AS Title 18, Chapter 9: Statewide Health Care

Chapter 09. Statewide Health Care. Article 1. Alaska Health Care Commission. Sec. 18.09.010. Alaska Health Care Commission. The Alaska Health Care Commission is established in the Department of Health. The purpose of the commission is to provide recommendations for and foster the development of a statewide plan to address the quality, accessibility, and availability of health care for all citizens of the state. Sec. 18.09.020. Composition; chair. The commission consists of 14 members as follows: (1) 11 voting members appointed by the governor as follows: (A) the state officer assigned the duties of medical director for the department, who shall serve as chair; (B) one member who represents the tribal health community in the state; (C) one member who represents a statewide chamber of commerce who is not financially associated with the health care industry; (D) one member who represents the Alaska State Hospital and Nursing Home Association; (E) one member who is a health care provider and (i) engaged in the active practice of the health care provider's profession in the state; (ii) licensed to practice in the state; (iii) not affiliated with the Alaska State Hospital and Nursing Home Association; (F) one member who represents the health insurance industry in the state; (G) one member who is (i) a health care consumer; (ii) a resident of the state; and (iii) not employed by and does not have a business interest in the health care industry; (H) one member who is a licensed primary care physician in the state and who is in the active practice of family medicine, primary care internal medicine, or pediatric medicine; (I) one member who represents the Alaska Mental Health Trust Authority; (J) one member who represents community health centers in the state; (K) one member who is involved in the United States Department of Veterans Affairs health care industry; (2) three nonvoting members appointed as follows: (A) one ex officio member from the house of representatives, appointed by the speaker of the house of representatives; (B) one ex officio member from the senate, appointed by the president of the senate; (C) an ex officio member representing the Office of the Governor. Sec. 18.09.030. Public members' terms of office. (a) Public members of the commission serve for staggered terms of three years or until a successor is appointed. (b) If a vacancy occurs in a public member's seat on the commission, the governor shall make an appointment for the unexpired portion of that member's term. (c) A public member may serve not more than two consecutive terms. (d) In this section, “public member” means those members appointed under AS 18.09.020 (1)(B) — (K). Sec. 18.09.040. Executive director. The commission may employ an executive director, who may not be a member of the commission and who may be current staff of the department. The executive director serves at the pleasure of the commission. The commission shall establish the duties of the executive director. The executive director is in the partially exempt service under AS 39.25 (State Personnel Act). Sec. 18.09.050. Staff. The department may assign employees of the department to serve as staff to the commission. The commission shall prescribe the duties of the commission staff. Sec. 18.09.060. Bylaws. The commission, on approval of a majority of its membership and consistent with state law, shall adopt and amend bylaws governing proceedings and other activities, including provisions concerning (1) a quorum to transact commission business and other aspects of procedure; (2) frequency and location of meetings; (3) establishment, functions, and membership of committees; and (4) conflicts of interest that require (A) a member to declare a substantial financial interest in an official action and to request to be excused from voting in that instance; (B) a ruling by the chair on a request by a member to be excused from voting; (C) an opportunity to override a ruling by the chair on a majority vote; (D) filing of a written disclosure form with the department that lists all potential conflicts of interest of a member valued at more than $5,000 annually if the interest is related to health care system income affecting the member or a member of the member's immediate family. Sec. 18.09.070. Duties of the commission. (a) The commission shall serve as the state health planning and coordinating body. Consistent with state and federal law, the commission shall provide recommendations for and foster the development of a statewide health plan containing the following: (1) a comprehensive statewide health care policy; (2) a strategy for improving the health of all residents of the state that (A) encourages personal responsibility for disease prevention, healthy living, and acquisition of health insurance; (B) reduces health care costs by using savings from (i) enhanced market forces; (ii) fraud reduction; (iii) health information technology; (iv) management efficiency; (v) preventative medicine; (vi) successful innovations identified by other states; and (vii) other cost-saving measures; (C) eliminates known health risks, including unsafe water and wastewater systems; (D) develops a sustainable health care workforce; (E) improves access to quality health care; and (F) increases the number of insurance options for health care services. (b) The commission may hold public hearings to gather information and opinions from health care consumers on matters before the commission. Hearings shall be conducted under AS 44.62.210 , except that the commission shall provide public notice of hearings not less than 15 days before the conduct of the hearing and include not fewer than three notices published in the statewide news media. (c) The commission shall submit to the governor and the legislature by January 15 of each year an annual report regarding the commission's recommendations and activities. The report shall include voting records, copies of financial disclosures, and conflicts of interest