Legislature(2023 - 2024)DAVIS 106

03/26/2024 03:00 PM House HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:45 PM Start
03:05:47 PM HB187
05:10:14 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 187 PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 26, 2024                                                                                         
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Prax, Chair                                                                                                 
Representative Justin Ruffridge, Vice Chair                                                                                     
Representative CJ McCormick                                                                                                     
Representative Dan Saddler                                                                                                      
Representative Jesse Sumner                                                                                                     
Representative Zack Fields                                                                                                      
Representative Genevieve Mina                                                                                                   
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 187                                                                                                              
"An  Act  relating  to  utilization  review  entities;  exempting                                                               
certain  health  care   providers  from  making  preauthorization                                                               
requests  for certain  services; and  providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 187                                                                                                                  
SHORT TITLE: PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS                                                                             
SPONSOR(s): REPRESENTATIVE(s) SUMNER                                                                                            
                                                                                                                                
05/03/23       (H)       READ THE FIRST TIME - REFERRALS                                                                        
05/03/23       (H)       HSS, L&C                                                                                               
02/15/24       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
02/15/24       (H)       Heard & Held                                                                                           
02/15/24       (H)       MINUTE(HSS)                                                                                            
03/14/24       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
03/14/24       (H)       Heard & Held                                                                                           
03/14/24       (H)       MINUTE(HSS)                                                                                            
03/21/24       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
03/21/24       (H)       <Bill Hearing Canceled>                                                                                
03/26/24       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
GREG LOUDON, Principal                                                                                                          
Parker, Smith & Feek Insurance, LLC                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Gave invited testimony in opposition to HB
187.                                                                                                                            
                                                                                                                                
GARY STRANNIGAN, Vice President                                                                                                 
Congressional and Legislative Affairs                                                                                           
Premera Blue Cross                                                                                                              
Everett, Washington                                                                                                             
POSITION STATEMENT:  Gave invited testimony on HB 187.                                                                        
                                                                                                                                
LORI WING-HEIER, Director                                                                                                       
Division of Insurance                                                                                                           
Department of Commerce, Community & Economic Development                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered committee questions related to HB
187.                                                                                                                            
                                                                                                                                
MARC REECE, Director                                                                                                            
Public Policy                                                                                                                   
Aetna, Inc                                                                                                                      
Denver, Colorado                                                                                                                
POSITION STATEMENT:  Answered committee questions related to HB
187.                                                                                                                            
                                                                                                                                
EZEQUIEL "ZEKE" SILVA III, MD, Chair                                                                                            
Specialty Society Relative Value Scale Update Committee                                                                         
American Medical Association; Chair                                                                                             
Council on Legislation                                                                                                          
Texas Medical Association                                                                                                       
San Antonio, Texas                                                                                                              
POSITION STATEMENT:  Answered questions during the hearing on HB
187.                                                                                                                            
                                                                                                                                
PAM VENTGEN, Executive Director                                                                                                 
Alaska State Medical Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Gave invited testimony on HB 187.                                                                        
                                                                                                                                
JEFF DAVIS, President                                                                                                           
Radiation Business Solutions                                                                                                    
Wenatchee, Washington                                                                                                           
POSITION STATEMENT:  Gave invited testimony on HB 187.                                                                        
                                                                                                                                
SHEELA TOLLMAN, Vice President                                                                                                  
External Affairs                                                                                                                
UnitedHealth Group, Inc.                                                                                                        
Seattle, Washington                                                                                                             
POSITION STATEMENT:  Gave invited testimony on HB 187.                                                                        
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:45 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX called  the House Health and  Social Services Standing                                                               
Committee  meeting  to  order  at   3:04  p.m.    Representatives                                                               
Ruffridge,  Saddler, Sumner,  Fields, Mina,  McCormick, and  Prax                                                               
were present at the call to order.                                                                                              
                                                                                                                                
         HB 187-PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS                                                                      
                                                                                                                                
3:05:47 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that  the only order  of business  would be                                                               
HOUSE  BILL  NO. 187,  "An  Act  relating to  utilization  review                                                               
entities;  exempting certain  health care  providers from  making                                                               
preauthorization  requests for  certain  services; and  providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
3:08:09 PM                                                                                                                    
                                                                                                                                
