03/20/2002 03:20 PM House L&C
| Audio | Topic |
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
March 20, 2002
3:20 p.m.
MEMBERS PRESENT
Representative Lisa Murkowski, Chair
Representative Andrew Halcro, Vice Chair
Representative Kevin Meyer
Representative Pete Kott
Representative Norman Rokeberg
Representative Harry Crawford
Representative Joe Hayes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 411
"An Act relating to physician assistants; providing that a
physician assistant is a health care provider covered by certain
laws relating to medical malpractice actions; adding physician
assistants to the list of providers against whom unfair
discrimination relating to health care insurance is prohibited
and to the list of providers who can provide proof of
disablement or handicap for the purpose of motor vehicle
registration or for the purpose of obtaining a special license
plate or a special parking permit; and providing for an
effective date."
- MOVED HB 411 OUT OF COMMITTEE
HOUSE BILL NO. 318
"An Act relating to a health insurance uniform prescription drug
information card; and providing for an effective date."
- MOVED CSHB 318(L&C) OUT OF COMMITTEE
PREVIOUS ACTION
BILL: HB 411
SHORT TITLE:PHYSICIAN ASSISTANTS
SPONSOR(S): REPRESENTATIVE(S)FATE
Jrn-Date Jrn-Page Action
02/13/02 2233 (H) READ THE FIRST TIME -
REFERRALS
02/13/02 2233 (H) HES, L&C
02/21/02 (H) HES AT 3:00 PM CAPITOL 106
02/21/02 (H) Moved Out of Committee
02/21/02 (H) MINUTE(HES)
02/22/02 2362 (H) HES RPT 5DP 1NR
02/22/02 2362 (H) DP: DYSON, COGHILL, WILSON,
CISSNA,
02/22/02 2362 (H) JOULE; NR: KOHRING
02/22/02 2363 (H) FN1: ZERO(ADM)
02/22/02 2363 (H) FN2: ZERO(CED)
03/20/02 (H) L&C AT 3:15 PM CAPITOL 17
BILL: HB 318
SHORT TITLE:UNIFORM PRESCRIPTION DRUG CARD
SPONSOR(S): LABOR & COMMERCE BY REQUEST
Jrn-Date Jrn-Page Action
01/14/02 1958 (H) READ THE FIRST TIME -
REFERRALS
01/14/02 1958 (H) L&C, FIN
02/01/02 (H) L&C AT 3:15 PM CAPITOL 17
02/01/02 (H) Heard & Held
02/01/02 (H) MINUTE(L&C)
02/25/02 (H) L&C AT 3:15 PM CAPITOL 17
02/25/02 (H) Scheduled But Not Heard
03/04/02 (H) L&C AT 3:15 PM CAPITOL 17
03/04/02 (H) Bill Postponed
03/20/02 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
REPRESENTATIVE HUGH FATE
Alaska State Legislature
Capitol Building, Room 416
Juneau, Alaska 99801
POSITION STATEMENT: Testified as sponsor of HB 411.
ED HALL, Liaison
Alaska Academy of Physician assistants
13601 Windward Circle
Anchorage, Alaska 99516
POSITION STATEMENT: Testified in support of HB 411.
JOHN RILEY, PA; Board Chair
Alaska Primary Care Association
6411 Italy Circle
Anchorage, Alaska 99516
POSITION STATEMENT: Testified in support of HB 411.
SUSAN MASON-BOUTERSE, Executive Director
Sunshine Community Health Center
Mile 44 Talkeetna Spur Road
Talkeetna, Alaska 99676
POSITION STATEMENT: Testified in favor of HB 411.
STAN RIDGEWAY, Deputy Director
Division of Insurance
Department of Community and Economic Development
P.O. box 110805
Juneau, Alaska 99801-0805
POSITION STATEMENT: Testified on HB 411. Addressed possible
HIPAA regulations as related to HB 318.
AMY ERICKSON, Staff
to Representative Lisa Murkowski
Alaska State Legislature
Capitol Building, Room 408
Juneau, Alaska 99801
POSITION STATEMENT: Introduced HB 318, and explained the
changes in the committee substitute.
ERIN CAREY BYRNE, Executive Director
Alaska Pharmaceutical Association
PO Box 101185
Anchorage, Alaska 99510-1185
POSITION STATEMENT: Testified on HB 318.
REED STOOPS, Lobbyist for Aetna and
Health Insurance Association of America
240 Main Street, Number 600
Juneau, Alaska 99801
POSITION STATEMENT: Testified on HB 318, and made suggestions
to amend the current language for the purpose of clarification.
ACTION NARRATIVE
TAPE 02-39, SIDE A
Number 0001
CHAIR LISA MURKOWSKI called the House Labor and Commerce
Standing Committee meeting to order at 3:20 p.m. Members
present at the call to order were Representatives Kott, Meyer,
Halcro, and Murkowski. Representatives Rokeberg, Crawford, and
Hayes arrived as the meeting was in progress.
HB 411-PHYSICIAN ASSISTANTS
CHAIR MURKOWSKI announced that the first matter before the
committee would be HOUSE BILL NO. 411, "An Act relating to
physician assistants; providing that a physician assistant is a
health care provider covered by certain laws relating to medical
malpractice actions; adding physician assistants to the list of
providers against whom unfair discrimination relating to health
care insurance is prohibited and to the list of providers who
can provide proof of disablement or handicap for the purpose of
motor vehicle registration or for the purpose of obtaining a
special license plate or a special parking permit; and providing
for an effective date."
Number 0090
REPRESENTATIVE HUGH FATE, Alaska State Legislature, sponsor of
HB 411, testified before the committee. He said HB 411 was
written at the request of the [American] Academy of Physician
Assistants. The academy submitted three resolutions to
accompany the bill and to be included in state law. He said the
resolutions were drafted in order to update existing state laws
to include physician assistants (PAs) as recognized providers of
medical care. He said that it is believed that when the laws
were drafted and passed physician assistants were not as
prevalent as healthcare providers in Alaska. Over the ensuing
years physician assistants have become integral to providing
healthcare to rural and urban areas in the state - in rural
areas, they are the primary healthcare providers and without
them, many areas of the state would be without "true medical
aid."
Number 0197
REPRESENTATIVE FATE said the three resolutions attempt to
rectify problematic areas of the statutes, since physician
assistants aren't listed as recognized healthcare providers.
This has hindered medical follow-up for the patients of
physician assistants. He said the statutory changes will
prevent discriminatory action against PAs without the
opportunity for them to be assessed by their peers.
REPRESENTATIVE FATE said [HB 411] gives PAs equal footing under
insurance programs for both payment and liability purposes. He
reported that HB 411 allows PAs the ability to authorize
handicapped and other special medical-problem license plates.
