Legislature(1999 - 2000)

04/12/2000 01:55 PM House FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
                  HOUSE FINANCE COMMITTEE                                                                                       
                       April 12, 2000                                                                                           
                         1:55 P.M.                                                                                              
                                                                                                                                
TAPE HFC 00 - 113, Side 1.                                                                                                      
TAPE HFC 00 - 113, Side 2.                                                                                                      
TAPE HFC 00 - 114, Side 1.                                                                                                      
TAPE HFC 00 - 114, Side 2.                                                                                                      
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair  Therriault  called   the  House  Finance  Committee                                                                   
meeting to order at 1:55 P.M.                                                                                                   
                                                                                                                                
PRESENT                                                                                                                       
                                                                                                                                
Co-Chair Therriault            Representative Foster                                                                            
Co-Chair Mulder                Representative Grussendorf                                                                       
Representative Austerman       Representative Moses                                                                             
Representative Bunde           Representative Phillips                                                                          
Representative J. Davies       Representative Williams                                                                          
Representative G. Davis                                                                                                         
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Representative   Norman   Rokeberg;   Janet   Seitz,   Staff,                                                                   
Representative   Norman   Rokeberg;  Alison   Elgee,   Deputy                                                                   
Commissioner,   Department  of   Administration;  John   Cyr,                                                                   
President,  National  Education  Association  (NEA),  Juneau;                                                                   
Dwight Perkins, Deputy Commissioner,  Department of Labor and                                                                   
Workforce  Development; Paul  Grossi,  Director, Division  of                                                                   
Worker's  Compensation,  Department  of Labor  and  Workforce                                                                   
Development;  Dale  Anderson,   Staff,  Representative  Eldon                                                                   
Mulder;   Mitch   Gravo,   Lobbyist,    State   Homebuilders'                                                                   
Association, Juneau.                                                                                                            
                                                                                                                                
TESTIFIED VIA TELECONFERENCE                                                                                                  
                                                                                                                                
Colleen  Savoie, Health  Care  Consultant,  Brady &  Company,                                                                   
Anchorage;  Jim  Jordan,  Executive  Director,  Alaska  State                                                                   
Medical  Association   (ASMA),  Anchorage;   Mary  Marshburn,                                                                   
Director,  Division of  Motor Vehicles  (DMV), Department  of                                                                   
Administration,    Anchorage;   Mark   Pfeffer,    Architect,                                                                   
Brookings,  Oregon;  Collen  Savoir,  Anchorage;  Paul  Lyle,                                                                   
Fairbanks;   John   Athens,   Fairbanks;   Kevin   Daughtery,                                                                   
Anchorage.                                                                                                                      
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
HB 211    An Act relating to liability  for providing managed                                                                   
          care services, to regulation of managed care                                                                          
          insurance plans, and to patient rights and                                                                            
          prohibited  practices under  health insurance;  and                                                                   
          providing for an effective date.                                                                                      
                                                                                                                                
          HB 211 was HEARD and  HELD in Committee for further                                                                   
          consideration.                                                                                                        
                                                                                                                                
HB 324    An Act requiring written consent by the person who                                                                    
          is the subject of the  information before releasing                                                                   
          personal  information  contained  in motor  vehicle                                                                   
          records,  to  comply   with  18  U.S.C.  2721;  and                                                                   
          providing for an effective date.                                                                                      
                                                                                                                                
          HB 324 was reported out of Committee with a "do                                                                       
          pass" recommendation and with a fiscal note by                                                                        
          Department of Administration dated 2/2/00.                                                                            
                                                                                                                                
HB 419    An Act relating to the weekly rate of compensation                                                                    
          and  minimum  and maximum  compensation  rates  for                                                                   
          workers'  compensation; specifying components  of a                                                                   
          workers' compensation  reemployment plan; adjusting                                                                   
          workers'   compensation   benefits  for   permanent                                                                   
          partial  impairment,  for reemployment  plans,  for                                                                   
          rehabilitation benefits,  for widows, widowers, and                                                                   
          orphans,  and for funerals;  relating to  permanent                                                                   
          total   disability   of   an   employee   receiving                                                                   
          rehabilitation  benefits;  relating to  calculation                                                                   
          of gross weekly earnings  for workers' compensation                                                                   
          benefits  for seasonal  and  temporary workers  and                                                                   
          for workers  with overtime or premium  pay; setting                                                                   
          time limits for requesting  a hearing on claims for                                                                   
          workers'    compensation,     for    selecting    a                                                                   
          rehabilitation  specialist,   and  for  payment  of                                                                   
          medical  bills;  relating  to  termination  and  to                                                                   
          waiver   of  rehabilitation   benefits,   obtaining                                                                   
          medical releases, and  resolving discovery disputes                                                                   
          relating  to  workers'   compensation;  setting  an                                                                   
          interest   rate  for  late  payments   of  workers'                                                                   
          compensation;  providing for updating  the workers'                                                                   
          compensation  medical fee  schedule; and  providing                                                                   
          for an effective date.                                                                                                
                                                                                                                                
          CS HB 419 (FIN) was reported out of Committee with                                                                    
          a "no recommendation"  and with fiscal notes by the                                                                   
          Office  of the Governor  dated 3/29/00,  Department                                                                   
          of  Labor and Workforce  Development dated  3/29/00                                                                   
          and the University of Alaska dated 3/29/00.                                                                           
                                                                                                                                
HB 439    An Act relating to the compensation of certain                                                                        
          public  employees  and  officials  not  covered  by                                                                   
          collective  bargaining  agreements;  and  providing                                                                   
          for an effective date.                                                                                                
                                                                                                                                
          HB 439 was HEARD and  HELD in Committee for further                                                                   
          consideration.                                                                                                        
                                                                                                                                
HB 445    An Act relating to a  rural school construction and                                                                   
          planned maintenance pilot program; and providing                                                                      
          for an effective date.                                                                                                
                                                                                                                                
          CS HB 445 (FIN) was reported out of Committee with                                                                    
          "individual recommendations" and with a zero                                                                          
          fiscal note by the House Finance Committee.                                                                           
                                                                                                                                
