Legislature(2015 - 2016)BARNES 124
04/06/2016 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB372 | |
| HB234 | |
| SB148 | |
| SB142 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 234 | TELECONFERENCED | |
| + | SB 148 | TELECONFERENCED | |
| + | SB 142 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 372 | TELECONFERENCED | |
HB 372-OMNIBUS INSURANCE
3:33:05 PM
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 372, "An Act relating to insurance; relating to
expenses for insurance examinations; relating to regulations for
insurance utilization review, benefits determination, health
care insurance grievance resolution procedures, independent
review of adverse determinations or final adverse
determinations, independent review organizations, and continuing
education providers; relating to required provisions for health
care insurance contracts and policies, including health care
provider choice; establishing civil penalties for insurers for
failure to provide requested records; amending the definition of
'wet marine and transportation' insurance; amending provisions
on limited licenses to include crop insurance; relating to
third-party administrator notification requirements; relating to
certification filing by reinsurance intermediary brokers;
relating to rate filings, delivery of insurance policies or
endorsements; relating to refunds of variable life insurance
policies and variable annuities; establishing limitations on
issuance of long- term care insurance; relating to requirements
for group health insurance policies; amending the definition of
'group health insurance'; relating to motor vehicle service
contracts; relating to notice requirements for meetings of
stockholders or members of a domestic insurer; establishing a
definition of 'bona fide association'; relating to requirements
and penalties for committing a fraudulent or criminal insurance
act; updating criteria for examinations; relating to rate filing
deviations; establishing civil penalties for certain wilful
violations; and providing for an effective date."
[Although not stated on the record of the House Labor and
Commerce Standing Committee meeting of 4/4/16, the committee
treated HB 372, Version H, as adopted and before the committee.]
3:33:28 PM
REPRESENTATIVE HUGHES moved to adopt Amendment 1 labeled 29-
LS1379\H.1, Wallace, 4/5/16, which read:
Page 8, lines 16 - 22:
Delete all material and insert:
"(15) "emergency medical condition" means a
medical condition manifesting itself by acute symptoms
of sufficient severity, including severe pain, that a
prudent person who possesses an average knowledge of
health and medicine could reasonably expect that the
absence of immediate medical attention would result in
serious impairment of bodily functions, serious
dysfunction of a bodily organ or part, or would place
the person's health or, with respect to a pregnant
woman, the health of the woman or her unborn child, in
serious jeopardy."
CHAIR OLSON objected for discussion purposes.
3:33:57 PM
KONRAD JACKSON, staff to Representative Kurt Olson, Alaska State
Legislature, informed the committee that Amendment 1 addresses
concerns expressed regarding page 8, Section 11, which is the
definition of an emergency medical condition. Amendment 1
changes the definition to more closely mirror what exists in the
Patient Protection and Affordable Care Act of 2010 (PPACA). He
pointed out that the word "layperson" was not included in the
requested change in order to conform to the Manual of
Legislative Drafting.
REPRESENTATIVE LEDOUX asked if there is a difference between a
"reasonable person" standard and a "prudent person" standard.
3:35:31 PM
MEGAN WALLACE, Attorney, Legislative Legal Counsel, Legislative
Legal Services, Legislative Affairs Agency, asked Representative
LeDoux to repeat the question.
REPRESENTATIVE LEDOUX asked for the difference between the
standards applied to define a reasonable person versus a prudent
person. Usually, she commented, the term prudent person is used
with regard to investment decisions; whereas, a person who has
committed a wrong and, as a layperson, should have known better
is characterized as a reasonable person.
MS. WALLACE replied that, in this case, the prudent person is
modified by "a prudent person that possesses an average
knowledge of health and medicine" and opined the term is not out
of place. She deferred to the Division of Insurance for
specialized knowledge as to which term is preferred; further,
neither prudent person nor reasonable person is defined in
statute.
3:38:05 PM
DONALD HALE, Insurance Specialist, Division of Insurance,
Department of Commerce, Community & Economic Development,
deferred to an attorney.
REPRESENTATIVE LEDOUX noted that her question could be resolved
in the next committee of referral.
CHAIR OLSON suggested that the intent of the change was also to
achieve compliance with PPACA.
REPRESENTATIVE JOSEPHSON directed attention to page 8, Section
11: AS 21.07, Patient protections under the health care
insurance policies. He noted that generally, there is a desire
to keep people out of emergency rooms unless necessary. He then
observed that the definitions of emergency medical condition in
the proposed legislation and in the amendment as written set a
high standard, and remarked:
You have to find that ... you could suffer serious
dysfunction, impairment, or serious jeopardy. ... Are
we saying that, that an insurance company could deny
coverage at an emergency room, unless it's plausible
that the visitor or the patient was reasonably going
to expect some of those types of egregious or serious
conditions? ... So, I'm just wondering, where this
definition gets applied.
MR. HALE expressed his understanding that the purpose is to
protect someone who seeks emergency care "and [their problem] is
not what they thought it was."
REPRESENTATIVE JOSEPHSON repeated Mr. Hale's statement that
"it's not what they thought it was or it could be precisely what
they thought it was."
MR. HALE agreed.
CHAIR OLSON opined that there are enough safeguards built in and
the emergency room would err on the side of caution.
REPRESENTATIVE KITO said that, from personal experience, even
medical professionals will recommend an emergency room visit out
of caution. He said he hoped the definition would protect those
individuals who believe they are in danger, or who are advised
by medical professionals to go to an emergency room.
REPRESENTATIVE LEDOUX, noting that the bill does not have
another committee referral, requested a definition of reasonable
person versus prudent person from the Division of Insurance.
Prudent person appears to be a stricter standard in that the
person must be smarter than a reasonable person, she said.
MS. WALLACE said a quick search reveals that "a reasonably
prudent person" and a "reasonable person" have been used in
similar context. She opined that a "prudent person" does not
represent a higher standard than a "reasonable person," but
merely is a minor differentiation.
3:46:30 PM
FRED PARADY, Deputy Commissioner, Office of the Commissioner,
Department of Commerce, Community & Economic Development
(DCCED), advised that Amendment 1 is useful in that the section
relates to patient protections under health care insurance
policies, and the Department of Commerce, Community & Economic
Development (DCCED) seeks to bring Alaska's insurance statutes
up to code with models based on PPACA. He offered to provide
additional guidance from the director of the Division of
Insurance.
REPRESENTATIVE HUGHES expressed interest in the context of the
definition; for example, some residents use an emergency room
for nonemergency care, and she asked whether the [bill]
establishes in statute that an insurance company might not have
to cover a charge for a condition not described.
MR. PARADY reiterated that he would like to speak with his
director in this regard. He stated that statute holds the
requirements for contract provisions for health care insurance,
one of which is that there be a utilization review process, and
the language in the statute defines the review. He opined the
definition is patient protection.
REPRESENTATIVE HUGHES said one reason health care costs are high
is because emergency room care is used for nonemergency medical
conditions. She asked whether there is an attempt here to not
cover something when a person goes to the emergency room for a
nonemergency medical condition.
CHAIR OLSON opined there is more coverage under PPACA, not less.
3:50:28 PM
CHAIR OLSON removed his objection to Amendment 1. There being
no objection, Amendment 1 was adopted.
3:51:21 PM
REPRESENTATIVE HUGHES moved to report the committee substitute
for HB 372, Version 29-LS1379\H, Wallace, 3/30/16, as amended,
out of committee with individual recommendations and the
accompanying fiscal notes. There being no objection, CSHB
372(L&C) was reported out of the House Labor and Commerce
Standing Committee.