statements. Sec. 18.09.080. Compensation, per diem, and expenses. A member appointed to the commission under AS 18.09.020 (1) is entitled to per diem, reimbursement for travel, and other expenses authorized by law for boards and commissions under AS 39.20.180 . Article 2. Statewide Immunization Program. Sec. 18.09.200. Statewide immunization program established; commissioner's duties. (a) In addition to health promotion and vaccine registration activities of the department, a statewide immunization program is established in the department for the purpose of monitoring, purchasing, and distributing included vaccines to providers approved by the department who agree to provide the included vaccines to state residents under terms consistent with the program and state and federal law. (b) The commissioner shall (1) establish a procedure that provides for participation by an assessable entity; (2) maintain a list of recommended vaccines for inclusion in the program; (3) for each included vaccine, establish the initial vaccine assessment for the first year of the program and thereafter make annual assessments based on the determinations made by the council established under AS 18.09.210 ; (4) notify assessable entities and other program participants of the annual vaccine assessment for each vaccine included in the program; (5) devise a method for crediting to assessable entities and other program participants overpayments of vaccine assessments made for reasons related to administrative error, program termination, or lower than anticipated actual usage of the program by covered individuals; (6) coordinate collective purchases of included vaccines; (7) establish a procedure for statewide distributions of vaccines purchased under the program; and (8) review vaccine assessment appeals for error. Sec. 18.09.210. State Vaccine Assessment Council; members; duties. (a) The State Vaccine Assessment Council is established in the department for the purpose of determining the amount of vaccine assessments made by the commissioner to be paid by assessable entities and other program participants in the state under procedures established by the council. (b) The council consists of eight members appointed by the commissioner as follows: (1) the department's chief medical officer for public health or the chief medical officer's designee, who shall serve as chair; (2) two health care providers licensed in the state, one of whom must be a pediatrician; (3) three members representing health care insurers licensed in the state under AS 21.54 , one of whom must be a plan administrator; each insurer must represent a different organization in the state; (4) a representative of a tribal or public health insurance plan; (5) the director of the division of insurance or the director's designee. (c) A member appointed to the council under (b)(2) — (4) of this section serves without compensation and reimbursement of expenses for a term of three years or until a successor is appointed. A member may not serve more than two consecutive terms. (d) The council shall meet at the call of the chair and conduct business by majority vote. (e) The department shall provide staff and other assistance to the council. (f) The council shall (1) establish and implement a plan of operation to (A) determine the amount of the annual vaccine assessment, subject to review by the commissioner, for each included vaccine for each covered individual following the initial vaccine assessment amounts determined by the commissioner; (B) use a method for determining the vaccine assessment amount that attributes to each assessable entity and other program participant the proportionate costs of included vaccines for covered individuals; (C) establish procedures for the collection and deposit of the vaccine assessment; (D) establish procedures for collecting and updating data from assessable entities and other program participants as necessary for the operation of the program and the determination of the annual vaccine assessment; the data collected must include the number of covered individuals by each assessable entity and other program participant and the annual vaccine program usage by each covered individual; (E) devise a system for reducing surplus payments made by an assessable entity and other program participant by crediting past overpayments to current year vaccine assessments; (2) submit to the commissioner and to the legislature, not later than July 1 of each year, an annual financial report, including assessment determinations and overall costs of the program, in a form acceptable to the commissioner and the legislature; (3) monitor compliance with the program requirements and vaccine assessments and submit a periodic noncompliance report to the commissioner and the director of insurance that lists assessable entities and other program participants that failed to (A) remit vaccine assessments as determined by the council and approved by the commissioner; or (B) comply with a reporting or auditing requirement under the program after notice from the council. Sec. 18.09.220. Vaccine assessment and reporting requirements. (a) An assessable entity and other program participant shall (1) pay to the department the annual combined vaccine assessments as determined under the program for the included vaccines covered by the assessable entity or other program participant for each covered individual on a schedule adopted by the council; (2) provide information requested by the council to determine the number of covered individuals, actual vaccine usage under the program, and other data necessary to calculate and monitor compliance with the vaccine assessment; and (3) provide audited financial statements upon request of the council. (b) A vaccine assessment must include a reasonable contribution toward support of the program and appropriate reserve funds, as determined by the council. A vaccine assessment may not include a provider fee for the administration of the vaccine. (c) A vaccine assessment shall be construed as a medical