Legislature(2023 - 2024)BARNES 124
04/22/2024 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB375 | |
| HB187 | |
| HB226 | |
| HB150 | |
| HB233 | |
| HB149 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 226 | TELECONFERENCED | |
| += | HB 187 | TELECONFERENCED | |
| *+ | HB 375 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | HJR 27 | TELECONFERENCED | |
| += | HB 233 | TELECONFERENCED | |
| += | HB 150 | TELECONFERENCED | |
| += | HB 149 | TELECONFERENCED | |
HB 187-PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
3:33:45 PM
VICE CHAIR RUFFRIDGE 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."
3:34:15 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 1 to HB 187,
labeled 33-LS0696\A.1, Wallace, 3/15/24, which read:
Page 1, lines 1 - 2:
Delete "exempting certain health care providers
from making preauthorization requests"
Insert "relating to prior authorization requests"
Page 3, following line 23:
Insert a new subsection to read:
"(j) If a utilization review entity requires a
prior authorization for a health care service for the
treatment of a chronic or long-term care condition,
the prior authorization is valid for the length of the
treatment and the utilization review entity may not
require the covered person to obtain another prior
authorization for the health care service."
Reletter the following subsection accordingly.
REPRESENTATIVE SADDLER objected for purposes of discussion.
REPRESENTATIVE FIELDS explained that Amendment 1 would clarify
that if someone is living with a chronic condition and a health
care service was granted prior authorization, another prior
authorization would not need to be obtained to cover the
service.
REPRESENTATIVE SADDLER asked Ms. Wing-Heier to speak to
Amendment 1.
3:35:28 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community & Economic Development, pointed out that if
the patient were to change insurance companies, prior
authorization may need to be requested again.
REPRESENTATIVE FIELDS said he had assumed that the company would
remain the same.
3:36:21 PM
SARENA HACKENMILLER, Staff, Representative Jesse Sumner, Alaska
State Legislature, on behalf of Representative Sumner, prime
sponsor of HB 187, said the sponsor has no issues with Amendment
1.
3:36:35 PM
REPRESENTATIVE PRAX asked whether there would be a requirement
for the provider to give prior authorization to use another
treatment as technology changes.
REPRESENTATIVE FIELDS said if the treatment changed and it was
not covered in the underlying prior authorization policy, the
new treatment could be approved through a prior authorization.
VICE CHAIR RUFFRIDGE shared a personal anecdote about a patient
who transitioned to a different treatment that required prior
authorization and consequently missed a dose of the medication,
which triggering a relapse in the disease.
3:38:28 PM
REPRESENTATIVE SADDLER how long prior authorization lasts.
MS. WING-HEIER said prior authorization is for specific
treatment that day, not for chronic conditions that require the
same treatment repeatedly.
REPRESENTATIVE SADDLER asked whether it would be reasonable to
provide prior authorization for a lifelong condition that
requires treatment over the course of a person's life.
MS. WING HEIER shared her understanding that for chronic
conditions such as MS, the prior authorization would live with
the consumer for the length of their treatment.
REPRESENTATIVE SADDLER sought to confirm that if Amendment 1
were adopted, another prior authorization would only be required
upon change in treatment or change in technology. He expressed
concern about open ended coverage and asked whether
Representative Fields would be comfortable with adding some kind
of chronological limitation.
3:41:18 PM
REPRESENTATIVE FIELDS said he would defer to maintaining timely
treatment over the alternative. He declined to suggest a
timeframe without input from someone with more medical
expertise.
REPRESENTATIVE SADDLER suggested that the timeframe could be
three years or the duration of the illness whichever is
shorter.
3:42:45 PM
MS. WING-HEIER said she would not oppose a timeframe of 36
months.
REPRESENTATIVE SADDLER asked Ms. Hackenmiller
MS. HACKENMILLER agreed that the sponsor would not oppose a
timeframe.
3:43:19 PM
REPRESENTATIVE SADDLER moved Conceptual Amendment 1 to Amendment
1 to insert "or every 36 months, whichever is shorter," on line
10 after the word "treatment". He said the intent is to avoid
an open-ended exemption from a prior authorization requirement.
