Legislature(2009 - 2010)BUTROVICH 205

02/15/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES

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01:32:47 PM Start
01:33:17 PM Presentation: Facing Foster Care in Alaska
02:03:33 PM SB258
02:49:50 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Facing Foster Care in Alaska
Moved SB 258 Out of Committee
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 15, 2010                                                                                        
                           1:32 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Bettye Davis, Chair                                                                                                     
Senator Joe Paskvan, Vice Chair                                                                                                 
Senator Johnny Ellis                                                                                                            
Senator Joe Thomas                                                                                                              
MEMBERS ABSENT                                                                                                                
Senator Fred Dyson                                                                                                              
ALSO PRESENT                                                                                                                  
Senator Charlie Huggins                                                                                                         
Senator Linda Menard                                                                                                            
Representative Carl Gatto                                                                                                       
COMMITTEE CALENDAR                                                                                                            
PRESENTATION: Facing Foster Care in Alaska                                                                                      
     - HEARD                                                                                                                    
SENATE BILL NO. 258                                                                                                             
"An  Act prohibiting  health care  insurers  that provide  dental                                                               
care coverage  from setting  a minimum  age for  receiving dental                                                               
care coverage, allowing  those insurers to set a  maximum age for                                                               
receiving dental  care coverage  as a dependent,  and prohibiting                                                               
those insurers  from setting fees  that a dentist may  charge for                                                               
dental services not covered under the insurer's policy."                                                                        
     - MOVED SB 258 OUT OF COMMITTEE                                                                                            
SENATE BILL NO. 219                                                                                                             
"An  Act  establishing  a  traumatic  brain  injury  program  and                                                               
registry  within the  Department of  Health and  Social Services;                                                               
and relating  to medical assistance coverage  for traumatic brain                                                               
injury services."                                                                                                               
     - SCHEDULED BUT NOT HEARD                                                                                                  
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB 258                                                                                                                  
SHORT TITLE: DENTAL CARE INSURANCE                                                                                              
SPONSOR(s): SENATOR(s) HUGGINS                                                                                                  
02/05/10       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/05/10       (S)       HSS, L&C                                                                                               
02/15/10       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
AMANDA METIVIER, statewide coordinator                                                                                          
Facing Foster Care in Alaska (FFCA)                                                                                             
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Presented information on foster care in                                                                   
REPRESENTATIVE LES GARA                                                                                                         
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Spoke about foster care.                                                                                  
SHARON LONG                                                                                                                     
Staff to Senator Huggins                                                                                                        
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions about SB 258.                                                                          
LINDA HALL, director                                                                                                            
Division of Insurance                                                                                                           
Department of Commerce, Community and Economic Development                                                                      
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Answered questions about SB 258.                                                                          
PAT SHIER, director                                                                                                             
Division of Retirement and Benefits                                                                                             
Department of Administration                                                                                                    
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions about SB 258.                                                                          
DR. DAVID LOGAN                                                                                                                 
Alaska Dental Society                                                                                                           
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 258.                                                                                         
DR. JOHN WALLER                                                                                                                 
Alaska Dental Society                                                                                                           
Fairbanks, AK                                                                                                                   
POSITION STATEMENT: Supported SB 258.                                                                                         
CHRIS FRANK                                                                                                                     
Governmental Affairs Department                                                                                                 
Aetna Insurance                                                                                                                 
POSITION STATEMENT: Opposed SB 258.                                                                                           