Representative Fate stated that the Division of Insurance,
Department of Community and Economic Development, "is neutral"
on HB 411. He noted that in the House Health, Education and
Social Services Standing Committee hearing [on HB 411] the
division made a point about direct payment to the office in
which the PA worked. He explained the receipt location of
payment is determined by either the officer under which the PA
works, or by regulation under the Division of Insurance.
Number 313
REPRESENTATIVE FATE said HB 411 attempts to bring PAs parity
"with other healing professions in their ability to authorize
those types of things that they can authorize under the
physician's office that they work."
REPRESENTATIVE CRAWFORD asked how a malpractice suit brought
against a PA would be handled if the PA was working under a
doctor somewhere.
REPRESENTATIVE FATE characterized the physician - PA
relationship as a "master-slave relationship." If a PA is hired
by a physician's office, that physician is ultimately
responsible for the actions of that PA. He pointed out that all
members of the medical profession have malpractice insurance.
However, Representative Fate said it would be a good idea for a
PA in rural Alaska, doing primary care work, to carry additional
malpractice insurance.
Number 0462
CHAIR MURKOWSKI asked if the medical association had looked at
the issue and weighed in one way or the other.
REPRESENTATIVE FATE said the Alaska Medical Association was
neutral when the PAs got a position on the Board Of Medical
Examiners. He said he believed that they were neutral on this
particular issue.
CHAIR MURKOWSKI asked if anyone opposes HB 411.
REPRESENTATIVE FATE replied no. He deferred any further
technical questions to Ed Hall.
REPRESENTATIVE MEYER inquired as to the educational requirements
for a PA.
REPRESENTATIVE FATE said that PAs have certain, "very specific
limitations" and a "standardized curriculum" that enable them to
be PAs, however, he was not aware of the specific requirements.
Number 0649
ED HALL, Liaison, Alaska Academy of Physician Assistants,
testified via teleconference. He said his organization believes
[HB 411] is very important to allow PAs the ability to practice
without the unnecessary encumbrances [the profession] has been
suffering, especially in comparison with other mid-level
caregivers, such as nurse practitioners. He specified that PAs
did not help to initiate [HB 411] as a ploy to be independent
practitioners. He emphasized that PAs must, by definition,
collaborate with, and ultimately answer to a physician.
MR. HALL said it was in the PA's best interest to carry
liability insurance, as is the common practice. He said most PA
education programs are Bachelor's programs, but that there are
also Master's programs. Certification is required in Alaska,
and is acquired by passing a national certifying exam, 100 hours
of continuing medical education every 2 years, and re-
certification every 6 years.
MR. HALL offered that the medical board gave the academy their
blessing and encouragement and he did not know of anyone who
stood against the legislation.
Number 0930
REPRESENTATIVE ROKEBERG asked if a PA must be practicing under a
licensed physician.
MR. HALL replied in the positive. He pointed out that
occasionally insurance companies choose not to reimburse because
care was provided by a PA. Therefore, [HB 411] will be an
answer to those insurance companies, he said.
Number 0985
REPRESENTATIVE ROKEBERG characterized AS 09.55.560 as the
"golden key to the kingdom" statute. He said a profession
defined under that statute can require a health care insurance
company to reimburse them for service. He asked if there were
any testifiers from the insurance industry.
CHAIR MURKOWSKI reported that there are no more people scheduled
to testify.
REPRESENTATIVE ROKEBERG viewed that as troubling, and asked if
any representatives of the insurance industry testified at the
House Health, Education and Social Services Standing Committee
meeting.
Number 1042
REPRESENTATIVE FATE responded in the negative.
REPRESENTATIVE ROKEBERG asked if it was possible for a PA to
practice without a physician being in the same location at the
same time.
Number 1068
MR. HALL answered that it was possible for a PA to practice out
of the direct supervision of a physician, but the law requires a
face-to-face meeting of the physician and PA twice a quarter.
Once a month there must be an electronic correspondence between
the [physician and the PA].
REPRESENTATIVE ROKEBERG asked for an example of healthcare
services denied reimbursement by an insurance company.
MR. HALL gave an example of a patient who came into his office
with a work-related injury. He also had an abscess on his elbow
that was treated and billed under [workers' compensation]. He
said the insurance company declined reimbursement of services
because they were provided by a PA. He explained that at the
time he was working with his collaborative physician in the same
office.
Number 1202
REPRESENTATIVE ROKEBERG asked if the charge for a procedure
would be different because it was performed by a PA rather than
a physician.
MR. HALL answered that the charge isn't cheaper in regard to
what is charged by the healthcare provider, but insurance
companies reimburse differently [depending upon who performed
the procedure]. He stated that HB 411 is not concerned with
that issue, but rather the bill establishes that a PA can bill
for a service in the first place. He voiced that [HB 411]
brings the statute in line with the existing practice in the
state.
Number 1279
REPRESENTATIVE ROKEBERG asked if a PA could be the only medical
care provider in a very rural community.
MR. HALL replied in the affirmative. He explained that if a
supervising doctor finds that an insurance company will not
reimburse, services might be denied in the remote areas. He
noted that nurse practitioners have no trouble being reimbursed
and they charge the same as PAs for the same services.
Number 1300
REPRESENTATIVE ROKEBERG asked if there is any "potentiality for
abuse" of the provision in Section 3 that allows a PA to issue a
"disabled parking pass."
MR. HALL stated he saw no more potential for abuse than is the
case for a doctor or nurse practitioner. He explained that
nurse practitioners are able to issue special parking permits
and that PAs are equivalent providers of service to nurse
practitioners, although PAs have more supervision from a
physician. He said he merely wants to see parity amongst mid-
level providers.
Number 1485
JOHN RILEY, Physician Assistant (PA); Board Chair, Alaska
Primary Care Association, testified via teleconference. He
informed the committee that his association's mission is to
support clinics who serve patients, regardless of one's ability
to pay. Physician assistants provide a large share of the
health care provided in rural Alaska, and many rural clinics are
staffed exclusively by PAs.
MR. RILEY said there have been several instances of insurance
companies refusing to reimburse services provided by PAs. He
gave an example that happened in Talkeetna. He urged passage of
[HB 411].
CHAIR MURKOWSKI asked Mr. Riley if the 250 PAs [in Alaska] he
had specified in the resolution were primarily in rural Alaska.
MR. RILEY related his belief that at least half of them were in
rural areas of the state.
Number 1599
SUSAN MASON-BOUTERSE, Executive Director, Sunshine Community
Health Center, testified via teleconference. She said hers is a
mid-level clinic with four PAs who provide the primary care.
She said the providers are critical to the community's ongoing
healthcare. Because state statutes do not include PAs in the
listing of healthcare providers, her clinic periodically has its
billing denied by third-party payers. She said it represents a
significant barrier to healthcare for individuals with health
insurance as well as a barrier to potential revenues for
clinics. She reported that in the current financial situation,
her clinic needs to be able to maximize whatever revenue it can.
