Legislature(2017 - 2018)CAPITOL 106

03/29/2018 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearings: State Medical Board TELECONFERENCED
-- Public Testimony --
+= SB 174 PROGRAMS FOR PERSONS WITH DISABILITIES TELECONFERENCED
Moved SB 174 Out of Committee
-- Testimony <Invited/Public> --
-- Public Testimony --
+= SB 108 MEDICAL CARE/LICENSING/MEDICAL BOARD TELECONFERENCED
Moved CSSSSB 108(FIN) Out of Committee
-- Testimony <Invited/Public> --
-- Public Testimony --
+= HB 358 INSURANCE COVERAGE FOR TELEHEALTH TELECONFERENCED
Moved HB 358 Out of Committee
-- Testimony <Invited/Public> --
-- Public Testimony --
*+ HJR 32 CONST. AM: PARENTAL CONSENT TO ABORTION TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 193 HEALTH CARE; BALANCE BILLING TELECONFERENCED
Moved CSHB 193(HSS) Out of Committee
-- Public Testimony --
              HB 193-HEALTH CARE; BALANCE BILLING                                                                           
                                                                                                                                
3:08:40 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be  HOUSE BILL  NO.  193,  "An Act  relating  to insurance  trade                                                               
practices  and frauds;  and relating  to  emergency services  and                                                               
balance  billing."   [In front  of the  committee was  Version T,                                                               
adopted as the working draft on March 8, 2018]                                                                                  
                                                                                                                                
3:09:06 PM                                                                                                                    
                                                                                                                                
RYAN JOHNSTON,  Staff, Representative  Jason Grenn,  Alaska State                                                               
Legislature, offered a brief recap  of the proposed bill, HB 193,                                                               
stating that  the bill was  effectively a ban on  balance billing                                                               
for  medical providers,  while also  instituting a  hold harmless                                                               
clause  for insurance  providers.   He  explained  that the  bill                                                               
would  only  remove a  patient  from  this billing  situation  in                                                               
emergency situations.                                                                                                           
                                                                                                                                
3:09:38 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened invited testimony on HB 193.                                                                             
                                                                                                                                
3:09:57 PM                                                                                                                    
                                                                                                                                
ANNE ZINK,  MD, Alaska American College  of Emergency Physicians,                                                               
paraphrased  from a  letter  of support,  dated  March 28,  2018,                                                               
which read:  [included in members' packets]:                                                                                    
                                                                                                                                
3:10:35 PM                                                                                                                    
                                                                                                                                
Representing more than 80% of  the emergency physicians providing                                                               
emergency medical  care to  the people of  our state,  the Alaska                                                               
Chapter of  the American College  of Emergency  Physicians writes                                                               
today to support HB193.                                                                                                         
                                                                                                                                
     HB 193  will protect  patients and families  across the                                                                    
     state from  the high costs  and sticker shock  that can                                                                    
     come from  "surprise medical  bills." Both  doctors and                                                                    
     patients  support this  important  measure, which  will                                                                    
     provide consumer  protections for  patients, strengthen                                                                    
     access to  care, and  put an  end once  and for  all to                                                                    
     surprise bills.                                                                                                            
                                                                                                                                
     As emergency  physicians in  Alaska, we  know firsthand                                                                    
     about the gaps in  patient healthcare coverage that can                                                                    
     cause  patients to  postpone or  avoid treatment  until                                                                    
     it's too late.  According to a national  survey, 44% of                                                                    
     people reported  that they  didn't seek  treatment when                                                                    
     they  were sick  or injured  because of  costs. At  the                                                                    
     same time,  35% of Americans would  have trouble paying                                                                    
     their  regular  bills  if  faced  with  a  $400  health                                                                    
     emergency. This  is alarming,  but not  surprising, and                                                                    
     we  must  work together  to  ensure  that patients  can                                                                    
     safely  access emergency  care  without worrying  about                                                                    
     going bankrupt.                                                                                                            
                                                                                                                                
