Legislature(2015 - 2016)BARNES 124
04/15/2015 03:15 PM LABOR & COMMERCE
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HB 159-HEALTH CARE RETAINER; INSURANCE EXEMPT 4:52:28 PM CHAIR OLSON announced that the next order of business would be HOUSE BILL NO. 159, "An Act exempting certain health care agreements from regulation as insurance." 4:53:38 PM REPRESENTATIVE WES KELLER, Alaska State Legislature, stated he served on the Alaska Health Commission in 2007. He has become convinced that health care reform means that the market must be working. This bill would exempt direct primary care associations from the Alaska insurance code definitions of insurance. The bill would not propose any new regulations or incur additional expenses. This would allow primary care physicians to have contractual agreement with patients for primary care services. It would remove the third party payer since patients would subscribe to the primary care service. He characterized it as the doctor being one call away. The contracts would be handled by existing law. He offered that the positive effects of this bill include improved quality and access of care that patients would have with their provider, which could reduce overall health care cost since administrative costs are drastically reduced. Further, the number of patients per doctor is also higher than the current system. He highlighted that doctors often have 15 minutes per patient and if one takes longer it can create stress for everyone. 4:57:04 PM REPRESENTATIVE HUGHES thanked for bringing this concept forward. She asked how reimbursement would work for the patient since it will prohibit the provider from billing insurance. KEN TRUITT, Staff, Representative Wes Keller, Alaska State Legislature, on behalf of the prime sponsor, Representative Wes Keller, said the concept behind the bill is that it wouldn't change any existing relationship. Patients can still seek reimbursement for their primary care costs, including membership into the primary care network. 4:58:03 PM REPRESENTATIVE HUGHES asked whether insurers will pay a monthly service fee and if patient and doctor contracts happen in other states. MR. TRUITT said he was not certain. The language for HB 159 was modeled on legislation that passed in Michigan. He has also reviewed other states that have primary care legislation, including Utah. CHAIR OLSON answered that several bills before the legislature this session are related to medical costs. 4:58:51 PM REPRESENTATIVE LEDOUX asked for further clarification on whether this bill would prohibit the doctors from billing insurance companies. MR. TRUITT answered yes; that the concept was to relieve physicians from dealing with third-party payers. For example, he said that billing manuals for Blue Cross was over 200 pages and showed several. The benefit from the provider would be payment via contract with the patient and no longer need to deal with the third party payers. 5:00:00 PM CHAIR OLSON asked for a copy of the manuals. REPRESENTATIVE KELLER offered to provide it. 5:00:09 PM REPRESENTATIVE LEDOUX said that currently some doctors hold down fees by not billing insurance. She asked the reason to have statutory provisions that prohibit doctors from billing an insurance company since doctors can currently opt not to bill insurance. She said it seemed to interfere, which didn't seem like limited government to her. REPRESENTATIVE KELLER offered to provide the logic from other states. 5:01:06 PM REPRESENTATIVE KITO asked which provider networks would use this program. He asked whether any doctor's office or company was seeking an alternate option or if it was a concept that the sponsor wanted to make available. REPRESENTATIVE KELLER replied he did not specifically know of anyone although he has doctor friends who have expressed interest or positively inclined. He said he became acquainted with health care agreements via the Alaska Health Commission, however, this type of contract is not currently available. 5:02:08 PM REPRESENTATIVE KITO asked whether these health care agreement contracts will result in monthly fees for patients or a fee for services. He was unsure how the patient would find the billing code and the amount of the procedure. REPRESENTATIVE KELLER answered that this bill does not speak to fees, but he noted it would need to be addressed. He said this bill allows contracts between doctor and their patients. He surmised that some of these contracts or subscriptions might even include clauses for visitor care. For example, a patient might pay a certain amount for a subscription for primary care, which allows visiting family or friends to use the service when in town. He said that in other states the rates have ranged from $80-$200 per month for these subscriptions. 5:04:07 PM REPRESENTATIVE JOSEPHSON asked for the client and patient care protections that might be given up in terms of regulatory protections in order to accrue the benefits. REPRESENTATIVE KELLER answered that he wasn't aware of any increased risk to patients. 5:04:55 PM CHAIR OLSON offered that the sponsor may continue work during the legislative interim. REPRESENTATIVE KELLER said that the Division of Insurance has indicated a willingness to work on this bill during the interim. 5:05:33 PM REPRESENTATIVE LEDOUX noted that this bill doesn't prohibit doctors from billing insurance, but the process would be addressed as part of the contract. She recalled reading about these services, also known as concierge services, in which people pay $200-300 per month to have the benefit of private physicians. She recalled that concierge plans have become popular in California in order for people to avoid dealing with Medicaid, Medicare, and the various private insurers. Again, she said, it might be difficult if the doctor doesn't provide billing information, but some people might be interested in this to get a doctor's appointment. 5:06:56 PM REPRESENTATIVE KELLER said many stories are available online that illustrate the benefits of this type of health care. [HB 159 was held over.]