She urged the committee to pass [HB 411].
Number 1692
CHAIR MURKOWSKI asked if someone needing a temporary disabled
permit would have to go to Wasilla.
MS. MASON-BOUTERSE said that was not necessarily the case
because there is a private physician in the Talkeetna area.
But, if the doctor is not around or the person is a patient at
the Sunshine Clinic, they would be required to leave town for
that service.
CHAIR MURKOWSKI noted that it would probably be easier to get
needed healthcare services in a place like Talkeetna than a
place like Unalaska because Talkeetna has a road out and
Unalaska is exclusively served by PAs.
Number 1751
REPRESENTATIVE HAYES said he believes [HB 411] to be a very good
bill and thanked Representative Fate for bringing it forward.
REPRESENTATIVE ROKEBERG directed the committee's attention to
page 2, lines 6-7, which reads, "an employee of a healthcare
provider operating within the course and scope of employment".
Section 1 defines what a healthcare provider is. He said he
felt the language authorizes a PA as it stands, however, being
specific would be an improvement.
Number 1835
CHAIR MURKOWSKI asked if there exists an employee-employer
relationship between PAs and their "collaborating physician."
REPRESENTATIVE FATE said that [as a dentist] he had experience
with similar circumstances with [dental] hygienists. He
recalled a question of private contracting versus the employee-
employer relationship, and for tax purposes it was deemed that
they were employees.
Number 1880
REPRESENTATIVE HALCRO asked why Medicare and Medicaid reimbursed
PAs less than they do regular physicians.
REPRESENTATIVE FATE deferred to Mr. Hall.
MR. HALL said, "Because they can" [reimburse PAs less]. He said
the argument about a lower education level is used, although the
standard of care is exactly the same. He explained that the
same double standard exists for an assistant physician to a
surgeon where the assistant physician is reimbursed at a lower
rate than the surgeon. It makes sense to add PAs to the list of
caregivers because the true role of PAs is not apparent to all
insurance companies, he remarked.
Number 1981
REPRESENTATIVE HALCRO asked, with regards to Section 2, if this
would protect PAs from discriminatory [lower] reimbursements.
MR. HALL replied in the positive.
REPRESENTATIVE HALCRO asked Representative Fate if the state's
match for the resulting higher Medicare and Medicaid
reimbursements would not be higher as well.
MR. RILEY said the same regulations for Medicare with the 85
percent reimbursement applies to nurse practitioners. He said
[HB 411] did not set any floor on fees. "It just states that if
you reimburse one provider for providing a service, you
reimburse all other providers on this list for providing that
service. It doesn't specify anything about the reimbursement
level," he explained.
CHAIR MURKOWSKI offered that there exists the ability to
discriminate amongst providers.
MR. RILEY said Medicaid does not have a differential
reimbursement for providers.
REPRESENTATIVE FATE explained that insurance companies do not
know who does the treatment. In matching the funds, the amount
wouldn't change, "and it's already taking into account, the
single experience that that charge is being made for."
Number 2094
REPRESENTATIVE HALCRO said he did not quite understand
Representative Fate's response but he expressed his fear that
the requirement that PAs be paid on the same level as a
physician will raise the level paid by Medicare or Medicaid, and
in turn raise the cost to the state.
REPRESENTATIVE FATE said:
I misconstrued your first statement there. Now it
becomes a differential of pricing rather than a
differential of treating, and that I really can't
answer and to how much. I'm not really sure whether
there's really been anything that will indicate what
that would be.... you know, if there could even be a
fiscal note to it because at the present time you
don't know how much is going to be transferred. You
don't know how much more work or less work or the same
work, the amount of work the PA will do to make that
differential in pricing cogent as far as the insurance
payments are concerned. So you might have a future
fiscal note, but at the present time it would be
nearly impossible to even ascertain what that would
be.
Number 2160
REPRESENTATIVE ROKEBERG said he believed it would be the
legislature's policy to allow a differential in pricing based on
the scope of a provider's occupational license as in AS
21.36.090(d). He said like many of the statutes, it could be
read different ways. He said, "Whether or not by underwriting
differently, and paying and reimbursing differently by the
license, you're providing unfair discrimination based the
service." He said he would feel a lot more comfortable if there
were someone at the meeting "from the Division of Insurance who
could interpret this."
Number 2208
STAN RIDGEWAY, Deputy Director, Division of Insurance,
Department of Community and Economic Development, testified
before the committee. He related his understanding that a
physician would be paid at a certain level, a nurse practitioner
at another, and so on. He said he isn't an expert and thus he
offered to have Katie Campbell look into it more deeply.
Number 2248
REPRESENTATIVE FATE reported that there is a "differential in
pricing and charging" and not a differential in payment. He
explained that a differential in payment is what would affect
[the state's funding] match. He stated that there is a "set
standard of amount to pay for certain services, regardless of
what the physician or PA charged." He said, "There is a
stability between the max that we already have, based on the
experience of services."
MR. RIDGEWAY gave an example of a reimbursement form with a
charge of $8,000. He said an insurance company might say, based
on contract, that it will pay $2,500. There is a big difference
between what is charged and what is actually paid. He voiced
that he doesn't think [HB 411] would interfere with that
arrangement, whereby Medicare, Medicaid, and insurance companies
set their fees at a certain level.
Number 2300
REPRESENTATIVE HALCRO asked:
If I am a PA, and you come to see me, and for the same
procedure I bill $100 and Medicare says, "Andrew,
you're a PA so normally if you were a doctor we would
reimburse $80, but we are going to reimburse you $65
because you are a PA." So therefore, I get less than
a physician would get. Now, we pass this bill,
there's no more discrimination; the first time they
send me a check for less than they'd send a physician
I go, "You can't discriminate against me, we just
passed a law, you need to pay me the $90."' Therefore
they have to pay $15 more, or however much more, and
then we would have to come up with an commensurate
match.
REPRESENTATIVE HALCRO asked if he was missing something.
MR. RIDGEWAY said that he did not have an answer to that
question, "mainly because you can charge anything, but what the
insurance company pays is totally different from what you
charge." He said that physicians can't come back and ask for
more money in some cases with Medicaid and Medicare because that
is an agreed amount.
Number 2358
CHAIR MURKOWSKI asked if it would be the insurance that would
cover a certain amount for a service, regardless of who performs
it.
MR. RIDGEWAY replied "yes."
TAPE 02-39, SIDE B
REPRESENTATIVE HAYES said he thought it more of a HESS
[Department of Health & Social Services] issue than an [Division
of] Insurance issue. He said, "If HESS thought it was a dollar
issue here, we would have a fiscal note from them" that would
probably be indeterminate.