HOUSE BILL NO. 211                                                                                                            
                                                                                                                                
     An Act relating to liability  for providing managed care                                                                   
     services,  to  regulation   of  managed  care  insurance                                                                   
     plans, and  to patient  rights and prohibited  practices                                                                   
     under health  insurance; and providing for  an effective                                                                   
     date.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  NORMAN  ROKEBERG  stated that  patients  need                                                                   
assurance that the  quality of their health care  will not be                                                                   
compromised  as  managed  care   expands.  CS  HB  2II  (L&C)                                                                   
requires  managed  care  entities  to  provide  a  reasonable                                                                   
standard of  health care,  and holds  them civilly  liable if                                                                   
they do not.  It also establishes requirements  for contracts                                                                   
between  managed   care  entities   and  their  health   care                                                                   
providers,  patients  and  their group  managed  care  plans,                                                                   
health  care insurers  and  the insured,  providing  patients                                                                   
with the following:                                                                                                             
                                                                                                                                
  • Access to emergency room services;                                                                                          
  • Availability of medical services or adequate referral                                                                       
     options;                                                                                                                   
  • Full disclosure of treatment options;                                                                                       
  • Choice of health care providers, including specialists;                                                                     
  • Clear descriptions of covered items and services,                                                                           
     benefits,     procedures,     compensation      methods,                                                                   
     availability    (and   exclusions)    of    prescription                                                                   
     medications  and  the  availability  of  translation  or                                                                   
     interpreter services;                                                                                                      
  • A point-of-service plan option;                                                                                             
  • Follow-through of preapproved payment;                                                                                      
  • Quick utilization review decisions;                                                                                         
  • Opportunity    for   appeals   of    utilization   review                                                                   
     decisions; and                                                                                                             
  • Added protection from denial, reduction, or termination                                                                     
     of payment for health care services.                                                                                       
                                                                                                                                
Representative   Rokeberg  noted   that   in  addition,   the                                                                   
legislation would  provide health care providers  the freedom                                                                   
to  share  all  testing  and  treatment  options  with  their                                                                   
patients,  and would  let them  advocate  for their  patients                                                                   
without  the risk  of being  penalized or  terminated by  the                                                                   
managed  care entity they  contract with.  It also  prohibits                                                                   
contracts  between  managed  care entities  and  health  care                                                                   
providers  from including  "hold  harmless"  clauses for  the                                                                   
managed care entity or financial  incentives for providers to                                                                   
withhold medically necessary services.                                                                                          
                                                                                                                                
Representative  Rokeberg  noted  that while  the  legislation                                                                   
streamlines the  health care system, managed  care might also                                                                   
increase   the  vulnerability   of   patients  and   doctors,                                                                   
resulting  in a  lower quality  of care.  The legislation  is                                                                   
necessary  to ensure  continued  quality health  care in  the                                                                   
face of a growing managed care industry.                                                                                        
                                                                                                                                
Representative  Rokeberg   continued  his  analysis   of  the                                                                   
legislation before Committee members.                                                                                           
                                                                                                                                
·  Section  2:  Imposes  civil  liability   on  managed  care                                                                   
   entities for certain  health care acts. Creates  a defense                                                                   
   to the civil action and certain exclusions to liability.                                                                     
·  Section  3:  Imposes  certain  provisions   that  must  be                                                                   
   included in a contract between a  health care provider and                                                                   
   a managed care  entity. Specifies that  certain provisions                                                                   
   cannot be  included in  a contract  between a health  care                                                                   
   provider  and   a  managed   care  entity.  Prohibits   an                                                                   
   indemnification clause  in a  contract between  a provider                                                                   
   and a  managed care  entity. Requires  that group  managed                                                                   
   care plans  include certain  contract provisions.  Imposes                                                                   
   certain requirements  regarding a  covered persons  choice                                                                   
   of  a  health  care  provider,   including  a  non-network                                                                   
   option, continuing  treatment  by a  health care  provider                                                                   
   whose contract  is  terminated,  and notification  when  a                                                                   
   provider contract is terminated for  cause. Specifies that                                                                   
   medical and  financial  information  concerning a  covered                                                                   
   person  or  applicant  is  confidential.   Establishes  an                                                                   
   external appeals  mechanism  for covered  persons. Adds  a                                                                   
   provision regarding religious non-medical providers.                                                                         
·  Section  4:  Makes  a violation  of  AS  21.07  an  unfair                                                                   
   insurance trade practice.                                                                                                    
·  Section 5: Prohibits  a health care insurer  from limiting                                                                   
   information on care or treatment.  Requires that treatment                                                                   
   decisions are  made  by a  licensed  health care  provider                                                                   
   trained  in  the area  in  question  and  that  denial  of                                                                   
   coverage occurs only after consultation.                                                                                     
                                                                                                                                
Representative  Rokeberg  spoke  to the  handout  distributed                                                                   
addressing  the federal Employee  Retirement Income  Security                                                                   
Act (ERISA) which was passed in  1974.  [Copy on File].  That                                                                   
piece of federal  law regulates employee pension  and welfare                                                                   
plans.                                                                                                                          
                                                                                                                                
Co-Chair Therriault  noted that the letters  from the medical                                                                   
association  had  been drafted  to  the  "M" version  of  the                                                                   
legislation.    He  asked the  differences  between  the  two                                                                   
versions.    Representative  Rokeberg pointed  out  that  the                                                                   
April 12   letter from the  Alaska State Medical  Association                                                                   
(ASMA) addressed the "W" version.  [Copy on File].                                                                              
                                                                                                                                
