Legislature(2021 - 2022)BUTROVICH 205
04/13/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| SB93 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 93 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 13, 2021
2:01 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 93
"An Act relating to the establishment of an all-payer health
claims database; and providing for an effective date."
- MOVED CSSB 93(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 93
SHORT TITLE: HEALTH INS. ALL-PAYER CLAIMS DATABASE
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/24/21 (S) READ THE FIRST TIME - REFERRALS
02/24/21 (S) HSS, L&C, FIN
03/11/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/11/21 (S) <Bill Hearing Rescheduled to 3/16/21>
03/16/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/16/21 (S) <Bill Hearing Canceled>
03/23/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/23/21 (S) Heard & Held
03/23/21 (S) MINUTE(HSS)
04/07/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
04/07/21 (S) Scheduled but Not Heard
04/13/21 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered question on SB 93.
ACTION NARRATIVE
2:01:50 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 2:01 p.m. Present at the
call to order were Senators Begich, Hughes, Costello, Reinbold,
and Chair Wilson.
SB 93-HEALTH INS. ALL-PAYER CLAIMS DATABASE
2:02:20 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 93
"An Act relating to the establishment of an all-payer health
claims database; and providing for an effective date."
2:02:56 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), Juneau,
Alaska, stated that she is available to answer questions.
CHAIR WILSON stated his office received five amendments.
2:03:28 PM
At ease.
2:04:02 PM
CHAIR WILSON reconvened the meeting for discussion on SB 93
Amendment 1.
SENATOR REINBOLD moved Amendment 1.
AMENDMENT 1
32-GS1530\A.1
Marx
3/24/21
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: SB 93
Page 3, line 11:
Delete "may"
Insert "shall"
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD stated that the amendment changes the word
"may" to "shall" on page 3 line 11 of the bill.
SENATOR COSTELLO asked if members know why the bill was drafted
using the word "may", which would not require the competitive
bid process to be used. She asked if the recovery from COVID-19
would have an impact.
MS. WING-HEIRER stated that the drafter of the bill had no
concerns changing the word to "shall". "May" was carried over
from the federal bill.
2:05:24 PM
CHAIR WILSON withdrew his objection. There being no further
objection, Amendment 1 passed.
2:05:34 PM
CHAIR WILSON moved Amendment 2.
AMENDMENT 2
32-GS1530\A.2
Marx
3/31/21
OFFERED IN THE SENATE BY SENATOR WILSON
TO: SB 93
Page 4, following line 14:
Insert a new section to read:
"Sec. 21.92.040. Eligibility for state grants.
(a) A health care insurer that is required to submit
health care data to the statewide all-payer health
claims database may not receive a state grant unless
the insurer submits the data as required by the
director under AS 21.92.010.
(b) A health care payer that agrees to
voluntarily report health care data to the statewide
all-payer health claims database may not receive a
state grant unless the payer reports the data to the
database as required by the payer's agreement."
Page 4, line 15:
Delete "Sec. 21.92.040"
Insert "Sec. 21.92.050"
2:05:41 PM
SENATOR BEGICH objected for purposes of discussion.
2:05:45 PM
At ease.
2:06:11 PM
CHAIR WILSON reconvened the meeting and stated that Amendment 2
is on page 4 line 14. Amendment 2 is incentive language for
healthcare facilities that enter data in the database and are
eligible to receive grants. He stated facilities must enter data
into the database to continue receiving state grants.
SENATOR REINBOLD stated that she disagrees with Amendment 2 as
it appears to be quid pro quo. Putting information into the
database should not be required in order to get a grant.
SENATOR COSTELLO asked if grant recipients in other fields are
required to submit information and if it is a problem getting
them to submit it.
CHAIR WILSON answered that there are entities that must give
reports in order to be eligible for state grants. Some
healthcare services must be Medicaid eligible in order to
receive grants. Some areas of behavioral health must be
inclusive of all providers, for example IHS beneficiaries. If a
state grant in behavioral health is received, all members must
be seen, not subsets of populations.
SENATOR HUGHES stated that she is for the amendment because its
purpose is to control costs in the state. Recipients benefit
from state grants. Requiring they provide de-identified
information at the onset of receiving a grant should not be a
problem.
2:09:02 PM
SENATOR BEGICH withdrew his objection and thanked members for
the description of change that Amendment 2 creates.
2:09:11 PM
SENATOR REINBOLD contended that Amendment 2 was outlandish.
Insurers should not have to provide confidential data that is
protected by the Health Insurance Portability and Accountability
Act (HIPPA). Awarding grants should not be dependent on
providing confidential data. She offered her belief that the
bill is unconstitutional.
