Legislature(2017 - 2018)BARNES 124
04/09/2018 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| HB193 | |
| HB358 | |
| HB376 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 358 | TELECONFERENCED | |
| + | HB 193 | TELECONFERENCED | |
| *+ | HB 376 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 193-HEALTH CARE; BALANCE BILLING
3:39:04 PM
CHAIR KITO announced that the next order of business would be
HOUSE BILL NO. 193, "An Act relating to insurance trade
practices and frauds; and relating to emergency services and
balance billing."
3:39:21 PM
RYAN JOHNSTON, Staff, Representative Jason Grenn, introduced HB
193 on behalf of Representative Grenn, prime sponsor. He
paraphrased the sectional analysis [included in committee
packet], which reads as follows [original punctuation provided]:
Section 1: Establishes a "Hold Harmless" standard for
insurance providers in the situation where a covered
person receives medical care from an out-of-network
medical provider in an emergency situation. An
insurance provider will hold a covered person harmless
to ensure that the covered person only pay what would
have been paid if the medical provider was an in-
network provider.
Outlines the standards to establish the situations
where a medical provider cannot balance bill a covered
person. An insurance provider shall pay a non-network
health care provider if the health care provider
renders to a covered person;
• emergency services or treats an emergency medical
condition
• services at an in-network facility
• services for which a referral was made by an in-
network health care provider to an out-of-network
health care provider without the explicit written
consent of the covered person.
The covered person is still required to pay the in-
network rates for the deductible, coinsurance and
copayment. The amount paid by the covered person is
required to be counted towards the covered persons
deductible.
The final payment determined for the medical provider
will subtract any amount paid by the covered person.
The insurance provider is to pay the greater of three
possible amounts;
• the median negotiated contract rate generated
using the in-network health care providers for
the service provided;
• That is equal to the 80th percentile of charges
for the services calculated using a method that
establishes a statistically credible profile that
reflects the general cost differences between the
geographical area where the service was preformed
and the other geographical areas when performed
by a health care provider in the same or similar
specialty; or
• That would be paid under Medicare for the service
provided.
Medical providers are required to send all bills to
the insurance provider, except for the deductible,
coinsurance and copayment.
Contains a clause that if a covered person knowingly
elects to use an out-of-network medical provider then
they can be balanced billed for the services.
Section 2: Health care insurance plans obtained under
AS 39.30.090 or provided under AS 39.30.091 will be
subject to the requirements of secs. 21.36.512 and
21.36.513.
Section 3: Bans the practice of "Balance Billing" by a
medical provider under the criteria of section 1 of
the bill. Stipulates that the medical provider can
still bill for the deductible, coinsurance and
copayment.
States that a medical provider will be paid according
to section 1 of the bill.
Section 4: Establishes the punishment for medical
providers under the Unfair Trade Practices and
Consumer Protection.
3:43:23 PM
REPRESENTATIVE BIRCH asked whether the bill sponsor has heard
concerns about equity for small businesses.
MR. JOHNSTON answered that was the motivation behind Section 2.
He said that requiring private insurers to follow the directive,
the state plan should be held to the same standard. He said
some aspects could not be addressed at the state level.
REPRESENTATIVE BIRCH asked about the fiscal note (FN).
MR. JOHNSTON answered it should be a cost savings for the state.
He said that currently the Division of Retirement and Benefits
pays 100 percent of the billed amount in an emergency situation.
He added the state does hold state employees harmless. He
stated the proposed bill states that it has to be in the state
in which the service was rendered, for example for an emergency
room visit in Oregon, the state would just use Oregon's 80
percentile. He said the language could be made clearer.
3:46:27 PM
DR. ANNE ZINK, MD, Matsu Emergency Department, testified in
support of HB 193. She presented a PowerPoint presentation on
"HB 193: A Patient Protection Bill,[included in committee
packet]. She said the question is what is right for the patient.
She stated the bill would end the "surprise insurance gap." She
described a scenario of someone in an emergency situation and
the subsequent related billing for services. She explained the
scenario in terms of in and out of network services. She
explained that the bill would put a ban on balance bill, ending
the "surprise insurance gap." She underlined that in order to
preserve a safety net for patients, the system has to be
geographically relevant.
REPRESENTATIVE WOOL asked about health spending versus health
costs.
DR. ZINK answered she was speaking to health spending.
3:56:56 PM
DR. ZINK spoke to "Alaska and the 80th Percentile Regulation:
Myth and Reality." She said Alaska is not the most expensive
area in the country for health care, as it follows the District
of Columbia. She said that rural states pay more for
physicians. She remarked that the 80th percentile rule did not
change the Alaska per capita private health insurance spending
curve. She added that Connecticut and New York established the
80th percentile as a benchmark for payment in 2014 and many
states are considering similar patient protection measures. She
underlined there were no increases in charges after the 80
percentile was adopted.
DR. ZINK pointed out that the National Insurance Commissioners
model legislation regarding out-of-network balance billing
stated as a guide:
A. For the purposes of this subsection, "usual and
customary cost" shall mean the eightieth percentile
of all charges for the particular health care
service performed by a provider in the same or
similar specialty and provided in the same
geographical area as reported in a benchmarking
database maintained by a nonprofit organization
specified by the commissioner. The nonprofit
organization shall not be affiliated with a
carrier.
4:00:02 PM
DR. ZINK went on to explain how emergency costs are coded
between Anchorage, Alaska, and Seattle, Washington, for in-
network and out-of-network services. She showed that
emergency costs are already the same or less that
th
neighboring states. She said that the 80 percentile is a
patient protection issue.
CHAIR KITO asked whether Americas Health Insurance Association
had indicated it would be harder to bring physicians into the
network if the proposed bill were to pass. He asked Dr. Zink to
give her thoughts.
DR. ZINK answered she does not have concerns. She explained
that if there is a relatively good out-of-network minimum, it
encourages providers to be in-network.
REPRESENTATIVE BIRCH asked where the hospitals fit into the
issue.
DR. ZINK shared her understanding the hospitals would be held to
the same provision in the proposed bill.
4:04:45 PM
REPRESENTATIVE WOOL asked Dr. Zink to explain the database she
mentioned in her presentation.
DR. ZINK answered that the proposed bill does not specify how
geographic relevance and a non-profit database would be
established.
REPRESENTATIVE WOOL asked about non-emergency medical services.
DR. ZINK answered that anything a patient feels is an emergency
has to be examined. She said the issue of emergency definitions
is defined in federal law.
CHAIR KITO mentioned a scenario in which an insurance employee
made a point of asking the anesthesiologist whether he or she is
in or out of network before proceeding.
DR. ZINK added that at time the person who is in network is not
available for the procedure and someone who is out-of-network is
used.
REPRESENTATIVE WOOL asked whether the answer is to ask the
medical professional prior to any procedure whether they are in-
network.
DR. ZINK answered in the affirmative. She added that is why it
is so important to pass the proposed legislation, as in an
emergency that scenario would not be possible.
4:11:14 PM
CHAIR KITO opened public testimony on HB 193.
CHAIR KITO held over HB 193.