04/11/1996 02:55 PM Senate L&C

                                                                               
                  HB 480 PHYSICIAN ASSISTANTS                                 
                                                                              
 REPRESENTATIVE THERRIAULT, sponsor, said this legislation clarified           
 the process that is currently in place for granting a physician               
 assistant the authority to practice in the State and to prohibit              
 unfair insurance discrimination against them.                                 
                                                                               
 JACK HEESCH, Alaska Academy of Physician Assistants, said it is his           
 understanding from the Division of Insurance that inclusion of the            
 physician assistants on the nondiscrimination list does not                   
 guarantee anybody a billing rate.  He explained that insurance                
 companies pay what is usual and customary.  People who work for a             
 doctor in a clinic and bill for physician services include the                
 physician, a physician assistant, an advanced nurse practitioner,             
 a physical therapist, an occupational therapist, an audiologist,              
 and a speech pathologist.  These bill at what is called a physician           
 service rate.                                                                 
                                                                               
 The truth of the matter, he said, is that some physician assistants           
 who see a patient in a doctors office bill as a physician provided            
 service at the same rate the doctor does.  In other cases they bill           
 at a lesser rate and in many cases at a substantially lesser rate.            
                                                                               
 The bottom line is AS21.36.090 (d) has nothing to do with what                
 anyone bills.  It says that if a patient walks into a doctors                 
 office, he doesn't have to be concerned if his insurance covers               
 seeing a physician assistant.  It doesn't dictate the rate which is           
 up to the insurance companies to figure out.                                  
                                                                               
 SENATOR KELLY asked if anyone in the room objected to that                    
 statement.                                                                    
                                                                               
 Number 165                                                                    
                                                                               
 JERRY REINWAND, Blue Cross, said the problem is that no one can               
 really explain what the antidiscrimination statute really does.               
 It's working because the Division has an interpretation that it               
 will work in a certain direction.  If this interpretation is                  
 correct, Mr. Heesch might be correct.  No one knows.  Their concern           
 is with what the statute really does and what does adding physician           
 assistants do, what are the cost and policy implications.  He                 
 thought it was a better idea to back off on this bill and let them            
 work with the Division of Insurance over the interim to define what           
 it really does before they add more to it.                                    
                                                                               
 Number 225                                                                    
                                                                               
 KATIE CAMPBELL, Division of Insurance, said they have historically            
 supported this section of the bill.  She said the interpretation              
 they have given this discrimination section allows for payment of             
 a service if a provider is licensed to provide a service under our            
 statutes.  Whoever is on that list can't be discriminated for a               
 service.  It's not their interpretation that this is setting a fee.           
 The question has never come up, there are no court cases, there               
 have been no questions to the Division regarding that portion of              
 the bill.                                                                     
                                                                               
 MR. HEESCH said they would like the committee to add physician                
 assistants language that was found in SB 100.                                 
                                                                               
 SENATOR TORGERSON moved to add that language.  There was discussion           
 and SENATOR KELLY said they would hold the bill until Tuesday and             
 directed staff to add the physician assistant language and the                
 intent to not set fees.