GREG  LOUDON, Principal,  Parker,  Smith &  Feek Insurance,  LLC,                                                               
gave invited  testimony in  opposition to HB  187.   He explained                                                               
that  Parker,  Smith  &  Feek  has concerns  that  HB  187  could                                                               
possibly promote fraud and medically unnecessary treatments.                                                                    
                                                                                                                                
3:10:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS  asked Mr.  Loudon for clarification  as to                                                               
how Parker, Smith  & Feek, LLC approaches  prior authorization on                                                               
treatments.                                                                                                                     
                                                                                                                                
MR.  LOUDON  replied that  the  way  Parker,  Smith &  Feek,  LLC                                                               
approaches  prior authorization  is  precedent  to all  insurance                                                               
companies.                                                                                                                      
                                                                                                                                
3:11:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  asked Mr.  Loudon to explain  how prior                                                               
authorization could prevent fraud, waste, and abuse.                                                                            
                                                                                                                                
MR. LOUDON explained that there  are examples of medical waste in                                                               
the insurance  industry, but  the goal is  to avoid  that through                                                               
proper prior authorization.                                                                                                     
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  commented in agreement with  Mr. Loudon                                                               
that  medical  waste  does  exist and  asked  how  the  insurance                                                               
company  "knows  best" when  it  comes  to diagnosing  a  medical                                                               
issue.                                                                                                                          
                                                                                                                                
MR.  LOUDON replied  that none  of  the health  plans offered  by                                                               
insurance companies are trying to  practice medicine, rather they                                                               
are  trying  to  provide  a different  perspective  on  insurance                                                               
authorization requests.                                                                                                         
                                                                                                                                
REPRESENTATIVE RUFFRIDGE asked if  a prior authorization's denial                                                               
is  an  exercise  of  influence  over the  top  of  an  insurance                                                               
provider.                                                                                                                       
                                                                                                                                
MR. LOUDON  answered that the fact  is that some of  the services                                                               
requested by a provider or patient are not medically necessary.                                                                 
                                                                                                                                
3:14:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA  asked what percentage of  services under the                                                               
Pacific  Health Coalition's  (PHC's)  health  plan require  prior                                                               
authorization and further questioned  how many of those services'                                                               
prior authorization requests get disapproved.                                                                                   
                                                                                                                                
MR. LOUDON  replied that he does  not have an idea  of statistics                                                               
at the moment.                                                                                                                  
                                                                                                                                
REPRESENTATIVE MINA  asked if PHC  works to reduce the  wait time                                                               
for prior authorization requests.                                                                                               
                                                                                                                                
MR. LOUDON  answered yes, PHC does  work to reduce wait  time for                                                               
prior  authorization  requests, and  he  added  that Aetna,  Inc.                                                               
processes all of the prior authorization requests for PHC.                                                                      
                                                                                                                                
REPRESENTATIVE MINA commented that  she would like more specifics                                                               
related   to  the   encouragement   of   streamlining  of   prior                                                               
authorization  and asked  for  examples  related to  difficulties                                                               
that   insurance    providers   face   when    processing   prior                                                               
authorization requests.                                                                                                         
                                                                                                                                
MR. LOUDON  answered that  he would defer  his answer  to someone                                                               
else  because PHC  does not  handle prior  authorization requests                                                               
directly.                                                                                                                       
                                                                                                                                
3:18:21 PM                                                                                                                    
                                                                                                                                
GARY  STRANNIGAN, Vice  President, Congressional  and Legislative                                                               
Affairs, Premera  Blue Cross, gave  invited testimony on  HB 187.                                                               
He explained that  the role of insurance companies  as it relates                                                               
to  their  oversight  of  prior authorization  is  to  provide  a                                                               
different perspective  on the grants and  authorization while not                                                               
obstructing  proper   medical  care.     He  cited  a   piece  of                                                               
legislation  in  the State  of  Washinton  and explained  how  it                                                               
addresses the issue  of prior authorization, and  he detailed how                                                               
Alaska could follow suit by mirroring those policies.                                                                           
                                                                                                                                
3:22:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE asked what the  average time for a prior                                                               
authorization requests' approval is for Alaska.                                                                                 
                                                                                                                                