expense of the assessable entity or other program participant. (d) An assessable entity or other program participant may appeal a determination of a vaccine assessment made by the council to the commissioner within 10 days after receiving notification of the assessment. The commissioner shall review the appeal and all materials relevant to the assessment that is the subject of the appeal and shall modify the assessment if the commissioner finds substantial evidence of an error. (e) [Repealed, § 6 ch 17 SLA 2019.] Sec. 18.09.225. Other program participants. (a) A health care provider or group of providers may opt into the program if approved by the commissioner under regulations adopted by the department. (b) An assessable entity may not deny a claim for coverage by a health care provider of vaccines not distributed under the program. (c) A health care provider may not bill a payor for or resell a vaccine distributed under the program. Sec. 18.09.230. Vaccine Assessment Fund. (a) The vaccine assessment fund is created in the general fund for the purpose of providing funding for the program. The fund consists of money appropriated to it by the legislature, including program receipts attributable to vaccine assessments under AS 18.09.220 , fees under AS 18.09.240 , money from other sources, and interest earned on money in the fund. Appropriations to the fund do not lapse. (b) The commissioner shall administer the fund in accordance with the provisions of this chapter. The commissioner may spend money appropriated to the fund for the purposes of the program under AS 18.09.200 and to pay the costs of administering the program without further appropriation. Sec. 18.09.240. Penalties. An assessable entity or other program participant that fails to pay a required annual vaccine assessment after notification of the assessment or fails to comply with a request for information necessary for determination of the assessment may be assessed an additional noncompliance fee as determined by the commissioner under regulations adopted by the department. Article 3. Dementia Awareness and Dementia Care Capacity. Sec. 18.09.300. Dementia awareness and dementia care capacity. (a) The department shall develop and implement an evidence-based, data-informed statewide dementia awareness campaign. The statewide dementia awareness campaign must include promotion of screening, early diagnosis, and treatment of dementia and assess appropriate levels of care and workforce capacity necessary for the population of persons affected by dementia in the state. (b) To build statewide dementia awareness and health care capacity, the department shall (1) use a public health approach to improve services and awareness of dementia and educate the public on strategies related to risk reduction, early diagnosis, and disease management; (2) collect and monitor data to set priorities, develop public health actions, and address social effects of Alzheimer's disease and other forms of dementia; (3) focus on changing systems, environments, and policies to promote risk reduction, improve early diagnosis, prevent and manage comorbidities, and avoid hospitalizations; (4) work with systems of care to identify ways to improve early diagnosis, primary care, care coordination, and development of the workforce for delivery of services to persons affected by dementia; (5) engage community members and stakeholders in decision making; and (6) develop a statewide strategic plan to improve systems of care infrastructure and awareness of dementia. (c) Beginning January 1, 2024, the department shall submit a biannual report to the senate secretary and chief clerk of the house of representatives and notify the legislature that the report is available. The report must include a description of accomplishments, barriers, and recommendations for priorities related to dementia care in the state. Article 4. General Provisions. Sec. 18.09.900. Regulations. The department may adopt regulations under AS 44.62 (Administrative Procedure Act) to carry out the purposes of this chapter. Sec. 18.09.990. Definitions. In this chapter, (1) “assessable entity” means (A) a health care insurer as defined in AS 21.54.500 ; (B) an entity that provides the state health care plan described in AS 39.30.090 and 39.30.091; (C) a public or private entity that offers a publicly funded plan in the state, to the extent participation in the program is authorized by law; (D) a third-party administrator as defined in AS 21.97.900 ; (2) “commission” means the Alaska Health Care Commission established in AS 18.09.010 ; (3) “commissioner” means the commissioner of health; (4) “council” means the State Vaccine Assessment Council; (5) “covered individual” means an adult or child who resides in the state and who is provided insurance coverage for an included vaccine by an assessable entity or who is a patient of another program participant; (6) “department” means the Department of Health. (7) “included vaccine” means a vaccine recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, United States Department of Health and Human Services, and included on a list maintained by the commissioner for inclusion in the program; (8) “other program participant” and “another program participant” mean a health care provider or group of providers who have opted into the program under AS 18.09.225 to both purchase vaccines for and administer vaccinations to residents of the state; (9) “program” means the statewide immunization program; (10) “provider” means a person licensed or certified by the state to administer vaccines or provide health care services or a partnership, corporation, or other entity made up of persons licensed or certified to administer vaccines or provide health care services; (11) “vaccine” means a preparation of killed microorganisms, living attenuated organisms, living fully virulent organisms, or other substances that are administered to humans for the purpose of producing or artificially increasing specific immunity to life-threatening and disabling diseases.