COLLEEN SAVOIE,  (TESTIFIED VIA TELECONFERENCE),  HEALTH CARE                                                                   
CONSULTANT, BRADY & COMPANY, ANCHORAGE,  noted three areas of                                                                   
concern with the  proposed legislation. She commented  on the                                                                   
conflict with  ERISA.  Ms. Savoie suggested  placing language                                                                   
in  the  bill  which  would  clarify  that  ERISA  supercedes                                                                   
language contained  in the  bill.   That action could  remove                                                                   
all conflict.   She  added that  there are  several items  of                                                                   
concern regarding  conflict resolution  such as removing  the                                                                   
fiduciary responsibility  from the  planned fiduciary.   Such                                                                   
an example  would be the  controversy over medical  necessity                                                                   
language which should be included  in the plan and decided by                                                                   
the plan's fiduciary.   Ms. Savoie pointed out  that language                                                                   
had been included  in several versions of HB  211 and defined                                                                   
by the medical community.                                                                                                       
                                                                                                                                
Ms. Savoie  noted, an additional  concern that the  bill does                                                                   
not protect client  participants.  The bill  is a "physicians                                                                   
advocate"  bill.   She emphasized  that in  the end, it  will                                                                   
have  an  adverse  affect  on all  the  participants.    This                                                                   
legislation  was not  requested  by the  Alaskan public,  but                                                                 
instead   it   was   drafted   by   the   Alaskan   physician                                                                   
organizations.   Ms. Savoie stated that members  and families                                                                   
belonging to the organizations  represented by her, do oppose                                                                   
the passage of HB 211 many of  which are labor organizations.                                                                   
                                                                                                                                
Ms. Savoie continued,  the third area of concern  is that the                                                                   
legislation would  be detrimental  and costly to  health care                                                                   
plan sponsors  and the  participants.   She pointed  out that                                                                   
health care  costs in  Alaska are the  highest in  the nation                                                                   
and  that these  costs  will continue  to  increase over  the                                                                   
years.    The   costs  will  be  passed  down   to  the  plan                                                                   
participants.   Ms.   Savoie   stressed   that  it   is   the                                                                   
"physicians" who  will be receiving the additional  income if                                                                   
the bill passes.                                                                                                                
                                                                                                                                
JIM  JORDAN,   (TESTIFIED   VIA  TELECONFERENCE),   EXECUTIVE                                                                   
DIRECTOR,   ALASKA   STATE   MEDICAL    ASSOCIATION   (ASMA),                                                                   
ANCHORAGE,  advised that  the proposed  version does  contain                                                                   
protection for the  Alaska clients.  He voiced  opposition to                                                                   
comments  made by  the previous  speaker.   Mr. Jordan  added                                                                   
that ASMA feels that the ERISA  pre-emption of various states                                                                   
regulating "quality  of care" issues, has  been significantly                                                                   
narrowed through  recent court  decisions and it  is expected                                                                   
that the National  Patients Bill of Rights will  address that                                                                   
issue.   Mr. Jordan  noted that  the current  version of  the                                                                   
bill  would provide  an important  patient  protection.   The                                                                   
issues  of  liability  and  medical   necessity  need  to  be                                                                   
addressed by the Legislature during the next session.                                                                           
                                                                                                                                
Representative  Rokeberg  requested  Mr. Jordan  explain  the                                                                   
importance of  inclusion of  ERISA in the  bill.   Mr. Jordan                                                                   
replied  that  there  is  a  question  as  to  how  ERISA  is                                                                   
currently  constructed  and  how  far  the State  can  go  in                                                                   
regulating that.   He noted that this is a  complex issue and                                                                   
up until the  last couple of years, the courts  have narrowly                                                                   
interpreted ERISA.  In recent  years, there have been several                                                                   
court  cases that  have moved  away from that  decision.   At                                                                   
this time, it  is important to determine the  quality of care                                                                   
issues versus quantity.  The court  has specified that in the                                                                   
decisions  regarding  the quality  of  care,  the State  will                                                                   
regulate.     That  area  would   still  be  dependent   upon                                                                   
interpretations made  by the court.   There are  three issues                                                                   
in  the midst  of the  debate.   The  first  two are  medical                                                                   
necessity and  liability and the  third deals with  the ERISA                                                                   
concerns,   expected   to  be   clarified   through   federal                                                                   
legislation.                                                                                                                    
                                                                                                                                
Vice Chair  Bunde inquired what  would happen if  a situation                                                                   
was  not an  emergency,  and how  then  would  the appeal  be                                                                   
addressed.    Representative Rokeberg  replied that there are                                                                   
two tracks of response.   The first is the 24-hour  track and                                                                   
the second would be eighteen-days to appeal.                                                                                    
                                                                                                                                
Vice Chair  Bunde voiced  concern with  the payment  and that                                                                   
itemizing the  qualifications of the appeal process  would be                                                                   
paid for by  the participants.  He questioned  how the appeal                                                                   
would come  to resolution.   Representative Rokeberg  replied                                                                   
that  it would  be  through  a  third party  external  review                                                                   
system.  Representative  Rokeberg advised that  it would cost                                                                   
nothing.       In   response    to   Representative    Bunde,                                                                   
Representative  Rokeberg stated  that if  the person  did not                                                                   
like the appeal,  that person could go to court,  which would                                                                   
create an arbitration situation.                                                                                                
                                                                                                                                
Representative Rokeberg stated  that the legislation provides                                                                   
for  truly independent  review  and  judgement  which is  the                                                                   
centerpiece  of   the  legislation.    Representative   Bunde                                                                   
clarified  that   the  last  review   would  rest   with  the                                                                   
independent third party before it goes to court.                                                                                
                                                                                                                                
(TAPE CHANGE, HFC 00 - 113, Side 2).                                                                                          
                                                                                                                                
Representative  Rokeberg pointed out  the letter  included in                                                                   
member's packets  from Blue Cross  and Blue Shield  of Alaska                                                                   
indicating their support of the bill.  [Copy on File].                                                                          
                                                                                                                                
JOHN CYR,  PRESIDENT, NATIONAL  EDUCATION ASSOCIATION  (NEA),                                                                   
PRESIDENT OF NEA-ALASKA HEALTH  TRUST, JUNEAU, noted that NEA                                                                   
Health  Trust insures  the health of  about 15,000  Alaskans,                                                                   
and is an ERISA trust.  He voiced  concern when he heard that                                                                   
the  ERISA  trust  interpretation  would be  decided  by  the                                                                   
court.   He asked what this  would cost the NEA  Health Trust                                                                   
down the road in  legal fees.  If a person  were insured with                                                                   
the NEA Alaska Health Trust, there  exists only a question of                                                                   
whether or  not the  procedure you need  would be  covered in                                                                   
the  health plan.   There  is  an appeals  procedure that  is                                                                   
built into  that process.   He stated  that the main  concern                                                                   
now is if a service is covered or not.                                                                                          
                                                                                                                                