ACTION NARRATIVE                                                                                                              
1:32:47 PM                                                                                                                    
CHAIR BETTYE DAVIS  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:32 p.m.  Present at the                                                               
call to order were Senators Ellis, Paskvan and Chair Davis.                                                                     
          ^PRESENTATION: FACING FOSTER CARE IN ALASKA                                                                       
1:33:17 PM                                                                                                                    
CHAIR  DAVIS announced  the first  order of  business would  be a                                                               
presentation on foster care in Alaska.                                                                                          
1:33:39 PM                                                                                                                    
AMANDA  METIVIER, Statewide  Coordinator, Facing  Foster Care  in                                                               
Alaska  (FFCA), said  FFCA advocates  for changes  to the  foster                                                               
care  system  by  sharing  personal  experiences.  FFCA  recently                                                               
finished a  digital storytelling project featuring  12 stories on                                                               
the topics of permanency, education and culture.                                                                                
1:35:10 PM                                                                                                                    
MS. METIVIER  began with Courtney's video  on education entitled:                                                               
"It's all  about me". Courtney said  she is 21 years  old and has                                                               
six brothers. She  was in foster care for  three years, separated                                                               
from three of  her brothers. She has been in  20 placements and a                                                               
behavioral hospital.  She was made fun  of in school for  being a                                                               
foster child. Going to school  made her depressed. In high school                                                               
she stayed within  the native program but  still started skipping                                                               
school due to depression and the separation from her family.                                                                    
1:36:44 PM                                                                                                                    
SENATOR THOMAS joined the meeting.                                                                                              
Courtney's video continued.  She failed two years  of high school                                                               
and gave up.  She went back to  live at home with  her mother and                                                               
enjoyed being back  with her brothers. Today she  is interning at                                                               
the community service center and working on her GED.                                                                            
1:37:37 PM                                                                                                                    
MS. METIVIER noted  about 40 percent of youth who  age out of the                                                               
foster care system end up  homeless. She introduced Marie's video                                                               
about  culture,  entitled: "The  Side  Effects  of Foster  Care."                                                               
Marie said she  has been in and out of  child protective services                                                               
her whole life due to her  mother's alcoholism. A couple of years                                                               
ago, she  stayed at  the children's home  in Kotzebue,  which she                                                               
appreciated  as  she did  not  have  to "migrate  through  school                                                               
districts".  Her cousin  brought  her some  native  food and  the                                                               
staff told her  she could not eat it because  it was not approved                                                               
by the FDA.  She said, "I am  an Alaska Native. Food  is a really                                                               
big part of  my culture" and "you can imagine  the shock, outrage                                                               
and sadness I felt when I  learned the first side effect of being                                                               
in foster care: The loss of my culture."                                                                                        
1:40:34 PM                                                                                                                    
MS. METIVIER  introduced the next  video clip, on  permanency, by                                                               
Angel, entitled, "My God Given Gift".  Angel said she has been in                                                               
foster  care on  and off  for as  long as  she can  remember. Her                                                               
birth mother  was an  alcoholic. Angel said  she has  been abused                                                               
"in  every  way possible".  She  took  care  of her  two  younger                                                               
brothers  but they  were  often separated  from  each other.  Her                                                               
birth mom  died when she  was 13 years  old. She and  one brother                                                               
moved to  an aunt's house,  then to a  30 day emergency  home and                                                               
then in  with the  Adams family. The  Adams family  treated Angel                                                               
like  family. She  doubted the  Adams family's  talk of  adoption                                                               
right  up  until  the  day  she  and  one  brother  were  in  the                                                               
courtroom. That  was the happiest  she has ever been  even though                                                               
her eldest brother was not adopted.                                                                                             
1:43:47 PM                                                                                                                    
MS. METIVIER introduced the next  video clip, also on permanency,                                                               
by Becca.  It was titled: "Finding  a Family". Becca said  she is                                                               
currently a ward  of the state. She has been  in custody for over                                                               
6  years but  she grew  up taking  care of  herself. She  entered                                                               
foster  care  during  junior high.  She  switched  homes  several                                                               
times, stayed  at homeless shelters, treatment  facilities and on                                                               
