02/29/2024 03:00 PM House HEALTH & SOCIAL SERVICES

              HB 371-MEDICAL REVIEW ORGANIZATIONS                                                                           
                                                                                                                                
3:12:08 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that  the next order  of business  would be                                                               
HOUSE  BILL  NO.   371,  "An  Act  relating   to  medical  review                                                               
organizations;  relating  to  the  definitions  of  'health  care                                                               
provider' and  'review organization'; and relating  to the duties                                                               
of the chief medical officer in the Department of Health."                                                                      
                                                                                                                                
3:12:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JUSTIN RUFFRIDGE,  Alaska  State Legislature,  as                                                               
prime sponsor  by request,  presented HB 371.   He  explained the                                                               
Department of  Health brought  forward the  request for  the bill                                                               
and  asked  to  be  able  to  modify  the  public  health  review                                                               
organization process, which seeks  to eliminate avoidable deaths,                                                               
injuries, and illnesses  of Alaskans.  This is  done by examining                                                               
clinical  and other  records and  identifying  areas of  concern.                                                               
The proposed legislation would allow  "medical provider types" to                                                               
be a  part of  these review  organizations, update  language, and                                                               
ensure access to data is timely.                                                                                                
                                                                                                                                
3:14:02 PM                                                                                                                    
                                                                                                                                
SABINA  BRAUN,  Staff,  Representative Justin  Ruffridge,  Alaska                                                               
State Legislature,  on behalf of Representative  Ruffridge, prime                                                               
sponsor  by  request,  gave  a   sectional  analysis  of  HB  371                                                               
[included  in  the  committee  packet],  which  read  as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     Section 1                                                                                                                
     AS  18.23.030(a)  is amended  to  add  an exemption  to                                                                  
     disclosure of data and is described in Sec 2.                                                                              
                                                                                                                                
     Section 2                                                                                                                
     AS  18.23.030  is  amended  to  add  a  new  subsection                                                                  
     allowing  a review  organization  to  publish a  report                                                                    
     containing   data  or   information  acquired   in  the                                                                    
     exercise of  its duties, ensuring  the report  does not                                                                    
     violate federal or  state law regarding confidentiality                                                                    
     of a person or decedent.                                                                                                   
                                                                                                                                
     Section 3                                                                                                                
     AS  18.23.070(3) Changes  the definition  of healthcare                                                                  
     provider in reference to a  review organization to mean                                                                    
     a  person licensed,  certified, or  otherwise permitted                                                                    
     by law to provide health  care services in the ordinary                                                                    
     course  of business  or practice  of  a profession  and                                                                    
     removes the list of specific provider types.                                                                               
                                                                                                                                
     Section 4                                                                                                                
     AS  18.23.070(5)(A)  and   AS.18.23.070(5)(B)  are  not                                                                
     modified by HB 371.                                                                                                        
     AS 18.23.070(5)(C)  The review  organization membership                                                                  
     is  approved  by  the  Chief  Medical  Officer  in  the                                                                    
     Department of Health and removes  the provision that at                                                                    
     least  75  percent of  the  committee  members must  be                                                                    
     health care providers.                                                                                                     
     AS  18.23.070(5)(D)  Allows  all  nationally-recognized                                                                  
     groups that accredit health  care organizations to have                                                                    
     review organizations.  Current law  limits this  to the                                                                    
     Joint   Commission  on   Accreditation  of   Healthcare                                                                    
     Organizations (JCAHO).                                                                                                     
                                                                                                                                
3:15:53 PM                                                                                                                    
                                                                                                                                
MS. BRAUN began a PowerPoint  Presentation [hard copy included in                                                               
the   committee   packet],   titled  "HB   371   Medical   Review                                                               
Organizations."   She  covered  slide 2,  which  read as  follows                                                               
[original punctuation provided, with some formatting changed]:                                                                  
                                                                                                                                