MR. STRANNIGAN  answered under five days  for standard turnaround                                                               
times and under one day for urgent requests.                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE asked  if the  goal that  the State  of                                                               
Washington  set with  its  prior authorization  bill  was met  on                                                               
behalf of Premera Blue Cross.                                                                                                   
                                                                                                                                
MR. STRANNIGAN said yes, Premera  Blue Cross is granting requests                                                               
in under three days as outlined by Washington's legislation.                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  asked where Premera Blue  Cross got its                                                               
figure of $120 million in fraud if HB 187 were to become law.                                                                   
                                                                                                                                
MR. STRANNIGAN explained  that the fraud is  actually specific to                                                               
a  set  of out-of-state  providers,  who  are providing  a  false                                                               
residency scheme in Alaska.                                                                                                     
                                                                                                                                
3:27:25 PM                                                                                                                    
                                                                                                                                
LORI WING-HEIER,  Director, Division of Insurance,  Department of                                                               
Commerce,  Community &  Economic Development,  answered committee                                                               
questions  related to  HB 187.   In  response to  a request  from                                                               
Representative Saddler, she clarified  for the committee that the                                                               
$120 million figure is in incurred  claims, not paid claims.  She                                                               
said  that  she  has  Department of  Health  (DOH)  investigators                                                               
knocking on  doors to  verify residency  and existence  and added                                                               
that "body  brokers" [insurance scammers]  are disproportionately                                                               
targeting   Alaska   Natives,   American  Indians,   and   people                                                               
experiencing homelessness.                                                                                                      
                                                                                                                                
3:30:21 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX asked  if prior authorization could  help control body                                                               
brokers.                                                                                                                        
                                                                                                                                
MS. WING-HEIER  answered that removing prior  authorization would                                                               
not help with residency scams.                                                                                                  
                                                                                                                                
3:31:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS asked  how many people are  getting sent to                                                               
clinics in the Lower 48 and how many are sent to Alaska.                                                                        
                                                                                                                                
MS. WING-HEIER  answered that  DOH is not  aware of  anyone being                                                               
sent to Alaska and said that most are sent to California.                                                                       
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  commented that he finds  this testimony                                                               
fascinating  and shared  his opinion  that it  is not  compelling                                                               
because Ms. Wing-Heier is claiming  that prior authorizations are                                                               
needed in  a greater  degree when,  in fact,  they are  a process                                                               
that is currently exacerbating this problem.                                                                                    
                                                                                                                                
MR. STRANNIGAN  explained that the  point of  prior authorization                                                               
is to  verify medical necessity and  said it is a  vital tool for                                                               
insurance companies to avoid medical waste.                                                                                     
                                                                                                                                
REPRESENTATIVE RUFFRIDGE asked if  downward pressure on insurance                                                               
scams is helping.                                                                                                               
                                                                                                                                
MR. STRANNIGAN  replied that  the current  mode of  operations is                                                               
not  working ideally  and  added  that part  of  the solution  is                                                               
removing friction from the system of prior authorization.                                                                       
                                                                                                                                
3:35:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA asked what percentage  of claims received are                                                               
denied and what percent are approved.                                                                                           
                                                                                                                                
MR.  STRANNIGAN said  that doesn't  know the  answer and  said he                                                               
would get back to the committee later.                                                                                          
                                                                                                                                
3:36:34 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  asked if  it is  regulation that  prior authorization                                                               
requests are processed by facsimile ("fax") machine.                                                                            
                                                                                                                                
MS. WING-HEIER answered  that it is not  a regulatory requirement                                                               
for  insurance providers  to process  prior authorization  by fax                                                               
machine, but  some providers use  those machines because  that is                                                               
the only resource they have.                                                                                                    
                                                                                                                                
MR. STRANNIGAN added that Premera  Blue Cross has been working to                                                               
encourage providers to switch to electronic processing.                                                                         
                                                                                                                                
3:38:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SADDLER  asked how electronic processing  of prior                                                               
authorization requests speeds up approvals.                                                                                     
                                                                                                                                
MR. STRANNIGAN answered that he doesn't have any specific data.                                                                 
                                                                                                                                