REPRESENTATIVE ROKEBERG disagreed with Representative Hayes and
said, "This is an insurance question."
Number 2327
CHAIR MURKOWSKI offered her understanding that the division had
taken a neutral position on the matter, and that the division
determined that there should be a zero fiscal note.
MR. RIDGEWAY said Representative Murkowski was correct and that
the division just regulates insurance. [House Bill 411] would
add no cost to the division, and therefore no fiscal note.
Number 2302
REPRESENTATIVE ROKEBERG said his interpretation of the
"relatively ambiguous language" was that the status quo is
preserved by [HB 411], "therefore, if there is an ability of an
underwriter to make a distinction between the service provided
by a PA or a physician, that this doesn't change that." He
added that he didn't care for the language, and that it needs to
be clarified.
REPRESENTATIVE ROKEBERG asked Representative Fate if he could
verify with the Division of Insurance what the impact of the
language in Section 2 is as far as allowing health insurance
companies to reimburse a PA at a different rate than that of a
physician. He asked if "that's allowable or this maintains the
status quo ... or as Mr. Ridgeway and we've discussed here, is
it based on the service, not the type of provider?"
Number 2199
REPRESENTATIVE KOTT moved to report HB 411 out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, HB 411 was moved out of House Labor
and Commerce Standing Committee.
HB 318-UNIFORM PRESCRIPTION DRUG CARD
Number 2173
CHAIR MURKOWSKI announced that the next order of business would
be HOUSE BILL NO. 318, "An Act relating to a health insurance
uniform prescription drug information card; and providing for an
effective date."
Number 2158
AMY ERICKSON, Staff to Representative Lisa Murkowski, Alaska
State Legislature, informed the committee that HB 318 has been
through seven new drafts since the last time it was heard. The
new version is clean, concise, and lists only the minimum
guidelines necessary to process prescription claims. She stated
that HB 318 is intended to provide practical guidelines for
entities producing member ID cards for use in the drug benefit
industry so that pharmacists will have the ability to spend more
time on patient care and less time deciphering insurance benefit
cards. Additionally, patients will spend less time at
pharmacies waiting for prescriptions, and claims processing will
be more consistent and accurate.
MS. ERICKSON reminded the committee that HB 318 is now
applicable to all health insurance plans, instead of just group
plans. House Bill 318 also extends requirements so that all
entities issuing drug cards are included, enrollees and
dependents can be listed on the cards now, and an insurer does
not have to reissue a second card if a previously issued card
has all the information required in HB 318.
Number 2088
REPRESENTATIVE ROKEBERG inquired about the reissuing of a new
card, whereby an insurer wouldn't have to issue another card
until "their regular cycle came up." He referred to subsection
(b) and asked if that clarifies the issue.
MS. ERICKSON said that is accurate.
REPRESENTATIVE ROKEBERG asked if the committee adopted a
different recommendation than the one he proposed.
MS. ERICKSON replied in the affirmative. She offered that
Representative Rokeberg was suggesting that no insurers would
have to reissue a new card prior to the effective date. She
explained that "was one of the points of contention that we did
not include in the bill."
REPRESENTATIVE ROKEBERG voiced that this would create a private
fiscal note.
MS. ERICKSON said, "Not if you decide that can't happen in
committee."
REPRESENTATIVE MEYER asked if the draft that is before the
committee is Version R.
Number 2017
REPRESENTATIVE HALCRO moved to adopt the proposed committee
substitute (CS) for HB 318, Version 22-LS1061\R, Ford, 3/14/02,
as the working document. There being no objection, Version R
was before the committee.
Number 1993
ERIN CAREY BYRNE, Executive Director, Alaska Pharmaceutical
Association, testified via teleconference in support of HB 318.
She noted that HB 318 was adequately adjusted to reflect the
issues raised by the insurer opposition. She noted that Version
R is not [the Alaska Pharmaceutical Association's] "original
idealized bill." The time has come for standard information to
be provided on insurance benefit cards.
MS. BYRNE informed the committee that 19 other states have
already enacted similar legislation, with eight additional
states pending action. She told the committee members that the
end beneficiaries of HB 318 are "your constituents who will wait
a minimal amount of time for medication dispensing and drug
therapy counseling."
Number 1945
REPRESENTATIVE HAYES asked why there isn't any federal
legislation to get a standardized ID card across the nation.
MS. BYRNE agreed that it seems more logical to enact this on the
federal level, but there is "a state rights assertion issue,"
whereas if the state can't "work it out" then the federal
regulation gets put into place. It would be a long and slow
process.
Number 1903
REPRESENTATIVE ROKEBERG referred to page 2, line 11, relating to
a bank identification number, and asked, "Whose bank ID number
is this?"
MS. BYRNE replied, "That's an either/or." Some [insurers] use
the international identifier and some use the bank
identification number (BIN). That is the standard that is on
cards in order for the claims to be processed.
REPRESENTATIVE ROKEBERG asked if [the number] is identifying the
insurance company or the individual person who is covered.
MS. BYRNE replied it is the company that is being identified.
In further response to Representative Rokeberg, Ms. Byrne
explained that "it's not for the bank, it's ... whichever
identifier number that the particular insurer wishes to use."
Most [insurers] don't use a [BIN], but it is an option.
REPRESENTATIVE ROKEBERG inquired about the international number.
MS. BYRNE explained that the international number is the claims
processing number. She offered that since the committee members
are State of Alaska employees, these numbers are already on
their insurance ID cards. She said it's simply referred to as a
"routing number," and that the [BIN] shouldn't be confused with
a bank account number.
REPRESENTATIVE ROKEBERG asked if the bank number has anything to
do with an electronic fund transfer.
MS. BYRNE replied in the negative.
REPRESENTATIVE ROKEBERG asked, "You want three groups of
numbers?"
MS. BYRNE responded by saying that most of the insurance cards
already contain these numbers. She offered that some insurance
cards have the appropriate information, but there are those
companies that need to start incorporating basic processing
information in order for pharmacists to better serve their
clients.
Number 1743
REPRESENTATIVE ROKEBERG referred to page 2, line 1, and asked if
the National Council for Prescription Drug Programs Pharmacy
Identification Card Implementation Guide is something that would
be periodically adjusted, because it ties in with the mandate
that the director of the Division of Insurance shall make
regulatory changes.
MS. BYRNE replied that it may change, but noted that included on
the National Council for Prescription Drug Programs (NCPDP)
advisory committee are the insurers; they're part of the NCPDP.
Number 1699
REPRESENTATIVE ROKEBERG expressed concern with directing the
Division [of Insurance] to adopt regulations to conform with a
guide that's going to change from time to time. He mentioned
that this would be granting legislative authority to the
"national council [NCPDP]."
