04/19/2000 09:21 AM Senate FIN

    COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 211(FIN) am                                                                         
     "An  Act   relating  to  regulation  of   managed  care                                                                    
     insurance  plans; amending  Rule 602,  Alaska Rules  of                                                                    
     Appellate  Procedure; and  providing  for an  effective                                                                    
     date."                                                                                                                     
                                                                                                                                
REPRESENTATIVE ROKEBERG stated  that patients need assurance                                                                    
that  the  quality   of  their  health  care   will  not  be                                                                    
compromised  as managed  care expands.   He  noted that  the                                                                    
legislation would  provide a  reasonable standard  of health                                                                    
care.    It  would   establish  requirements  for  contracts                                                                    
between  managed   care  entitles  and  their   health  care                                                                    
providers,  patients and  their  group  managed care  plans,                                                                    
health  care insurers  and their  insured and  would provide                                                                    
patients with the following:                                                                                                    
                                                                                                                                
     ·    Access to emergency room services;                                                                                    
     ·    Availability  of  medical   services  or  adequate                                                                    
          referral options;                                                                                                     
     ·    Full disclosure of treatment options;                                                                                 
     ·    Choice   of  health   care  providers,   including                                                                    
          specialists;                                                                                                          
     ·    Clear descriptions of  covered items and services,                                                                    
          benefits,   procedures,    compensation   methods,                                                                    
          availability  (and   exclusions)  of  prescription                                                                    
          medications  and the  availability of  translation                                                                    
          or interpreter services;                                                                                              
     ·    A point of service plan option;                                                                                       
     ·    Follow-through of pre-approved payment;                                                                               
     ·    Quick utilization review decisions;                                                                                   
     ·    Opportunity  for  appeals  of  utilization  review                                                                    
          decisions;                                                                                                            
     ·    Added  protection   from  denial,   reduction;  or                                                                    
          termination of payment for health care services.                                                                      
                                                                                                                                
In  addition,   the  legislation   will  give   health  care                                                                    
providers  the freedom  to share  all testing  and treatment                                                                    
options  with their  patients, and  would let  them advocate                                                                    
for their  patients without the  risk of being  penalized or                                                                    
terminated by  the managed care  entity they  contract with.                                                                    
The  bill  would  prohibit contracts  between  managed  care                                                                    
entities   and   health   care  providers   from   financial                                                                    
incentives  for providers  to  withhold medically  necessary                                                                    
services.                                                                                                                       
                                                                                                                                
Representative Rokeberg  stressed that HB 211  was necessary                                                                    
to ensure  continued quality  health care in  the face  of a                                                                    
growing  managed care  industry.   He urged  the Committee's                                                                    
support of the legislation.                                                                                                     
                                                                                                                                
Co-Chair  Torgerson commented  that Representative  Rokeberg                                                                    
had  requested   that  Amendment  #1,   1-LS0472/X.1,  Ford,                                                                    
4/15/00, not be offered at this time.  [Copy on File].                                                                          
                                                                                                                                
Co-Chair  Parnell MOVED  to adopt  Amendment #2.   [Copy  on                                                                    
File].                                                                                                                          
                                                                                                                                
Representative Rokeberg  explained the amendment.   He noted                                                                    
that  the  first portion  of  the  amendment was  technical.                                                                    
Subsection © clarifies concerns  voiced by Legislative Legal                                                                    
and  would  make the  language  more  understandable to  the                                                                    
average person.                                                                                                                 
                                                                                                                                
Co-Chair  Parnell  noted  an important  limitation  allowing                                                                    
persons to  communicate privately for the  purpose of health                                                                    
care services.                                                                                                                  
                                                                                                                                
There being NO OBJECTION, Amendment #2 was adopted.                                                                             
                                                                                                                                
Senator Green  indicated a "conflict  of interest"  with the                                                                    
legislation because she has  associations with the insurance                                                                    
industry.     She  referenced  the  definition   of  medical                                                                    
necessity and  asked if there  was a  distingushment between                                                                    
medical necessity and medical treatment.                                                                                        
                                                                                                                                
Representative Rokeberg  acknowledged that concern  has been                                                                    
debated.  He stated, sometimes  it is better to "not" define                                                                    
something for  matters of  flexibility.   The bill  will let                                                                    
common law define medical necessity.                                                                                            
                                                                                                                                
Senator  Green  asked  if  there was  any  language  in  the                                                                    
legislation which might rewrite the tort reform bill.                                                                           
                                                                                                                                
Representative  Rokeberg replied  the liability  section was                                                                    
different, creating a  "new cause of action".   He noted the                                                                    
concern had  been substantially worked, keeping  in mind the                                                                    
State Constitution private situation.                                                                                           
                                                                                                                                
Senator Adams  MOVED to report  SCS COMMITTEE  SUBSTITUTE HB
 (FIN)  out of Committee with  individual recommendations                                                                    
and  with the  accompanying  fiscal note.    There being  NO                                                                    
OBJECTION, it was so ordered.                                                                                                   
                                                                                                                                
SCS COMMITTEE  SUBSTITUTE HB 211  (FIN) was reported  out of                                                                    
Committee with a "no recommendation"  and with a fiscal note                                                                    
by the Department of Community  & Economic Development dated                                                                    
3/07/00.