Mr. Cyr  requested that language  be added to the  bill which                                                                   
clearly  states that  ERISA trusts  are not  covered by  this                                                                   
bill.  He emphasized that by litigating  some sections of the                                                                   
bill  would mean  that  ultimately,  NEA members  would  bear                                                                   
those costs.                                                                                                                    
                                                                                                                                
Additionally,  Mr. Cyr  asked what  the proposed  legislation                                                                   
would do  to health  care costs.   At  this time, the  school                                                                   
districts across  the State are looking at  a 15-20% increase                                                                   
to health care  costs across the board.  As  an employer, the                                                                   
cost of health  went up 44% last year.  Small  businesses can                                                                   
not afford any future raises in the health care costs.                                                                          
                                                                                                                                
Co-Chair Therriault  asked if ERISA indicated  that State law                                                                   
does not apply,  would there need to be language  added which                                                                   
clarifies that State  law does not apply to  the federal law.                                                                   
Mr. Cyr commented  that he did not believe  so until previous                                                                   
testimony  regarding  the  courts being  the  final  decision                                                                   
making body.  Co-Chair Therriault  advised that the Committee                                                                   
would hold the bill to determine if that concern was valid.                                                                     
                                                                                                                                
Representative  Rokeberg stated that  the testimony  from Mr.                                                                   
Jordan  indicates  that the  line  of cases  has  to do  with                                                                   
quantity and quality.  Only if  it were a quality care issue,                                                                   
would case law come down.  He  emphasized that the bill would                                                                   
not apply to Mr. Cyr's organization.                                                                                            
                                                                                                                                
Representative  J. Davies questioned  how removing  the ERISA                                                                   
concern  would  "hurt"  the bill.    Representative  Rokeberg                                                                   
stated that  it was a  quality of care  issue, and  should be                                                                   
applicable.    Representative  J. Davies  stated  that  could                                                                   
exclude   an  entire   section   of  actions   of   quantity.                                                                   
Representative   Rokeberg   replied   that   would   not   be                                                                   
appropriate;   he  noted that  there  are a  large number  of                                                                   
people that would not be affected by the bill.                                                                                  
                                                                                                                                
Mr. Cyr reiterated that NEA Health  Trust does not oppose the                                                                   
bill,  however, they  currently  have an  ERISA trust,  which                                                                   
insures about 15,000 Alaskans.   He stated that he would like                                                                   
to see continue  in the future.   If the passage of  the bill                                                                   
meant that health care costs would  increase for members that                                                                   
are insured, then NEA would oppose the legislation.                                                                             
                                                                                                                                
Co-Chair  Therriault clarified  that the  risk of  litigation                                                                   
which  NEA  is fearful  of,  is  regarding whether  they  are                                                                   
included in the bill or not.   Representative J. Davies asked                                                                   
if Mr.  Cyr understood the  distinction between  quantity and                                                                   
quality  and if  it would  be appropriate  to State  regulate                                                                   
that.                                                                                                                           
                                                                                                                                
Mr. Cyr  replied that  if it  is the  quality of health  care                                                                   
that is the issue,  and NEA is not a "player",  then it would                                                                   
not  be a  concern.   If there  is a  question regarding  the                                                                   
quality  of the  service that  NEA provides,  he pointed  out                                                                   
that  there already  exists a  major  appeals process  within                                                                   
their system.                                                                                                                   
                                                                                                                                
Co-Chair  Therriault asked  the services  that NEA  provides.                                                                   
Mr.  Cyr replied  that NEA  serves  all the  teachers in  the                                                                   
Anchorage  area   school  district  and  all   the  outlining                                                                   
districts.   NEA is self-insured  and pays health  care costs                                                                   
for all their  covered employees.  The issues  of quality are                                                                   
the timeliness of return, and  are handled internally.  Those                                                                   
issues are covered under ERISA  and it is preferred that they                                                                   
stay that  way.  When  the Health  Trust was established,  it                                                                   
was set up under that set of guidelines.                                                                                        
                                                                                                                                
Representative  J. Davies stated  that he did  not understand                                                                   
the  difference  between  quality  and  quantity.    Mr.  Cyr                                                                   
stressed   that   under   ERISA,   there   is   a   fiduciary                                                                   
responsibility to  their membership to have  enough financial                                                                   
savings and insurance to meet their medical needs.                                                                              
                                                                                                                                
Representative  Rokeberg  noted that  a  definition of  ERISA                                                                   
does exist.  He stressed that  NEA is exempt because they are                                                                   
self-insured.    It  is  only those  ERISA  groups  that  are                                                                   
currently  covered  by  insurance  companies  that  would  be                                                                   
impacted  by  this  bill.  The   potential  impact  may  have                                                                   
provisions  at the federal  level which  would effect  ERISA.                                                                   
Representative Rokeberg requested  Mr. Jordan to provide case                                                                   
examples.                                                                                                                       
                                                                                                                                
Mr.  Jordan stated  that there  had been  an extensive  legal                                                                   
analysis  provided  to  the  Chair  of  the  House  Judiciary                                                                   
Committee.  He spoke to the quantity  versus quality concerns                                                                   
voiced by Representative  J. Davies.  When the  court makes a                                                                   
determination of the privacy of  regulation of the regulatory                                                                   
authority that would be a mandated  benefit such as the State                                                                   
mandating  that there be  coverage for  diabetes, would  be a                                                                   
quantity  type issue.   It  appears that  would be  preempted                                                                   
from having the State regulate the interests.                                                                                   
                                                                                                                                