MS. BYRNE added that [HB 318] only requires a card to be
reissued when a change is substantive. She said NCPDP requires
a 90 percent consensus of all present to make any change [to the
guide].
Number 1658
CHAIR MURKOWSKI noted that the [division] director is directed
to look to the standards that are set out in the NCPDP guide, or
the standards that are outlined in [paragraph] (2).
MS. BYRNE thanked Representative Murkowski and said, "That's
absolutely correct."
REPRESENTATIVE ROKEBERG restated his belief that this would be
"granting legislative power to the national council by statute."
CHAIR MURKOWSKI disagreed with Representative Rokeberg's concern
and stated, "What we are doing is directing the Director of the
Division of Insurance to look to the standards that we have
identified in [paragraph] (2)." She offered that these
standards might be more neatly outlined in the NCPDP's Pharmacy
Identification Card Implementation Guide and should be looked at
as an example of what is expected to be on the card.
Number 1543
REED STOOPS, Lobbyist for Aetna and Health Insurance Association
of America, informed the committee that he is representing Mike
Wiggins [Vice President, National Accounts, Aetna] who is unable
to testify today. He thanked Representative Murkowski and Ms.
Erickson for their work on HB 318 and trying to take into
account the objections of the insurance industry. He noted that
there are additional changes that the insurance industry would
like to see made to Version R.
MR. STOOPS explained that the first problem is that the
insurance industry would "strongly prefer" a national standard
because most insurers do business in all 50 states. He
mentioned that it is difficult to comply with each state's
slightly different set of standards.
Number 1437
MR. STOOPS identified a second concern [his clients have] as the
uniform prescription drug information card that HB 318 is
seeking. The uniform prescription drug information card that HB
318 is seeking is "really different" from what the industry
usually issues, which is a multi-purpose, general health benefit
card. This card is used when one goes to a doctor or a
pharmacist and has the name of the company on it and one's ID
number. He explained that from the perspective of the
pharmacist, they want a uniform prescription drug card, which is
an exclusive card that deals with drugs. He stated, "What we've
ended up with is sort of a blend, whereby now we're trying to
make our general health care card a drug card." There have been
some conflicts between objectives in trying to make that happen.
Number 1406
MR. STOOPS said that based on the initial testimony heard, [his
clients] thought that there was an agreement that Aetna, Blue
Cross, and some of the other major insurers had sufficient
information on their general card, and that reissuance of those
cards was not going to be required by virtue of the legislation.
Trying to incorporate the new standards with the information
that's already on the cards would require even Aetna would have
to reissue its' cards. Aetna has approximately 90,000 cards in
place in Alaska, and the cost to reissue those cards would be a
couple hundred thousand dollars, or about $2 a card.
MR. STOOPS explained that pharmacists have an electronic system
in the pharmacies that link directly up with [Aetna's] database.
A lot of the information that's necessary to process a claim is
in that computer database and not on the card. Ultimately, the
way the payment gets issued is electronically. Almost all of
the pharmacists in [Alaska] are linked electronically, at least
to Aetna.
Number 1318
MR. STOOPS next addressed some issues in the current draft of HB
318, and offered some amendments. The first amendment, on page
2, lines 22-24, would be to clarify that [HB 318] may not be
construed to require the reissuance of a uniform prescription
drug information card issued before the effective date. He
noted that would alleviate the concern about a fiscal note.
MR. STOOPS also noted that the National Council for Prescription
Drug Pharmacy Program Identification Card Implementation Guide
is an either/or standard. He said this isn't a [normal
occurrence] in a piece of legislation to leave the standards,
which can change from time to time, up to the director of [the
Division of Insurance]. He stated, "I think it would be our
preference just to state whatever the standards are clearly in
statute, and then amend those statutes from time to time if you
find that those need to be amended in the future."
Number 1244
MR. STOOPS explained that [Aetna] is trying to match the
information on its card to "the language in (C)(i), (D), and
(E)." He stated it's confusing what those [sections] actually
mean, so we had some suggestions to clarify the language in (D)
and (E) so that we're sure that the information we're providing
is what the statute asked for." He offered to submit copies of
Aetna and Blue Cross' identification cards. He said, "I
couldn't find what that bank identification number conformed to
- at least on the two cards that we had available to us."
CHAIR MURKOWSKI asked if Mr. Stoops indicated that he wanted to
delete the international bank ID number [BIN]. She offered her
understanding that there is an "international number and then
there's a bank identification number."
Number 1189
MR. STOOPS explained that [Aetna's card] has a group number, a
control number, a payor number, and an RX group number. The
Blue Cross card has a group number and an RX group number, but
it doesn't have anything that corresponds to a bank
identification number. Since the card currently doesn't have
the required number, [Aetna] would have to reissue cards for the
sake of providing that number. He said if the first amendment
he suggested were adopted, [Aetna] wouldn't have to reissue the
current card and could "deal with that in the future."
MR. STOOPS next addressed sections (D) and (E), which indicated
what address and phone numbers need to be on the card. He
explained:
Generally we've got the name of the company, which is
Aetna, the post office box, the mailing address, and
there's an 800 number that you as the enrollee or any
provider can call. And if its pharmacists that calls
that 800 number, they can be routed from that number
to another pharmacy claim office. But by putting two
numbers on the card then you create some confusion
among the enrollee on "which 800 number am I supposed
to call?" And in most cases you the member ... just
want a single 800 number that can route you wherever
you need to go for the information, rather than having
multiple numbers for multiple purposes. It's not the
end of the world if we have to provide it, but it just
seems that there's a simpler way to accomplish that
objective.
CHAIR MURKOWSKI asked if this number requires one "to sit on the
line for 15 minutes tracking, [for example], 'OK, now if your
last name begins with an M-U-R, you can press 3.'"
MR. STOOPS explained that every time a pharmacist enters into a
contract they receive a "special [phone] number" [so he/she will
have a direct contact number].
Number 1058
REPRESENTATIVE CRAWFORD asked how often [Aetna] reissues cards.
MR. STOOPS said it depends. A new card needs to be issued every
time a contract changes. Normally an insurance company will
have a contract for 1-3 years with a customer, and when that
contract expires if there's a new carrier the card will be
reissued. He stated, "I don't believe there's any [cards] that
stay in effect indefinitely, they're ... reissued as necessary
on a rotating basis."
REPRESENTATIVE CRAWFORD related his belief that there isn't any
established time in which any of the carriers reissue cards.
MR. STOOPS agreed, but specified that if there is going to be a
requirement to reissue the cards, then there will be an
associated cost and thus there is the need for a fiscal note.
Furthermore, he inquired as to what information is really
necessary for the pharmacist. He questioned whether there
should be two separate cards with one for drugs or should there
be a single-purpose card.
Number 0946
REPRESENTATIVE HAYES asked whether anyone has introduced federal
legislation to deal with this issue.