SENATOR HUGHES asked Ms. Wing-Heier to speak to the assertion
that the amendment will violate HIPPA laws and reveal
confidential information.
MS. WING-HEIER LORI WING-HEIER, Director, Division of Insurance
Department of Commerce, Community and Economic Development
Anchorage, Alaska replied that the bill already asks that
healthcare insurers submit data and there are penalties if they
do not. Amendment 2 states that if insurers do not submit the
data, they will not be eligible for state grants. Amendment 2
does not change the type of data to be submitted therefore HIPPA
laws have no relevance to the amendment.
SENATOR HUGHES asked if there is any data in the database that
breaks patient confidentiality.
MS. WING-HEIER answered no. The data must be de-identified.
SENATOR REINBOLD questioned if any of the healthcare data
submitted to the claims database regard the patient, their
diagnosis or medication.
MS. WING-HEIER clarified that the database will not identify a
patient, but information on pharmaceuticals, medicines and
procedures will be collected. That is the intent of the
database.
2:11:09 PM
SENATOR REINBOLD asked how the state rates in keeping data
secure.
MS. WING-HEIER replied she cannot answer the question.
SENATOR REINBOLD stated that the bill is dangerous, and she is
against the amendment.
SENATOR HUGHES asked if it is correct that a patient's name will
not be attached to submitted data.
MS. WING-HEIER replied yes. Information is de-identified, and
data cannot be tied back to an individual.
SENATOR COSTELLO asked what the procedure would be if a grantee
did not submit the information but had begun utilizing the
grant. She asked if it would increase the state costs to retract
and reissue grants.
MS. WING-HEIER offered her belief that the grant would be held
up until amends were made. It would not automatically cancel any
grant.
CHAIR WILSON noted the objection and asked for a roll call.
2:12:24 PM
A roll call vote was taken. Senators Hughes, Costello, Begich,
and Wilson voted in favor of Amendment 2 and Senator Reinbold
voted against it. Therefore, Amendment 2 passed by a 4:1 vote.
2:13:13 PM
SENATOR BEGICH moved Amendment 3.
AMENDMENT 3
32-GS1530\A.3
Marx
4/9/21
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 93
Page 3, line 7:
Delete the second occurrence of "and"
Page 3, following line 7:
Insert a new paragraph to read:
"(5) establish by regulation a schedule of
reasonable fees to be charged to an authorized
requester that is a business entity for the use and
distribution of data from the database to the business
entity; and"
Renumber the following paragraph accordingly.
2:13:18 PM
SENATOR COSTELLO objected for purposes of discussion.
2:13:22 PM
SENATOR BEGICH stated that Amendment 3 provides the opportunity
for the director to establish, by regulation, a reasonable fee
schedule for enterprises that request more than publicly
available data. It is preceded in the bill by a "ma clause. A
director is not required to set fees for enterprises but is
provided an opportunity should there be a need to recoup costs.
The database would be free to the public.
2:14:20 PM
SENATOR COSTELLO removed her objection.
2:14:33 PM
SENATOR HUGHES asked if reasonable fees are defined.
SENATOR BEGICH replied that the language came from Legislative
Legal Services, and they could answer the question.
CHAIR WILSON stated legal services is not in attendance and
suggested others who might answer.
MS. WING-HEIER stated that reasonable fees for the regulation
project would be established by collecting data from similar
databases and determining the median. Public comment would also
be taken. The federal bill states who must be charged to use the
database, such as universities, researchers and insurance
companies.
SENATOR HUGHES asked if the division charging a fee is to
recover data collection costs rather than making a profit.
SENATOR BEGICH replied yes; producing data has a cost and other
states have instituted fees for similar data sets. The fees are
to cover costs, not to be onerous.
SENATOR REINBOLD stated her objection to the bill and the
database. She offered her belief that the state should not be
collecting data on diagnoses, pharmaceuticals and other private
data. She does not trust the government to protect the data it
collects. She does not want database information to be available
for individuals and enterprises to delve into.
CHAIR WILSON asked for a roll call.
2:18:12 PM
A roll call vote was taken. Senators Costello, Begich, Hughes,
and Wilson voted in favor of Amendment 3 and Senator Reinbold
voted against it. Therefore, Amendment 3 passed by a 4:1 vote.
2:18:48 PM
SENATOR BEGICH moved Amendment 4.
AMENDMENT 4
32-GS1530\A.4
Marx
4/9/21
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 93
Page 3, following line 26:
Insert a new paragraph to read:
"(6) engage consumer protection
stakeholders and the community in the process
described in (5) of this subsection to ensure claims
and other data from the database are available in a
format accessible to all authorized requesters;"
Renumber the following paragraphs accordingly.