VICE CHAIR RUFFRIDGE objected. He acknowledged why a sideboard
would be considered; however, the bill applies to a group of
people who are taking medication or receiving services for rare
and debilitating conditions. He opined that the proposed
amendment would make the purpose of the underlying amendment
worse, and that people may feel "sucker punched" at the three-
year mark.
3:45:31 PM
REPRESENTATIVE CARRICK echoed Vice Chair Ruffridge's comments
and said she would want to hear more from providers on long term
care conditions before putting a timeframe on it.
3:47:03 PM
REPRESENTATIVE FIELDS agreed with his colleagues that a provider
should be consulted before implementing a timeframe.
3:47:48 PM
The committee took an at-ease at 3:47 p.m.
3:48:38 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, agreed that three years could catch patients and
physicians off guard and interrupt treatment, which could have
dilatory effects. She said she would heir on the side of no
time limit rather than risking that interruption of care.
REPRESENTATIVE SADDLER sought clarity on the meaning of a
chronic long-term condition.
MS. VENTGEN said something under six months is acute and
something over 6 months is chronic.
REPRESENTATIVE SADDLER questioned the impact of Amendment 1.
MS. VENTGEN opined that Amendment 1 would be a good addition to
the bill.
REPRESENTATIVE SADDLER withdrew Conceptual Amendment 1 to
Amendment 1.
3:51:42 PM
REPRESENTATIVE SADDLER removed his objection to Amendment 1.
There being no further objection, Amendment 1 was adopted.
3:51:54 PM
REPRESENTATIVE PRAX moved to adopt Amendment 2 to HB 187,
labeled 33-LS0696\A.2, Klein/Wallace, 4/15/24, which read:
Page 1, lines 1 - 2:
Delete "utilization review entities; exempting
certain health care providers from making
preauthorization"
Insert "health care insurers and prior
authorization"
Page 1, line 6, following "standards":
Insert ", requirements,"
Page 1, lines 8 - 9:
Delete ", including processes for utilization
review entities under AS 21.07.100"
Insert "; the regulations
(A) must require health care insurers that
use prior authorizaton offer a simple prior
authorization process for patients and providers; and
(B) may require that health care insurers
design programs to waive prior authorization for
health care providers who satisfy criteria established
by the director"
Page 2, line 1, through page 4, line 19:
Delete all material.
Renumber the following bill section accordingly.
VICE CHAIR RUFFRIDGE objected.
REPRESENTATIVE PRAX explained that Amendment 2 would direct the
Division of Insurance to establish regulations that require
health insurers to offer simple and streamlined processes for
patients and providers through a number of ways. It would also
establish processes for health insurance to design prior
authorization exemption or waiver programs based on the criteria
developed by the division. The amendment would delete Section 2
because the details would be outlined in regulation.
3:53:18 PM
REPRESENTATIVE WRIGHT asked the bill sponsor to speak to
Amendment 2.
MS. HACKENMILLER said the bill sponsor does not find the
proposed amendment stringent enough, as HB 187 aims to expediate
healthcare access to Alaskans.
REPRESENTATIVE PRAX reiterated this support for Amendment 2.
VICE CHAIR RUFFRIDGE maintained his objection.
3:55:05 PM
A roll call vote was taken. Representatives Saddler and Prax
voted in favor of Amendment 2. Representatives Wright, Carrick,
Fields, and Ruffridge voted against it. Therefore, Amendment 2
failed by a vote of 2-4.
3:55:47 PM
REPRESENTATIVE PRAX moved to adopt Amendment 3 to HB 187,
labeled 33-LS0696\A.3, Klein, 4/19/24, which read:
Page 1, line 2, following "services;":
Insert "relating to health care data exchange;"
Page 4, line 20:
Delete all material and insert:
"* Sec. 3. AS 21.54 is amended by adding a new
section to read:
Article 2A. Health Care Data Exchange.
Sec. 21.54.200. Health care data exchange. To
facilitate the electronic exchange of health care data
in accordance with federal timelines, a health care
insurer offering individual and group health insurance
policies shall implement and maintain version 5.0.0 of
Health Level Seven Fast Healthcare Interoperability
Resources application program interfaces, or a more
recent version of Health Level Seven Fast Healthcare
Interoperability Resources adopted by the director by
regulation.
