERENCED | |
| *+ | HB 205 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 187-PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
4:42:43 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 187, "An Act relating to utilization review
entities; exempting certain health care providers from making
preauthorization requests for certain services; and providing
for an effective date."
4:44:22 PM
CHAIR PRAX opened public testimony on HB 187.
JEANNIE MONK, Senior Vice President, Alaska State Hospital &
Healthcare Association, testified in support of HB 187, saying
it would reduce the wait time for certain healthcare services by
exempting healthcare providers from the preauthorization
process. She said that HB 187 represents a step forward in
ensuring timely access to essential medical care. She said that
prior authorization can be extremely frustrating and stressful
for patients and said the last thing a patient wants to worry
about is whether or not their insurance company will cover their
medical bills. She said for patients in rural areas, the issue
of prior authorization is exacerbated by the remote nature of
rural medical care. She emphasized that the prior authorization
process is extremely time consuming for medical providers as
well. Often a healthcare provider will hire teams of staff just
to manage insurance and prior authorization requests. She said
the proposed legislation would strike a good balance between all
aspects of the prior authorization process, and she urged the
committee to pass HB 187.
4:48:00 PM
REPRESENTATIVE FIELDS asked how many medical conditions exist
where the treatment might be longer than 12 months.
MS. MONK said she would follow up with an answer later.
4:48:37 PM
REPRESENTATIVE RUFFRIDGE asked Representative Fields to clarify
his question as to how it relates to prior authorization.
REPRESENTATIVE FIELDS asked if a hypothetical treatment regime
that would need to be executed for longer than 12 months is
addressed in HB 187.
4:49:36 PM
REPRESENTATIVE JESSE SUMNER, Alaska State Legislature, as prime
sponsor, in response to Representative Fields, cited psoriasis
medication as an ongoing treatment regime and said that the
exemption for prior authorization, as addressed under HB 187, is
for the healthcare provider, not the patient.
CHAIR PRAX asked Ms. Monk how often prior authorization requests
are denied and how long payment would take if a request were
approved.
MS. MONK replied that it varies greatly, but there is no data
set on it. She said there are hundreds of procedures all over
Alaska that have to be authorized every day.
4:52:05 PM
TAMMY THIEL, Executive Director, Denali Oncology Group,
testified in support of HB 187. She gave context to the primary
role of the Denali Oncology Group (DOG) and explained how the
current prior authorization process is negatively affecting
medical care in Alaska. She said HB 187 prescribes a solution
for these issues by introducing the concept of a "gold card"
that grants exemption to healthcare providers who consistently
follow evidence-based medicine and achieve an 80 percent
approval rating on prior authorization requests. She said this
could greatly streamline the process of prior authorization and
urged the committee's support for HB 187.
4:55:11 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, testified in support of HB 187. She said that
prior authorization is a process that serves a purpose but can
often inhibit timely and quality healthcare. She said the "gold
card" provision of HB 187 is sensical and would make the process
of prior authorization smoother for all parties involved. She
gave a note on statistics surrounding prior authorization
approval/disapproval rates, along with patient outcomes
depending on the approval or disapproval of the prior
authorization. She cited a survey from the American Medical
Association (AMA) that found that prior authorization
requirements delay necessary treatment and care in 94 percent of
cases. She said the physical, emotional, and financial impact
to patients from delays caused by prior authorization are
significant and devastating, and change should be made. She
said that HB 187 makes sound and logical changes to these
problems and urged the committee's support of HB 187.
4:59:48 PM
MARC REECE, Director of Public Policy, AETNA, testified in
opposition to HB 187. He said that HB 187 is not a good
solution to the ailments that currently exist in the prior
authorization system. He explained that the purpose of prior
authorization is to ensure that healthcare is paid for and
administered as soon as possible and said that HB 187 doesn't
help with that purpose. He said that the bill sponsor doesn't
recognize the impact of the proposed legislations' proposed
"gold card" exemption program. The 80 percent threshold is far
lower than every other state that has tried to implement an
exemption program.
5:03:06 PM
REPRESENTATIVE MINA asked what mechanisms are currently in place
that insurance companies can pursue to reduce the wait time for
prior authorization.
MR. REECE responded that AETNA is actively trying to reduce the
prior authorization approval process by removing certain
services from prior authorization and by automating the approval
process through clinical standards that must be met.
5:05:14 PM
PREET KLAUR, Policy & Legislative Manger, Premera Blue Cross
Blue Shield of Alaska, testified in opposition to HB 187. She
said the proposed bill would be costly and confusing for
insurance companies and their members. She warned that HB 187
would increase the risk for adverse medical events, citing an
unnamed study that found that over 10 percent of authorization
reviews prevented adverse drug events and medical errors. She
emphasized that prior authorization is a critical tool in
ensuring that healthcare is cost-effective and safe, and added
that all prior authorization requests are resolved within 5
days, or within 24 hours if it is an emergency request. She
explained an existing support structure for medical providers
that allows for a reevaluation process if there were wrongful
disapproval of a prior authorization request.
REPRESENTATIVE MINA asked what mechanisms Premera Blue Cross
Blue Shield of Alaska was pursuing to reduce prior authorization
approval times.
MS. KLAUR answered that Premera Blue Cross Blue Shield of Alaska
has created a reevaluation process for a denied approval and
implemented an electronic portal online for easier access to
information regarding its prior authorization approval.
5:10:18 PM
REPRESENTATIVE MINA asked whether HB 187 applies to the
healthcare plans utilized by the State of Alaska.
STEVE RAMOS, Acting Chief Health Administrator, Division of
Retirement & Benefits, Department of Administration, answered
that HB 187 is housed under Title 21 under Alaska Statute, and
the Alaska Care plans as administered by the Division of
Retirement and Benefits are not insurance plans, so they are
subject to Title 39 under Alaska Statute.
REPRESENTATIVE MINA asked Representative Sumner, "Is your intent
to also cover the state plan and [Employee Retirement Income
Security Act] (ERISA) plans or are you only sticking to Title
21?"
REPRESENTATIVE SUMNER answered that is correct.
5:11:56 PM
CHAIR PRAX, after ascertaining there was no one else who wished
to testify, closed public testimony on HB 187.
CHAIR PRAX announced that HB 187 was held over.