SB 45-DIRECT HEALTH AGREEMENT: NOT INSURANCE  1:36:06 PM CHAIR BJORKMAN announced the consideration of SENATE BILL NO. 45 "An Act relating to insurance; relating to direct health care agreements; and relating to unfair trade practices." He stated that this is the third hearing of this bill and Jasmine Martin would give a recap. 1:36:36 PM JASMINE MARTIN, Staff, Senator David Wilson, Alaska State Legislature, Juneau, Alaska, gave a recap of SB 45. She stated that this bill would allow healthcare providers and their patients to enter into direct healthcare agreements and clarify that these do not lie within the state insurance bounds. CHAIR BJORKMAN solicited a motion to adopt the proposed committee substitute for SB 45. 1:37:17 PM SENATOR GRAY-JACKSON moved to adopt the committee substitute (CS) for SB 45, work order 33-LS0211\R, as the working document. CHAIR BJORKMAN objected for the purpose of discussion. 1:37:47 PM KONRAD JACKSON, Staff, Senator Jesse Bjorkman, Alaska State Legislature, Juneau, Alaska, presented an explanation of changes from version U to version R of SB 45. He stated that the first change is in the title, relating to the duties of the director of the Division of Insurance in the Department of Commerce, Community and Economic Development (DCCED). An addition on line 4 provides for an effective date. Another addition regarding healthcare services provided under a direct healthcare agreement reads as, "care provided by a primary care provider to that patient", along with additional language in the bill that specifies the definition relating to the primary care physician. The next change on page 4, is the deletion of a section from line 19 to line 22, removing the portion of the bill that would exempt this by regulation of the Division of Insurance. An insertion puts this clearly under the direction of the Division of Insurance and includes language that provides for penalties. Language has been added that requires physicians licensed under AS 08.64 who established residency in the state. Language defining a primary care provider has been added to paragraph 10. On the last page there are three new sections. One section is transition language to allow the director of the Division of Insurance to begin drafting regulations. The remaining sections are effective date clauses. CHAIR BJORKMAN removed his objection. Finding no further objections, CSSB 45, work order 33-LS0211\R, was adopted as the working document. CHAIR BJORKMAN said the committee received three amendments for consideration. The amendments were drafted to the previous version U of the bill, CSSB 45(HSS), rather than CSSB 45, work order 33-LS0211/R. The committee will consider the amendments as conceptual amendments, and grants Legislative Legal the authority to make conforming changes to the bill for any conceptual amendment the committee adopts. 1:42:21 PM SENATOR DUNBAR moved to conceptually adopt Amendment 1, work order 33-LS0211\U.1, for SB 45. 33-LS0211\U.1 Marx 3/28/23 AMENDMENT 1 OFFERED IN THE SENATE BY SENATOR DUNBAR TO: CSSB 45(HSS) Page 3, line 29: Delete "or (g)" CHAIR BJORKMAN objected for the purpose of discussion. SENATOR DUNBAR explained that Amendment 1 deletes subsection (g). 1:43:51 PM CHAIR BJORKMAN removed his objection; he found no further objection and Amendment 1 was adopted. 1:44:08 PM SENATOR DUNBAR did not offer Amendment 2. SENATOR DUNBAR moved to conceptually adopt Amendment 3, work order 33-LS0211\U.6, for CSSB 45. 33-LS0211\U.6 Wallace 4/6/23 AMENDMENT 3 OFFERED IN THE SENATE BY SENATOR DUNBAR TO: CSSB 45(HSS) Page 2, following line 24: Insert a new subsection to read: "(c) The amount of the periodic fee may not be based solely on the patient's health status or sex." Reletter the following subsections accordingly. Page 3, line 29: Delete "(c) or (g)" Insert "(d) or (h)" Page 3, line 31: Delete "(f) or (g)" Insert "(g) or (h)" Page 6, line 24: Delete "AS 21.03.025(n)" Insert "AS 21.03.025(o)" Page 6, line 25: Delete "AS 21.03.025(n)" Insert "AS 21.03.025(o)" Page 6, line 27: Delete "AS 21.03.025(n)" Insert "AS 21.03.025(o)" CHAIR BJORKMAN objected for purposes of discussion. SENATOR DUNBAR explained that Amendment 3 inserts a new subsection that reads "The amount of the periodic fee may not be based solely on the patient's health status or sex." This subsection is intended to prevent gender discrimination in fees. The remaining amendment contains conforming changes. 1:45:00 PM CHAIR BJORKMAN removed his objection. 1:45:07 PM SENATOR GRAY-JACKSON sought clarification that Amendment 3 pertains to health status as well as sex. SENATOR DUNBAR answered yes. He clarified that the page and line numbers in Amendment 3 do not match version \R of the bill, noting that Legislative Legal will make conforming changes in the final version of the bill. 1:46:03 PM CHAIR BJORKMAN removed his objection; he found no further objection and Amendment 3 was adopted. CHAIR BJORKMAN sought the will of the committee. 1:46:30 PM SENATOR GRAY-JACKSON moved to report CSSB 45, work order 33- LS0211\R, as amended, from committee with individual recommendations and attached fiscal note(s). She further moved that the committee grant Legislative Legal authorization to make conforming changes. 1:46:57 PM CHAIR BJORKMAN found no objection and CSSB 45(L&C) was reported from the Senate Labor and Commerce Standing Committee.