     What good is insurance if  it fails us in an emergency?                                                                    
     Insurance companies  are shifting hundreds  of millions                                                                    
     of dollars in  costs to patients and  doctors each year                                                                    
     through higher  premiums, deductibles  and cost-sharing                                                                    
     requirements.  At  the   same  time,  Alaska  insurance                                                                    
     companies are  narrowing their  networks    making them                                                                    
     smaller through  limiting access  to doctors  and care,                                                                    
     which means fewer options and  choices for patients and                                                                    
     creating  large  coverage   gaps  where  care  patients                                                                    
     thought would  be covered, turns  out not to  be. These                                                                    
     gaps are  leading to surprise  bills, adding  even more                                                                    
     costs for patients.                                                                                                        
                                                                                                                                
     Alaska  patients  and  families deserve  better.  Right                                                                    
     now, the state has a  regulation in place that requires                                                                    
     insurance companies  to cover  these unexpected  out of                                                                    
     network  costs  during  emergencies  through  fair  and                                                                    
     appropriate payments to  doctors. But, Alaska insurance                                                                    
     companies are  working to  undermine this  regulation                                                                      
     and we need your help  to ensure patients are protected                                                                    
     in the long  run. We're working to support  a new bill,                                                                    
     HB 193,  that will end surprise  billing altogether and                                                                    
     provide the protection patients need.                                                                                      
                                                                                                                                
     HB  193  is  a  comprehensive  solution  that  protects                                                                    
     patients and ends surprise  bills by requiring insurers                                                                    
     to  cover unexpected,  emergency out  of network  care,                                                                    
     and limiting  patient financial  exposure. HB  193 will                                                                    
     protect patients from receiving  large bills that their                                                                    
     insurance   companies   have   refused   to   pay.   By                                                                    
     establishing  an  appropriate  and  fair  reimbursement                                                                    
     standard between  insurers and doctors, the  bill takes                                                                    
     patients  out  of the  middle  and  improves access  to                                                                    
     care.                                                                                                                      
                                                                                                                                
     HB  193   sets  a  fair  minimum   standard,  the  80th                                                                    
     percentile rule  that has been working  in Alaska since                                                                    
     2004, which insurers use as  a benchmark to pay out-of-                                                                    
     network   physicians,  providers   or  facilities   for                                                                    
     unexpected care.  HB 193 bans balance  billing, meaning                                                                    
     no  further  bills  would  go   to  patients  in  these                                                                    
     situations.  Because  doctors  will  be  payed  fairly,                                                                    
     there is no need for additional bills.                                                                                     
                                                                                                                                
     Despite  negative   attention  created   by  misleading                                                                    
     information  by insurance  companies, patients  support                                                                    
     the  80th percentile  rule,  and  want their  insurance                                                                    
     plans  to fairly  cover out-of-network  emergency care.                                                                    
     The 80th percentile rule  relies on transparent market-                                                                    
     based information that takes  into account local market                                                                    
     prices  for services.  They are  based in  market costs                                                                    
     and not  set by government or  manipulated by insurance                                                                    
     companies.                                                                                                                 
                                                                                                                                
     Although  critics  have  claimed  that  providers  with                                                                    
     extremely large  market share  can impact  prices under                                                                    
     this standard,  there's no evidence  or report  of foul                                                                    
     play.  ISER (UAA's  Institute  of  Social and  Economic                                                                    
     Research)  is  currently  looking  at  this  issue  for                                                                    
     Alaska. Research  in New  York State  has shown  that a                                                                    
     similar  standard  did  not  increase  cost  after  its                                                                    
     implementation there.                                                                                                      
                                                                                                                                
     Without  the 80th  percentile rule  in HB193,  patients                                                                    
     will be  left unprotected as insurance  companies shirk                                                                    
     their  responsibility   to  pay.  In   fact,  insurance                                                                    
     companies  would  be  allowed  to set  any  rates  they                                                                    
     wanted     with  no  regard  for  costs  or  impact  on                                                                    
     emergency room staffing or services.                                                                                       
                                                                                                                                