MR. STOOPS informed the committee that there have been meetings
with the National Pharmacists by all the major insurers.
Although there was the recommendation for national legislation,
he said he wasn't sure whether the legislation was introduced.
CHAIR MURKOWSKI returned to the international bank
identification number and related her understanding that the
insurance companies worked with the pharmacy associations on
this NCPDP pharmacy identification card guide. Therefore, she
expressed concern that Aetna, a major player in Alaska, says
that it isn't aware of one of the things included in the guide.
MR. STOOPS said that he understood that there was an agreement
that the pharmacists would work collaboratively in order to seek
national legislation such that all insurers would have similar
national standards. Mr. Stoops said he didn't know which
insurers participated in the development of that implementation
guide and whether those insurers would be the same each year.
Although all of the HIAA members or Aetna wouldn't all be
included, everyone doing business in the state would have to
meet the guidelines if the Director of Insurance specified the
need to meet the regulations [based on the guidelines].
CHAIR MURKOWSKI pointed out the "or" on page 2, line 2.
MR. STOOPS agreed. However, he said he read the bill to mean
that it's in the opinion of the director and thus the director
can look at the standards in the bill "or" the director can look
at the implementation guide and make a decision. If the
director chooses the implementation guide, then the standards
will change [as time passes]. Therefore, the conservative
preference is to look to the statutes for what is required, and
if there is a need to change, then the legislature would
determine the changes through a process such as this. Mr.
Stoops emphasized that of all the issues with the bill, this
isn't the largest of them.
REPRESENTATIVE ROKEBERG pointed out that on page 2, line 1, the
language "current" means any future guides with revisions.
Therefore, the director would be forced to review any change in
the guide "or" [follow paragraph (2)].
Number 0655
LIZ MERTEN, Northwest Regional Director, National Association of
Chain Drugstores (NACD), explained, from the perspective of
pharmacies, that the real purpose of this bill is to simplify
the claims processing by ensuring that all necessary information
to process a drug claim is contained on the card in some sort of
standardized readable format. She informed the committee of a
survey contracted by NACDS in 1999, which found that 20 percent
of a pharmacist's day was spent rectifying claims of patients
that were standing before them. In a survey released last month
by Shearing (ph), now 29 percent of a pharmacist's time is spent
on this matter. The amount of time spent on rectifying claims
coupled with the shortage in pharmacists and the increase in
prescriptions in the U.S. [is of concern]. The Shearing (ph)
survey asked pharmacists what would provide them the opportunity
to speed up the process and take time with their patients,
behind the answer of increased utilization of technicians was
the standardized pharmacy identification card.
MS. MERTEN directed attention to page 2, line 18, which
specifies "unless provided electronically at the time of
adjudication." She informed the committee that in a meeting
with Blue Cross, Aetna, and herself all agreed to insert the
aforementioned language. That language was inserted in order to
address that when a pharmacist is on-line adjudicating a case
with Aetna that is where the phone number appears on the screen.
Based on the [same] meeting, the language on page 2, lines 8-13
was developed after the actual identifiers that were included in
earlier versions of the bill were removed. Ms. Merten
highlighted the importance of the language on page 2, lines 24-
26, which says, "does not require issuance of a separate
prescription drug information card if an existing information
card contains the information required under this section." The
intent has never been to require a separate prescription card
but rather that in working with the insurers, a new card with
the necessary information would be issued.
MS. MERTEN turned to the "or" on page 2, line 2, which she said
was inserted to address the concerns heard from insurance
companies who are concerned with compliance of the NCPDP
guidelines. She recalled that after the meeting with the
insurers, one of the insurers asked what would happen if the BIN
number and the control number were no longer used to process
their claims. Ms. Merten pointed out that in such a situation
the NCPDP guidelines would be so important because it would
eliminate the need to return to the legislature to address the
statutes. The "or" provides flexibility to not be locked into
the laundry list specified in paragraph (2) on page 2, line 3.
MS. MERTEN, in response to Representative Hayes' earlier
question, informed the committee that legislation has been
introduced at the federal level. However, that legislation is
tied to senior drug legislation that has moved very far in the
process. At this point, the pharmacists need help. In
conclusion, Ms. Merten encouraged the committee's support of the
legislation.
CHAIR MURKOWSKI returned to the international bank
identification number.
TAPE 02-40, SIDE A
CHAIR MURKOWSKI asked if the international bank identification
number is something that must be included in the laundry list,
or could the language on page 2, lines 8-10, say that the card
"may include" the items listed in sub-subparagraphs (i)-(iii).
MS. MERTEN said that the BIN is probably the most important
number because it's the one number that absolutely has to be
available to the pharmacist for processing. She explained that
the BIN specifies where the pharmacist is to go to process the
claim. The BIN is required in any claims processing.
Number 0174
CHAIR MURKOWSKI expressed her confusion, then, because major
companies say that they don't know what the BIN is.
MS. MERTEN pointed out that most insurance companies contract
the processing of their claims, and therefore aren't aware that
the [processor] uses a BIN [for them].
REPRESENTATIVE ROKEBERG surmised then that if Blue Cross changed
its subcontracting provider, Blue Cross would have to reissue
the card.
MS. MERTEN replied yes. In further response to Representative
Rokeberg, Ms. Merten wasn't sure whether Blue Cross would
reissue cards if it changed its tertiary care provider in
Alaska.
Number 0349
CHAIR MURKOWSKI asked if there is any national discussion with
regard to the requirement to reissue new cards within the next
year.
MS. BYRNE answered that HIPAA will go into effect for insurers
in April 2003. The piece that ties into this discussion is that
there are a number of programmatic changes that insurers will
have to go through in order to comply with the privacy issues
and with HIPAA. Therefore, insurers will no longer be allowed
to use social security numbers as a unique identifier, which
Aetna, Blue Cross, and others use. This change will necessitate
reprogramming of their software system and new cards will have
to be issued. Therefore, while insurers are already
reprogramming their computers, they might as well do everything
at once for the HIPAA requirements and a uniform prescription
card. Ms. Byrne confirmed that the July 1, 2003, effective date
falls after the HIPAA requirements take effect.
Number 0559
CHAIR MURKOWSKI closed the public testimony. She then turned to
the concern about issuing new cards and the fiscal note that
would be required. The suggested language is that [the
insurers] wouldn't be required to reissue the benefit card prior
to the effective date of this section, July 2003. As mentioned
earlier, this time frame would fall after the HIPAA changes and
thus she questioned the concern.
MR. STOOPS related his understanding that whether the HIPAA
changes will require insurers to issue a new card is speculation
at this point. In regard to his suggested language, Mr. Stoops
recalled from the first hearing that the major insurers in
Alaska have adequate information on their cards. Therefore, to
make that clear he suggested: "An insurer who has a card in
effect today, before this law went into effect, wouldn't reissue
the card until they're normally required to reissue it." He
acknowledged that the opportunity may come when the HIPAA
changes happen. When those [HIPAA] changes occur and whatever
standards are adopted by the legislature, then the change would
be made then, avoiding the fiscal impact that is of concern.