the streets.  She found her  current permanent placement  after a                                                               
failed reunification  with her mother  and 23  placement changes.                                                               
She is a college student,  a photographer and a representative of                                                               
the state's foster youth and  alumni. Permanence has bettered her                                                               
outcome exponentially; every youth has the right to that.                                                                       
1:47:44 PM                                                                                                                    
MS. METIVIER started  one final video by  Shane, entitled "Within                                                               
Temptation." Shane  said alcohol  has been a  part of  his family                                                               
for  as  long as  he  can  remember.  He witnessed  his  parent's                                                               
arguments escalate to  heartaches and fights. His  heart has been                                                               
full  of  fear  and  that   eventually  mutated  to  madness.  He                                                               
described a fight  he had with his father. Alcohol  was the ruler                                                               
in his house.  He was taken away  from his home and  it felt like                                                               
being  "thrown down  a  flight of  stairs".  He discussed  taking                                                               
things  one  step  at  a  time  with  the  help  of  friends  and                                                               
advocates. He described his  thoughts, experience and temptations                                                               
with the metaphor of a storm.                                                                                                   
1:51:11 PM                                                                                                                    
CHAIR  DAVIS  acknowledged  Representative  Gara's  presence  and                                                               
thanked him for  his advocacy in foster  care legislation, having                                                               
been a foster  child himself. She also  recognized Senator Menard                                                               
and Senator Huggins as being in the room.                                                                                       
CHAIR DAVIS gave  further thanks to Ms. Metivier for  her work to                                                               
improve foster care. She noted  support that Rasmussen Foundation                                                               
and Kacey Foundation have given  Ms. Metivier's work. Chair Davis                                                               
noted that she used to be  a foster care coordinator in Anchorage                                                               
and spent a lot of time  with foster children and families. Angel                                                               
was adopted by Senator Davis' cousin, the Adams family.                                                                         
1:55:10 PM                                                                                                                    
SENATOR THOMAS  asked the ages of  the kids when the  video clips                                                               
were made.                                                                                                                      
MS.  METIVIER replied  that  the video  project  was finished  in                                                               
November. All clips were by kids between the ages of 18 and 20.                                                                 
1:55:46 PM                                                                                                                    
SENATOR ELLIS asked  Ms. Metivier what the next step  is and what                                                               
she hopes to achieve this session in terms of policy or budget.                                                                 
MS. METIVIER replied  that one goal is  educational stability. As                                                               
youth  bounce  between foster  home  and  other placements,  they                                                               
bounce between schools  and fall behind. By the time  they get to                                                               
high  school, foster  kids are  so far  behind that  they do  not                                                               
graduate. She  spoke with the  Anchorage school  district's Child                                                               
in Transition  program and found that  only a quarter of  the 9th                                                               
graders were  on track to graduate  on time. Foster kids  are not                                                               
making it through high school and  then are out of custody at 18.                                                               
If  they  do not  achieve  permanence  before  aging out  of  the                                                               
system,  they  do  not  have  a  support  system  in  place.  She                                                               
mentioned current  legislation about extending foster  care to 21                                                               
years old  and tuition  waivers for  kids who do  age out  of the                                                               
system. Currently  the state supplies  ten tuition  waivers; last                                                               
year 12  kids applied.  If kids  do not  get the  tuition waiver,                                                               
they often do not try again because they have other struggles.                                                                  
1:57:25 PM                                                                                                                    
SENATOR THOMAS asked the ages that Ms. Metivier works with.                                                                     
MS. METIVIER said the members of FFCA are ages 16-24.                                                                           
SENATOR THOMAS  asked how  many potential  foster homes  exist in                                                               
relation to the number of kids who need them.                                                                                   
MS.  METIVIER said  she  does not  know the  number  but knows  a                                                               
shortage exists.  In Anchorage, a  lot of older youth  are placed                                                               
at Covenant House  and stay at the shelter off  and on. Placement                                                               
shortages  are  worse for  older  kids  because people  are  more                                                               
hesitant to take in teenagers.                                                                                                  
1:58:46 PM                                                                                                                    
CHAIR  DAVIS asked  Representative  Gara to  speak about  current                                                               
1:59:12 PM                                                                                                                    
REPRESENTATIVE LES GARA  said Ms. Metivier is  the best advocate.                                                               