* Sec. 4. Section 1 of this Act takes effect
January 1, 2025.
* Sec. 5. Except as provided in sec. 4 of this Act,
this Act takes effect immediately under
AS 01.10.070(c)."
VICE CHAIR RUFFRIDGE objected.
REPRESENTATIVE PRAX explained that Amendment 3 would add a new
requirement for health care insurers that offer individual and
group policies in Alaska to implement new federal technology
standards related to inner operability and prior authorization.
The proposed amendment would synchronize the state to federal
requirements and ensures that it would be available to fully
insured plans in the state so that providers and patients who
treat or are covered under these commercial plans can benefit
from the new technologies that will simplify the authorization
process.
3:57:11 PM
REPRESENTATIVE FIELDS shared his understanding that Alaska
insurers would presumably comply with federal requirements
regardless of Amendment 3.
MS. HACKENMILLER said she believed so. She said the bill
sponsor had not heard from the industry on whether the
technology requirements could be met by the effective date. For
that reason, she indicated that she was not comfortable inviting
that into the bill.
3:58:21 PM
VICE CHAIR RUFFRIDGE asked Ms. Wing-Heier to respond to
Representative Fields' question.
MS. WING-HEIER confirmed that state insurers would need to
comply with federal rules.
3:59:01 PM
REPRESENTATIVE SADDLER asked whether "version 5.0.0 of Health
Level Seven Fast Healthcare Interoperability Resources
application program interfaces" is a federal program.
MS. WING-HEIER was not familiar with the technology behind it or
what it does.
3:59:40 PM
REPRESENTATIVE PRAX asked when the federal law would become
effective.
MS. WING HEIER offered to follow up with the effective date. In
response to a follow up question, she said insurance companies
are looking to do more of an electronic prior authorization that
would move much faster than faxes.
4:01:13 PM
VICE CHAIR RUFFRIDGE asked whether state law would need to
change for there to be a move away from faxes into an electronic
format.
MS. WING-HEIER answered yes, because Alaska Statutes reference
fax machines.
VICE CHAIR RUFFRIDGE maintained his objection.
4:02:03 PM
A roll call vote was taken. Representative Prax voted in favor
of Amendment 3. Representatives Wright, Carrick, Fields,
Saddler, and Ruffridge voted against it. Therefore, Amendment 3
failed by a vote of 1-5.
4:02:50 PM
REPRESENTATIVE PRAX moved to adopt Amendment 4 to HB 187,
labeled 33-LS0696\A.6, Wallace, 4/19/24, which read:
Page 1, line 2, following "services;":
Insert "relating to prior authorization requests
for health care services;"
Page 2, line 1:
Delete "a new section"
Insert "new sections"
Page 3, line 24, through page 4, line 19:
Delete all material and insert:
"Sec. 21.07.110. Prior authorization standards.
(a) A health care insurer requiring prior
authorization for a health care service shall
(1) base prior authorization requirements
on peer-reviewed clinical review criteria that
(A) are evidence-based;
(B) accommodate new and emerging
information;
(C) are evaluated at least annually and
updated when necessary;
(2) provide detailed descriptions of prior
authorization requirements to health care providers
and facilities, written in easily understandable
language;
(3) provide in an electronic format current
prior authorization requirements and restrictions,
including the written clinical review criteria, to
health care providers and facilities upon request; and
(4) establish an electronic prior
authorization process.
(b) When a health care insurer receives an
electronic prior authorization request from a health
care provider or facility, the health care insurer
shall
(1) for a request that includes sufficient
information for the health care insurer to make a
determination, make a determination and notify the
health care provider or facility of the results of the
determination,
(A) for a standard request, within three
calendar days, excluding holidays, after the health
care provider or facility submits the request;
(B) for an expedited request, within one
calendar day after the health care provider or
facility submits the request;
(2) for a request that does not include
sufficient information for the health care insurer to
make a determination, within one calendar day after
the health care provider or facility submits the
request, request additional information from the
health care provider or facility.
(c) If a health care insurer determines that a
health care provider or facility has failed to submit
sufficient information to make a determination for an
electronic prior authorization for a covered person,
the health care insurer may establish a reasonable
time frame for submission of additional information
and shall communicate the time frame to the health
care provider or facility and to the covered person.
