Legislature(2025 - 2026)BELTZ 105 (TSBldg)
03/19/2025 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB132 | |
| SB133 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 132 | TELECONFERENCED | |
| *+ | SB 133 | TELECONFERENCED | |
SB 133-INSURANCE; PRIOR AUTHORIZATIONS
2:14:44 PM
CHAIR BJORKMAN reconvened the meeting and announced the
consideration of SENATE BILL NO. 133 "An Act relating to prior
authorization requests for medical care covered by a health care
insurer; relating to a prior authorization application
programming interface; relating to step therapy; and providing
for an effective date."
2:15:14 PM
KONRAD JACKSON, Staff, Senator Jesse Bjorkman, Alaska State
Legislature, Juneau, Alaska, introduced SB 133 on behalf of the
Senate Labor and Commerce Committee and provided the sectional.
He stated SB 133, which addresses insurance and prior
authorizations, is the result of extensive collaboration among
healthcare industry stakeholders through numerous meetings over
the summer. He said providers, insurers, and other key players
have reached full agreement on the legislation, which is a rare
but appreciated occurrence in the legislative process.
MR. JACKSON stated the initial draft of the sectional summary
was incorrect and the following is the correct version for SB
133:
[Original punctuation provided.]
Sectional Summary ver. \N
This is a summary only. Note that this summary should
not be considered an authoritative interpretation
of the bill and the bill itself is the best statement
of its contents.
Section 1. AS 21.07.080 is amended making conforming
changes to preserve the original intent by
citing AS 21.07.005 - 21.07.090 (the original chapter
contents).
2:17:37 PM
MR. JACKSON continued with the sectional summary:
Section 2. AS 21.07 is amended by adding a new
section:
Article 2. Prior Authorization.
Sec 21.07.100. Prior authorization requests.
(a) Requires that each health care insurer
offering a health plan, after January 1,
2027, shall
designate a prior authorization process
that is reasonable, efficient, and
minimizes the
administrative burden on health care
providers and facilities and that complies
with the
standards for medical care and prescription
drugs.
(b) Requires that if a health care provider
submits a prior authorization request, the
health
care insurer shall make a determination and
notify the provider within:
a. 72-hours after receiving a standard
request submitted by a method other
than facsimile;
b. 72-hours, excluding weekends, after
receiving a standard request submitted
by facsimile; or
c. 24-hours after receiving an expedited
request.
(c) Provides, that when a prior authorization
request is submitted that does not contain
the information necessary to make a
determination, the health care insurer
shall request specific additional
information within:
a. One calendar day after receiving an
expedited request;
b. Three calendar days after receiving a
standard request.
(d) Allows an insurer, in making a
determination, that if the submitted
information is not sufficient to make a
determination the insurer may request
additional information with a due date of
not less than five (5) working days nor
more than fourteen (14) working days.
(e) Mandates that after the submission of the
prior authorization request, the provider
shall receive confirmation that the request
has been received with a date and time of
the receipt.
(f) Provides a prior authorization request is
considered approved if the health care
insurer fails to provide a written denial,
approval or request for additional
information within the time specified
above.
2:20:02 PM
MR. JACKSON continued with the sectional summary:
[Sec. 21.07.110.]
(a) Provides that a health care insurer shall
make its most current prior authorization
standards available, on the health care
insurer's website including information or
document needed to make a determination. If
the health care insurer provides a portal,
the prior authorization standards shall be
available on the portal.
(b) Provides that a health care insurer's prior
authorization standards must include prior
authorization requirements used by the
insurer and by the insurer's utilization
review organization. The requirements must
be based on peer-reviewed, evidence-based
clinical review criteria and be
consistently applied by all sources.
(c) Provides that if the prior authorization
standards published by the health care
insurer differ from those published by
their utilization review organization, the
standard most favorable to the covered
person shall be used.
(d) Provides that a health care insurer shall
indicate on its website, for each service
subject to prior authorization,
(1) Whether a standardized electronic
prior authorization request
transaction is available; and
(2) The date the prior authorization
requirement became effective and was
published on their website.
(e) Provides that if the prior authorization
requirement is terminated, the health care
insurer shall indicate on its website the
date the requirement was removed.
2:21:50 PM
MR. JACKSON continued with the sectional summary:
Sec. 21.07.120. Peer review of prior authorization
requests.
(a) Provides that an insurer shall establish a
process for the health care provider to
request a clinical peer review of a prior
authorization request.
(b) The peer reviewer must have relevant
clinical expertise in the specialty area or
be an equivalent specialty of the provider
submitting the prior authorization request.
(c) Provides that a heath care insurer shall
provide to the health care provider upon
request, the qualifications of a peer
reviewer issuing an adverse decision.
Sec. 21.07.130. Period of validity of prior
authorization.
(a) Requires that a prior authorization request,
for a chronic condition, must be valid for
not less than twelve (12) months while the
covered person is covered by the insurer's
policy. Also addresses how the prior
authorization may be renewed.
(b) Provides that, except for (a) above, a prior
authorization request shall be valid for
ninety (90) calendar days or a duration
that is clinically appropriate, whichever
is longer.
2:23:00 PM
MR. JACKSON continued with the sectional summary:
Sec. 21.07.140. Adverse determinations.
Provides that if a health care insurer makes an
adverse determination, the insurer shall notify
the covered person and their health care provider and
provide each
(1) A clear explanation of the adverse
determination,
(2) A statement of the covered person's
right of appeal; and
(3) Instructions on how to file the
appeal.
Sec. 21.07.150. Prior authorization application
programming interface.