CHAIR MURKOWSKI asked if Aetna regularly reissues cards on a
cycle.
MR. STOOPS explained that when the state goes out to bid for
insurance, the terms of the contract are changed. Therefore,
there is usually one or more times in which the cards are
reissued during the term of a contract. With other clients, the
reissuance of cards would occur when the client requires such or
when Aetna does so for its own administrative efficiency. The
reissuance is done on a rotating basis, which he presumed other
insurers did as well. In further response to Chair Murkowski,
Mr. Stoops recalled that Aetna is in year two of five under the
current contract with the state. He related his understanding
that there is a plan to reissue cards before the end of this
contract. He explained that this reissuance will occur partly
because the state wants changes. Again, the best way to avoid a
fiscal impact is to specify an effective date and as new cards
are issued, those cards must meet the requirements of the
statute.
REPRESENTATIVE HAYES asked if there is any way to find out about
the HIPAA requirement as that seems to be the answer to the
question before putting a $200,000 fiscal note on the bill.
CHAIR MURKOWSKI disagreed that this would create a $200,000
fiscal note. She related her understanding that HIPAA currently
says that a social security number can't be used as the
identifier. She asked if there is anyone who could speak [to
how things are going to go].
Number 0962
STAN RIDGEWAY, Deputy Director, Division of Insurance,
Department of Community & Economic Development (DCED), informed
the committee that the general belief is that HIPAA privacy
regulations are slated to go into effect in April 2003.
However, most believe that April 2003 is too soon and thus Mr.
Ridgeway wasn't sure that the April 2003 date would be met. He
noted that there is a website that deals with frequently asked
questions and answers with regard to the uniformity for
insurance cards. He said that the committee may find this
information helpful.
REPRESENTATIVE ROKEBERG recalled that there are more than 600
pages of federal regulations and thus the complexity of this has
made the effective date a moving target.
Number 1071
REPRESENTATIVE ROKEBERG moved that the committee adopt the
following amendment, Amendment 1:
Page 2, line 31
Delete paragraph (4)
Insert "may not be construed to require the
reissuance of a health benefit card issued prior to
the effective date of this section."
REPRESENTATIVE HAYES objected and asked if Amendment 1 would
still leave the situation in which the information isn't the
information that the pharmacists want or need.
CHAIR MURKOWSKI related her understanding that at the date of
the adoption of [this legislation] everyone would receive new
cards. As the new cards are issued, the new cards would be
subject to the requirements established in this legislation.
MS. BYRNE agreed and specified that Version R is the result of
meetings through Ms. Merten with representatives of insurance
companies. She stressed that more than one insurance company
was at the table.
REPRESENTATIVE ROKEBERG remarked that it doesn't make sense that
a company could be required to reissue a card before the
effective date of this legislation.
MS. BYRNE noted that this was a request from the insurance
industry.
MR. STOOPS explained his understanding that the effect of
Amendment 1 would be that once the card is issued, until the
card is reissued after the [effective] date, [the card] would
remain in effect. Mr. Stoops clarified that the desire was to
keep the current card in effect until it was necessary to
reissue the card in any case, at which time the standards of the
bill would be incorporated. Therefore, the fiscal impact is
avoided.
REPRESENTATIVE CRAWFORD asked whether Amendment 1 works for the
Northwest Ironworkers and other self-insured groups around the
state.
MR. STOOPS stated that the policy issue is in regard to whether
the legislature feels that the standards are important enough
that they should be met now. However, there would be a fiscal
impact to such because it will cost the insurer a couple dollars
a card to reissue the card. He pointed out that the cost will
come right to [the state for those under the] State of Alaska's
system. However, the insurance companies for the self-insured
groups will pay for it, and therefore the enrollee will
ultimately pay the cost. In response to Representative Hayes,
Mr. Stoops explained that [were HIPAA regulations to go into
effect] and everyone had to reissue the cards, then the cost
would be blended into the cost of doing business. But, if this
legislation were to pass, reissuing the cards would be purely
because of the legislation.
REPRESENTATIVE ROKEBERG pointed out that the health insurance
industry is one of the few industries that has no price
elasticity, and therefore it can pass along [the impact] of
whatever it wants.
MR. STOOPS noted that for the State of Alaska, [Aetna] is only
the claim administrator and the state itself determines the
rate.
Number 1409
REPRESENTATIVE HAYES inquired as to why the language [in
Amendment 1] wasn't included in Version R.
CHAIR MURKOWSKI recalled that the language [attempted] to
clarify that the requirement [came into play] when a new card
was reissued. She said she didn't believe it was anyone's
intent that on the effective date of this act everyone would
receive new cards. However, there was the assumption that what
is on the Aetna cards already met the requirements being sought
in the bill.
REPRESENTATIVE HAYES withdrew his objection.
There being no objection, Amendment 1 was adopted.
Number 1527
REPRESENTATIVE ROKEBERG moved Amendment 2, which would on page
1, line 14 - page 2, line 2, delete references to the National
Council for Prescription Drug Programs Pharmacy Identification
Card Implementation Guide and renumber accordingly. Also, the
amendment would specify the minimum requirements for the card in
the current paragraph (2).
CHAIR MURKOWSKI objected. She related her belief that the
language in paragraph (1) on page 1, line 14 - page 2, line 2,
is to give the director some formal guidelines. She said she
would want to know that the director was looking at these
guidelines when implementing the standards. Furthermore,
because the guidelines come about due to the collaboration and
the discussion from both the pharmacy industry and the insurance
industry it seems important to reference it.
REPRESENTATIVE HAYES agreed with Chair Murkowski. Without the
"or" he feared that the problems with the mechanical code would
surface here.
REPRESENTATIVE MEYER noted his confusion with the language
"provisions of an implementation guide prepared by a pharmacy
association."
CHAIR MURKOWSKI clarified that Aetna is saying that it wasn't
part of the working group [that developed the National Council
for Prescription Drug Programs Pharmacy Identification Card
Implementation Guide] and thus they don't want to refer to the
guide.
REPRESENTATIVE ROKEBERG said that the primary reason he supports
the amendment is because he believes that Alaska's insurance
people and the director of the Division of Insurance and
pharmaceutical folks should all be at the table together. The
guide referenced in the legislation is one in which Alaska's
people weren't involved. Therefore, he recommends leaving the
decisions to the director and the local players.
CHAIR MURKOWSKI pointed out that under the current draft the
director doesn't have to confer with anyone.
