SB 45 — An Act relating to insurance; relating to direct health care agreements; relating to the duties of the director of the division of insurance in the Department of Commerce, Community, and Economic Development; and providing for an effective date.

33-LS0211\SLAWS SENATEOF BILLALASKA NO.Source Chapter No.

45HCS INCSSB THE45(2d LEGISLATUREL&C) OFam THEH(efd STATEadd OFH) ALASKA_______ THIRTY-THIRDAN LEGISLATUREACT -Relating FIRSTto SESSIONinsurance; BY SENATORS WILSON, Hughes, Myers, Kaufman Introduced:

1/25/23 Referred:

Health & Social Services, Labor & Commerce A BILL FOR AN ACT ENTITLED "An Act relating to insurance;

and relating to unfairthe tradeduties practices."of BEthe ITdirector ENACTEDof BYthe THEdivision LEGISLATUREof OFinsurance THEin STATEthe OFDepartment ALASKA:of Commerce, Community, and Economic Development;

*and Sectionproviding 1.for an effective date.

_______________ BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:

THE ACT FOLLOWS ON PAGE 1 Enrolled SB 45 AN ACT Relating to insurance;

relating to direct health care agreements;

relating to the duties of the director of the division of insurance in the Department of Commerce, Community, and Economic Development;

and providing for an effective date.

_______________ * Section 1.

(a) A direct health care agreement is a written agreement between a health care provider or health care business and a patient or the representative of a patient tomay provideenter healthinto carea servicesdirect inhealth exchangecare foragreement. payment of a periodic fee.

AHealth patientcare isservices iibleprovided tounder enter into a direct health care agreement underare thislimited sectionto if the patienttype isof eligiblehealth tocare receiveservices assistancethat undera ASprimary 47.07care (Medicalprovider Assistancemay forprovide Needyto Persons)a orpatient. AS 47.08 (Assistance for Catastrophic Illness and Chronic or Acute Medical Conditions).

(b) A directpatient healthis carenot agreementeligible mustto (1)enter describeinto thea healthdirect care services that the health care provideragreement orunder healththis caresection businessif makes available to the patient inis exchangeeligible forto paymentreceive ofassistance aunder SB0045AAS -1-47.07 SB(Medical 45Assistance Newfor TextNeedy UnderlinedPersons) [DELETEDor TEXTAS BRACKETED]47.08 33-LS0211\S(Assistance periodicfor feeCatastrophic Illness and eachChronic locationor atAcute whichMedical theConditions). health care services are available;

(b) To be eligible to enter into a direct health care agreement under this -1- Enrolled SB 45 section, a health care provider or health care business must (1) accept new patients who are enrolled in the Medicare program;

or (2) maintain a practice in which 20 percent or more of the patients (A) are enrolled in the Medicare program;

or (B) do not have health insurance.

(c) A direct health care agreement must (1) describe the health care services that the health care provider or health care business makes available to the patient in exchange for payment of a periodic fee and each location at which the health care services are available;

(3) identify and include contact information for a representative of the health care provider or health care business that is responsible for receiving and addressing (A) a complaint made by a patient relating to the agreement;

(4)and prominently(B) statea thatrequest made by a patient to amend the agreementagreement, isincluding nota healthpatient's insurancerequest andto doeschange notthe meetname anof individualthe representative of the patient or otherthe healthpatient's insurancemailing mandateaddress, thatphysical mayaddress, betelephone requirednumber, byelectronic federalmail law;address, or other personal information;

and(4) (5) prominently state that the patient is not entitled to the protections under AS 21.07 (Patient Protections Under Health Care Insurance Policies)Policies). or AS 21.36 (Trade Practices and Frauds).

(c)(d) A direct health care agreement must allow a patient or the representative of a patient tomay terminate thea direct health care agreement in writing within 30 days after entering into the agreement.

If a patient Enrolled SB 45 -2- or representative terminates an agreement under this subsection, the health care provider or health care business shall, not later than 30 days after the patient or representative terminates the agreement, refund to the patient or representative payments made under the agreement, less payments made for services the health care provider or health care business has already performed that are not included in the periodic fee.