Some issues  that FFCA is  pushing can  be done as  budget items,                                                               
though legislation could be better.  The effort that a child with                                                               
a stable  family has to  put forth  is different than  the effort                                                               
that a child  who has bounced between 10 homes  has to put forth.                                                               
As  legislators   consider  the  qualifications   for  university                                                               
financial aid, the reality for foster kids must be addressed.                                                                   
CHAIR   DAVIS  agreed   foster  children   have  to   be  treated                                                               
differently  when looking  for scholarships.  She suggested  that                                                               
perhaps tuition waivers  should be increased from 10 to  20 or an                                                               
unlimited number.  She also noted  the push to allow  foster kids                                                               
to stay within  the school they were in when  they entered foster                                                               
care rather than changing schools every time they change homes.                                                                 
CHAIR DAVIS called a brief at ease from 2:02 p.m. to 2:03 p.m.                                                                  
        SB 258-DENTAL CARE INSURANCE/PREFERRED PROVIDERS                                                                    
2:03:33 PM                                                                                                                    
CHAIR DAVIS announced the consideration of SB 258.                                                                              
SENATOR  HUGGINS,  sponsor   of  SB  258,  said  SB   258  is  an                                                               
opportunity to  assist young people  in maintaining  oral health.                                                               
SB  258  avoids a  minimum  age  [for dental  coverage].  Similar                                                               
legislation has been introduced in  20 states and has been passed                                                               
in one.  Whether or not  an insurance  company should be  able to                                                               
cap fees not covered by the insurance company is also an issue.                                                                 
2:08:08 PM                                                                                                                    
SHARON LONG,  staff to Senator  Huggins, said some  contracts are                                                               
in effect in Alaska that do "fee capping" currently.                                                                            
2:09:00 PM                                                                                                                    
LINDA  HALL,  director,  Division  of  Insurance,  Department  of                                                               
Commerce  and Economic  Development (DCCED),  showed a  pie chart                                                               
and  the   segment  representing  the  portion   of  the  Alaskan                                                               
insurance marketplace  that the Division of  Insurance regulates.                                                               
When the  legislature makes mandates, changes  or prohibitions to                                                               
insurance programs,  only a small  piece of the pie  is affected.                                                               
These kinds of  changes impact individuals and  small groups, not                                                               
employers  of   over  100  employees.  She   cautioned  that  the                                                               
legislature recognize who the legislation  will impact and who it                                                               
will not impact. She is neutral on SB 258.                                                                                      
2:11:19 PM                                                                                                                    
CHAIR  DAVIS  said she  appreciates  that  small businesses,  etc                                                               
would be  affected by SB 258.  She asked if the  legislature also                                                               
could also mandate that the state plan abide by the law.                                                                        
MS.  HALL replied  that the  legislature can  choose to  have the                                                               
legislation apply to the state  plan. However, federal law cannot                                                               
be  pre-empted to  have  this  proposed law  apply  to the  self-                                                               
insured  groups   because  they   are  regulated   federally  and                                                               
different qualifications exist for Medicare and Medicaid.                                                                       
2:12:27 PM                                                                                                                    
SENATOR  THOMAS  read from  Section  1  of  SB 258  [amending  AS                                                               
      (a) A health care insurer who provides coverage for                                                                       
         dental care may not include in the health care                                                                         
     insurance plan or contract a provision that                                                                                
         (1)   prohibits   a   covered   person   from                                                                          
      obtaining dental care services from a dentist of the                                                                      
     person's choice, including a specialist;"                                                                                  
He  asked how  many of  those, not  impacted by  SB 258,  allow a                                                               
different  tier of  compensation outside  the preferred  provider                                                               
2:14:05 PM                                                                                                                    
MS. HALL was unsure of Senator  Thomas' question. She said SB 258                                                               
does  not  impact a  preferred  provider  network either  in  the                                                               
private marketplace or the self-insured market place.                                                                           
SENATOR THOMAS  said that a  small number of people  are affected                                                               
if SB  258 prevents an  insurer from implementing a  policy which                                                               
forces a person to go  to certain providers. But other provisions                                                               
in SB 258 allow  an insurer to change the rates  if a person goes                                                               
to a  dentist outside  the preferred  provider group.  This seems                                                               
like a fair compromise.                                                                                                         
