Legislature(2023 - 2024)BELTZ 105 (TSBldg)
03/13/2024 01:30 PM Senate LABOR & COMMERCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB234 | |
| SB146 | |
| SB219 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 234 | TELECONFERENCED | |
| *+ | SB 146 | TELECONFERENCED | |
| *+ | SB 219 | TELECONFERENCED | |
SB 219-PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
2:50:37 PM
CHAIR BJORKMAN reconvened the meeting and announced the
consideration of SENATE BILL NO. 219, "An Act relating to
utilization review entities; exempting certain health care
providers from making preauthorization requests for certain
services; and providing for an effective date."
2:51:03 PM
SENATOR DAVID WILSON, District N, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 219, paraphrased the sponsor
statement for SB 219:
[Original punctuation provided.]
Sponsor Statement
Senate Bill 219
"An Act relating to utilization review entities;
exempting certain health care providers from making
preauthorization requests for certain services; and
providing for an effective date."
SB 219 aims to reduce the wait time for certain health
care services by exempting qualified health care
providers from making preauthorization requests for
said services. Currently, Alaskans who need certain
health care services must wait days or weeks to get
preauthorized to receive health care services because
of the processing time between the health care
provider and insurance companies. This bill would help
Alaskans receive health care services immediately,
especially health care services that could save their
lives.
Health care providers shall qualify for a prior
authorization exemption if at least 80 percent of
prior authorization requests submitted in the past 12-
month period were approved for that health care
service. Utilization review entities will provide
exempted health care providers with a list of health
care services for which the exemption applies and the
duration of the exemption. This helps eliminate
unnecessary delays in care by granting providers
exemptions who have demonstrated consistent adherence
to approval guidelines from prior authorization
requirements.
Other states with prior authorization exemptions have
seen increased frequency of patients who receive the
health care services they need and help eliminate
unnecessary delays in care. This bill will help
Alaskans receive fast, efficient, and quality
healthcare when they need it without waiting for a
preauthorization process that could cause their health
to decline even more.
Please contact Julia Fonov in my office at (907) 465-
4711 or [email protected] for any questions.
SENATOR WILSON explained that the onus is on the patient to seek
out preauthorization, although many healthcare providers take
this on in order to help the patients move forward with their
care. He stated that patients in his district have suffered for
months trying to get authorization for services. The lack of
integrated care in Alaska makes it difficult for people with
complex health issues to get the help that they need. He noted
that other states have passed similar programs, while some are
considering similar changes. He noted that he would not be
reviewing the sectional analysis in the interest of time.
2:54:43 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association (ASMA), Anchorage, Alaska, explained that prior-
authorization is a cost-control process requiring healthcare
professionals to obtain advance approval from health insurance
plans before a prescription medication or medical service
qualifies for payment and delivery. She stated that these are
time-consuming barriers to effective delivery of necessary
treatment and are especially burdensome for providers who
routinely get these authorizations approved. Prior
authorizations are approved over 80 percent of the time;
however, they delay necessary care 94 percent of the time. Up to
80 percent of patients abandon recommended care at least some of
the time. 33 percent of physicians report that prior
authorization has led to serious adverse events for the patients
in their care. 89 percent of physicians report that prior
authorization has a negative impact on patient care. 62 percent
of physicians report that prior authorization has led to
additional office and emergency department visits.
2:56:15 PM
MS. VENTGEN went on to explain that insurance companies claim
that their panel of reviewers is well qualified; however,
physicians report having to get prior approval from nurse
practitioners, physician assistants, and retired physicians -
not physicians who are well-versed in current standards of care.
She stated that she has heard from oncologists that it can take
multiple phone calls to get a physician reviewer - a peer-to-
peer reviewer - who must then be educated on the type and stage
of cancer and current best practices for treatment before
finally getting approval. She shared a story of an oncology
patient who sought treatment from a specialist who was out of
network and was faced with paying $40,000 out of pocket before
they could see this physician. She said that SB 219 will
decrease the burden on providers, increase the quality of care
to patients, and decrease costs of unnecessary office and
emergency department visits prior to authorization.