CHAIR WILSON objected for purposes of discussion.
2:19:00 PM
SENATOR BEGICH stated Amendment 4 came from a desire to involve
community groups in the process so that the database is
accessible to all Alaskans. This amendment asks the division to
work with community groups and consumer protection stakeholders
to ensure the database is available and easy to use for all
Alaskan citizens.
2:19:31 PM
CHAIR WILSON asked Ms. Wing-Heier how engagement of stakeholders
and the community would work in terms of accessing the data.
MS. WING-HEIER replied outreach to various groups, such as the
Alaska Native Tribal Health Consortium, would be done to
determine interest. If a group expresses interest, the division
will strive to put a translatable feature on the database to
meet that group's need. The division will prioritize those
groups who express interest in using the database.
CHAIR WILSON asked Senator Begich to clarify user accessibility.
SENATOR BEGICH replied the data from the database would be
available in a format accessible to all authorized requesters.
This means the data must be understood by requesters and it
means that data must be accessible. Consumers would be engaged
in determining what barriers there are to accessing information.
Ways would then be identified to make the data available.
Amendment 5 is relevant to this point, as it provides a
continual means of keeping the database current. Amendment 4 is
about format, but it is also about making sure the database is
accessible to users by virtue of language or other matters.
2:21:44 PM
SENATOR HUGHES asked if Alaska Native Tribal Health providers
will contribute to the database.
MS. WING-HEIER replied yes. Providers that are insured plans and
Medicaid will contribute to the database.
SENATOR HUGHES commented that de-identified information is an
advantage of the database since information will be publicly
accessible. She appreciates that the information will be in a
format that makes ascertaining identity impossible, even for
small communities. She asked if another fiscal note will be
necessary.
MS. WING-HEIER replied she did not know. Based on other
projects, programs come with translation capability. Language is
a small portion of the programs; mostly programs are about
numbers, which don't need translation.
SENATOR HUGHES asked if an increment will be added at this
point.
MS. WING-HEIER answered no.
SENATOR REINBOLD asked if anyone in the state is excluded from
the database.
MS. WING-HEIER replied the division is not excluding anyone.
SENATOR REINBOLD asked if everybody in the state of Alaska will
be in the database.
MS. WING-HEIER replied that insured plans, Alaska Care, and
Medicaid are expected to contribute to the database. There will
be people who are not included. The bill specifically states
insurance companies and everyone else is voluntary.
SENATOR REINBOLD asked if there is any tribal health that is
excluded from the data.
MS. WING-HEIER responded no.
SENATOR REINBOLD sought confirmation that people associated with
tribal health are not excluded but they may not be included
either.
MS. WING-HEIER answered correct.
SENATOR REINBOLD stated that she objects to the amendment
because if it was really about healthcare, it would be promoting
healthy lifestyle instead of being a massive database that
everyone has access to.
2:25:22 PM
CHAIR WILSON removed his objection and asked for a roll call. A
roll call vote was taken.
2:25:32 PM
Senators Begich, Hughes, and Wilson voted in favor of Amendment
4 and Senators Costello and Reinbold voted against it.
Therefore, Amendment 4 passed by a 3:2 vote.
2:25:57 PM
SENATOR BEGICH moved Amendment 5.
AMENDMENT 5
32-GS1530\A.5
Marx
4/9/21
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 93
Page 3, following line 20:
Insert a new paragraph to read:
"(4) engage stakeholders in the development
and maintenance of the database;"
Renumber the following paragraphs accordingly.
2:26:02 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR BEGICH stated that Amendment 5 asks for stakeholders to
be engaged in the development and maintenance of the database.
Currently the director could design the database without input
from stakeholders.
CHAIR WILSON asked Ms. Wing-Heier if she had any issues with the
amendment.
MS. WING-HEIER stated the department does not object to the
amendment. Stakeholder engagement is encouraged. The regulations
of the database will be an open and transparent process and
involve stakeholders. She suggested that hearings could be held
once or twice a year to take public comment.
2:27:37 PM
SENATOR HUGHES noted the prior amendment mentioned stakeholders
as being consumer protection stakeholders. She asked the Senator
Begich if Amendment 5 includes consumer protection stakeholders.
She opined that doing so would ensure information is de-
identified and the database is used to lower healthcare costs
for the state.
SENATOR BEGICH replied that is the intent of the amendment.
SENATOR HUGHES stated that sometimes only people in the
healthcare industry are considered. She appreciates that
consumer protection stakeholders will be included in the
amendment.
SENATOR REINBOLD asked for the stakeholders mentioned in the
amendment to be identified.
