Legislature(2017 - 2018)BARNES 124

04/09/2018 03:15 PM LABOR & COMMERCE

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03:17:26 PM Start
03:18:21 PM Confirmation Hearing(s)
03:39:04 PM HB193
04:11:39 PM HB358
04:20:42 PM HB376
04:51:28 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 358 INSURANCE COVERAGE FOR TELEHEALTH TELECONFERENCED
Heard & Held
-- Public Testimony --
+ HB 193 HEALTH CARE; BALANCE BILLING TELECONFERENCED
Heard & Held
-- Public Testimony --
*+ HB 376 ESTABLISH THE ALASKA STATE BANK TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
              HB 193-HEALTH CARE; BALANCE BILLING                                                                           
3:39:04 PM                                                                                                                    
                                                                                                                                
CHAIR KITO  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."                                                                                                               
                                                                                                                                
3:39:21 PM                                                                                                                    
                                                                                                                                
RYAN JOHNSTON,  Staff, Representative Jason Grenn,  introduced HB
193  on  behalf  of  Representative Grenn,  prime  sponsor.    He                                                               
paraphrased  the   sectional  analysis  [included   in  committee                                                               
packet], which reads as follows [original punctuation provided]:                                                                
                                                                                                                                
     Section 1:  Establishes a "Hold Harmless"  standard for                                                                    
     insurance providers in the situation where a covered                                                                       
     person  receives medical  care  from an  out-of-network                                                                    
     medical   provider  in   an  emergency   situation.  An                                                                    
     insurance provider will hold  a covered person harmless                                                                    
     to ensure that  the covered person only  pay what would                                                                    
     have  been paid  if  the medical  provider  was an  in-                                                                    
     network provider.                                                                                                          
                                                                                                                                
     Outlines  the  standards  to establish  the  situations                                                                    
     where a medical provider  cannot balance bill a covered                                                                    
     person. An  insurance provider shall pay  a non-network                                                                    
     health  care  provider  if  the  health  care  provider                                                                    
     renders to a covered person;                                                                                               
        • emergency services or treats an emergency medical                                                                     
          condition                                                                                                             
        • services at an in-network facility                                                                                    
        • services for which a referral was made by an in-                                                                      
          network health care provider to an out-of-network                                                                     
          health care provider without the explicit written                                                                     
          consent of the covered person.                                                                                        
     The covered  person is  still required  to pay  the in-                                                                    
     network  rates  for  the  deductible,  coinsurance  and                                                                    
     copayment.  The amount  paid by  the covered  person is                                                                    
     required  to be  counted  towards  the covered  persons                                                                    
     deductible.                                                                                                                
     The final  payment determined for the  medical provider                                                                    
     will subtract any amount paid by the covered person.                                                                       
     The insurance provider  is to pay the  greater of three                                                                    
     possible amounts;                                                                                                          
        • the median negotiated contract rate generated                                                                         
          using  the in-network  health  care providers  for                                                                    
          the service provided;                                                                                                 
        • That is equal to the 80th percentile of charges                                                                       
          for the  services calculated  using a  method that                                                                    
          establishes a statistically  credible profile that                                                                    
          reflects the general  cost differences between the                                                                    
          geographical area where  the service was preformed                                                                    
          and  the other  geographical areas  when performed                                                                    
          by a health  care provider in the  same or similar                                                                    
          specialty; or                                                                                                         
        • That would be paid under Medicare for the service                                                                     
          provided.                                                                                                             
     Medical  providers are  required to  send all  bills to                                                                    
     the  insurance  provider,  except for  the  deductible,                                                                    
     coinsurance and copayment.                                                                                                 
     Contains a  clause that if  a covered  person knowingly                                                                    
     elects to  use an out-of-network medical  provider then                                                                    
     they can be balanced billed for the services.                                                                              
                                                                                                                                
     Section 2:  Health care insurance plans  obtained under                                                                    
     AS  39.30.090 or  provided under  AS 39.30.091  will be                                                                    
     subject  to the  requirements  of  secs. 21.36.512  and                                                                    
     21.36.513.                                                                                                                 
                                                                                                                                
     Section 3: Bans the practice  of "Balance Billing" by a                                                                    
     medical  provider under  the criteria  of section  1 of                                                                    
     the  bill. Stipulates  that  the  medical provider  can                                                                    
     still   bill  for   the  deductible,   coinsurance  and                                                                    
     copayment.                                                                                                                 
     States that  a medical provider will  be paid according                                                                    
     to section 1 of the bill.                                                                                                  
                                                                                                                                
