HB 144-INSURANCE; PRIOR AUTHORIZATIONS  5:23:46 PM CO-CHAIR FIELDS announced that the next order of business would be HOUSE BILL NO. 144, "An Act relating to prior authorization requests for medical care covered by a health care insurer; relating to a prior authorization application programming interface; relating to step therapy; and providing for an effective date." [Before the committee was CSHB 144(HSS).] 5:23:53 PM REPRESENTATIVE JUSTIN RUFFRIDGE, Alaska State Legislature, as prime sponsor, presented CSHB 144(HSS). He explained that prior authorization (PA) was a requirement for health services and medications to be approved by the payer before a patient receives said services or medications. He noted that prior authorization has been a barrier to receiving healthcare due to both technology and old equipment. He stated that CSHB 144(HSS) was a collaborative effort to address prior authorizations in Alaska, adapt timelines for access to care, particularly in urgent or emergency situations, update access for chronic care, and update requirements for response time. He concluded that CSHB 144(HSS) was designed to be "good for patients," and improve access to healthcare. 5:26:10 PM BUD SEXTON, Staff, Representative Justin Ruffridge, Alaska State Legislature, on behalf of Representative Ruffridge, prime sponsor of CSHB 144(HSS), began on slide 2 of the PowerPoint [included in the committee file], and outlined problems that the proposed legislation was meant to address. Slide 2 read as follows [original punctuation provided]: • Need for Prior Authorization (PA) before obtaining services. • Time • Individuals with Chronic Conditions. • Crafting a solution that takes into account the needs and protocols for all parties. MR. SEXTON moved to slide 3, giving an overview of the collaborative efforts put into crafting CSHB 144(HSS) and outlined the goals of the proposed legislation, which read as follows [original punctuation provided]: • Over the past year, numerous meetings between stakeholders. • Easy to understand process. • Establish timelines • Enforcement MR. SEXTON clarified that CSHB 144(HSS) would establish mechanisms of enforcement for the Division of Insurance. MR. SEXTON gave an overview of the timelines expected under CSHB 144(HSS), shown on slide 4, which read as follows [original punctuation provided]: • Easy to understand by patients and healthcare providers. • Process must be reasonable and efficient. • Determination with 72 hours for standard request. • 24 hours for an expedited request. • Prior Authorization request is approved if timeline is not met under the updated process. MR. SEXTON gave a summary of the proposed process for prior authorizations with incomplete information, shown on slide 5, which read as follows [original punctuation provided]: • If more information is needed to make a determination, the insurer shall send a request within one calendar day for an expedited request and three calendar days for a standard request. • Information due to the insurer between five to 14 days. MR. SEXTON moved to slide 6 of the PowerPoint, and gave a summary of improvements to the prior authorization process, which read as follows [original punctuation provided]: • PA standards listed on the health care insurer's website or portal (both locations if available). • PA criteria based on peer-reviewed, evidenced-based clinical review criteria. • Consistently applied by all sources including Utilization Review Organizations. MR. SEXTON moved to slide 7 and asserted that CSHB 144(HSS) was intended to be favorable to the patients. He gave the bullet points of slide 7, which read as follows [original punctuation provided]: • Patients benefit?if the standards by the insurer and the utilization review organization are different. • For each service, the insurer must list: • If a prior authorization process is necessary. • Date the requirement became effective MR. SEXTON moved to slide 8 and gave an overview of changes to care regarding chronic conditions, which read [original punctuation provided]: • PA is valid for not less than 12 months. • Automatic renewal if condition remains unchanged. • Stage 4 metastatic cancer/Step therapy. MR. SEXTON moved to slide 9 and gave an overview of accountability and compliance under CSHB 144(HSS), which read [original punctuation provided]: • Dept of Insurance Director shall monitor compliance. • Examination of health care insurers at least every two years: • PA response times and adherence to timeframes. • Accuracy and completeness of PA requirements. • Consistency of PA practices by Utilization Review Organizations and Third-Party Administrators. MR. SEXTON moved to slide 10 and gave an overview of enforcement mechanisms under CSHB 144(HSS), which read as follows [original punctuation provided]: • The director may impose penalties • May impose a penalty for each instance of noncompliance • Persistent or severe violations may warrant suspension or revocation of health insurer's certificate of authority 5:30:50 PM JARED KOSIN, President & CEO, gave invited testimony on CSHB 144(HSS). He stated that AHHA strongly supported CSHB 144(HSS). He asserted that, while prior authorization is a useful process for reviewing appropriateness of medical care, it was a deeply flawed process that has, in past, led to critical delays in patient care. He stated that CSHB 144(HSS) was a collaboration among providers, insurers, regulators to improve the PA process for patients. He highlighted improvements for patients under CSHB 144(HSS), including: long-term approval for chronic conditions, decreasing turnaround times from five days to 72 hours, no restrictions on key therapies for stage IV cancers, and requiring an exception process to step therapy protocol. He asserted that the proposed legislation creates transparency around "the processes that are used, how they're used, when they're effective, who [is] doing these reviews, ... how accountability is going to be applied, and ... how bill is being enforced." He concluded by asserting that CSHB 144(HSS) was a comprehensive bill with strong support from both insurers and hospitals in Alaska and invited questions from the committee. 5:33:25 PM GARY STRANNIGAN, Vice President, Congressional & Legislative Affairs, Premera Blue Cross, gave invited testimony on CSHB 144(HSS). He stated that Premera Blue Cross has been providing services to residents in Alaska before statehood. He stated that Premera Blue Cross supported efforts to promote the affordability of their products in continued service of their customers. He asserted that affordability has become a gateway in restricting access to care. He stated that prior authorization was important to affordability in helping ensure that members are getting the "right care at the right time in the right setting at the right price." He asserted that CSHB 144(HSS) was representative of a reasonable compromise by all parties and encouraged the passage of CSHB 144(HSS). [CSHB 144(HSS) was held over.]