MS. HALL clarified that the  part about allowing an individual to                                                               
go to the  dentist of their choice is already  in statute. SB 258                                                               
addresses  kids  and  says  an   insurance  company  cannot  deny                                                               
coverage  under a  certain age.  SB 258  also says  the insurance                                                               
company  may put  an age  cap on  a dependent;  for example,  the                                                               
company will cover dependents up to 21 and full-time students.                                                                  
2:17:11 PM                                                                                                                    
SENATOR PASKVAN asked if other  types of coverage, such as direct                                                               
federal  or Employment  Retirement Income  Security Act  (ERISA),                                                               
prohibit establishing a minimum age for receiving dental care.                                                                  
MS. HALL said she does not know  but she did not think a standard                                                               
is applied in statute to the insured plans.                                                                                     
2:18:04 PM                                                                                                                    
CHAIR DAVIS  commented that  SB 258  will only  apply to  a small                                                               
portion of insurers  but perhaps other plans  are already meeting                                                               
the mandate. She asked if Ms.  Hall agrees that some insurers are                                                               
already complying.                                                                                                              
MS. HALL said thinks that  even the private insurance marketplace                                                               
has coverage for young children  and caps coverage for dependents                                                               
at  a  certain   age.  SB  258  may  have   a  pro-active  intent                                                               
considering things  seen in  other parts of  the country.  SB 258                                                               
has  a  third  component  involving   whether  or  not  insurance                                                               
companies can  negotiate prices with  dentists for  services that                                                               
the  insurance company  does  not cover.  For  example: A  dental                                                               
policy  that  does not  cover  orthodontia  still puts  in  their                                                               
contract that the patient would  only pay a certain amount toward                                                               
orthodontic work.  She asked if  legislators want to  speak about                                                               
what should or  should not be in a contract  between an insurance                                                               
company and a dentist. That is a policy call.                                                                                   
2:20:57 PM                                                                                                                    
PAT  SHIER,  director,  Division   of  Retirement  and  Benefits,                                                               
Department  of Administration,  confirmed that  SB 258  would not                                                               
apply  to the  state health  and retiree  health plan.  The state                                                               
plan does not have a coverage floor for young children.                                                                         
2:22:00 PM                                                                                                                    
SENATOR  PASKVAN clarified  there  is no  minimum  age under  the                                                               
state's current plan.                                                                                                           
MR. SHIER replied that is correct.                                                                                              
SENATOR PASKVAN asked  if the maximum age at which  a person ages                                                               
out of coverage is established by the state of Alaska.                                                                          
MR. SHIER  answered the state  plans require  that a person  be a                                                               
student after age 18 in order  to be covered as a dependent under                                                               
a parent's  plan. Coverage can  continue for a student  until his                                                               
or her 23rd birthday.                                                                                                           
SENATOR PASKVAN said  SB 258 would permit the insurer  to set the                                                               
maximum  age  rather  than  the   employer.  He  said  the  state                                                               
currently sets the maximum age and then self-insures.                                                                           
MR. SHIER  responded that  Title 21 appears  to give  the insurer                                                               
2:24:00 PM                                                                                                                    
DR. DAVID LOGAN,  Alaska Dental Society, said SB  258 is valuable                                                               
for consumers.  For the  past few years,  the dental  society has                                                               
worked with  the dental board  to allow dental  reimbursement for                                                               
medical  providers.  Providers  are  doing  things  like  looking                                                               
inside mouths and applying fluoride  as part of well-baby checks.                                                               
Alaska is still  first in the nation for baby  bottle caries. For                                                               
children  and parents  facing  this  problem, reimbursement  from                                                               
dental  benefits can  be the  difference between  proceeding with                                                               
care or not.                                                                                                                    
Regarding   insurance  company's   fee  capping   on  non-covered                                                               
services: he,  like many dentists, were  surprised that insurance                                                               
companies could do that.                                                                                                        
2:26:29 PM                                                                                                                    
He said there  is no negotiation with  insurance companies. About                                                               
15  years ago,  dentists  were prevented  from regulating  dental                                                               
advertising. Dentists are prohibited  from speaking to or working                                                               