REPRESENTATIVE  SADDLER asked  if Premera  Blue Cross  tracks the                                                               
number of claims that require prior authorization.                                                                              
                                                                                                                                
MR. STRANNIGAN said that Premera  Blue Cross does track that data                                                               
and said he would get the data to the committee in short order.                                                                 
                                                                                                                                
3:39:26 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX asked  if Premera Blue Cross is  the largest insurance                                                               
provider in Alaska.                                                                                                             
                                                                                                                                
MR. STRANNIGAN confirmed that is correct.                                                                                       
                                                                                                                                
CHAIR  PRAX  asked  whether  HB  187  would  cover  only  private                                                               
insurance or all insurance policies.                                                                                            
                                                                                                                                
MR.  STRANNIGAN  answered  that  HB 187  would  cover  the  fully                                                               
insured   marketplace,   that    being   individual   plans   and                                                               
small/medium group plans.                                                                                                       
                                                                                                                                
CHAIR PRAX asked  how the Affordable Care Act  (ACA) would affect                                                               
HB 187.                                                                                                                         
                                                                                                                                
MS. WING-HEIER answered that the  person picks a plan and carrier                                                               
through ACA.                                                                                                                    
                                                                                                                                
3:42:10 PM                                                                                                                    
                                                                                                                                
MARC  REECE,  Director,  Public   Policy,  Aetna,  Inc,  answered                                                               
committee questions  related to  HB 187.   He explained  that the                                                               
mechanism that most concerns Aetna  is the concept of a one-size-                                                               
fits-all regulation that  outlines 80 percent as  a threshold for                                                               
prior  authorization.   He said  that  over 80  percent of  prior                                                               
authorization  cases   are  already  granted  and   detailed  the                                                               
complexities  of prior  authorization  where  a proposed  blanket                                                               
regulation might negatively impact  a company's ability to verify                                                               
the necessity of a treatment and avoid medical waste.                                                                           
                                                                                                                                
3:47:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SUMNER  asked whether  there is any  percent other                                                               
than 80 that Aetna would be comfortable with.                                                                                   
                                                                                                                                
MR. REECE  said that Aetna  would not  be comfortable with  a set                                                               
percent in  statute because each  prior authorization  request is                                                               
so  different from  each other  and  said that  having a  blanket                                                               
regulation  would hinder  insurance companies  and remove  nuance                                                               
from the process of prior authorization approval.                                                                               
                                                                                                                                
3:49:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  asked Mr. Reece  if he is  a healthcare                                                               
provider.                                                                                                                       
                                                                                                                                
MR. REECE answered that he is  not a healthcare provider; he is a                                                               
subject matter expert.                                                                                                          
                                                                                                                                
REPRESENTATIVE RUFFRIDGE asked Mr.  Reece to describe who decides                                                               
at Aetna  whether a  prior authorization  request is  approved or                                                               
not.                                                                                                                            
                                                                                                                                
MR.  REECE  answered  that  it   depends  on  the  service  being                                                               
requested.   He further detailed  that the insurance  company has                                                               
someone  with  unique clinical  knowledge  related  to the  prior                                                               
authorization request and a knowledge  of the backdrop of policy.                                                               
He gave  examples of automated  prior authorization  requests and                                                               
responses and  emphasized that insurance companies  are trying to                                                               
switch  to  automated  electronic  prior  authorization  requests                                                               
sooner rather than later.                                                                                                       
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE  noted  prior authorization  serves  as                                                               
sort  of a  check-and-balance  to an  already clinically  complex                                                               
medical and  policy decision  and asked  why the  onus of  a drug                                                               
treatment  falls  to  the  patient   rather  than  the  insurance                                                               
provider.                                                                                                                       
                                                                                                                                
MR. REECE offered  the committee to look into the  details of the                                                               
checklists referenced  in prior  authorization cases and  gave an                                                               
example of a  diabetic patient with the onset of  a new condition                                                               
that  would require  a separate  prior authorization  request and                                                               
explained how  the separate cases  and insurance  providers would                                                               
work together to get that person the medical care they need.                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE commented  that  pharmacists exist  for                                                               
the purpose described in Mr.  Reece's example and thanked him for                                                               
his testimony.                                                                                                                  
                                                                                                                                