     Alaska patients and families  need this full protection                                                                    
     from  surprise bills.  This  bill  with strengthen  the                                                                    
     healthcare  system,   offering  protection   first  and                                                                    
     foremost  to patients,  and  ensuring  the doctors  and                                                                    
     emergency  rooms can  keep their  doors  open and  keep                                                                    
     staffed with  needed specialists and providers  to best                                                                    
     treat patients in emergencies.                                                                                             
                                                                                                                                
     We hope we can count on your support for HB 193.                                                                           
                                                                                                                                
3:12:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON,  noting  that   there  were  two  major                                                               
insurance  providers  in  Alaska,   asked  if  her  business  was                                                               
currently in-network for either of those providers.                                                                             
                                                                                                                                
DR. ZINK expressed agreement that her group was in-network.                                                                     
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked if  her group contracted  with out                                                               
of network physicians.                                                                                                          
                                                                                                                                
DR. ZINK replied that her  group covered the emergency department                                                               
at the Mat-Su  Regional Medical Center, and, as they  billed as a                                                               
unified  group,   they  were  in-network   with  all   the  major                                                               
providers.   She explained that  most providers wanted to  be in-                                                               
network and did  not want to shift that burden  to patients.  She                                                               
stated that they did not  have any contract negotiations, and, as                                                               
they were busy with patients,  they "just take what the insurance                                                               
companies give  us."   She declared "that's  the reason  why this                                                               
legislation is really important."                                                                                               
                                                                                                                                
DR. ZINK  expressed her  agreement with  Representative Johnston,                                                               
that the  bulk of their  emergency room visits, if  insured, were                                                               
in-network.                                                                                                                     
                                                                                                                                
3:14:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  about the  operations  in  other                                                               
emergency room facilities in Alaska.                                                                                            
                                                                                                                                
DR. ZINK  replied that there  was a similar model  throughout the                                                               
state for emergency providers, that  most were independent groups                                                               
contracted with  a hospital.   She pointed out that  the networks                                                               
were shrinking  in the  Lower 48,  resulting in  larger insurance                                                               
gaps.   She  expressed her  hope that  this proposed  legislation                                                               
would get in front of that.   She declared that her group did not                                                               
send many  balance bills, although this  was a huge issue  in the                                                               
Lower 48.                                                                                                                       
                                                                                                                                
3:15:04 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony on HB 193.                                                                              
                                                                                                                                
3:15:33 PM                                                                                                                    
                                                                                                                                
SAMI  ALI, MD,  Alaska Emergency  Medicine Associates,  explained                                                               
that her  group of physicians  staffed the emergency room  at the                                                               
Providence  Alaska  Medical  Center  and  provided  care  to  all                                                               
patients who  came through the  emergency room.  She  pointed out                                                               
that the  facility did  not use mid-level  providers.   She asked                                                               
that  the  80th  percentile  rule be  preserved  to  prevent  any                                                               
reduction in  quality care or  to accessibility for  medical care                                                               
for patients  in Alaska.   She declared  support for  proposed HB
193 as it would enable physician  groups in Alaska to recruit and                                                               
retain  high quality  physicians,  as this  was  a difficulty  in                                                               
Alaska.                                                                                                                         
                                                                                                                                