* Sec. 3. AS 21.07.250 is amended by adding new
paragraphs to read:
(15) "health care service" means
(A) the provision of pharmaceutical
products, services, or durable medical equipment; or
(B) a health care procedure, treatment, or
service provided
(i) in a health care facility licensed in
this state; or
(ii) by a doctor of medicine, by a doctor
of osteopathy, or within the scope of practice of a
health care provider who is licensed in this state;
(16) "health maintenance organization" has
the meaning given in AS 21.86.900;
(17) "prior authorization" means the
process used by a utilization review entity to
determine the medical necessity or medical
appropriateness of a covered health care service
before the health care service is provided or a
requirement that a covered person or health care
provider or facility notify a health care insurer or
utilization review entity before providing a health
care service;
(18) "utilization review entity" means an
individual or entity that performs prior authorization
for
(A) an employer in this state with
employees covered under a health benefit plan or
health insurance policy;
(B) a health care insurer;
(C) a preferred provider organization;
(D) a health maintenance organization; or
(E) an individual or entity that provides,
offers to provide, or administers hospital,
outpatient, medical, prescription drug, or other
health care benefits to a person treated by a health
care provider licensed in this state under a health
care policy, plan, or contract."
Renumber the following bill section accordingly.
VICE CHAIR RUFFRIDGE objected.
REPRESENTATIVE PRAX explained that Amendment 4 would provide for
tighter prior authorization turnaround times, which is three
days for standard and one day for urgent requests, so long as
the complete prior authorization request is completed via an
electronic portal.
4:03:52 PM
REPRESENTATIVE WRIGHT asked to hear from the bill sponsor.
MS. HACKENMILLER shard her belief that the intent of Amendment 4
is already being accomplished in the underlying bill. She
cautioned against the length of the proposed amendment and
pointed out that it would essentially rewrite the bill. She
asked Ms. Wing-Heier to speak to the current turnaround times
for prior authorization requests.
4:04:44 PM
MS. WING-HEIER said Amendment 4 would delete the bill as written
and make it so that each treatment for prior authorization would
be submitted through an electronic portal and either approved or
not approved. She said that those using this in Washington
state report a more expedited system. She requested that the
committee change the timeframes to mirror current statute if
Amendment 4 were adopted because current turnaround times are
shorter than those stipulated in Amendment 4.
4:05:53 PM
VICE CHAIR RUFFRIDGE asked whether Amendment 4 borrowed language
from Washington and whether Representative Prax had worked with
the director on its drafting.
REPRESENTATIVE PRAX confirmed that the language mirrored that of
Washington's statutes.
VICE CHAIR RUFFRIDGE maintained his objection.
4:07:09 PM
A roll call vote was taken. Representative Prax voted in favor
of Amendment 4. Representatives Fields, Saddler, Wright,
Carrick, and Ruffridge voted against it. Therefore, Amendment 4
failed by a vote of 1-5.
4:07:53 PM
REPRESENTATIVE PRAX moved to adopt Amendment 5 to HB 187,
labeled 33-LS0696\A.5, Klein/Wallace, 4/20/24, which read:
Page 3, following line 23:
Insert a new subsection to read:
"(j) A utilization review entity shall allow a
health care provider to complete a post-authorization
for a health care service instead of a prior
authorization if, before providing the health care
service, the health care provider notifies the
utilization review entity and the covered person that
the provider will seek a post-authorization and the
health care provider agrees to hold the covered person
harmless if the post-authorization is denied."
Reletter the following subsection accordingly.
VICE CHAIR RUFFRIDGE objected.
REPRESENTATIVE PRAX explained that Amendment 5 would direct
utilization review entities to allow a medical provider to use a
post authorization process instead of a prior authorization
provided that the medical provider notifies the utilization
review entity and the covered person of their intent to do so
and agrees to hold the covered person harmless.
4:09:43 PM
REPRESENTATIVE SADDLER questioned the incentive for a post
authorization.