3:58:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA asked how  a provider differentiation program                                                               
would work.                                                                                                                     
                                                                                                                                
MR.  REECE answered  that providers  look at  member outcome  and                                                               
history of  service from that provider  to that member.   He said                                                               
that  some  providers would  draw  parallels  between a  provider                                                               
differentiation  program  and  a  blanket  percentage  for  prior                                                               
authorization approval  and said  that there  is not  a one-size-                                                               
fits-all solution for HB 187.                                                                                                   
                                                                                                                                
REPRESENTATIVE MINA asked what  percentage of insurance providers                                                               
is part of  the differentiated status and  further questioned the                                                               
specifics   of   the   processes   and   opportunities   of   the                                                               
differentiated status for providers.                                                                                            
                                                                                                                                
MR. REECE replied  that he does not have  information specific to                                                               
Alaska, but  reassured the  committee that  there are  over 1,000                                                               
insurance  providers  in  the nation  enrolled  in  the  provider                                                               
differentiation program  and gave an  example of how  the program                                                               
is executed in practice.                                                                                                        
                                                                                                                                
REPRESENTATIVE MINA asked  what actions Aetna has  taken to speed                                                               
up the prior authorization process for patients.                                                                                
                                                                                                                                
MR. REECE  explained that the  process of prior  authorization is                                                               
improving  day  by   day.    He  credited   automation  of  prior                                                               
authorization  cases with  the majority  of its  improvements and                                                               
clarified  again  that  he  does  not  have  any  Alaska-specific                                                               
numbers.                                                                                                                        
                                                                                                                                
REPRESENTATIVE MINA asked what the  percentage of services billed                                                               
as  prior authorization  is denied  and further  asked about  the                                                               
turnaround time for approved cases of prior authorization.                                                                      
                                                                                                                                
MR.  REECE answered  that  he  doesn't have  the  number for  the                                                               
percentage  of  services  that require  prior  authorization  and                                                               
added   that  the   percentage  of   approval/denial  for   prior                                                               
authorization claims  is 80 approval  and 20 percent denial.   He                                                               
finalized  his remarks  by saying  that the  turnaround time  for                                                               
prior  authorization cases  is generally  5  days for  non-urgent                                                               
cases and less than 24 hours for urgent cases.                                                                                  
                                                                                                                                
4:07:27 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX   offered  his  understanding  that   relatively  few                                                               
procedures compared  to the  whole of  procedures performed  by a                                                               
medical care provider actually required prior authorization.                                                                    
                                                                                                                                
MR. REECE responded that that is a fair statement.                                                                              
                                                                                                                                
CHAIR PRAX  added to his  previous statement that  comparing part                                                               
of  prior  authorization  cases  to the  total  number  of  prior                                                               
authorization cases isn't a fair way to describe the issue.                                                                     
                                                                                                                                
MR.  REECE  responded that  there  is  logic behind  every  prior                                                               
authorization  case  and  said  that Aetna  takes  pride  in  its                                                               
improvements in the prior authorization process.                                                                                
                                                                                                                                
CHAIR PRAX  asked what percentage  of denied  prior authorization                                                               
request win their appeal case.                                                                                                  
                                                                                                                                
MR.  REECE  replied  that  he   did  not  have  that  information                                                               
currently and would follow up with the committee later.                                                                         
                                                                                                                                
4:10:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE asked  for  an example  of an  "urgent"                                                               
prior authorization request as previously mentioned.                                                                            
                                                                                                                                
MR.  REECE  explained that  the  general  idea behind  an  urgent                                                               
precertification is that the request  is not a medical emergency;                                                               
however,  it could  be  something  like a  new  drug regimen,  an                                                               
admission  to   a  hospital,  or  certain   medical  or  surgical                                                               
procedures.   He  added that  something like  a knee  replacement                                                               
wouldn't be considered as "urgent".                                                                                             
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE   asked  Mr.  Reece  to   send  to  the                                                               
committee  a list  of examples  of specific  cases that  would be                                                               
labeled as "urgent."                                                                                                            
                                                                                                                                
