Legislature(1993 - 1994)
03/14/1994 01:40 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 14, 1994
1:40 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
All members present.
COMMITTEE CALENDAR
SENATE BILL NO. 270
"An Act creating the Alaska Health Commission; relating to the
delivery, quality, access, and financing of health care; relating
to review and approval of rates and charges of health insurers;
relating to certain civil actions against health care providers and
health insurers; repealing Alaska Rule of Civil Procedure 72.1; and
providing for an effective date."
SENATE BILL NO. 284
"An Act establishing the Alaska Health Insurance Corporation and
requiring licensed health care providers to comply with certain
statutes and regulations relating to the corporation; relating to
disability insurance claims processing and to approval of rates for
disability insurance, including health insurance; and providing for
an effective date."
PREVIOUS SENATE COMMITTEE ACTION
SB 270 - See Health, Education & Social Services minutes dated
2/9/94, 2/18/94, 3/2/94, 3/9/94 and 3/11/94.
SB 284 - See Health, Education & Social Services minutes dated
2/14/94, 2/18/94, 3/2/94, 3/9/94 and 3/11/94.
WITNESS REGISTER
Nancy Usera, Commissioner
Department of Administration
P.O. Box 110200
Juneau, Alaska 99811-0200
POSITION STATEMENT: Reviewed SB 270.
Jay Livey, Deputy Commission
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Reviewed SB 270.
David Walsh, Director
Division of Insurance
P.O. Box 110805
Juneau, Alaska 99811
POSITION STATEMENT: Reviewed SB 270.
David Stebing, Assistant Attorney General
General Civil Section
Department of Law
1031 W. 4th, Suite 200
Anchorage, Alaska 99501-1994
POSITION STATEMENT: Reviewed SB 270.
Al Zangri, Chief
Bureau of Vital Statistics
P.O. Box 110675
Juneau, Alaska 99811-0675
POSITION STATEMENT: Offered information about data collection
systems.
ACTION NARRATIVE
TAPE 94-19, SIDE A
Number 003
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:40 p.m. He introduced
SB 270 (COMPREHENSIVE HEALTH CARE) and SB 284 (COMPREHENSIVE HEALT ALT
INSURANCE ACT) as the only business before the committee. He
stated that the data collection aspect of both bills would first on
the committee's agenda.
NANCY USERA, Commissioner of the Department of Administration,
deferred to Jay Livey who did most of the developmental work on the
data collection section and who has a more in depth knowledge of
that piece of SB 270.
SENATOR DUNCAN asked if fiscal implications would be discussed
today. CHAIRMAN RIEGER noted that the Department of Commerce and
the Department of Administration are reviewing the fiscal notes
together to make sure there are no inconsistencies in the
approaches of the fiscal notes of both bills. They should have
some information for the committee next week. Chairman Rieger said
that fiscal implications could be addressed, but the specifics of
the fiscal notes should be discussed when both departments come
back with their information.
SENATOR DUNCAN expressed the need for the departments to review
other approaches to the fiscal notes. He did not believe that an
objective fiscal note could come from the insurance industry who
opposes such legislation as SB 284.
NANCY USERA commented that it seems that everyone wants a common
set of assumptions; to provide information that reflects the costs
of these proposals. She agreed that there were different sets of
assumptions. She said that she was open to suggestions.
SENATOR DUNCAN stated that he was available for meeting.
Number 095
JAY LIVEY, Deputy Commissioner of the Department of Health and
Social Services, noted the presence of others who could also speak
to health care data collection and its uses. He began with an
overview of health care data collection. He explained that health
data should be collected so that information regarding the type of
person being served, the services they are receiving, the cost of
those services, and the outcome of those services are available.
From all that information, notions of improving or restructuring
the services to decrease the costs and better the outcomes could be
derived.