The(e) A health care provider or health care business may chargeimmediately terminate a terminationdirect feehealth forcare terminationagreement if (1) a patient's behavior threatens the safety of anthe agreementhealth undercare thisprovider, subsection,the notstaff toof exceedthe anhealth amountcare equalprovider toor onehealth month'scare costbusiness, or other patients of the periodichealth fee.care provider or health care business;

(d)(2) Aa directpatient healthengages carein agreementdisrespectful, mustderogatory, allowor aprejudiced healthbehavior carethat provider,is awithin healththe carepatient's business,control aand patient,the orpatient thedoes representativenot ofstop athe patientbehavior toeven terminateafter the agreementhealth incare SBprovider 45or -2-the SB0045Astaff Newof Textthe Underlinedhealth [DELETEDcare TEXTprovider BRACKETED]or 33-LS0211\Shealth writingcare afterbusiness atrequests leastthe 30patient days'to notice.stop the behavior;

Theor agreement(3) musta require that the patient pay the health care provider or health care business the periodicrepresentative fee, prorated through the date of terminationa of the agreement, and that the patient paybreaches any additional fees for services the healthterms careof provider or health care business has already performed that are not included in the periodicagreement. fee.

The(f) healthA carepatient provider or healththe carerepresentative businessof maya chargepatient amay terminationimmediately feeterminate fora terminationdirect ofhealth ancare agreement underif thisa subsectionhealth bycare aprovider patient or representative,a nothela toth exceedcare anbusiness amountbreaches equalthe toterms one month's cost of the periodicagreement. fee.

(e)(g) A health care provider or health care business may not change the periodic fee under the agreement more than once a year and shall provide at least 45 days' written notice of a change in the periodic fee.

(f)If Aa health care provider or health care business mayincreases billthe amount of the periodic fee, a patient or the representative of a patient formay terminate the periodicagreement feeby onlyproviding afterto the endhealth care provider or health care business written notice of the periodtermination tonot later than the day before the date on which the change to the periodic fee applies.is scheduled to take effect.

(g)(h) AExcept patient'sas employerotherwise mayprovided payin thethis periodicsection, feea andhealth additionalcare feesprovider, the patient owes a health care providerbusiness, a patient, or healththe carerepresentative businessof undera patient may terminate a direct health care agreement.agreement for any reason in writing after at least 30 days' notice.

(i) A health care provider or health care business may charge a termination fee -3- Enrolled SB 45 only for termination of an agreement by a patient or the representative of a patient under (d) or (h) of this section.

The termination fee may not exceed an amount equal to one month's cost of the periodic fee.

(j) Upon termination of an agreement under (g) or (h) of this section, the patient shall pay the health care provider or health care business the periodic fee, prorated through the date of termination of the agreement, and any additional fees for services the health care provider or health care business has already performed that are not included in the periodic fee.

(k) A health care provider or health care business may bill a patient or the representative of a patient for the periodic fee only after the end of the period to which the periodic fee applies.

(l) A patient's employer may pay the periodic fee and additional fees the patient owes a health care provider or health care business under a direct health care agreement.

(h)(m) A direct health care agreement and a health care provider or health care business mayproviding immediatelyhealth terminatecare services under a direct health care agreement ifare (1)subject ato patientAS repeatedly21.36 fails(Trade toPractices complyand withFrauds) to the treatmentextent planapplicable forand thewhen patientnot recommendedin byconflict with the healthexpress careprovisions providerof orthis healthsection. care business;

(2)(n) A health care provider or health care business may not decline to enter into a patient'sdirect behaviorhealth threatenscare theagreement safetywith ofa thenew patient or terminate a direct health care provider,agreement thewith staffan existing patient solely because of the healthpatient's carerace, providerreligion, color, national origin, age, sex, physical or healthmental caredisability, business,marital status, change in marital status, pregnancy, parenthood, or any other patientscharacteristic of thea healthclass careof providerpersons orprotected healthby carea business;state law that prohibits discrimination.

or(o) (3)A ahealth patientcare engagesprovider in disrespectful, derogatory, or prejudicedhealth behaviorcare thatbusiness ismay withindecline theto patient'senter controlinto anda thedirect patienthealth doescare notagreement stopwith thea behaviornew evenpatient afterif the health care provider or thehealth staffcare ofbusiness the(1) healthis careunable providerto orprovide to the patient the health care businessservices requests the patientEnrolled toSB stop45 the-4- behavior.patient requires;

SB0045A -3- SB 45 New Text Underlined [DELETED TEXT BRACKETED] 33-LS0211\S (i) A health care provider or a(2) healthdoes carenot businesshave may immediately terminate a direct health care agreement if a patient or the representativecapacity ofto aaccept patientnew breachespatients. the terms of the agreement.