     Why?                                                                                                                       
     To  review injuries,  deaths, and  illness in  order to                                                                    
     provide   insight   for   public  policy   and   health                                                                    
     interventions to improve Alaskan's health.                                                                                 
     How?                                                                                                                       
     In-depth review  of deaths, injuries, and  illnesses by                                                                    
     examining clinical records and additional data.                                                                            
     Who?                                                                                                                       
     Hospitals,   clinics,  associations   of  health   care                                                                    
     providers,  professional  standards organizations,  the                                                                    
     State   Medical   Board,  health   care   accreditation                                                                    
     organizations,   and    those   established    by   the                                                                    
     Commissioner of Health to review public health issues.                                                                     
                                                                                                                                
MS. BRAUN,  at slide  3, "Intent," emphasized  the intent  of the                                                               
bill to  increase flexibility.   Noting  current statute  on this                                                               
issue  is  vague, she  showed  slide  4,  "HB  371 -  Changes  to                                                               
Existing Statutes,"  which read as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     •  Allows a  review  organization to  publish a  report                                                                    
     containing   data  or   information  acquired   in  the                                                                    
     exercise of  its duties, ensuring  the report  does not                                                                    
     violate federal or  state law regarding confidentiality                                                                    
     of a person or decedent.                                                                                                   
                                                                                                                                
     • Broadens who can serve on the review organizations.                                                                      
                                                                                                                                
     •  Changes   who  can  approve  Department   of  Health                                                                    
     morbidity  or mortality  review organizations  from the                                                                    
     Alaska  State  Medical  Board   to  the  Chief  Medical                                                                    
     Officer in the Department of Health.                                                                                       
                                                                                                                                
     • Removes  composition requirement  of 75%  health care                                                                    
     providers.                                                                                                                 
                                                                                                                                
     • Broadens who can establish review organizations.                                                                         
                                                                                                                                
MS.  BRAUN showed  slide 5,  "Reasoning," which  read as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     •   This   bill   increases   flexibility   to   ensure                                                                    
     appropriate   representation   across  diverse   review                                                                    
     committees.                                                                                                                
                                                                                                                                
     • This  bill removes  the current  list of  health care                                                                    
     providers allowed  to be on the  review committee. This                                                                    
     bill  modifies  the  requirement  of  the  health  care                                                                    
     committee  of having  75%  health  care providers.  The                                                                    
     current  definition of  health  care  providers in  the                                                                    
     current statute is narrow and missing key types.                                                                           
                                                                                                                                
     • Current  law requires  that the Alaska  State Medical                                                                    
     Board approve  members of  Department of  Health review                                                                    
     organizations,   not   allowing   for   efficient   and                                                                    
     effective decision making tailored to committee needs.                                                                     
                                                                                                                                
MS. BRAUN drew  attention to slide 6, which  shows three examples                                                               
of current medical review  committees/boards, and she highlighted                                                               
two  of them:   the  Maternal  Child Death  Review Committee,  on                                                               
which she  said it would  be helpful to  have a midwife;  and the                                                               
Overdose Fatality  Review Committee, on  which she said  it would                                                               
be helpful to  have an Alaska State Trooper.   In conclusion, she                                                               
offered to answer questions.                                                                                                    
                                                                                                                                
3:19:23 PM                                                                                                                    
                                                                                                                                
LINDSEY KATO,  Director, Division of Public  Heath, Department of                                                               
Health,  offered invited  testimony in  support of  HB 371.   She                                                               
said   morbidity   and   mortality   review   organizations   are                                                               
instrumental in  determining the causes and  contributing factors                                                               
of death, illness, and injury.   The intent is to provide insight                                                               
and recommendation  toward public policy and  interventions.  She                                                               
noted that  the Maternal  Child Death  Review Committee  has been                                                               
instrumental in  providing recommendations that have  resulted in                                                               
changes to training  within the Office of  Childrens Services and                                                               
updating law enforcement  forms used in investigation.   Ms. Kato                                                               
stated that  unfortunately current statute is  ambiguous in terms                                                               
of whether  the agencies are  allowed to report  current findings                                                               
with those  in the best  position to  help make changes,  such as                                                               
legislators.  She echoed Ms.  Braun's statement about the current                                                               
limitation  of 75  percent health  care providers  making up  the                                                               
review organizations,  and the  department would  like to  have a                                                               
wider  sampling of  people to  be  on the  review committees  and                                                               
boards.  She  also noted that the current  statute mandating that                                                               
the  State   Medical  Board  approve  members   of  DOH's  review                                                               
organizations is  cumbersome, and  that moving that  authority to                                                               
the chief medical officer in  the department would "create a more                                                               
efficient and effective process."   She emphasized the importance                                                               
of review  committees/boards and the  need for flexibility.   She                                                               
offered to answer questions.                                                                                                    
                                                                                                                                