4:12:58 PM                                                                                                                    
                                                                                                                                
EZEQUIEL "ZEKE" SILVA III, MD,  Chair, Specialty Society Relative                                                               
Value  Scale  Update  Committee,  American  Medical  Association;                                                               
Chair,  Council   on  Legislation,  Texas   Medical  Association,                                                               
answered  questions during  the hearing  on HB  187. He  began by                                                               
saying  that Texas  passed  the  first "gold  card"  bill in  the                                                               
United  States  and  explained   the  adverse  effects  of  prior                                                               
authorization  in healthcare,  attributing  declining health  and                                                               
loss of life to prior authorization.                                                                                            
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE asked  about  the similarities  between                                                               
Texas'  2021   "gold  card"  legislation  and   Alaska's  current                                                               
proposed legislation.                                                                                                           
                                                                                                                                
DR.   SILVA  explained   that  Texas'   threshold  in   its  2021                                                               
legislation was 90 percent and  Alaska's proposed threshold is 80                                                               
percent.    He shared  the  Texas  Medical Association's  (TMA's)                                                               
belief   that the threshold is  not what led to  the shortcomings                                                               
of prior authorization  in Texas, rather it is  how the insurance                                                               
companies make their determinations.                                                                                            
                                                                                                                                
4:17:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA   asked  if  the  2021   Texas  "gold  card"                                                               
legislation only covered physicians.                                                                                            
                                                                                                                                
DR. SILVA said yes.                                                                                                             
                                                                                                                                
REPRESENTATIVE  MINA asked  how  the passage  of  the 2021  Texas                                                               
"gold  card"  legislation  impacted  fraud  and  abuse  of  prior                                                               
authorization in Texas.                                                                                                         
                                                                                                                                
DR. SILVA answered  that the passage of the  legislation in Texas                                                               
gave  the  presumption   of  good  will  and   good  practice  to                                                               
physicians by  giving them legal  tools to make the  judgement of                                                               
the necessity of a prior authorization request.                                                                                 
                                                                                                                                
REPRESENTATIVE  MINA asked  how  the passage  of  the 2021  Texas                                                               
"gold  card" legislation  impacted  delay of  treatment in  prior                                                               
authorization requests.                                                                                                         
                                                                                                                                
DR.  SILVA   answered  by   giving  an   example  of   how  prior                                                               
authorization requests  could lead to an  "avoidable service" and                                                               
explained  that the  solution  most often  utilized  to combat  a                                                               
delay of prior  authorization services is to send  the patient to                                                               
the emergency department of a given hospital.                                                                                   
                                                                                                                                
4:22:32 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX asked if physicians  are specialized in the fields for                                                               
which they are sending prior authorization requests.                                                                            
                                                                                                                                
DR. SILVA explained  that the focus of  prior authorization cases                                                               
is on the  outcome of the patients and emphasized  that the point                                                               
of a  "gold card" is  to ensure  that one certain  physician will                                                               
always be  approved once they are  proven as a provider  in their                                                               
specific field of medicine.                                                                                                     
                                                                                                                                
4:25:26 PM                                                                                                                    
                                                                                                                                
PAM   VENTGEN,   Executive   Director,   Alaska   State   Medical                                                               
Association (ASMA), gave invited testimony  in support of HB 187.                                                               
She made  clear to the  committee that she was  present primarily                                                               
to answer  committee questions.   She  emphasized that  the "gold                                                               
card" proposed  under HB 187  is targeted towards  physicians who                                                               
consistently  receive approval  for  prior  authorization in  the                                                               
past, not  physicians who've received  approval once or  twice in                                                               
the past.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  FIELDS   asked  what   the  balance   is  between                                                               
legitimate mental health treatment  and systematic abuse of prior                                                               
authorization by a fraudulent person.                                                                                           
                                                                                                                                
MS.  VENTGEN answered  that there  have been  egregious cases  of                                                               
fraud, but  those cases  were primarily  happening before  HB 187                                                               
was a prospect for Alaska's medical industry.                                                                                   
                                                                                                                                
4:29:22 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX asked  if certain  prior authorizations  requests are                                                               
being consistently turned down compared to others.                                                                              
                                                                                                                                
