Legislature(1997 - 1998)
01/16/1998 09:00 AM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 197 - REGULATING HEALTH MAINTENANCE ORGS. CHAIRMAN WILKEN called the Senate Health, Education and Social Services (HESS) Committee to order at 9:06 a.m. Present were Senators Wilken, Ward and Leman. Chairman Wilken announced the first order of business was to continue taking public testimony on SB 197, which would also be heard in committee on Wednesday, January 21, at the sponsor's request. GORDON EVANS, representing the Health Insurance Association of America (HIAA), clarified HIAA's position on SB 197. In previous testimony, Mr. Evans stated that HIAA believed SB 197 is unnecessary; opposed Section 2 which mandates certain benefits for chiropractors; and did not oppose the provisions in Sections 1 and 3. HIAA believes Section 1, which proposes to amend current law to require a carrier to include, in its evidence of coverage, guidelines explaining when treatment may be denied, is unnecessary because managed care plans are currently required to file a Schedule of Benefits with the Division of Insurance when establishing plans in Alaska. The Schedule of Benefits, which is provided to encourage active enrollment, is a legal document that describes in detail what the plan does and does not cover, and rules and procedures governing eligibility. Instead, HIAA would be willing to provide to the patient or health care provider, upon request, a written explanation of an adverse determination. Regarding Section 3, MR. EVANS said three of the five parts impose limits on communication between a health care provider and the enrollee, and require written notification of cause for termination of a health care provider. HIAA believes those provisions are contractual matters. Most managed care firms guard their current customers and information about their plan for purposes of confidentiality. Consequently, plans will include contractual provisions asking the health care provider to agree to not disparage the health plan to enrollees or attempt to induce the enrollees to leave a plan or join another. These types of contractual provisions are not unique to HMOs; they are imposed by other employers through contracts or employment manuals: no business can tolerate its employees driving customers away. As the general contractor employing the provider, health plans could be held jointly liable for libelous statements by a provider or spurious claims which may impact another provider's business. Also provider's who might have multiple contractual arrangements with health facilities and plans could attempt to steer patients to facilities in which they have a personal financial interest. Finally, the medical community has protected itself against disclosure of data which compares physicians and facilities based upon clinical outcomes. The same level of analytical objectivity should be required in any qualitative statements made by physicians who are in a contractual relationship with an HMO. MR. EVANS read part of the written testimony he submitted for the committee file and concluded his remarks by saying insurers should not be required to subject every denial of health care coverage to a second provider's opinion. HIAA always opposes mandating benefits because that practice will drive up costs and ultimately limit the affordability of quality care for consumers. Mr. Evans stated he would be willing to work with the sponsor on changes to SB 197 that HIAA could support. Number 140 SENATOR WARD asked if the sponsor requested that SB 197 be held in committee. CHAIRMAN WILKEN repeated the bill would be held until Wednesday at the sponsor's request.