Mr. Livey explained the three main sources of data. The first
source of data is primary data elements which most states collect
in order to do public health surveillance. Primary data elements
include unintentional injuries, suicides, cancer deaths, infant
mortality rates, etcetera. He identified the second source of data
as the claims payment system which utilizes data from large
organizations such as AETNA, who covers all state employees, and
the Medicaid program. This could be used in policy analysis. He
noted that currently, the Vital Statistics division of Public
Health share information with Medicaid regarding women in prenatal
care. Due to Alaska's small sample size, another year of data is
needed to be statistically valid. He pointed out another problem
with data collection would be determining how to link existing data
bases so that policy makers can determine if the health care
services being provided are the services needed.
Number 165
The third level of data collection is additional data such as
hospital discharge data which provides diagnosis information,
demographic information, cost information, etcetera. Discharge
data in Alaska is sketchy. Mr. Livey believed that in addition to
information from the uniform claims form, this additional data
would be helpful with health care reform. He presented the
committee with a booklet of a health data form from Florida and its
use of discharge data. He discussed information generated from the
Maine Medical Assessment Foundation. He explained that Maine
looked at outcome data from the point of view of regional
statistics which can yield practice patterns of physicians. He
explained that this information helps to determine ways to improve
the system.
Mr. Livey said that the data collection portion of SB 270 deals
with adopting a uniform claims form, collecting and analyzing data
regarding delivery of health care services in Alaska, and adopting
regulations which define health care data. The type of data
collection proposed in SB 270 is not comprehensive health data
collection. He said that SB 270 attempts to define the roles of
future health care data collection in order to achieve rationality
and cooperative use of data already collected. He explained that
the data collection he had discussed was not anticipated by SB 270
and is not reflected in the fiscal note of SB 270; however, SB 270
would provide a starting point for organization of the data
collection systems.
CHAIRMAN RIEGER asked if under SB 270 this would be coordinated
through the Division of Insurance. JAY LIVEY said that data
collection would be coordinated through the Health Commission. The
information from the uniform claims form and how it is used and
analyzed would be left to the deliberations of the Commission.
CHAIRMAN RIEGER inquired of the language requiring that the
Commission do the data collection. JAY LIVEY pointed out that
section 44.19.621 under paragraph (1) and section 44.19.626 both
specify that the Commission would do data collection.
Number 259
SENATOR ELLIS asked why would they want to collect a small amount
of data to decide what kind of data would be collected in the
future. He said that the people in the department and those who
worked on this issue for three years already know the kind of
information that should be collected for the future.
JAY LIVEY explained that the uniform claims form should be
implemented in order to collect uniform data while saving some
administrative costs. He felt that the data from the uniform
claims form was needed to do further kinds of reform. There are
still things to be learned about the health system. He did not
feel that it would be a waste of time. SENATOR ELLIS said that
SB 270 and its data collection was so limited.
CHAIRMAN RIEGER asked if the discharge data, the third level of
data, would be incorporated on the uniform claims form. JAY LIVEY
said he did not know. That would be one of the issues the
Commission would need to review. He pointed out that collecting
such data would be a question of the extent that additional
information could be included on the form. The costs of doing that
versus the provider getting the data would have to be reviewed.
CHAIRMAN RIEGER asked where Mr. Livey envisioned the actual
collection of data; in the Commission or a department of the State.
JAY LIVEY explained that he believed that the information from the
form would be dumped into files for analysis. That information
would be available to various people. Mr. Livey stated that the
analysis would be done with existing resources, not by the
Commission.
DAVID WALSH, Director of the Division of Insurance, stated that the
collection data would have minimal impact on the Division after the
uniform claims form is developed. The key to data collection is
the uniform claims form.
CHAIRMAN RIEGER inquired of Mr. Walsh's thoughts regarding the
third level of data, discharge data, being a part of the uniform
claims form. DAVID WALSH imagined that the third level of data
would be part of the form after things were running. He deferred
to Mr. Livey regarding how crucial that data would be to the health
analysis.