MS.  VENTGEN answered  that  an  approval or  denial  of a  prior                                                               
authorization case  depends on the  type of practice and  type of                                                               
procedure being  given.   She used oncologists  as an  example of                                                               
prior authorization  requests being granted and  explained that a                                                               
person who is granting prior  authorization requests might not be                                                               
in the specific field of medicine  that is being practiced by the                                                               
specialist submitting the request.                                                                                              
                                                                                                                                
4:32:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE  asked Ms.  Ventgen  to  explain how  a                                                               
given physician  would prove  that a  patient is  in need  of the                                                               
care  that  the  physician  is   requesting  that  the  insurance                                                               
companies cover.                                                                                                                
                                                                                                                                
MS. VENTGEN answered  by giving a list of  daily living obstacles                                                               
that  a patient  might be  experiencing and  how those  obstacles                                                               
might  supplement  a  doctor's case  for  an  insurance  approval                                                               
request.                                                                                                                        
                                                                                                                                
4:35:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA asked how insurance  companies are working to                                                               
lower wait times for patients seeking prior authorization.                                                                      
                                                                                                                                
MS. VENTGEN  explained that there  are several  factors affecting                                                               
the  current  delay in  services,  most  of them  being  analogue                                                               
processing  services  that  are hindering  electronic  processing                                                               
services.  She  added that there are many  cases where physicians                                                               
were plainly unaware that a  patient might need medication in the                                                               
first place.                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA  asked Ms.  Ventgen to  give examples  of how                                                               
outside companies are pressuring  patients and physicians to take                                                               
certain treatments and further questioned  how the ASMA is making                                                               
efforts  to  promote  more  affordable  patient-focused  care  in                                                               
Alaska.                                                                                                                         
                                                                                                                                
MS.  VENTGEN  replied  that  there  is  a  heavy  influence  from                                                               
commercial   pharmaceutical  companies   on  both   patients  and                                                               
physicians to  take a  certain drug or  participate in  a certain                                                               
treatment  and   said  that  the  biggest   issue  in  pressuring                                                               
pharmaceuticals is mass advertising.                                                                                            
                                                                                                                                
4:39:43 PM                                                                                                                    
                                                                                                                                
JEFF  DAVIS,   President,  Radiation  Business   Solutions,  gave                                                               
invited testimony on HB 187.   He began his testimony by giving a                                                               
history of his career in Alaska  and gave his support for HB 187.                                                               
He emphasized the effect that  prior authorization and its issues                                                               
have on  patients rather than insurance  providers or physicians.                                                               
He said that prior authorization  was noble in its conception but                                                               
has deteriorated  in its honest  intention over time.   Delays in                                                               
treatment as  a result  of prior  authorization have  caused more                                                               
harm than  good for  patients and physicians  across Alaska.   He                                                               
concluded his opening  remarks by saying that the goal  of HB 187                                                               
is to  set a clear  standard of prior authorization  approval for                                                               
insurance providers and physicians.                                                                                             
                                                                                                                                
4:45:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA  asked Mr.  Davis  if  he could  respond  to                                                               
concerns that HB  187 would not allow for  insurance companies to                                                               
check or substantiate a new type of treatment.                                                                                  
                                                                                                                                
MR. DAVIS explained  that a physician would be  "gold carded" for                                                               
a specific medical service, not a new procedure or medication.                                                                  
                                                                                                                                
4:48:06 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX asked  if most  of the  prior authorization  requests                                                               
that were initially denied were approved on appeal.                                                                             
                                                                                                                                
MR. DAVIS explained  that a denial of a  prior authorization goes                                                               
through an  appeals process and  gave his understanding  that the                                                               
success of  an appeal is  driven by the patient  being physically                                                               
present to the  attending physician, who may then  explain to the                                                               
reviewing  physician  their justification  for  the  appeal.   He                                                               
added  that in  unusual  circumstances,  certain companies  might                                                               
take a  month or up  to two months to  grant final approval  to a                                                               
prior authorization request.                                                                                                    
                                                                                                                                
CHAIR PRAX asked how common  the one- to two-month approval times                                                               
were.                                                                                                                           
                                                                                                                                