MS. WING-HEIER explained that insurers already have the right to
do post authorization reviews of claims for compliance with the
prior authorization. She said in some ways Amendment 5 makes
sense because if a post authorization review showed that the
prior authorization was not adhered to, there would be a dispute
in the payment and the consumer would be held harmless. She
conveyed that insurers had testified that they would rely more
on post authorizations if the bill were to pass because they
were losing the right to do prior authorizations.
REPRESENTATIVE SADDLER asked what happens when a post
authorization is performed.
MS. WING-HEIER explained that if a person needs another
procedure after a surgery, the insurer will go back to review
that what happened is necessary and depending on what they find,
may not reimburse the provider for the additional procedure that
was not included in the prior authorization.
VICE CHAIR RUFFRIDGE opined that Amendment 5 would make the
situation worse because health care providers may be unwilling
to take a gamble.
4:15:11 PM
MS. VENTGEN opined that Amendment 5 would not create additional
patient protections or alleviate delays and therefore, would not
benefit the bill in any way.
REPRESENTATIVE PRAX stated that Amendment 5 would address the
concern that treatment delayed in the appeals process could have
adverse effects.
MS. VENTGEN asked how insurance companies would be incentivized
to process the claim after the fact.
REPRESENTATIVE PRAX said it would be handled in the courts and
governed by the rules of the policy.
MS. VENTGEN shared her belief that Amendment 5 would result in
nothing but more delays and burdens on providers and staff to
process continuous repeals.
VICE CHAIR RUFFRIDGE maintained his objection.
4:19:14 PM
A roll call vote was taken. Representative Prax voted in favor
of Amendment 5. Representatives Carrick, Fields, Saddler,
Wright, and Ruffridge voted against it. Therefore, Amendment 5
failed by a vote of 1-5.
4:19:54 PM
REPRESENTATIVE PRAX moved to adopt Amendment 6 to HB 187,
labeled 33-LS0696\A.7, Wallace, 4/22/24, which read:
Page 1, lines 1 - 2:
Delete "exempting certain health care providers
from making preauthorization requests for certain
services"
Insert "relating to prior authorization; relating
to prior authorization application programming
interfaces"
Page 1, line 8:
Delete "processes for"
Insert "selective application of prior
authorization by"
Page 2, line 1:
Delete "a new section"
Insert "new sections"
Page 2, line 2, through page 4, line 19:
Delete all material and insert:
"Sec. 21.07.100. Utilization review entities and
prior authorizations. A utilization review entity
authorized to do business in the state shall implement
and maintain a program that allows for the selective
application of prior authorization to reduce a health
care provider's prior authorization requirements based
on the stratification of the health care provider's
performance and adherence to evidence-based medicine.
The program must promote quality, affordable health
care and reduce unnecessary administrative burdens for
both the utilization review entity and the health care
provider. The utilization review entity has sole
discretion to determine the criteria a health care
provider must meet to participate in the program and
which health care services, excluding pharmacy
services, are included in the program. A utilization
review entity shall submit to the director a written
description of the program that includes a full
narrative description, the criteria for participation,
a list of the procedures and services subject to
selective application of prior authorization, and the
number of health care providers participating in the
program.
Sec. 21.07.110. Standards for prior authorization
requests. (a) A health care insurer offering a health
plan issued or renewed on or after January 1, 2025,
shall comply with the standards for prior
authorizations for health care services and
prescription drugs as provided in this section.
(b) If a participating health care provider
electronically submits a prior authorization request
that contains the necessary information to make a
determination, a health care insurer shall make a
determination and notify the provider of the decision
within
(1) three calendar days after receiving the
request, excluding holidays; or
(2) one calendar day after receiving an
expedited request.
(c) If a participating health care provider
submits a nonelectronic prior authorization request
that contains the necessary information to make a
determination, a health care insurer shall make a
determination and notify the provider of the decision
within
(1) five calendar days after receiving the
request, excluding holidays; or
(2) two calendar days after receiving an
expedited request.
(d) If a health care insurer receives
insufficient information to make a determination under
(b) or (c) of this section, the health care insurer
shall request additional information from the provider
or facility within
(1) one calendar day after receiving an
electronic prior authorization request under (b) of
this section;
(2) five calendar days after receiving a
nonelectronic prior authorization request under (c) of
this section; or
(3) one calendar day after receiving a
nonelectronic expedited prior authorization request
under (c) of this section.