Mr. Jordan continued,  the quality concern is  more difficult                                                                   
to explain.   He stated that  the definition assumes  that an                                                                   
item would  need to be covered  under the health plan.   That                                                                   
could have  to do  with a particular  service that  a patient                                                                   
might want that  the health plan determines  is not medically                                                                   
necessary.   It is  the type  of discussion  of what  is "not                                                                   
medically  necessary",  which  is a  quality  issue  concern.                                                                   
This area  is where the court  would decide whether  to allow                                                                   
more  regulatory  authority.   Mr.  Jordan noted  that  these                                                                   
types  of  cases are  being  brought  forward by  the  people                                                                   
enrolled under  these plans.   He  acknowledged that  this is                                                                   
one  of  the  key  issues  being  discussed  on  the  federal                                                                   
legislation level.   Currently,  the ERISA plan  participants                                                                   
are  not  necessarily  covered  because  of  the  ERISA  pre-                                                                   
exemption  language.   Federal  law does  have priority  over                                                                   
State law.                                                                                                                      
                                                                                                                                
Representative  J.  Davies  asked  further  clarification  of                                                                   
"medical necessity".   He questioned the consequences  of not                                                                   
being   able  to   come  to   an   agreement  in   Committee.                                                                   
Representative Rokeberg replied  that a common law definition                                                                   
of medical necessity has been  used since statehood.  Medical                                                                   
necessity  is either  defined  or indicated  in all  provided                                                                   
contracts.  Whether it is fully  defined or not is the issue.                                                                   
The medical profession wishes  to redefine it and are working                                                                   
their  way  around   the  system.    They  believe   this  is                                                                   
justifiable.  He  assumed that the issue is how  to have cost                                                                   
containment  and place constraints  on them.   Every  plan is                                                                   
different  and the  standards will  be different.   He  noted                                                                   
that the review  process created in the bill,  uses the terms                                                                   
medical necessity  and sets  out the  scope of the  contract.                                                                   
Additionally,  it  will  determine   the  perimeters  of  the                                                                   
external review board definition.                                                                                               
                                                                                                                                
Representative   J.  Davies  summarized   comments   made  by                                                                   
Representative Rokeberg,  pointing out that it  is determined                                                                   
in the external review process  and then ultimately in court.                                                                   
Representative Rokeberg agreed.                                                                                                 
                                                                                                                                
Vice Chair  Bunde asked  if cost was  a factor considered  in                                                                   
the medical judgement.  Representative  Rokeberg replied that                                                                   
sometimes cost  should be  a factor and  that being  aware of                                                                   
cost makes all providers more sensitive to that concern.                                                                        
                                                                                                                                
Representative J. Davies asked  if the bill touched the issue                                                                   
of whether  the doctors were aware  of these costs  and their                                                                   
interest in  that.   He suggested that  the decision  for the                                                                   
medical group  to prescribe  would mean  more money  in their                                                                   
pockets.  Representative  Rokeberg exclaimed that  there is a                                                                   
prohibition to giving incentives.                                                                                               
                                                                                                                                
HB 211 was HELD in Committee for further consideration.                                                                         
                                                                                                                                
(TAPE CHANGE, HFC 00 - 114, Side 1).                                                                                          
                                                                                                                                
HOUSE BILL NO. 419                                                                                                            
                                                                                                                                
     An Act relating  to the weekly rate of  compensation and                                                                   
     minimum  and  maximum compensation  rates  for  workers'                                                                   
     compensation;   specifying  components  of   a  workers'                                                                   
     compensation   reemployment  plan;  adjusting   workers'                                                                   
     compensation benefits for  permanent partial impairment,                                                                   
     for  reemployment  plans, for  rehabilitation  benefits,                                                                   
     for  widows, widowers,  and orphans,  and for  funerals;                                                                   
     relating  to permanent total  disability of  an employee                                                                   
     receiving    rehabilitation   benefits;    relating   to                                                                   
     calculation  of  gross  weekly   earnings  for  workers'                                                                   
     compensation   benefits  for   seasonal  and   temporary                                                                   
     workers and  for workers  with overtime or  premium pay;                                                                   
     setting time  limits for requesting a hearing  on claims                                                                   
     for    workers'    compensation,   for    selecting    a                                                                   
     rehabilitation  specialist, and  for payment of  medical                                                                   
     bills;  relating   to  termination  and  to   waiver  of                                                                   
     rehabilitation  benefits,  obtaining  medical  releases,                                                                   
     and resolving  discovery  disputes relating to  workers'                                                                   
     compensation;   setting  an   interest  rate   for  late                                                                   
     payments   of  workers'   compensation;  providing   for                                                                   
     updating   the   workers'   compensation   medical   fee                                                                   
     schedule; and providing for an effective date.                                                                             
                                                                                                                                
Representative J.  Davies noted a  change to Amendment  1, 1-                                                                   
LS1418\I.2,  Ford, 4/12/00.    [Copy on  File].   The  change                                                                   
would  be  to  Page  1,  Line   14,  inserting  "sub"  before                                                                   
"contractor".                                                                                                                   
                                                                                                                                
Representative J.  Davies MOVED to  ADOPT Amendment #1.   Co-                                                                   
Chair Therriault OBJECTED for the purpose of discussion.                                                                        
                                                                                                                                
Representative  J.  Davies commented  on  the  intent of  the                                                                   
amendment.    Present  law  states  that  the  contractor  is                                                                   
responsible for  providing workmen's  comp insurance  for the                                                                   
employees  of the  subcontractor.   The  law  was written  to                                                                   
protect those employees.   It was not written  to require the                                                                   
contractor  to provide  insurance for  the subcontractor.  At                                                                   
present time,  it is the practice  to interpret it  that way.                                                                   
That  in fact  makes  the subcontractor  an  employee of  the                                                                   
contractor.   The amendment  would clarify  that the  statute                                                                   
means insuring just the employees  and not the subcontractor,                                                                   
himself.   Representative  J. Davies pointed  out that  there                                                                   
currently  are court  cases over  this issue.   The  proposed                                                                   
language  provides   clarification.    The   consequences  of                                                                   
leaving  the  language  vague,  creates  circumstances  where                                                                   
there  would be  people  working  without being  insured.  He                                                                   
reiterated  that  the  proposed language  would  clarify  the                                                                   
understanding.                                                                                                                  
                                                                                                                                