Number 1790
MR. RIDGEWAY acknowledged that the insurers don't want to end up
with 50 [different] cards. However, he pointed out that part of
the role of NAIC is look at uniformity. Mr. Ridgeway said he
feels that the "or" language offers clarity, and furthermore the
regulation process would allow all parties to be part of the
development and implementation of those regulations.
Upon determining there was no further discussion with regard to
Amendment 2, a roll call vote was taken. Representatives
Rokeberg and Meyer voted for the adoption of Amendment 2.
Representatives Crawford, Hayes, Murkowski, and Kott voted
against the adoption of Amendment 2. Therefore, Amendment 2
failed by a vote of 2:4. [Although someone "voted" on
Representative Halcro's behalf, Representative Halcro was not in
attendance for this vote.]
Number 1952
REPRESENTATIVE ROKEBERG moved that the committee adopt Amendment
3, which reads as follows:
Page 2, line 11,
Delete sub-subparagraph (i)
REPRESENTATIVE HAYES objected.
REPRESENTATIVE ROKEBERG reiterated earlier testimony that Blue
Cross - Washington/Alaska covers over 50 percent of the insureds
[in Alaska] and does not have the [international bank
identification number] on the card. He said that he didn't
believe it was on the Aetna card either. He pointed out that
the adoption of Amendment 1 means that these companies can't be
forced to reissue these cards, and therefore leaving sub-
subparagraph (i) in the bill would result in the companies being
noncompliant with the law.
REPRESENTATIVE HAYES inquired as to the use of the
[international bank identification number].
MS. ERICKSON explained that the BIN is an electronic claims
routing information number. She related her understanding that
the Blue Cross and Aetna cards have the BIN, although it isn't
labeled as such. For example, on some it has been labeled as
the "ID NO." She also recalled that the payor number of Aetna's
card is comparable to the BIN.
REPRESENTATIVE ROKEBERG pointed out that per statute, the card
would have to be labeled differently, and therefore the card
would have to be reissued. Furthermore, Representative Rokeberg
guessed that every pharmacist in the Alaska knows the BIN for
Blue Cross - Washington/Alaska.
CHAIR MURKOWSKI inquired as to the problem of leaving sub-
subparagraph (i) when the number is already included [on the
card] not to mention that it's the key identifier.
MS. ERICKSON indicated that using the language, "which may
include" and then specifying the laundry list of items would be
appropriate because then the other components could be used if
the BIN isn't available. Therefore, Ms. Erickson suggested that
the committee not delete sub-subparagraph (i) and consider
including the language "which may include".
Number 2095
REPRESENTATIVE ROKEBERG agreed that providing the discretion
with the language "which may include" could be the solution.
Representative Rokeberg withdrew Amendment 3. He then moved
that the committee adopt conceptual Amendment 4, which reads as
follows:
Page 2, line 10, after "routing,"
Delete "including"
Insert "may include"
There being no objection, conceptual Amendment 4 was adopted.
The committee took a brief at-ease.
Number 2140
MR. STOOPS questioned whether the standard would be met if [the
number is provided electronically], although a small percentage
of pharmacists aren't linked electronically. He expressed
concern that the language [on page 2, line 17] isn't clear in
this regard. He explained that the card itself has a number
that the pharmacist can call and be linked. However, the
pharmacists are given a direct number when under contract with
Aetna. The only reason to not include that number on the card
is to avoid the customer calling the pharmacy claim number.
REPRESENTATIVE ROKEBERG moved that the committee adopt
conceptual Amendment 5, which reads as follows:
Page 2, line 18, after "assistance"
Insert "or a link to a telephone number for
pharmacy benefit claims assistance"
MR. STOOPS explained that he had suggested that the card could
specify an 800 number that would link to the pharmacy claim
number as opposed to having two numbers on the card.
REPRESENTATIVE ROKEBERG clarified that if conceptual Amendment 5
were to be adopted then on page 2, lines 17-18, subparagraph (E)
would read as follows: "a help desk telephone number for
pharmacy benefit claims assistance or a link to a telephone
number for pharmacy benefit claims assistance, unless provided
electronically at the time of adjudication."
There being no objection, conceptual Amendment 5 was adopted.
REPRESENTATIVE ROKEBERG moved on to subparagraph (D) on page 2,
lines 14-16, and questioned whether the language "name" referred
to the company name.
REPRESENTATIVE HALCRO pointed out that the "benefits
administrator" refers to the company. He pointed out that the
language specifies "the name and address of the benefits
administrator or other entity responsible for prescription
claims submission ...".
REPRESENTATIVE ROKEBERG asked if Mr. Stoop's concern with this
was because Version R is drafted only to prescription benefit
claims rather than all benefit medical claims.
MR. STOOPS answered yes. He pointed out that Aetna administers
the pharmacy [claims] and thus Aetna's address should suffice.
However, Blue Cross hires a [benefits administrator] and under
subparagraph (D) ...
TAPE 02-40, SIDE B
MR. STOOPS continued: ... Blue Cross would have to [insert the
name and address] of whoever they contract with for prescription
benefits. Therefore, he assumed that there would be two
addresses [on the card] for those companies that don't
administer their own prescription claims: the name and address
of the company and the name and address of the contractor.
REPRESENTATIVE HALCRO indicated that the language "or other
entity responsible" takes care of the aforementioned.
REPRESENTATIVE ROKEBERG surmised that the card would have to be
changed every time the insurer changed contractors.
REPRESENTATIVE HALCRO said, "You should anyways, I would
imagine, because, of course, ... you're going to allow your
customers to know who to call."
REPRESENTATIVE ROKEBERG pointed out that this is for
correspondence [via] "snail mail."
CHAIR MURKOWSKI clarified that this language is in reference to
submitting claims, and she agreed that the information [would be
necessary].
MR. STOOPS pointed out that insurers may have claims routed to a
main address and part of it would then be sent to the pharmacy
claim section. He explained that he felt it would be sufficient
to have the name and address of the insurer.
REPRESENTATIVE HALCRO suggested that perhaps a disclaimer
stating that certain numbers are provided for the use of the
pharmacy only.
MR. STOOPS said that the question then becomes whether the
customer would actually read that disclaimer.
REPRESENTATIVE HAYES remarked that it would be best to leave the
language as it is and if it is found to be a problem, it could
be addressed via amendment on the floor.
REPRESENTATIVE ROKEBERG reviewed the language "or other entity
responsible" and agreed that it would cover anyone.
REPRESENTATIVE HAYES disclosed that he has a conflict of
interest due to his position in the insurance industry.
Number 2210
REPRESENTATIVE HAYES moved to report CSHB 318, Version 22-
LS1061\R, Ford, 3/14/02, as amended out of committee with
individual recommendations and the accompanying fiscal note.
There being no objection, CSHB 318(L&C) was reported from the
House Labor and Commerce Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
5:50 p.m.
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