HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE May 8, 1997 3:07 p.m. MEMBERS PRESENT Representative Con Bunde, Chairman Representative Joe Green, Vice Chairman Representative Al Vezey Representative Brian Porter Representative Fred Dyson Representative J. Allen Kemplen Representative Tom Brice MEMBERS ABSENT Representative Al Vezey COMMITTEE CALENDAR *HOUSE BILL NO. 219 "An Act relating to chiropractic health care services provided by a health maintenance organization." - HEARD AND HELD (* First public hearing) PREVIOUS ACTION BILL: HB 219 SHORT TITLE: CHIROPRACTIC CARE BY HMO SPONSOR(S): REPRESENTATIVE(S) KOTT JRN-DATE JRN-DATE ACTION 04/01/97 897 (H) READ THE FIRST TIME - REFERRAL(S) 04/01/97 897 (H) HES 05/08/97 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER NICOLE POIRRIER, Student Intern for Representative Kott Alaska State Legislature Capitol Building, Room 204 Juneau, Alaska 99801 Telephone: (907) 465-3777 POSITION STATEMENT: Provide sponsor statement for HB 219 MITCHELL D. GRAVO, Lobbyist Alaska Chiropractic Society 170 Botanical Circle Anchorage, Alaska 99515 Telephone: (907) 244-2884 POSITION STATEMENT: Testified in support of HB 219 ACTION NARRATIVE TAPE 97-44, SIDE A Number 0000 CHAIRMAN CON BUNDE called the House Health, Education and Social Services Standing Committee meeting to order at 3:07 p.m. Members present at the call to order were Representatives Bunde, Green, Porter and Dyson. Representatives Brice and Kemplen arrived at 3:11 p.m. and 3:13 p.m., respectively. Representative Vezey was absent. HB 219 - CHIROPRACTIC CARE BY HMO Number 0014 CHAIRMAN BUNDE announced that committee would hear HB 219, "An Act relating to chiropractic health care services provided by a health maintenance organization." Number 0053 NICOLE POIRRIER, Student Intern for Representative Kott, said that HB 219 will allow Alaskans to choose chiropractic services notwithstanding the positions of their health maintenance organizations or gatekeepers. This bill will give Alaskans the right to choose their own initial treatment for their health services. Health Maintenance Organizations (HMO's) attempt to control the cost of health care by requiring all participants to initially go through a gatekeeper. A gatekeeper is usually a medical doctor or a registered nurse who listens to the health complaint and refers the enrollee to the appropriate health care provider. There has been a long-standing animosity between traditional Western medicine and the chiropractic profession. This animosity has improved in recent years, but a prejudice still exists. Many times a gatekeeper will not refer a patient to a chiropractor even if the HMO plan covers chiropractic services and even if such a referral would be the most effective means of solving the health complaint. MS. POIRRIER stated that the bill addresses the issue of fairness. It would require that an HMO allow their clients to self-refer to a chiropractor, thus guaranteeing a patient's right to choose these types of services. It also contains language stipulating that an HMO cannot limit a health care provider from disclosure of information to a patient regarding their condition or treatment options. At this time, there are no HMO's operating in Alaska, but this bill is being introduced in order to assure fairness and access in the future. Number 0177 CHAIRMAN BUNDE clarified that there are no HMO's in the state of Alaska and that this bill would be considered pre-emptive legislation. He asked if there are other fields of treatment that would also prefer not to go through a gatekeeper. He questioned whether or not the legislature would be setting up a special privilege for chiropractors. Number 0234 MITCHELL D. GRAVO, Lobbyist, Alaska Chiropractic Society, answered that the chiropractic profession has been tracking their experience within the HMO system. He mentioned that chiropractors fall into a category of practitioners who would experience the same type of prejudice. He thought that instead of waiting until there is a problem in Alaska with HMO's not referring chiropractors, it was better to have legislation such as HB 219 to address the problem now, when there would be little opposition. Number 0368 REPRESENTATIVE JOE GREEN repeated the question of whether this type of legislation would lead to the exemption of other types of treatment from having to go through a gatekeeper. Number 0414 MR. GRAVO answered no, unless HB 219 was amended to include the other types of treatment. REPRESENTATIVE GREEN suggested that other types of practitioners might use this type of legislation to allow them to avoid the HMO gatekeeper. Number 0414 MR. GRAVE stated that if he was representing those other interests, he would use that argument, the self-referral argument. The person who is going to receive the treatment should make the decision about what kind of health care it is, not some large organization. Number 0441 CHAIRMAN BUNDE commented that HMO's put side boards on treatment to save money. The state can decide to allow those type of side boards or can choose not to allow HMO's to come into the state. Number 0475 REPRESENTATIVE BRIAN PORTER felt that HB 219 was a balanced approach. It allows 30 days of treatment and if the treatment period extends past that, then there is a check and balance by the organization. Number 0490 CHAIRMAN BUNDE announced that this is the first time HB 219 has been heard and it would be held for further discussion. He took a brief at ease at 3:14 p.m. which reconvened at 3:16 p.m. He said the committee might work on the foundation formula over the summer and suggested that the committee take HB 215 and HB 216 back to their district. Number 0571 REPRESENTATIVE DYSON stated that he would be working on Fetal Alcohol Syndrome issues this summer and that he would keep the chair apprised of his work. Number 0590 ADJOURNMENT There being no further business to conduct, CHAIRMAN BUNDE adjourned the meeting of the House Health, Education and Social Services Standing Committee at 3:18 p.m.