Vice  Chair   Bunde  asked  why   the  contractor   would  be                                                                   
responsible     for    the     subcontractor's     employees.                                                                   
Representative  J.  Davies  advised  that this  is  a  public                                                                   
policy  issue decided  in the  past.   The  question lies  in                                                                   
regard to where the subcontractor  with no employees "falls".                                                                   
This needs to be defined one way or another.                                                                                    
                                                                                                                                
Representative Phillips stated  that was already contained in                                                                   
state  law.   She understood  that the  contractor does  take                                                                   
care  of  insurance   for  the  employees  but   not  for  an                                                                   
independent   subcontractor.      Representative   G.   Davis                                                                   
addressed that  the language of  the amendment  would clarify                                                                   
the conflict.                                                                                                                   
                                                                                                                                
DWIGHT PERKINS, DEPUTY COMMISSIONER,  DEPARTMENT OF LABOR AND                                                                   
WORKFORCE  DEVELOPMENT,  agreed   that  there  does  exist  a                                                                   
problem and  recognized that there  is a timing issue  in the                                                                   
legislation.  He  noted that there had been  discussion in HB
378, a similar bill, previously.   Mr. Perkins noted that the                                                                   
Labor Union  does have  a concern with  the legislation.   He                                                                   
noted  that  the  Department   would  defer  to  the  ad  hoc                                                                   
committee's  recommendations.   Mr. Perkins interjected  that                                                                   
the  Department wanted  to work  with the  homebuilders.   He                                                                   
noted that there is concern that  the legislation could weigh                                                                   
down the worker's comp fee bill,  which previously passed the                                                                   
House floor.                                                                                                                    
                                                                                                                                
PAUL  GROSSI, DIRECTOR,  DIVISION  OF WORKER'S  COMPENSATION,                                                                   
DEPARTMENT OF  LABOR AND  WORKFORCE DEVELOPMENT,  stated that                                                                   
the  Department  does  not  have  a  major  position  on  the                                                                   
amendment.  He additionally deferred  to the ad hoc committee                                                                   
recommendations.   He emphasized that the Department  did not                                                                   
want to stop the bill.                                                                                                          
                                                                                                                                
Co-Chair   Therriault   questioned  the   proposed   problems                                                                   
presented from  organized labor.  Mr. Perkins  responded that                                                                   
those concerns  were along  the line  of why a  subcontractor                                                                   
was  not  considered  an  employee  and  why  shouldn't  that                                                                   
individual   be   covered  by   the   contractor's   worker's                                                                   
compensation  insurance.   Mr. Perkins  pointed out  that law                                                                   
requires  that if  there  are employees,  that  they must  be                                                                   
covered by  worker's comp.   The  conflict arises within  the                                                                   
Division of Insurance.                                                                                                          
                                                                                                                                
Representative J.  Davies noted that the law  states that the                                                                   
contractor is  responsible for the subcontractor's  employees                                                                   
if  the   subcontractor  does   not  have  insurance.     The                                                                   
assumption  is   that  the   subcontractor  will   carry  the                                                                   
insurance.                                                                                                                      
                                                                                                                                
Representative  Phillips stressed  that would  be a  separate                                                                   
issue from employee  insurance.  Mr. Grossi  interjected that                                                                   
the  general   contractor  would   have  liability;   a  sole                                                                   
proprietor subcontractor  is not required in  current statute                                                                   
to have worker's compensation insurance.                                                                                        
                                                                                                                                
Vice Chair  Bunde stated that  any subcontractor who  did not                                                                   
have the insurance would have  a competitive advantage over a                                                                   
subcontractor who  did pay the  insurance costs.   Mr. Grossi                                                                   
agreed that their costs would be less.                                                                                          
                                                                                                                                
Representative  J. Davies  pointed out  the Letter of  Intent                                                                   
which provides further clarification of the amendment.                                                                          
                                                                                                                                
Co-Chair Therriault WITHDREW his  OBJECTION to the amendment.                                                                   
He  advised concern  that  it  could change  the  title.   He                                                                   
requested further information from the ad hoc group.                                                                            
                                                                                                                                
KEVIN DAUGHTERY,  (TESTIFIED VIA TELECONFERENCE),  ANCHORAGE,                                                                   
explained that  he did have concern  with the amendment.   He                                                                   
noted that  there has  always been  concern when  traditional                                                                   
business  practices change.    He stated  that the  amendment                                                                   
would provide a modification to current law.                                                                                    
                                                                                                                                
Mr. Daughtery commented that when  an owner/operator works as                                                                   
a  subcontractor, then  the  general contractor  must  insure                                                                   
that proper  worker's comp insurance  is available.   If that                                                                   
were removed, it would change the current process.                                                                              
                                                                                                                                
Mr. Daughtery spoke  to the seriousness of this  problem.  He                                                                   
suggested that language  be added to the fee bill.   He noted                                                                   
that  there is  currently an  ongoing  disagreement with  the                                                                   
Department.   He acknowledged  that this is serious  business                                                                   
and  that these  problems in  the  construction industry  are                                                                   
being addressed  on the national  level.  He  reiterated that                                                                   
he was opposed to the amendment as drafted.                                                                                     
                                                                                                                                
Representative Phillips stressed  that the provision is not a                                                                   
modification  to current  law but rather  a clarification  of                                                                   
current  law.  She  emphasized that  the amendment  clarifies                                                                   
the existing practice.                                                                                                          
                                                                                                                                
Co-Chair Mulder  pointed out that  the amendment  was drafted                                                                   
to address  the subcontractor  who does  not have  employees.                                                                   
Mr.  Daughtery   argued  that   the  amendment  would   be  a                                                                   
modification  to  current  practice.    In  the  construction                                                                   
industry, if  there is  a situation where  everyone on  a job                                                                   
claims to be an owner/operator,  the problem is the safety of                                                                   
the workers.   They  would be  disadvantaged by the  process.                                                                   
He reiterated that  it would be a statutory  change and would                                                                   
impact the  industry.   Co-Chair Mulder asked  if this  was a                                                                   
subversion of what was intended.                                                                                                
                                                                                                                                