States that each insurer shall maintain a prior
authorization application programming interface that
automates the prior authorization process for
providers to determine whether a prior authorization
is required for medical care, identify prior
authorization information and documentation
requirements, and facilitate the exchange of prior
authorization requests and determinations from its
electronic health records or practice management
system. The application programming interface must be
consistent with the technical standards and
implementation dates established in the Centers for
Medicare and Medicaid Services rules on
interoperability and patient access.
2:24:23 PM
MR. JACKSON continued with the sectional summary:
Sec 21.07.160. Step therapy restrictions and
exception.
(a) Requires that an insurer that provides
coverage under a policy for the treatment
of Stage 4 advanced metastatic cancer shall
not limit or exclude coverage for a drug
that is approved by the Federal Drug
Administration (FDA) and that is on the
insurer's prescription drug formulary by
mandating that a covered person with Stage
4 advanced metastatic cancer undergo step
therapy.
(b) Provides that if coverage of a prescription
drug for treatment of any medical condition
is restricted by the insurer, or their
utilization review organization because of
a step therapy protocol, the health care
insurer or utilization review organization
must provide a covered person, and his/her
provider, with access to a clear,
convenient, and readily accessible process
to request a step therapy exception
determination.
(c) A step therapy exception determination shall
be granted if the covered person has tried
the step therapy required prescription
drugs while under a current or previous
health insurance policy.
(d) The insurer, or utilization review
organization, may request relevant
documentation from the covered person or
provider to support the exception request.
(e) States that this section shall not be
construed to prevent:
(1) An insurer, or utilization review
organization, from requiring a covered
person to try a generic equivalent or
other brand name drug prior to
providing coverage for the requested
prescription drug; or
(2) A provider from prescribing a
prescription drug he or she determines
is medically appropriate.
2:26:52 PM
MR. JACKSON continued with the sectional summary:
Sec 21.07.170. Annual report.
Health care insurers shall submit annual reports, on a
form prescribed by the director, detailing their
adherence to AS 21.07.100 through AS 21.07.180.
Sec 21.07.180. Compliance and enforcement
(a) Requires that the director shall monitor
compliance with the provision of AS
21.07.100 AS 21.07.180.
(b) States that the examination of an insurer's
prior authorization practices shall be
consistent with AS 21.06.120 through AS
21.06.230. Examinations shall be performed
at least every two years
(c) Provides that if an insurer is found to be
non-compliant with the provisions of AS
21.07.100 through AS 21.07.180, the
director may impose penalties including
fines for each instance of non-compliance,
orders to rectify deficiencies within a
specified time frame or for suspension or
revocation of the insurer's certificate of
authority for persistent or severe
violations.
(d) Provides that the director shall adopt
regulations establishing penalties for
noncompliance.
[Section 3. Sec 21.07.250 is amended to]
Add definitions for:
(15) Chronic Condition
(16) Covered person
(17) Expedited request
(18) Prior Authorization
(19) Standard request
(20) Step-therapy protocol
(21) Utilization review organization
Section 4. The uncodified laws of the State of Alaksa
are amended by adding a new section to
read: Transition Regulations providing that the
director may adopt regulations necessary to
implement this Act.
Section 5. Provides that Section 4 takes effect
immediately.
Section 6. Provides that except as provided in Sec 5,
this act takes effects on January 1, 2027.
2:29:54 PM
SENATOR DUNBAR stated his belief that AS 27.07.100 is the heart
of SB 133 and sought confirmation the enforcement provision
falls to the Division of Insurance. He said on page 8 [AS
21.07.180(c)] it states, "If a health care insurer does not
comply with AS 21.07.100-21.07.180, the director may impose
penalties including a penalty in each instance of
noncompliance," and asked whether SB 133 is modeled after the
actions of other states.
2:30:38 PM
MS. WING-HEIER replied that SB 133 is based on models from other
states. SB 133 represents a compromise of a bill from last year
that payers and providers worked on during the interim. She
stated that both parties support bringing it to the legislature.
2:31:02 PM
SENATOR DUNBAR asked what constitutes an appropriate penalty,
how often the division expects to issue it and whether the
division has the capacity to follow up once it is issued.
2:31:35 PM
MS. WING-HEIER responded that SB 133 allows the division to
adopt fines, penalties, and caps in line with current
regulation. She provided an example of penalties ranging from
$250-1000 and a cap of up to $25,000. She stated that AS 21.06
was specifically included in SB 133 so that the insurance
company incurs the expense of an examination.
2:32:32 PM
SENATOR DUNBAR stated he might have misunderstood how
enforcement works and asked if enforcement would be ongoing and
complaint driven, not just periodic reviews, and whether
insurers would also cover those costs.
2:33:00 PM
MS. WING-HEIER replied that the division typically handles one
off complaints internally, but a surge in similar complaints
triggers a market conduct review to investigate broader issues
within the insurer.
2:34:06 PM
At ease.
2:34:51 PM
CHAIR BJORKMAN reconvened the meeting.
[CHAIR BJORKMAN held SB 133 in committee.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB132 ver G.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 132 |
| SB132 Sponsor Statement ver G.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 132 |
| SB132 Sectional Summary ver G.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 132 |
| SB132 Fiscal Note-DCCED-DOI 03.16.25.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 132 |
| SB133 ver N.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 133 |
| SB133 Sponsor Statement ver. N.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 133 |
| SB133 Sectional Summary ver. N.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 133 |
| SB133 Public Testimony-Letter-AHHA 03.18.25.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 133 |
| SB133 Public Testimony-Letter-CPH 03.17.25.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 133 |
| SB133 Sectional Summary -corrected- ver. N.pdf |
SL&C 3/19/2025 1:30:00 PM |
SB 133 |