(e) If a health care insurer determines that a
health care provider has not provided sufficient
information to make a determination under (b) or (c)
of this section, the health care insurer may establish
a due date for submission of the additional
information. The health care insurer must notify the
health care provider and enrollee of the due date
along with the request for additional information.
(f) A health care insurer shall maintain a
written description of the insurer's prior
authorization requirements that uses detailed, easily
understandable language. The health care insurer shall
make its most current prior authorization requirements
and restrictions, including the written clinical
review criteria, available to health care providers
and health care facilities in an electronic format
upon request. The prior authorization requirements
must be based on peer-reviewed, evidence-based
clinical review criteria that accommodate new and
emerging information related to the appropriateness of
clinical criteria with respect to ethnicity, including
African American and Indigenous peoples, gender, and
underserved populations. The health care insurer shall
evaluate and, if necessary, update the clinical review
criteria at least annually.
Sec. 21.07.120. Prior authorization application
programming interface. (a) A health care insurer shall
maintain an electronic prior authorization application
programming interface that enables an in-network
provider to determine whether a prior authorization is
required for a certain health care service, 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
support the exchange of prior authorization requests
and determinations for health care services beginning
January 1, 2026, and must
(1) use version 5.0.0 Health Level Seven
Fast Healthcare Interoperability Resources application
program interfaces, or a more recent version of Health
Level Seven Fast Healthcare Interoperability Resources
adopted by the director by regulation, in accordance
with standards and provisions defined in 45 C.F.R.
170.215 and 45 C.F.R. 156.122(3)(b);
(2) automate the process to determine
whether a prior authorization is required for durable
medical equipment or a health care service;
(3) allow a health care provider to query
the health care insurer's prior authorization
documentation requirements;
(4) support an automated approach using
nonproprietary open workflows to compile and exchange
the necessary data elements to populate the prior
authorization requirements that are compliant with the
Health Insurance Portability and Accountability Act of
1996 (P.L. 104-191) or for which an exception has been
made by the federal Centers for Medicare and Medicaid
Services; and
(5) indicate that a prior authorization
denial, or an authorization of a service less
intensive than the service included in the original
request, is an adverse benefit determination and is
subject to the health care insurer's grievance and
appeal process.
(b) A health care insurer shall establish and
maintain an electronic process or application
programming interface that enables an in-network
provider to determine whether a prior authorization is
required for a covered prescription drug. The
electronic process or application programming
interface must support the exchange of prior
authorization requests and determinations for
prescription drugs, including information on covered
alternative prescription drugs, beginning January 1,
2027, and must
(1) allow a health care provider to
identify prior authorization information and
documentation requirements;
(2) facilitate the exchange of prior
authorization requests and determinations from its
electronic health records or practice management
system and may include the necessary data elements to
populate the prior authorization requirements that are
compliant with 42 U.S.C. 201 et seq. (Health Insurance
Portability and Accountability Act of 1996 (P.L. 104-
191)) or for which an exception has been made by the
federal Centers for Medicare and Medicaid Services;
and
(3) indicate that a prior authorization
denial, or the authorization of a prescription drug
other than the drug included in the original request,
is an adverse benefit determination and is subject to
the health care insurer's grievance and appeal
process.
* Sec. 3. The uncodified law of the State of Alaska
is amended by adding a new section to read:
TRANSITION: COMPLIANCE. (a) If a health care
insurer determines that the insurer will not be able
to satisfy the requirements of AS 21.07.120(a),
enacted by sec. 1 of this Act, by January 1, 2026, the
health care insurer shall submit a written
justification to the director on or before
September 1, 2025, describing
(1) the reasons the health care insurer
cannot reasonably satisfy the requirements;
(2) the effects of noncompliance on health
care providers and enrollees;
(3) the current or proposed means of
providing health information to health care providers;
and
(4) a timeline and implementation plan to
achieve compliance with the requirements of (a) of
this section.
(b) The director may grant a health care insurer
a one-year extension of the time allowed to comply
with the requirements of AS 21.07.120(a), enacted by
sec. 1 of this Act, if the director determines that
the health care insurer has made a good faith effort
to comply.