MR. DAVIS  shared his  belief that Premera  Blue Cross  and Aetna                                                               
are  good companies  that do  the best  for patients  and further                                                               
explained that  there are quite  a few companies below  those two                                                               
that cause issues for the rest.                                                                                                 
                                                                                                                                
4:55:38 PM                                                                                                                    
                                                                                                                                
SHEELA  TOLLMAN, Vice  President, External  Affairs, UnitedHealth                                                               
Group, Inc.  (UHG) gave invited testimony  on HB 187.   She began                                                               
by  giving  explanation  to  a  federal rule  that  is  meant  to                                                               
simplify  the  process  of   prior  authorization  for  insurance                                                               
providers  that   she  believed   hadn't  yet  been   taken  into                                                               
consideration for HB 187 and said  that there must be steps taken                                                               
by  all  parties  to  get  to  a  real-time  prior  authorization                                                               
approval process.                                                                                                               
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE asked  Ms.  Tollman whether  UHG is  in                                                               
support of HB 187.                                                                                                              
                                                                                                                                
MS.  TOLLMAN  answered  that  UHG  is  supportive  of  trying  to                                                               
simplify  the  burden  on  patients   and  physicians  but  still                                                               
recognizes the importance of prior authorization.                                                                               
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE commented  that  he would  like to  see                                                               
written comment from  UHG to the committee on how  it would amend                                                               
HB  187 and  added  his belief  through  experience that  federal                                                               
rules  often don't  streamline processes,  rather they  make them                                                               
more complex.                                                                                                                   
                                                                                                                                
5:01:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA  asked  what percentage  of  UHG's  services                                                               
require   prior   authorization   and  further   questioned   the                                                               
turnaround time for prior authorization requests.                                                                               
                                                                                                                                
MS. TOLLMAN said UHG would follow up with the committee later.                                                                  
                                                                                                                                
5:03:16 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX asked  Ms. Tollman  when  the new  federal rule  that                                                               
impacts prior authorization will be implemented.                                                                                
                                                                                                                                
MS. TOLLMAN said  that the respective rules would  go into effect                                                               
in 2026 and 2027.                                                                                                               
                                                                                                                                
5:04:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE  asked  whether the  new  federal  rule                                                               
would govern all types of insurance plans.                                                                                      
                                                                                                                                
MS.  TOLLMAN  responded  that  the  new  federal  rule  would  be                                                               
applicable to all insurance plans in Alaska.                                                                                    
                                                                                                                                
CHAIR PRAX  asked whether  the proposed "gold  card" idea  may be                                                               
negotiated in or out of network health care plans.                                                                              
                                                                                                                                
5:06:27 PM                                                                                                                    
                                                                                                                                
MS.  WING-HEIER answered  that the  DOH  sees no  reason why  the                                                               
proposed "gold  card" idea may  not be negotiated  into agreement                                                               
with insurance providers around the State.                                                                                      
                                                                                                                                
CHAIR PRAX  asked whether the  federal rule would be  required by                                                               
the Centers for  Medicare and Medicaid services to  be adopted by                                                               
all other providers in the nation.                                                                                              
                                                                                                                                
MS. WING-HEIER explained that it would take DOH time and money                                                                  
to analyze how federal bills would affect Alaska.                                                                               
                                                                                                                                
5:08:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA asked whether Ms. Wing-Heier had a breakdown                                                                
of Alaskans that are covered by insurance companies that would                                                                  
be affected by the new federal rule.                                                                                            
                                                                                                                                
MS. WING-HEIER answered that she would send that information to                                                                 
the committee after the meeting.                                                                                                
                                                                                                                                
CHAIR PRAX announced that HB 187 was held over.                                                                                 
                                                                                                                                
5:10:14 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:10 p.m.                                                                                                          

Document Name Date/Time Subjects
HB 187 Pacific Health Coalition Opposition.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HB 187 Premera One Pager.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HB 187 Denali Oncology Support.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HB187 Community Oncology Alliance Support.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HB 187 Alaska Regional Hospital Support.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HB 187 United Health Testimony.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HHSS 3.26.24 DOI Follow Up.pdf HHSS 3/26/2024 3:00:00 PM
HB 187
HHSS Committee Follow Up Premera on 3.26.24.pdf HHSS 3/26/2024 3:00:00 PM
HB 187