SENATOR BEGICH stated that the stakeholders would be consumer
stakeholders, those who deposit information into the database
and consumers of the data, which could be members of the public,
businesses and researchers.
2:29:44 PM
SENATOR REINBOLD stated objection to Amendment 5.
SENATOR HUGHES stated she was in favor of the amendment because
it is an important safeguard.
CHAIR WILSON removed his objection.
SENATOR REINBOLD stated that the database is unnecessary. It
chases federal dollars to data mine Alaskan's sensitive
information. She offered her belief that it will not be censored
or achieve its objective.
2:30:34 PM
CHAIR WILSON called for a roll call.
2:30:57 PM
A roll call vote was taken on Amendment 5. Senators Begich,
Hughes, Costello, and Wilson voted in favor of Amendment 5 and
Senator Reinbold voted against it. Therefore, Amendment 5 passed
by a 4:1 vote.
2:31:30 PM
At ease
2:31:51 PM
CHAIR WILSON reconvened the meeting and asked for closing
comments on SB 93.
SENATOR REINBOLD asked if the database will show doctors'
charges or define what the insurance companies paid.
MS. WING-HEIER stated that showing doctor and insurance
information is intended. The grant requires that the department
of labor's formatting be used. She cannot say what information
will be contained in the database until the Department of Labor
and Workforce Development (DOLWD) provides formatting. If her
department was doing the formatting, the database would have
both.
2:33:01 PM
SENATOR REINBOLD stated she will be voting no on SB 93. She
opined that it is the second worst bill in committee. The bill
is not necessary. It chases federal dollars, while the federal
government is trillions of dollars in debt. She stated that the
Alaska State Constitution Article 1 Section 22 provides privacy
rights. She is concerned the bill violates HIPPA laws.
Legislators should uphold the oath of office and not pass the
bill. It is ridiculous to require patients' information be
divulged in order to be eligible for grants. She referenced
Legislative Budget and Audit reports that recommended increased
security for two state databases. She offered her belief that
the bill could lead to a universal payer system.
SENATOR HUGHES commented that the database will not be in
violation of HIPPA laws, and it will not infringe on Alaskan's
privacy. She offered her belief that it is not leading to a
universal one payer system. Alaska has the highest healthcare
costs in the entire world. The database is a step towards
figuring out how to bring healthcare costs down. If this bill
allowed for identifying information to be in the database she
would be against it.
SENATOR COSTELLO stated that for too long Alaskan's have
struggled with healthcare costs. The healthcare industry has
been shrouded in secrecy. Revealing information on what people
pay begins the process of transparency, which will lead to
consumers having more choice in healthcare.
2:38:32 PM
SENATOR BEGICH stated that the bill now requires a competitive
bid, which means the director will be writing a request for
proposal (RFP). Concerns brought up by the committee can be met
in the RFP.
SENATOR REINBOLD opined that people should think for themselves.
2:39:24 PM
At ease
2:40:26 PM
CHAIR WILSON reconvened the meeting.
2:40:26 PM
SENATOR REINBOLD offered her belief that de-identified
information can be reidentified and databases do not reduce
healthcare costs.
2:41:17 PM
CHAIR WILSON solicited a motion to move the bill from committee.
2:41:21 PM
SENATOR HUGHES moved to report SB 93, version A as amended, from
committee with individual recommendations and attached fiscal
note(s).
2:41:25 PM
SENATOR REINBOLD objected.
CHAIR WILSON asked for a roll call
2:41:30 PM
A roll call vote was taken. Senators Hughes, Costello, Begich,
and Wilson voted in favor of reporting SB 93 as amended from
committee and Senator Reinbold voted against it. Therefore, the
motion passed by a 4:1 vote.
Chair Wilson stated CSSB 93 (HSS) was moved from the Senate
Health and Social Services Standing Committee.
2:42:11 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 2:42 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 93 Cliff Groh Letter of Support (3.25.21).pdf |
SHSS 4/13/2021 1:30:00 PM |
SB 93 |
| SB 93 AHTP Letter of Support.pdf |
SHSS 4/13/2021 1:30:00 PM |
SB 93 |
| SB 93 Hope Letter of Support.PDF |
SHSS 4/13/2021 1:30:00 PM |
SB 93 |
| SB 93 Providence Letter of Support.PDF |
SHSS 4/13/2021 1:30:00 PM |
SB 93 |
| SB 93 ACEP Letter of Support.pdf |
SHSS 4/13/2021 1:30:00 PM |
SB 93 |
| SB 93 Adopted Amendments 4.13.21 SHSS.pdf |
SHSS 4/13/2021 1:30:00 PM |
SB 93 |