(c) By September 13, 2024, and at least every
six months thereafter until September 13, 2027, the
director shall provide an update to the health and
social services committees of the legislature
regarding the development of rules and implementation
guidance from the federal Centers for Medicare and
Medicaid Services, including standards for development
of application programming interfaces and
interoperable electronic processes related to prior
authorization functions. The updates must include
recommendations, as appropriate, on whether the status
of the federal rule development aligns with the
provisions of this Act. The director shall also report
on any actions by the federal Centers for Medicare and
Medicaid Services to exercise enforcement discretion
related to the implementation and maintenance of an
application programming interface for prior
authorization functions. The director shall consult
with health care insurers, health care providers, and
health care consumers on the development of these
updates and any recommendations."
Renumber the following bill section accordingly.
VICE CHAIR RUFFRIDGE objected.
REPRESENTATIVE PRAX explained that Amendment 6 would combine the
approaches of two states to make improvements to Alaska's prior
authorization system to see that the cost and safety features
are not lost, but the performance of the system is improved for
providers, patients and health insurance carriers alike. From
Washington state, the proposed amendment provides for tighter
prior turnaround times, so long as a complete prior
authorization request is submitted via online portal. From a
Louisiana statute, Amendment 6 provides that all health carriers
must establish a gold card program that promotes quality,
affordable health care, and reduces unnecessary administrative
burden.
4:22:15 PM
REPRESENTATIVE WRIGHT asked to hear from the bill sponsor.
MS. HACKENMILLER said Amendment 6 would effectively kill the
bill and rewrite the entire legislation. She invited Ms. Wing-
Heier to speak to the proposed amendment.
4:22:50 PM
MS. WING HEIER confirmed that Amendment 6 would rewrite the
entire bill and align it with Washington state. She said it's a
different approach to prior authorization in that each request
would be submitted through a portal and approved, as opposed to
a blanket approval for a procedure for a given length of time.
VICE CHAIR RUFFRIDGE maintained his objection.
4:23:32 PM
A roll call vote was taken. Representative Prax voted in favor
of Amendment 6. Representatives Wright, Fields, Carrick,
Saddler, and Ruffridge voted against it. Therefore, Amendment 6
failed by a vote of 1-5.
4:24:24 PM
REPRESENTATIVE SADDLER moved to report HB 187, as amended, out
of committee with individual recommendations and the
accompanying fiscal notes.
REPRESENTATIVE PRAX objected. He expressed concern that there
were many nuances to prior authorization and that the bill would
run the risk of driving up the cost of health care.
4:25:22 PM
A roll call vote was taken. Representatives Saddler, Wright,
Carrick, Fields, and Ruffridge voted in favor of moving HB 187,
as amended, from committee. Representative Prax voted against
it. Therefore, CSHB 187(L&C) was reported out of the House
Labor and Commerce Standing Committee by a vote of 5-1.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB226 Letter of Support - ANHB.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB 187 AK Medical Association Testimony.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 187 ANTHC Support.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 187 AHIP Comments AK.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 187 Fiscal Note DCCED.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 187 Letter from AETNA.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 187 Premera Letter.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB187 Survey Data.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB187 Letter of Support - AHHA.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB187 Sectional Analysis Version A.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB187 Sponsor Statement.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB187 State Law Chart.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 226 Letter of Support - Albertsons.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Explanation - Alaska Pharmacy Assn.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Explanation of Changes Ver. S to Ver. R.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Letter of Support - Fred Meyer.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Letter of Support. Dan Nelson. 2.14.24.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Sponsor Statement.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Sectional Analysis Ver. S.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| PHY Letter of Support - HB187 - Prior Auth Exempt for Health Providers - 04-19-2024.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB187 Amendments.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 187 |
| HB 375 SEMA Support - House.pdf |
HL&C 4/22/2024 3:15:00 PM STRA 5/7/2024 1:30:00 PM STRA 5/9/2024 9:00:00 AM |
HB 375 |
| HB226 Explanation of Changes Ver. R to Ver. D.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| HB226 Ver. D.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |
| LOS for HB 226.pdf |
HL&C 4/22/2024 3:15:00 PM |
HB 226 |