Mr. Daughtery explained that there  are rules, which start on                                                                   
the federal  level.   He noted  that this  language would  be                                                                   
wrong,  and would  "loosen"  the  law.   Co-Chair  Therriault                                                                   
suggested   that  making   it  tighter   would  be   a  clear                                                                   
modification to the existing law.                                                                                               
                                                                                                                                
MITCH  GRAVO,  LOBBYIST, STATE  HOME  BUILDERS'  ASSOCIATION,                                                                   
Juneau,  testified on  the amendment.  He  stressed that  the                                                                   
amendment  would restate  Section  #1 in  the  statutes in  a                                                                   
different  manner.  The  amendment   only  addresses  if  the                                                                   
contractor would  be required to  cover with insurance  for a                                                                   
subcontractor  with  no employees.    There  is no  statutory                                                                   
authority for the contractor to  cover the subcontractor.  He                                                                   
added  that there  currently  are  a couple  of  homebuilders                                                                   
dealing with a  dispute regarding coverage with  an insurance                                                                   
company.    Mr.  Gravo  stressed   that  the  intent  of  the                                                                   
legislation  clarifies  that  if  a contractor  has  hired  a                                                                   
subcontractor  and there  are  no employees,  the  contractor                                                                   
would  not be  required  to purchase  workmen's  compensation                                                                   
insurance for that worker.                                                                                                      
                                                                                                                                
There being NO  further OBJECTION, Amendment  #1 was adopted.                                                                   
Representative  J. Davies  MOVED to ADOPT  the House  Finance                                                                   
Committee Letter of Intent.                                                                                                     
                                                                                                                                
Representative  G. Davis spoke  in support  of the  Letter of                                                                   
Intent. There being NO OBJECTION, it was adopted.                                                                               
                                                                                                                                
Co-Chair  Therriault   MOVED  to   ADOPT  Amendment   #2,  1-                                                                   
LS1418\I.1,  Ford, 4/11/00.    [Copy on  File.]   Mr.  Grossi                                                                   
discussed Amendment  #2. He stated  that the amendment  would                                                                   
mitigate  concerns  regarding   the  waiver  of  reemployment                                                                   
benefits  and   that  a  doctor   would  have   to  recommend                                                                   
reemployment benefits.  There being  NO OBJECTION, it  was so                                                                   
adopted.                                                                                                                        
                                                                                                                                
Representative Foster  MOVED to report CSHB 419  (FIN) out of                                                                   
Committee  with  individual  recommendations   and  with  the                                                                   
accompanying fiscal  note. There  being NO OBJECTION,  it was                                                                   
so ordered.                                                                                                                     
                                                                                                                                
CS HB  419 (FIN)  was reported  out of  Committee with  a "no                                                                   
recommendation"  and with  a House Finance  Letter of  Intent                                                                   
and  fiscal  notes  by  the  Office  of  the  Governor  dated                                                                   
3/29/00, Department of Labor and  Workforce Development dated                                                                   
3/29/00 and University of  Alaska dated 3/29/00.                                                                                
                                                                                                                                
HOUSE BILL NO. 445                                                                                                            
                                                                                                                                
     An Act relating to a rural school construction and                                                                         
     planned maintenance pilot program; and providing for an                                                                    
     effective date.                                                                                                            
                                                                                                                                
Representative  J.   Davies  MOVED  to  ADOPT   the  proposed                                                                   
committee substitute,  work draft 1-LS1596\G,  Ford, 4/12/00.                                                                   
There being NO OBJECTION, it was adopted.                                                                                       
                                                                                                                                
DALE ANDERSON,  STAFF, REPRESENTATIVE  MULDER, discussed  the                                                                   
committee  substitute and  the changes  made to  it from  the                                                                   
original  version  of  the  legislation.   He  observed  that                                                                   
changes had been made in response  to concerns regarding sole                                                                   
source bids.                                                                                                                    
                                                                                                                                
MARK  PFEFFER,  (TESTIFIED  VIA  TELECONFERENCE),  ARCHITECT,                                                                   
BROOKINGS, OREGON,  spoke in support of the  legislation.  He                                                                   
stressed that  the legislation would streamline  the schedule                                                                   
and produce  savings.  He  stated that the legislation  would                                                                   
allow all the  traditional methods of design  process between                                                                   
architects  and owners  and between  owners and  contractors,                                                                   
while at the same time, allows  for a management process that                                                                   
provides accountability.                                                                                                        
                                                                                                                                
Representative  J.  Davies referenced  Line  19,  Page 2.  He                                                                   
questioned if including "price" would be redundant.                                                                             
                                                                                                                                
Representative   J.  Davies  MOVED   to  delete   the  second                                                                   
occurrence  of "price"  on Line  19, Page 2.  There being  NO                                                                   
OBJECTION, it was adopted.                                                                                                      
                                                                                                                                
Vice  Chair  Bunde provided  members  with  an email  from  a                                                                   
constituent regarding  the bill.   [Copy on File].   Co-Chair                                                                   
Mulder noted  that there was  a zero House Finance  Committee                                                                   
fiscal note.                                                                                                                    
                                                                                                                                
Representative Foster  MOVED to report CSHB 445  (FIN) out of                                                                   
Committee  with  individual  recommendations   and  with  the                                                                   
accompanying fiscal  note.  There being NO  OBJECTION, it was                                                                   
so ordered.                                                                                                                     
                                                                                                                                
CS  HB  445   (FIN)  was  reported  out  of   Committee  with                                                                   
"individual recommendations" and  with a new zero fiscal note                                                                   
by the House Finance Committee.                                                                                                 
                                                                                                                                