with contracts as most trade  groups would. Dentists individually                                                               
assess  contracts  and  can  talk  with  specialists  but  cannot                                                               
discuss  contracts  with  other  dentists  or  come  together  to                                                               
negotiate  different  terms.  Dentists   sign  up  for  contracts                                                               
because a managed care company  might direct patients to them. As                                                               
part  of  the contract  with  the  insurance company,  a  dentist                                                               
agrees to  discount fees  50 to 70  percent for  covered services                                                               
and abide by a standard fee structure for non-covered services.                                                                 
2:29:55 PM                                                                                                                    
A dental business  needs to remain profitable. If  a managed care                                                               
company forces costs  lower, those costs don't  evaporate but get                                                               
shifted.  Dentistry  has  largely  managed to  avoid  most  cost-                                                               
DR. LOGAN  said if insurance  companies were sincere,  they would                                                               
[cover] services  and pay  a benefit.  Services would  be covered                                                               
and  could  avoid  SB  258's  prohibition  on  fee  capping.  The                                                               
insurance  companies  could set  a  fair  premium and  cover  the                                                               
consumer. The dentist would agree  to a discounted fee structure.                                                               
As it  stands now,  insurance companies  want to  limit dentists'                                                               
fees without  making any  sacrifices on  their part;  they market                                                               
these plans to employers at the expense of dental offices.                                                                      
CHAIR DAVIS  said she knows  that Dr.  Logan supports SB  258. He                                                               
asked if Dr.  Logan would give his other  valuable information to                                                               
the committee in writing as time is limited.                                                                                    
2:34:10 PM                                                                                                                    
DR. JOHN  WALLER, Alaska Dental  Society, Fairbanks,  agreed with                                                               
Dr. Logan  and added that  SB 258 is  mainly a business  bill. He                                                               
wanted to illustrate his points with  an analogy of being a small                                                               
hotel owner. He  has a certain number rooms not  being filled and                                                               
so contracts  with a local  tour company who guarantees  him more                                                               
customers, at  cost, for the  rooms. He is bringing  those people                                                               
in with  the assumption that  they may  spend money on  his food,                                                               
gift items  or tours. He can  make his profit on  the other items                                                               
even if the rooms are rented  at cost. SB 258 prevents an insurer                                                               
from saying  that all  services must  be operated  at cost.  As a                                                               
business  person, a  contract  where  costs are  all  set by  the                                                               
insurance contract is  far less attractive and  viable because it                                                               
eliminates the  possibility of  bringing people  in and  making a                                                               
profit on some  services. The insurance industry is  playing on a                                                               
dentist's sense of  duty to his or her patients  in order to fund                                                               
a marketing scheme that is profitable to the insurance company.                                                                 
He feels  the elimination of  a minimum age is  straight forward;                                                               
he has done a lot of work on toddlers.                                                                                          
2:37:23 PM                                                                                                                    
CHRIS FRANK,  governmental affairs,  Aetna Insurance,  opposes SB
258  because it  prevents  insurers from  contracting rates  with                                                               
dental providers for both covered  and non-covered services. This                                                               
payment arrangement  is common in  dental contracts  and provides                                                               
consumers  with predictability  on out-of-pocket  costs and  more                                                               
fee   information  for   dental   procedures.  Eliminating   this                                                               
arrangement  could cause  problems for  employers when  employees                                                               
complain about  increased costs  for non-covered  services. Aetna                                                               
has established a  fee schedule including nearly  every service a                                                               
dentist provides. That  fee schedule is offered to  a dentist and                                                               
who  agrees to  be contracted  under  that fee  schedule. SB  258                                                               
could  prevent  a dentist  from  voluntarily  agreeing to  having                                                               
these types of services covered in their negotiated rates.                                                                      
The definition of what is or  is not a covered service comes into                                                               
play - benefits  may be covered up to a  dollar amount and beyond                                                               
that,  it's  not  a  covered service.  He  questioned  what  rate                                                               
consumers  would then  be charged  since some  of the  service is                                                               
covered and some is not due to caps or deductibles.                                                                             
2:40:15 PM                                                                                                                    
SENATOR THOMAS said  he thought a non-covered  service would only                                                               
be mentioned in a contract to clarify that it is not covered.                                                                   
MR.  FRANK  replied Aetna  offers  many  different contracts.  It                                                               