2:57:50 PM
CHAIR BJORKMAN asked if she would be surprised to hear that some
providers in his community often receive a denial in a matter of
minutes when they submit prior authorization claims.
2:58:05 PM
MS. VENTGEN replied that insurance companies will routinely
initially deny these requests. This initiates the appeal
process, involving multiple phone calls, long phone wait times,
and some offices hire additional staff to handle these prior
authorizations. She noted that it takes many hours per week to
deal with these authorizations.
2:58:35 PM
CHAIR BJORKMAN asked if, in her professional opinion, it is
possible for an experienced professional medical team to
evaluate most prior authorizations in a matter of minutes.
2:58:46 PM
MS. VENTGEN replied yes, if they were experienced in the
particular specialty area.
2:59:20 PM
CHAIR BJORKMAN stated that he has heard from providers who hit
send on a prior authorization request and receive denials within
five minutes. He commented that many of these providers report
that insurance companies are utilizing artificial intelligence
to deny these claims. He added that this would be explored more.
2:59:54 PM
MS. VENTGEN said that she does not know but would not be
surprised. She noted that if a prior approval is denied, some
will go on to appeals and some will not. If they do go on to
appeals, they are delayed for a prolonged period. She said that
a significant number of these requests are ultimately approved,
and this is what SB 219 is intended to address. She added the
physicians who receive approval are then exempted from this
process for a period of time.
3:01:00 PM
JEANNIE MONK, Senior Vice President, Alaska Hospital and
Healthcare Association, Juneau, Alaska, testified in support of
SB 219 and said that Alaska Hospital and Healthcare (AHA) is
committed to the well-being of patients and the efficient
operation of hospitals. She stated that AHA believes SB 219 is a
significant step forward in ensuring timely access to essential
medical care while reducing burdensome administrative
requirements. She explained that this directly impacts patient
health and wellbeing. The authorization process adds additional
stress for patients in need of medical care by adding
unnecessary delays and obstacles to treatment. She said that
this can apply to diagnostic testing, medications, and surgery.
This can present an even greater challenge for patients in rural
areas. She pointed out that making arrangements for time off
work, childcare, and transportation to receive medical care is
already challenging - and the uncertainty of whether the
insurance company will approve the procedure (and when) makes
planning more difficult (especially when travel is involved).
She said that patients may have to call repeatedly - and may
make travel arrangements or leave their community only to find
out that the initial request has been denied and the provider
must appeal.
MS. MONK explained that this process was intended to prevent
unnecessary procedures; however, prior authorization has also
become a tool to delay and deny necessary medical treatment and
avoid paying for services altogether. She reiterated that this
is a time consuming process for hospitals and medical practices,
who must have staff who navigate these administrative hurdles in
order to receive approval before they can deliver the necessary
care. She added that SB 219 recognizes the validity of the prior
authorization process while limiting unnecessary obstacles. She
explained that providers with a proven track record of
responsible practice can be exempt from the requirement for
specific services. This would streamline the care delivery
process and allow providers to focus on providing patients with
timely treatment. She opined that SB 219 strikes a good balance
between insuring responsible healthcare practices and reducing
administrative burden.
3:04:52 PM
SENATOR DUNBAR asked if there are any Employment Retirement
Insurance Security Act (ERISA) impacts. He noted a potential
"no" response from the director of the Division of Insurance and
requested this information in writing for the next hearing. He
pointed out that SB 219 applies to healthcare providers with a
proven track record and asked if there is any concern that this
may prevent new healthcare providers from entering the field
because they will be at a competitive disadvantage.
3:06:04 PM
SENATOR WILSON said that he would work with the director of the
Division of Insurance to provide information about ERISA
impacts. With respect to new healthcare providers, he said that
SB 219 would not impact new players coming into the market. He
explained that existing players would need to renew every 12
months. In their first year, new providers would be working
toward their initial authorization status but after that,
everyone would be on an equal playing field.
3:06:34 PM
CHAIR BJORKMAN held SB 219 in committee.