HOUSE BILL NO. 324                                                                                                            
                                                                                                                                
     An Act  requiring written consent  by the person  who is                                                                   
     the   subject  of  the   information  before   releasing                                                                   
     personal   information   contained  in   motor   vehicle                                                                   
     records, to  comply with  18 U.S.C. 2721;  and providing                                                                   
     for an effective date.                                                                                                     
                                                                                                                                
MARY  MARSHBURN, (TESTIFIED  VIA  TELECONFERENCE),  DIRECTOR,                                                                   
DIVISION OF MOTOR VEHICLES (DMV),  ANCHORAGE, stated that the                                                                   
reason for HB 324 was to bring  statewide law into accordance                                                                   
with the past  federal legislation regarding  confidentiality                                                                   
of vehicle records.    The information is  confidential under                                                                   
current State law and would continue to be so.                                                                                  
                                                                                                                                
Ms. Marshburn pointed out that  current State law mirrors the                                                                   
former federal  law and would  release vehicle records  for a                                                                   
limited amount  of uses.  One  of those permitted  uses would                                                                   
be  for marketing  and  telecommunications.    For that  use,                                                                   
recently  passed federal  legislation directs  the states  to                                                                   
update their  regulations and  the penalty  for not  being in                                                                   
                                                       st                                                                       
compliance is a $5000 dollar per day, beginning June 1.                                                                         
                                                                                                                                
Vice Chair Bunde asked if it would  be prohibited to use that                                                                   
information in  political campaigns.   Ms. Marshburn  replied                                                                   
that the personal information could not be used.                                                                                
                                                                                                                                
(TAPE CHANGE, HFC 00 - 114, Side 2).                                                                                          
                                                                                                                                
In  response   to  Representative  Williams,   Ms.  Marshburn                                                                   
reiterated  that the penalty  would be  $5000 dollars  a day.                                                                   
She noted  that the  loss of  revenue expected  by the  State                                                                   
would be  approximately $200  thousand dollars  a year.   She                                                                   
pointed  out that  the fiscal  note had been  drafted to  the                                                                   
worst case scenario  and indicated that the  Department could                                                                   
submit a revised fiscal note.                                                                                                   
                                                                                                                                
Representative  G.  Davis  MOVED  to  report HB  324  out  of                                                                   
Committee  with  individual  recommendations   and  with  the                                                                   
accompanying fiscal  note.  There being NO  OBJECTION, it was                                                                   
so ordered.                                                                                                                     
                                                                                                                                
HB  324  was  reported  out  of  Committee  with  "individual                                                                   
recommendations"  and with the  Department of  Administration                                                                   
fiscal note dated 2/2/00.                                                                                                       
                                                                                                                                
HOUSE BILL NO. 439                                                                                                            
                                                                                                                                
     An Act  relating to the  compensation of  certain public                                                                   
     employees  and  officials   not  covered  by  collective                                                                   
     bargaining  agreements; and  providing for an  effective                                                                   
     date.                                                                                                                      
                                                                                                                                
ALISON    ELGEE,   DEPUTY    COMMISSIONER,   DEPARTMENT    OF                                                                   
ADMINISTRATION,  stated that the  bill provides  for cost-of-                                                                   
living  increases   the  same   as  those  provided   in  the                                                                   
collective bargaining agreements  that the Administration has                                                                   
reached with the twelve unions  representing State employees,                                                                   
which would be  a lump sum payment of up to  $1,200 (prorated                                                                   
at $50 per  pay period) for  fiscal year 2001, a  two percent                                                                   
increase in fiscal  year 2002, and a three  percent in fiscal                                                                   
year 2003.                                                                                                                      
                                                                                                                                
Ms.  Elgee noted  that the  bill  was modified  in the  House                                                                   
State Affairs  Committee to remove legislators.   She pointed                                                                   
out that the fiscal note accompanying  the bill, incorporates                                                                   
the  cost  of  including  the legislators.    That  cost  was                                                                   
provided to  the Committee as  part of the budget  amendments                                                                   
submitted in February 2000 from the Governor's Office.                                                                          
                                                                                                                                
PAUL LYLE,  (TESTIFIED VIA TELECONFERENCE),  FAIRBANKS, asked                                                                   
to  waive testimony  on the  bill until  amendments had  been                                                                   
proposed.                                                                                                                       
                                                                                                                                
JOHN  ATHENS,  (TESTIFIED  VIA   TELECONFERENCE),  FAIRBANKS,                                                                   
requested  to  waive his  testimony  on  the bill  until  the                                                                   
amendments had been submitted.                                                                                                  
                                                                                                                                
Representative  G.  Davis  advised   that  he  supported  the                                                                   
legislation  should the  other labor  contracts be  approved.                                                                   
Representative  Bunde stated  the only  change that  he would                                                                   
suggest would be  to draw a cut off the increase  at Range 24                                                                   
and higher.                                                                                                                     
                                                                                                                                
Representative  J. Davies  MOVED  to include  legislators  as                                                                   
well as State employees.  Representative  Austerman OBJECTED.                                                                   
He  questioned what  that action  would  really represent  in                                                                   
regard  to  pay increases.    Ms.  Elgee explained  that  the                                                                   
legislators   would  then   become   subject  to   percentage                                                                   
increases as proposed for other employees.                                                                                      
                                                                                                                                
Representative    Austerman    maintained   his    objection,                                                                   
indicating  that until  there was  a clear  message from  the                                                                   
Legislature that  the employee  contract would be  funded, he                                                                   
found it difficult to vote for such an amendment.                                                                               
                                                                                                                                
A roll call vote was taken on the motion.                                                                                       
                                                                                                                                
IN FAVOR:      J. Davies, G. Davis, Foster, Moses                                                                               
OPPOSED:       Williams, Austerman, Bunde, Grussendorf                                                                          
                                                                                                                                
Representative   Phillips,  Co-Chair   Mulder  and   Co-Chair                                                                   
Therriault were not present for the vote.                                                                                       
                                                                                                                                
The MOTION FAILED (4-4).                                                                                                        
                                                                                                                                
HB 439 was HELD in Committee for further consideration.                                                                         
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
The meeting adjourned at 4:20 P.M.                                                                                              
                                                                                                                                
                                                                                                                                

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