HB 123-DISCLOSURE OF HEALTH CARE COSTS  2:14:28 PM CHAIR WILSON announced the consideration of HB 123. [The committee adopted the work draft SCS for CSHB 123, labeled 30- LS0380\G, on 3/16/18.] 2:15:01 PM CHAIR WILSON moved Amendment 1, 30-LS0380\G.3. 30-LS0380\G.3 Bruce 3/30/18 AMENDMENT 1 OFFERED IN THE SENATE BY SENATOR WILSON TO: SCS CSHB 123( ), Draft Version "G" Page 5, line 26: Delete "$5,000" Insert "$10,000" Page 6, line 25: Delete all material. Reletter the following subparagraph accordingly. 2:15:17 PM SENATOR VON IMHOF objected for purposes of discussion. 2:15:30 PM CHAIR WILSON explained that on page 5, line 26, Amendment 1 changes the cap on the amount of civil penalties from $5,000 to $10,000 and on page 6, line 25, includes tribal facilities with health care facilities so that they have to comply with the bill's requirements. SENATOR BEGICH asked if he worked with the bill sponsor. 2:16:10 PM REPRESENATIVE IVY SPOHNHOLZ, Alaska State Legislature, sponsor of HB 123 said she did discuss the changes and supports them. 2:16:32 PM SENATOR VON IMHOF removed her objection. 2:16:37 PM CHAIR WILSON found no further objection and Amendment 1 passed. 2:16:41 PM CHAIR WILSON moved Amendment 2, labeled 30-LS0380\G.5. 30-LS0380\G.5 Bruce 4/3/18 AMENDMENT 2 OFFERED IN THE SENATE BY SENATOR WILSON TO: SCS CSHB 123( ), Draft Version "G" Page 7, following line 20: Insert new bill sections to read:  "* Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to read: TRANSITION: REGULATIONS. The Department of Health and Social Services may adopt regulations necessary to implement the changes made by this Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not before the effective date of the law implemented by the regulation.  * Sec. 4. Section 3 of this Act takes effect immediately under AS 01.10.070(c)." Renumber the following bill section accordingly. Page 7, line 21: Delete "This" Insert "Except as provided in sec. 4 of this Act, this" SENATOR VON IMHOF objected for purposes of discussion. 2:16:52 PM CHAIR WILSON said these changes were requested by DHSS so that it can adopt regulations necessary to implement the changes made by this Act. 2:17:34 PM SENATOR VON IMHOF removed her objection. 2:17:41 PM There being no objection, Amendment 2 passed. 2:17:46 PM CHAIR WILSON moved Amendment 3, labeled 30-LS0380\G.6. 30-LS0380\G.6 Bruce 4/3/18 AMENDMENT 3 OFFERED IN THE SENATE BY SENATOR WILSON TO: SCS CSHB 123( ), Draft Version "G" Page 1, line 1, following "information;": Insert "relating to health care insurers;" Page 4, line 6: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 4, line 8: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 4, line 14: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 4, lines 23 - 24: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 5, line 17: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 5, line 25, following "section": Insert "or a health care insurer that fails to comply with the requirements of (g) and (h) of this section" Page 5, line 31: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 7, following line 20: Insert a new bill section to read:  "* Sec. 3. AS 21.96 is amended by adding a new section to read: Sec. 21.96.200. Good faith estimate. Upon request of a covered person who is receiving nonemergency health care services, a health care insurer shall provide a good faith estimate of the amount of the reasonably anticipated charges for treating the patient's specific condition under AS 18.23.400(g) and (h)." Renumber the following bill section accordingly. 2:18:08 PM SENATOR VON IMHOF objected for purposes of discussion. CHAIR WILSON said the amendment adds health care insurers to entities that shall provide a good faith estimate to patients who request non-emergency health care services. SENATOR BEGICH asked what the intent of the amendment was. CHAIR WILSON answered that the intent was to allow good faith estimates to be provided not only from those providing the services, but the insurers also because the posted prices may not be applicable for people who have insurance. If the doctor's office cannot contact the insurer, the patient can give the codes to the insurer to get a more detailed, specific estimate. It allows the same time frame to comply with the good faith estimates. SENATOR BEGICH asked if the bill sponsor supports the amendment. 2:20:20 PM REPRESENTATIVE SPOHNHOLZ said it is welcomed. Getting a good faith estimate from insurers in a timely manner is a reasonable thing to expect. SENATOR VON IMHOF asked for clarification that with this amendment, insurers will be participating in good faith estimates but not posting prices like health care facilities and providers are being asked to do. CHAIR WILSON said correct. SENATOR VON IMHOF asked if there is another definition of insurer that says private insurer, self-insured, Medicare/Medicaid, TRICARE, etc. 2:21:47 PM BERNICE NESBITT, Staff, Representative Ivy Spohnholz, Alaska State Legislature, testified on HB 123. She said page 6, line 30, of the bill states that "health care insurer" has the meaning given in AS 21.54.500. 2:22:25 PM At ease. 2:24:26 PM CHAIR WILSON reconvened the meeting. 2:24:41 PM SENATOR GIESSEL asked Director Wing-Heier to comment on the insurer component of the bill. LORI WING-HEIER, Director, Division of Insurance, Department of Commerce, Community and Economic Development (DCCED), testified on HB 123. She said that for transparency, the amount paid is an important factor that needs to be addressed. The amount paid is most often going to be what the insurance company has either negotiated or the insurer can inform the consumer how they will pay if it is the 80th percentile or some other formula, so that the consumer will understand what they may pay out of pocket. Without that component, a consumer might look at provider prices and decide to not go forward because the cost of services look too high. SENATOR GIESSEL asked if it would be impossible for insurers to put their reimbursement amounts up because it is so personalized to each insured person. MS. WING-HEIER said correct. Network contracts may differ between employers and health care plans may differ in deductibles and copays. Those factors have to be taken into account when someone is looking at the cost. SENATOR GIESSEL asked if insurers are required now to respond to client's request for that information. MS. WING-HEIER said yes. One of the largest insurers has a good website for clients to go to. Insurers are becoming more transparent to empower consumers to do the research on their own. It's a long way from perfect, but the attempt is starting. 2:27:20 PM SENATOR VON IMHOF removed her objection. 2:27:32 PM CHAIR WILSON found no further objection and Amendment 3 passed. SENATOR VON IMHOF thanked Representative Spohnholz for bringing the bill forward. It is a good start. She said she has put a lot of thought into this bill and would like to continue dialogue with Representative Spohnholz to do a new bill next year that adds the other components of the health care cycle. Providers such as doctors and hospitals provide the procedures and then insurers pay for the procedures. Health care trusts manage health care plans for public entities and then patients need to compare prices and pay attention to value and ask for good faith estimates. HB 123 addresses providers and insurers to an extent, it encourages patients to ask for good faith estimates, but there is more work to be done building on this bill to bend the cost of health care growth in the future. CHAIR WILSON said as Representative Spohnholz described, the bill is the first couple of steps in a marathon. There is a long way to go to lower health cost and unravel the complexity of health care in this state. This is a good faith effort toward that. 2:30:23 PM SENATOR VON IMHOF moved to report the Senate Committee Substitute for Committee Substitute for HB 123, Version G, as amended, from committee with individual recommendations and forthcoming fiscal notes. 2:30:39 PM CHAIR WILSON found no objection and SCS CSHB 123(HSS) moved from the Senate Health and Social Services Standing Committee.