     Section  4:  Establishes  the  punishment  for  medical                                                                    
     providers   under  the   Unfair  Trade   Practices  and                                                                    
     Consumer Protection.                                                                                                       
                                                                                                                                
3:43:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH asked whether the bill sponsor has heard                                                                   
concerns about equity for small businesses.                                                                                     
                                                                                                                                
MR. JOHNSTON answered  that was the motivation  behind Section 2.                                                               
He said that requiring private  insurers to follow the directive,                                                               
the state  plan should  be held  to the same  standard.   He said                                                               
some aspects could not be addressed at the state level.                                                                         
                                                                                                                                
REPRESENTATIVE BIRCH asked about the fiscal note (FN).                                                                          
                                                                                                                                
MR. JOHNSTON answered it should be  a cost savings for the state.                                                               
He said  that currently the  Division of Retirement  and Benefits                                                               
pays 100 percent of the  billed amount in an emergency situation.                                                               
He  added the  state  does  hold state  employees  harmless.   He                                                               
stated the  proposed bill states that  it has to be  in the state                                                               
in which the  service was rendered, for example  for an emergency                                                               
room  visit in  Oregon,  the  state would  just  use Oregon's  80                                                               
percentile.  He said the language could be made clearer.                                                                        
                                                                                                                                
3:46:27 PM                                                                                                                    
                                                                                                                                
DR.  ANNE  ZINK, MD,  Matsu  Emergency  Department, testified  in                                                               
support of  HB 193.   She presented a PowerPoint  presentation on                                                               
"HB  193:  A Patient  Protection  Bill,[included    in  committee                                                               
packet]. She said the question is  what is right for the patient.                                                               
She stated the bill would end  the "surprise insurance gap."  She                                                               
described a  scenario of  someone in  an emergency  situation and                                                               
the subsequent related  billing for services.   She explained the                                                               
scenario  in terms  of  in  and out  of  network  services.   She                                                               
explained that the  bill would put a ban on  balance bill, ending                                                               
the "surprise  insurance gap."   She underlined that in  order to                                                               
preserve  a  safety  net  for  patients, the  system  has  to  be                                                               
geographically relevant.                                                                                                        
                                                                                                                                
REPRESENTATIVE  WOOL asked  about health  spending versus  health                                                               
costs.                                                                                                                          
                                                                                                                                
DR. ZINK answered she was speaking to health spending.                                                                          
                                                                                                                                
3:56:56 PM                                                                                                                    
                                                                                                                                
DR. ZINK  spoke to  "Alaska and  the 80th  Percentile Regulation:                                                               
Myth and  Reality."  She  said Alaska  is not the  most expensive                                                               
area in the  country for health care, as it  follows the District                                                               
of  Columbia.     She  said  that  rural  states   pay  more  for                                                               
physicians.  She  remarked that the 80th percentile  rule did not                                                               
change the  Alaska per capita  private health  insurance spending                                                               
curve.  She  added that Connecticut and New  York established the                                                               
80th  percentile as  a benchmark  for  payment in  2014 and  many                                                               
states are considering similar patient  protection measures.  She                                                               
underlined  there were  no  increases in  charges after  the  80                                                                
percentile was adopted.                                                                                                         
                                                                                                                                
DR. ZINK  pointed out that  the National  Insurance Commissioners                                                               
model  legislation   regarding  out-of-network   balance  billing                                                               
stated as a guide:                                                                                                              
                                                                                                                                
       A. For the purposes of this subsection, "usual and                                                                       
         customary cost" shall mean the eightieth percentile                                                                    
         of  all charges  for  the  particular  health  care                                                                    
         service performed  by  a provider  in  the same  or                                                                    
         similar  specialty   and  provided   in  the   same                                                                    
         geographical area  as  reported  in a  benchmarking                                                                    
         database  maintained by  a  nonprofit  organization                                                                    
         specified  by   the  commissioner.   The  nonprofit                                                                    
         organization  shall  not   be  affiliated   with  a                                                                    
         carrier.                                                                                                               
                                                                                                                                