3:22:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA  asked  Ms.  Kato how  many  medical  review                                                               
committees currently exist in Alaska.                                                                                           
                                                                                                                                
LINDSEY noted the  two previously mentioned and  the newly formed                                                               
Congenital Syphilis Review  Board.  She added that  there is also                                                               
interest in  the issue of  suicide.   In response to  a follow-up                                                               
question  regarding   the  ambiguity   of  statute   relating  to                                                               
reporting, she said  there have been modified reports  given as a                                                               
result rather  than formal  reports.  She  added that  trends and                                                               
issues identified have to be censored in the reports.                                                                           
                                                                                                                                
3:23:41 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX  asked  for   additional  information  regarding  the                                                               
committees.                                                                                                                     
                                                                                                                                
MS. KATO  gave examples  about how  often the  various committees                                                               
meet.  In  response to follow-up questions, she  said the reviews                                                               
include detailed public safety reports,  including those from law                                                               
enforcement and  OCS, as  well as medical  reports.   She offered                                                               
her understanding  that there are  no legal  implications related                                                               
to  these  reviews.     She  reiterated  that   the  groups  meet                                                               
currently; the  desire is for there  to be a broader  list of who                                                               
can serve on them.                                                                                                              
                                                                                                                                
3:26:01 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX opened public testimony on HB 371.                                                                                   
                                                                                                                                
3:26:40 PM                                                                                                                    
                                                                                                                                
JEANNIE   MONK,  spokesperson,   Alaska  Hospital   &  Healthcare                                                               
Association (AHHA) [formerly the  Alaska State Hospital & Nursing                                                               
Home Association (ASHNHA)]  testified in support of HB  371.  She                                                               
noted that  the review  organizations are  also used  by entities                                                               
outside of  Alaska.   She said medical  review committees  are an                                                               
important tool  used by hospitals to  discuss information related                                                               
to the  care and treatment  of patients and  support improvements                                                               
in care.   She  said AHHA  supports all  of the  changes proposed                                                               
under HB 371.   She noted that  AHHA is a partner  with the state                                                               
and works  with the  Maternal Child  Death Review  Committee, and                                                               
AHHA  thinks removing  the  75 percent  limit  will benefit  that                                                               
committee by  allowing a more  diverse committee.  She  said AHHA                                                               
also  supports the  aforementioned  change to  the state  medical                                                               
officer as  a means  of providing  "more efficient  and effective                                                               
decision  making."   She  noted  that AHHA  is  currently in  the                                                               
process  of  forming  an association  with  these  organizations,                                                               
bringing together  hospitals and  nursing homes.   She  said AHHA                                                               
thinks the  clarification related to  the sharing of  reports and                                                               
recommendations  will   help  in   using  the   information  more                                                               
effectively.  She  urged the committee to forward  HB 371 through                                                               
the committee process.                                                                                                          
                                                                                                                                
3:29:05 PM                                                                                                                    
                                                                                                                                
MS. MONK,  in response to  Chair Prax, confirmed that  the review                                                               
organizations conduct  conversations about issues and  then share                                                               
findings "without disclosing any confidential information."                                                                     
                                                                                                                                
3:29:54 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX, after  ascertaining there was no one  else who wished                                                               
to testify, closed public testimony on HB 371.                                                                                  
                                                                                                                                
3:30:51 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX announced that HB 371 was held over.