would be administratively complicated  to specify what is covered                                                               
or  not for  each individual.  Aetna is  trying to  establish one                                                               
common  set of  fee  schedules  for all  dental  services in  the                                                               
SENATOR  THOMAS asked  if Mr.  Frank is  saying a  single booklet                                                               
contains all  services and  then somehow  people are  supposed to                                                               
figure out  what applies to  them, rather than having  a pamphlet                                                               
for each company or group insured with a common plan.                                                                           
MR. FRANK said  Aetna has a common fee schedule  across the state                                                               
for all services that Aetna  has contracted with the dentist for.                                                               
An employer may pick and  choose different types of benefits, not                                                               
the costs.  The fee schedule is  the same but the  actual benefit                                                               
could vary greatly depending on what plan the employer chooses.                                                                 
2:43:20 PM                                                                                                                    
SENATOR PASKVAN asked if the fee  schedule is available for "a la                                                               
carte selection" by the consumer.                                                                                               
MR.  FRANK  replied  that  Aetna  can  provide  a  consumer  with                                                               
information if he  or she calls and asks "what  would it cost for                                                               
X?" Consumers  do not choose "I  want that fee schedule  for that                                                               
service".  The costs  are provided  when asked  but the  consumer                                                               
does not pick and choose which one they want.                                                                                   
SENATOR PASKVAN asked,  "so you don't make that  available to the                                                               
MR. FRANK answered  that a consumer can call and  ask about their                                                               
benefits. Or they can ask about  their out of pocket exposure for                                                               
a  service. It  could become  difficult  to determine  what is  a                                                               
covered benefit  and what is  not because the dentist  could then                                                               
charge  retail   rates,  not  our  contracted   rates,  for  some                                                               
services. That's where unpredictability begins.                                                                                 
2:45:25 PM                                                                                                                    
SENATOR PASKVAN said he can  understand that an insurer contracts                                                               
with a  dentist that  charges, for example,  $75 for  a cleaning,                                                               
twice a  year. If a  person wanted  a third cleaning,  that would                                                               
not be  covered and a  consumer might  be confused if  that third                                                               
cleaning cost more  than $75, as a  non-covered service. However,                                                               
he did not  understand the pricing mechanism and  the fee capping                                                               
on non-covered service.  It is  not included in the fee structure                                                               
that the customer is being charged.                                                                                             
2:46:19 PM                                                                                                                    
MR.   FRANK  said   Senator  Paskvan   is  right;   the  proposed                                                               
legislation would  not impact Aetna  but would impact  a consumer                                                               
who  would  not  have  cost   predictability.  For  example,  two                                                               
cleanings per  year are $75  each and  are covered, but  it could                                                               
cost the consumer  $100 for a 3rd cleaning.  Or, orthodontic care                                                               
may be  capped at $2,000 and  beyond that, what does  the dentist                                                               
charge and what  does the consumer pay? If  Aetna cannot contract                                                               
for both  covered and non-covered  services, the consumer  has to                                                               
find out what the dentist is  going to charge for the service now                                                               
that it is  uncovered. He suggested that  the legislation include                                                               
an option  for dentists to  agree to  have both covered  and non-                                                               
covered services provided in their contract with Aetna.                                                                         
2:47:54 PM                                                                                                                    
CHAIR DAVIS said she the  conversation is going beyond what needs                                                               
to be discussed in health and  social services. She would like to                                                               
move SB 258  from this committee. The next  committee of referral                                                               
is Labor and Commerce.                                                                                                          
2:49:01 PM                                                                                                                    
SENATOR PASKVAN moved to report SB 258 from committee with                                                                      
individual recommendations and attached fiscal note(s).                                                                         
CHAIR DAVIS announced that without objection, SB 258 moved from                                                                 
the Senate Health and Social Services Standing Committee.                                                                       
SENATOR PASKVAN told Mr. Frank he is still interested in                                                                        
receiving answers to his questions about the mutuality of                                                                       
obligations under contracts and why it's not an a la carte.                                                                     
2:49:50 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Davis adjourned the Senate Health and Social Services                                                                     
Standing Committee meeting at 2:49 p.m.                                                                                         

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