Number 336
SENATOR DUNCAN directed the committee to page 14 of SB 284 which
deals with health care data collection. He stated that a
comprehensive data system was necessary in order to achieve
universal coverage while controlling health care expenditures. The
principle source of data in SB 284 is the claims clearinghouse. He
believed that the comprehensive data care system should be a high
priority in any comprehensive reform proposal which could be one of
the differences in the two bills. The Corporation of SB 284 is
charged with establishing the health care data system, and
periodically monitoring and updating the system. He noted that
lines 8-19 on page 14 of SB 284 list the type of data to be
collected.
Senator Duncan pointed out that section 21.58.270 addresses the
statewide health care expenditure target. He also noted that in
order for the statewide expenditure target to change, other data
besides that listed on lines 8-19 must be collected. He
acknowledged that a comprehensive data collection system would be
costly, but must be done to have a good reform proposal. He
discussed Vermont's approach to this same problem. In order to
have a reform proposal that would work, a comprehensive data system
must be in place which SB 284 recognizes from the beginning. He
believed that there was a common consensus on the need for a
comprehensive data system in order to have universal system with
cost control; the difference would be on how and when that would be
achieved.
JAY LIVEY stated that those who use health care data say that in
the long term they may want to go further with data collection than
the common claims form. He explained that if the claims payment
form basically provides information the provider takes to ensure
payment then it may differ from information on the issues of
diagnosis, treatment, and outcome which are also needed. He did
agree that it was a good starting place and better than the current
system.
CHAIRMAN RIEGER asked if either bill contains provisions regarding
confidentiality of this health information. JAY LIVEY pointed out
that page 6, line 19 of SB 270 requires disclosure of medical
information and continues on to page 7 describing the penalties for
disclosure of that information.
CHAIRMAN RIEGER inquired of the meaning of subsection (b) when it
references AS 09.25.110 and 09.25.120 on line 28, page 6 of
SB 270.
Number 453
DAVID STEBING, Assistant Attorney General, said that he believed
that was the Public Records Act.
CHAIRMAN RIEGER expressed concern with that section because he
would not want medical information to be part of the public record.
DAVID STEBING recalled that medical information was well protected
by the Public Records Act; medical records are an exception to
disclosure.
SENATOR DUNCAN referred to page 11, lines 24-30 of SB 284 which
speaks to public disclosure of medical and financial information.
Confidentiality of information from the uniform claims form should
be maintained.
JAY LIVEY said that they could review the citations. He explained
that the intent of that section was to provide protection of the
client and the data they furnish.
CHAIRMAN RIEGER informed the committee of the fingerprint bill
which goes into great detail about the release and use of that
information. He felt that the release and use of medical
information probably needs some work.
JAY LIVEY noted the problems of collecting data from self insured
firms. The ERISA bill said that the state does not have
jurisdiction over those kinds of health programs or benefits,
therefore, in order to collect that data federal waivers would be
needed. He said that this would be an issue under either bill. He
did acknowledge that the data could be given voluntarily, but the
state cannot pass mandatory regulations.
CHAIRMAN RIEGER asked if epidemiological information was being
gathered on computers.
AL ZANGRI, Chief of the Bureau of Vital Statistics, stated that
currently epidemiological data is computerized. In response to
Chairman Rieger, he said that it does not require huge computer
systems for the data being collected. He noted that more data
would necessitate more power, more computers.
CHAIRMAN RIEGER asked if a mainframe would be needed if one had
500,000 data bases and 50 pieces of information per person. AL
ZANGRI said no. A mini computer could store, access and use that
amount of data; however, a mainframe would be needed to analyze
that data.
SENATOR DUNCAN asked if there were systems already set up that
could be contracted for use to save money. AL ZANGRI believed that
would be possible. Currently, the Division of Medical Assistance
contracts computer services with an outside firm.