3:18:38 PM                                                                                                                    
                                                                                                                                
STEVEN  COMPTON,   MD,  President,  Alaska  Heart   and  Vascular                                                               
Institute, stated  that practicing cardiology in  Anchorage was a                                                               
challenge, as it  was difficult to recruit physicians  to come to                                                               
Alaska.    He   reported  that  to  attain  the   same  ratio  of                                                               
cardiologists  to  population  as  the  Lower  48,  it  would  be                                                               
necessary to more than double  the number of cardiologists in the                                                               
state.    He noted  that,  as  the  Baby Boomer  demographic  was                                                               
entering the  age for  needing more  cardiology care,  the demand                                                               
for  services had  "accelerated tremendously  in the  last decade                                                               
and  will continue  to do  so," and  that the  state was  already                                                               
underserved.  He  stated that it was a  fundamental commitment of                                                               
his organization  to provide  care to  anyone who  walked through                                                               
the door.   He reported that  his group served 30  percent of the                                                               
state Medicare  population, and noted  that all  Medicare clinics                                                               
lost  money and  were heavily  subsidized by  the hospitals.   He                                                               
said that  the "way we keep  the lights on is  by cost shifting."                                                               
He explained that the Medicare  charges were paid with funds from                                                               
private payers,  allowing them  to maintain access  to care.   He                                                               
declared support for the proposed bill.                                                                                         
                                                                                                                                
3:23:10 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony on HB 193.                                                                              
                                                                                                                                
3:23:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY moved  to report  CSHB 193,  Version 30-                                                               
LS0466\T,   Wallace,  3/6/18,   out  committee   with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  193(HSS) was moved from the  House Health and                                                               
Social Services Standing Committee.                                                                                             

Document Name Date/Time Subjects
SB 174 30-LS1258 D.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Sponsor Statement.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Fiscal Note.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Supporting Documents.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Public Input.pdf HHSS 3/29/2018 3:00:00 PM
SHSS 2/21/2018 1:30:00 PM
SB 174
SB 174 Supporting Documents - Written Testimony - Laura Bonner - 3.13.2018.pdf HCRA 3/13/2018 8:00:00 AM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Supporting Document-Support Letter 03.15.2018.pdf HCRA 3/15/2018 8:00:00 AM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB 174 Supporting Documents - Written Testimony - Laura Bonner - 3.13.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Fiscal Note DHSS-SDSA 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Sectional Analysis ver D 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Sponsor Statement 03.15.18.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 supporting Documents-2018 Alaska's Developmental Disabilities System 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Supporting Document-Support Letter-Lizette Stiehr 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HR 3
SB 174
SB174 Supporting Document-Support Letters 03.15.2018.pdf HHSS 3/20/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
SB 174
SB174 Supporting Document--Written Testimony from Kenai LIO 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
SB 174
Sai-Ling Liu 2017_Redacted.pdf HHSS 3/29/2018 3:00:00 PM
Medical Board Confirmation
HB 193 Addtional Documents - Policy Implications of Legislating AlaskaCare Benefits Final 2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Document - Letter of Concern AHIP 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Documents - DOA Position Statement 3.26.18.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Document - NCSL Reports 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Additional Document - Emergency CPT Code Table 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Supporting document - Georgetown Universtiy Health Policy Insititute 3.28.2018.pdf HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Definitions 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Draft Proposed Blank CS ver T 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Sectional Analysis 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Sponsor Statement 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB193 Fiscal Note CED--IO 3.7.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
SSSB108 Supporting Document Backlog Stats DCCED 2-13-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Supporting Document Flow Chart 2016.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) Fiscal Note DCCED 3-14-18.PDF HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) Sectional Analysis 3-14-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) vsn I 3-14-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Power Point 3-24-18_cg.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Version U 1-18-18.PDF HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108(FIN) Explanation of Changes 3-14-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 CS (FIN) Sponsor Statement 3-13-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support - Foundation Health Partners 2-7-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support ASMA 2-27-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support ASMB 2-9-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Letter of Support Cmmsr Navarre 2-2-16.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
SSSB108 Support Letter AK State Medical Bd 1-24-18.pdf HHSS 3/29/2018 3:00:00 PM
SB 108
HB358 Sectional Analysis ver J 03.07.18.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 358
HJR032 Sponsor Statement 2.27.18.pdf HHSS 3/29/2018 3:00:00 PM
HJR 32