4:00:02 PM                                                                                                                    
                                                                                                                                
DR. ZINK  went on to  explain how emergency costs  are coded                                                                    
between Anchorage, Alaska, and  Seattle, Washington, for in-                                                                    
network  and  out-of-network  services.    She  showed  that                                                                    
emergency  costs   are  already   the  same  or   less  that                                                                    
                                          th                                                                                    
neighboring states.  She said that the 80 percentile is a                                                                       
patient protection issue.                                                                                                       
                                                                                                                                
CHAIR KITO  asked whether  Americas Health  Insurance Association                                                               
had indicated  it would  be harder to  bring physicians  into the                                                               
network if the proposed bill were to  pass.  He asked Dr. Zink to                                                               
give her thoughts.                                                                                                              
                                                                                                                                
DR.  ZINK answered  she does  not have  concerns.   She explained                                                               
that if  there is  a relatively  good out-of-network  minimum, it                                                               
encourages providers to be in-network.                                                                                          
                                                                                                                                
REPRESENTATIVE  BIRCH  asked where  the  hospitals  fit into  the                                                               
issue.                                                                                                                          
                                                                                                                                
DR. ZINK shared her understanding  the hospitals would be held to                                                               
the same provision in the proposed bill.                                                                                        
                                                                                                                                
4:04:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  asked Dr. Zink  to explain the  database she                                                               
mentioned in her presentation.                                                                                                  
                                                                                                                                
DR. ZINK  answered that  the proposed bill  does not  specify how                                                               
geographic  relevance   and  a   non-profit  database   would  be                                                               
established.                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL asked about non-emergency medical services.                                                                 
                                                                                                                                
DR. ZINK answered  that anything a patient feels  is an emergency                                                               
has to be examined.  She  said the issue of emergency definitions                                                               
is defined in federal law.                                                                                                      
                                                                                                                                
CHAIR KITO  mentioned a scenario  in which an  insurance employee                                                               
made a point of asking the  anesthesiologist whether he or she is                                                               
in or out of network before proceeding.                                                                                         
                                                                                                                                
DR. ZINK added that  at time the person who is  in network is not                                                               
available for the procedure and  someone who is out-of-network is                                                               
used.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  WOOL  asked whether  the  answer  is to  ask  the                                                               
medical professional prior to any  procedure whether they are in-                                                               
network.                                                                                                                        
                                                                                                                                
DR. ZINK answered  in the affirmative.  She added  that is why it                                                               
is  so important  to  pass  the proposed  legislation,  as in  an                                                               
emergency that scenario would not be possible.                                                                                  
                                                                                                                                
4:11:14 PM                                                                                                                    
                                                                                                                                
CHAIR KITO opened public testimony on HB 193.                                                                                   
                                                                                                                                
CHAIR KITO held over HB 193.                                                                                                    
                                                                                                                                

Document Name Date/Time Subjects
HB193 Supporting Documents Alaska ACEP 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Supporting Documents EDPMA_ALASKA_FINAL 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Supporting Documents Balance Billing by Providers State Consumer Protections - The Commonwealth Fund 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Supporting Documents Georgetown University Health Policy Institute 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Supporting Documents NASHP Surprise-Balance-Billing 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Supporting Documents Surprise Medical Bills _ The Henry J. Kaiser Family Foundation 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 ver I 3.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Additional Documents Emergency CPT Code Reference Table 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Definitions 03.08.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Fiscal Note DCCED DOI 3.2.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Fiscal Note DOA DRB 4.5.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Sectional Anaylsis ver I 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 Sponsor Statement 03.30.2018.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB358 ver J 03.30.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 358
HB358 Sectional Analysis ver J 03.30.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 358
HB376 Support Document Economists Ignore One of Capitalism's Biggest Problems.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Support Document Reconstruction Finance Corporation.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Support Document Public Banking Institute-FAQ.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Support Document Why Public Banks Outperform Private Banks.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 ver O.PDF HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Economic Charts.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Opposition Letter.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Sectional Analysis ver A 4.6.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Sponsor Statement 4.6.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Support Document Bank of North Dakota.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB376 Support Document Benjamin Franklin quote House of Commons 1766.pdf HL&C 4/9/2018 3:15:00 PM
HB 376
HB193 Support Letters 4.9.18.pdf HL&C 4/9/2018 3:15:00 PM
HB 193
HB193 AKACEP presentation.pdf HL&C 4/9/2018 3:15:00 PM
HB 193