SENATOR DUNCAN expressed the need to analyze such things as the
possibility that the more information contracted, the cheaper it
would be per individual. He asked if a data collection system as
in SB 270 was used, would the legislature be approached the next
session with recommendations.
Number 542
JAY LIVEY explained that any health care reform strategy would have
its own set of special data requirements. In a single payer system
with expenditure limits, demographic data would need to be
collected. In a pay or play system with a subsidy, other types of
data may be needed to locate that subsidy. Any health care reform
system would also need to review comprehensive data needs. He
reiterated that the total cost of any health care reform is not
reflected in the fiscal note of SB 270.
NANCY USERA expressed concern with comparing the provisions of
SB 270 and SB 284. SB 270 does not commit to comprehensive reform
as SB 284 does; SB 270 begins the process. She expressed her
preference to deal with the conceptual approaches of the bills
rather than compare specific provisions. These two bills do two
very different things due to the difference in their approaches.
SENATOR DUNCAN agreed with Ms. Usera's statements. He said that he
did not understand why any new data collection system was needed in
SB 270 since Mr. Livey had outlined what was needed under a
universal coverage, single payer system. He inquired of what the
data collection would discover under SB 270 that is not already
known.
JAY LIVEY identified that Alaska has some unique data collection
issues. The Commission would recommend how to integrate the
various data systems. He did not believe that they know how to
accomplish integration of the various data systems.
SENATOR ELLIS stated that the data collection system under SB 270
would make sense if nothing was going to be done. He asserted that
a more comprehensive, far reaching data collection system would be
required if any type of reform is attempted. He noted that people
from across the political spectrum feel that something must be done
about the health care situation.
TAPE 94-19, SIDE B
Number 593
Senator Ellis concluded that the approach of SB 270 was acceptable
if the purpose was to continue with the status quo.
NANCY USERA clarified that under SB 270 data would be collected to
determine how best to collect data. She explained that SB 270
would not be necessary if a spending plan for the 1995 fiscal year
could be created in order to accomplish the entire reform.
JAY LIVEY noted that not a lot of information is being collecting
from claims payment information. Once everyone uses the uniform
claims form, that information would be available in a uniform way.
The information from the data collection of SB 270 would be
available for day to day operations which is a benefit in itself.
CHAIRMAN RIEGER asked if SB 270 addressed the publication of fees
or the availability of price lists. NANCY USERA said no, but
pointed out that there was a draft amendment in the House to
SB 270. The amendment would suggest a provision of rate lists upon
the request of the consumer.
CHAIRMAN RIEGER asked if the amendment for SB 270 would be similar
to the language on page 13, lines 13-19 of SB 284. NANCY USERA
stated that the language in SB 284 requires that rates be reported
by the provider to the Corporation. Ms. Usera indicated that
subsection (a) of section 21.58.230 is similar to the proposed
amendment for SB 270, but the amendment does not include a
provision like subsection (b). In summary, the amendment would
require disclosure of rates to the consumer upon request, but the
provider is not required to report that information to the
Commission.
SENATOR DUNCAN clarified that SB 284 requires disclosure to the
consumer and the Corporation. He noted that there was a major
difference between the two bills regarding disclosure of rates.
Number 528
SENATOR SALO pointed out that the last sentence of subsection (a)
on page 13, line 18 of SB 284 seems to promote uniformity regarding
what providers place on a price list. She inquired if the
amendment to SB 270 addressed that issue. NANCY USERA said no.
SENATOR DUNCAN agreed with Senator Salo's point of difference and
also the fact that under the amendment to SB 270 disclosure occurs
only upon the consumer's request. He did not believe that a
comparison could be made with a price list from only one physician.
NANCY USERA read the amendment to SB 270 regarding disclosure of
provider fees, the fine, and the appeal process. She explained
that this amendment was a consumer effort to increase consumer
involvement and to contain administrative costs.
