HB 500: "An Act relating to medical review organizations; and providing for an effective date."

00 HOUSE BILL NO. 500 01 "An Act relating to medical review organizations; and providing for an effective date." 02 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 03 * Section 1. AS 18.23.070(5) is amended to read: 04 (5) "review organization" means 05 (A) a hospital governing body or a committee whose 06 membership is limited to health care providers and administrative staff, except 07 where otherwise provided for by state or federal law, and that is established by 08 a hospital, by a clinic, by one or more state or local associations of health care 09 providers, by an organization of health care providers from a particular area or 10 medical institution, or by a professional standards review organization 11 established under 42 U.S.C. 1320c-1, to gather and review information relating 12 to the care and treatment of patients for the purposes of 13 (i) evaluating and improving the quality of health care 14 rendered in the area or medical institution; 15 (ii) reducing morbidity or mortality;

01 (iii) obtaining and disseminating statistics and 02 information relative to the treatment and prevention of diseases, illness, 03 and injuries; 04 (iv) developing and publishing guidelines showing the 05 norms of health care in the area or medical institution; 06 (v) developing and publishing guidelines designed to 07 keep the cost of health care within reasonable bounds; 08 (vi) reviewing the quality or cost of health care services 09 provided to enrollees of health maintenance organizations; 10 (vii) acting as a professional standards review 11 organization under 42 U.S.C. 1320c; 12 (viii) reviewing, ruling on, or advising on controversies, 13 disputes, or questions between a health insurance carrier or health 14 maintenance organization and one or more of its insured or enrollees; 15 between a professional licensing board, acting under its powers of 16 discipline or license revocation or suspension, and a health care 17 provider licensed by it when the matter is referred to a review 18 organization by the professional licensing board; between a health care 19 provider and the provider's patients concerning diagnosis, treatment, or 20 care, or a charge or fee; between a health care provider and a health 21 insurance carrier or health maintenance organization concerning a 22 charge or fee for health care services provided to an insured or enrollee; 23 or between a health care provider or the provider's patients and the 24 federal or a state or local government, or an agency of the federal or a 25 state or local government; 26 (ix) acting on the recommendation of a credential 27 review committee or a grievance committee; 28 (B) the State Medical Board established by AS 08.64.010; 29 (C) a committee established by the commissioner of health and 30 social services and approved by the State Medical Board to review public 31 health issues regarding morbidity or mortality; at least 75 percent of the

01 committee members must be health care providers; 02 (D) the Joint Commission on Accreditation of Healthcare 03 Organizations (JCAHO).