COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 211(FIN) am "An Act relating to regulation of managed care insurance plans; amending Rule 602, Alaska Rules of Appellate Procedure; and providing for an effective date." REPRESENTATIVE ROKEBERG stated that patients need assurance that the quality of their health care will not be compromised as managed care expands. He noted that the legislation would provide a reasonable standard of health care. It would establish requirements for contracts between managed care entitles and their health care providers, patients and their group managed care plans, health care insurers and their insured and would provide patients with the following: · Access to emergency room services; · Availability of medical services or adequate referral options; · Full disclosure of treatment options; · Choice of health care providers, including specialists; · Clear descriptions of covered items and services, benefits, procedures, compensation methods, availability (and exclusions) of prescription medications and the availability of translation or interpreter services; · A point of service plan option; · Follow-through of pre-approved payment; · Quick utilization review decisions; · Opportunity for appeals of utilization review decisions; · Added protection from denial, reduction; or termination of payment for health care services. In addition, the legislation will give health care providers the freedom to share all testing and treatment options with their patients, and would let them advocate for their patients without the risk of being penalized or terminated by the managed care entity they contract with. The bill would prohibit contracts between managed care entities and health care providers from financial incentives for providers to withhold medically necessary services. Representative Rokeberg stressed that HB 211 was necessary to ensure continued quality health care in the face of a growing managed care industry. He urged the Committee's support of the legislation. Co-Chair Torgerson commented that Representative Rokeberg had requested that Amendment #1, 1-LS0472/X.1, Ford, 4/15/00, not be offered at this time. [Copy on File]. Co-Chair Parnell MOVED to adopt Amendment #2. [Copy on File]. Representative Rokeberg explained the amendment. He noted that the first portion of the amendment was technical. Subsection © clarifies concerns voiced by Legislative Legal and would make the language more understandable to the average person. Co-Chair Parnell noted an important limitation allowing persons to communicate privately for the purpose of health care services. There being NO OBJECTION, Amendment #2 was adopted. Senator Green indicated a "conflict of interest" with the legislation because she has associations with the insurance industry. She referenced the definition of medical necessity and asked if there was a distingushment between medical necessity and medical treatment. Representative Rokeberg acknowledged that concern has been debated. He stated, sometimes it is better to "not" define something for matters of flexibility. The bill will let common law define medical necessity. Senator Green asked if there was any language in the legislation which might rewrite the tort reform bill. Representative Rokeberg replied the liability section was different, creating a "new cause of action". He noted the concern had been substantially worked, keeping in mind the State Constitution private situation. Senator Adams MOVED to report SCS COMMITTEE SUBSTITUTE HB 211 (FIN) out of Committee with individual recommendations and with the accompanying fiscal note. There being NO OBJECTION, it was so ordered. SCS COMMITTEE SUBSTITUTE HB 211 (FIN) was reported out of Committee with a "no recommendation" and with a fiscal note by the Department of Community & Economic Development dated 3/07/00.