CHAIRMAN RIEGER inquired of the possibility of Anti-Trust
Exemptions standing in the way of the publication of rates. He
asked if the publication of price lists would have to be linked to
an Anti-Trust Exemption. NANCY USERA was not familiar with that
issue; however, she assumed that since the Department of Law helped
draft the legislation that issue had been reviewed.
JAY LIVEY said that he thought the Anti-Trust Exemption was related
to whether someone called another similar company and asked their
rates before publishing their own rates. He deferred to David
Stebing. DAVID STEBING did not know.
CHAIRMAN RIEGER asked if the committee had a general consensus that
the publication of fees was a useful provision.
SENATOR ELLIS stated that this would be a form of informed
consumerism which could be useful in controlling health care costs.
He considered that this issue was used to dress up SB 270. There
are many other ways that informed consumerism can be used regarding
health reform. He did agree that the issue was worthy of
discussion.
SENATOR LEMAN did not have a problem with the publication of fees.
He emphasized the need to realize what the list may be worth, no
two procedures would be alike which could be reflected in the price
list. Perhaps, an estimate comforts consumers.
SENATOR DUNCAN agreed with Senator Ellis. He noted that under
SB 284 the publication of fees would be used to control costs
through peer review and sanctions. He explained that the
publication of fees would even out prices due to peer review. The
price lists were not intended to encourage shopping around per se.
He pointed out that page 3 of SB 284 requires that health care
providers shall comply and there has been no indication that this
would be a problem with the Anti-Trust Exemption.
Number 444
NANCY USERA did not believe that the publication of fees would be
any different than calling an airline and inquiring of their
prices. She did note that SB 270 does require an estimate for a
specific procedure for a specific individual.
CHAIRMAN RIEGER said that he would have the publication of fees and
the Anti-Trust Exemption reviewed. He expressed his belief that
asking for prices in a medical situation would be awkward, so
publishing fees seems to help.
SENATOR ELLIS asked what would change between the social dynamics
of the physician and the patient. CHAIRMAN RIEGER reiterated the
awkwardness of asking a physician how much a procedure costs.
SENATOR ELLIS did not see anything in the bill that would alleviate
that discomfort. CHAIRMAN RIEGER said that a price list may help
in some situations.
JAY LIVEY pointed out that the Resources and Access Task Force
reviewed the funding services for health care. The Task Force
discovered that a significant amount of out of pocket money is
spent in Alaska which leads to a different dynamic when purchasing
health care. He believed that the publication of fees would have
the most impact on those individuals who pay out of their pocket
for services.
SENATOR SALO believed that for patients to become more
participatory in the economic efficiency decisions would be
beneficial. The posting of rates under SB 270 and SB 284 would be
beneficial in helping the patient make decisions. She pointed out
that under SB 284, the Corporation would decide what procedure
prices should be published; however, under SB 270, only the twenty
most common procedure prices would be published. She believed that
in both bills, price lists would be a good provision because it may
promote patients becoming move involved in their own care.
CHAIRMAN RIEGER agreed that anything promoting price sensitivity
would probably be useful.
Number 398
SENATOR DUNCAN indicated that the problem with this provision is
whether or not the publication is required or upon consumer
request. He explained that under SB 270, the consumer would still
have to ask which Chairman Rieger had thought awkward. Without
standardized reporting and data there is nothing meaningful. He
noted that under SB 284, one of the charges of the Corporation
would be to pursue federal waivers in any area where there may be
difficulty. The federal Anti-Trust law which could cause problems
should be covered by the waiver process.
SENATOR ELLIS said that the Anti-Trust issue should be taken care
of under the federal reform. The application of waivers would be
addressed and not necessary.
CHAIRMAN RIEGER mentioned that on Wednesday the public health issue
of SB 270 and SB 284 would be addressed.
There being no further business before the committee, the meeting
was adjourned at 2:47 p.m.
| Document Name | Date/Time | Subjects |
|---|