Insurance & Commerce - Senate
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Bills discussed (4)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
|
SB168
Act 381
· 4 mentions in agenda, chapter, transcript
Matched: “…OF PERSONAL PROPERTY FROM A SELF-SERVICE STORAGE FACILITY. SB168 K. Hammer TO MODIFY THE EXEMPTIONS OF CERTAIN ENTITIES FROM…”
|
TO MODIFY THE EXEMPTIONS OF CERTAIN ENTITIES FROM INSURANCE REGULATION. | K. Hammer | Notification that SB168 is now Act 381 |
|
SB290
Act 553
· 4 mentions in transcript, agenda, chapter
Matched: “…tee. All right. Senator Letting, you want to come down with Senate Bill 290? And there is an amendment, I think, to add a sponsor that…”
|
CONCERNING COVERAGE OF DIAGNOSTIC EXAMINATIONS FOR BREAST CANCER UNDER CERTAIN HEALTH BENEFIT PLANS. | G. Leding | Notification that SB290 is now Act 553 |
|
HB1027
Act 363
· 2 mentions in transcript, agenda
Matched: “…have an even better quorum now. Is there anyone here to run House Bill 1027? Okay. All right. So we're going to defer House Bill 1027,…”
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TO AMEND THE LAW CONCERNING THE SALE AND REMOVAL PROCEDURE OF PERSONAL PROPERTY FROM A … | Cavenaugh | Notification that HB1027 is now Act 363 |
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SB112
· 1 mention in agenda
Matched: “…EALTH BENEFIT PLANS. DEFERRED BILLS Number Sponsor Subtitle SB112 Teague CONCERNING SUITABILITY IN ANNUITY CONTRACT TRANSACTI…”
|
CONCERNING SUITABILITY IN ANNUITY CONTRACT TRANSACTIONS. | Teague | Died in Senate Committee at Sine Die adjournment. |
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Representative David Ray
Unverified
0:00
All right, Chair Cesar Cuomo, we're going to go ahead and run through a couple bills here that I don't think have any opposition. Again, if anybody objects, we'll just defer this until the next day. But for right now, let's go ahead and start with Senate Bill 168. Senator Hammer, if you want to come. Mr. Chair, may I invite somebody to the table
Senator Kim Hammer
Unverified
0:26
in case there's in-depth questions? questions I can't answer to help me out. That'd be fine. Thank you. So if you'd just
Representative David Ray
Unverified
0:42
state your name for the record and you're recognized to
Senator Kim Hammer
Unverified
0:46
present your bill. Thank you, Mr. Chair. Kim Hammer, State Senator, District 38 for Senate Bill 168. so members back in 2017 we actually established the premise of what this bill is all about and what this does is expanding it to be able to incorporate specialists that could take advantage of of the processes that are in place as i mentioned we did this in 2017 so it's broadening
it is the term that was used i could give you a high level illustration that it would just provide to other provider groups to be able to take advantage of the same things that we allowed in 2017. And Mr. Chair, I'll be glad to answer questions or my guest speaker, if Chair would recognize, could take it a little further if you'd like.
Chair
Unverified
1:34
Okay. Senator, I'll let you recognize for a question. I
Senator Ricky Hill
Unverified
1:41
saw the word definitions here and I was desperately trying to find a definition for direct care.
So I just need to know, since we're striking primary,
Senator Joyce Elliott
Unverified
1:53
is there going to be a practical difference here? Is that just wordsmithing? I'm going to give the answer, and if the
Senator Kim Hammer
Unverified
1:59
Chair would allow, I'll let Josh expand on it. But primary care was what was established in 2017. We're broadening the scope of it so it captures all health care that would want to take advantage of it. Of it? I'm
Speaker 17
2:18
Okay. Thank you. Okay. All right. Thank you, Senator. Thank you for the question. Yeah, so the purpose here is a way
Speaker 19
2:27
to think about this is kind of like a Netflix or gym membership type model. You're paying a monthly fee to a provider for an agreed upon set of services. So the definition that is in current law pertains to primary care. And as the Senator said, this really just allows any kind of specialist. So think about a physical therapist, a dentist, mental health provider, to enter into a similar monthly payment arrangement for an agreed-upon set of services.
Speaker 20
2:55
Okay, is that something that's commonly done? Because I just have to pay my insurance when I
Senator Joyce Elliott
Unverified
3:01
go, so I'm not sure I'm following. Sure. So, Senator, about eight
Speaker 17
3:04
or nine other states currently allow for something similar to this. I think what's really important, these arrangements are not paid for by
Senator Joyce Elliott
Unverified
3:12
insurance. Yeah, that's why I don't know what it means. That's why I was inquiring. Sure.
Speaker 19
3:17
So I can go into a little bit more depth if that's helpful. So what happens is in the direct primary care world, this is the most common version right now.
So I'll just describe that. So there's a primary care doctor who agrees to enter into a written agreement with me to pay, let's just say, $50, $60 a month, in which I receive a set of services. It could be anywheres of 30, 40 different procedures or services that I pay no additional fees for. Usually I get same-day appointments or next-day appointments. They usually spend upwards of an hour with me every time that I go see them. So they are developing a real relationship with me to understand my health.
This is great for people with chronic conditions who need a little bit more services or want to be able to text or use telehealth, whereas now under the status quo as you are alluding to you have to go through your insurance plan they may approve certain things or not some of us only see our primary care doctors for 15 minutes or 20 minutes it feels rushed so this allows for a totally different model of health care in which there's a direct relationship that's the basics of those arrangements is it's clear how much i pay what services are provided and how i can leave the relationship
Senator Joyce Elliott
Unverified
4:33
or not if I want to. If you know, who is usually able to afford this? Like what income
Speaker 19
4:41
groups? Senator, thank you. In my conversations with direct primary care doctors all over the country, it is lots of different people. It's anybody from somebody who's uninsured, somebody who's on Medicaid who's struggling with access, folks will pay. Some of them do sliding scale fees based on income. The average fee for direct primary care, just again using that an illustration because it's the most common right now is usually around somewhere between
$75 to $90 a month without a sliding scale for people with no surprise bills, full transparency, I know exactly what I'm getting going forward. And if I have a high deductible health plan, I have a predictability of how much I'm going to spend for most of my services for the entire year before having to go through and use my deductible or out-of-pocket costs. All right. That's a wide variety. Thank you.
Speaker 30
5:29
Thanks, Mr. J.R. Any other questions from members?
Chair
Unverified
5:37
Anybody here to speak for or against
Senator Missy Irvin
Unverified
5:44
the bill? Senator Irvin, you're recognized for a question. So
just on the, when you're saying health care, what are other examples? I mean, I understand the primary care and the direct primary care perspective, but what other, I mean, you're changing the words from primary care to health care. So are there other examples of
Speaker 19
6:06
where this is actually happening outside of primary care? So I've heard of a handful of examples, dentistry, mental health, physical therapy.
The providers in this space have said anybody who has chronic conditions or anybody that wants a more frequent in-touch, this is a good opportunity. Honestly, Senator, I think we're also paving a pathway for the future in which we are allowing innovation to emerge. And then there are relationships that I haven't heard about right now that could benefit from this. A lot of providers that go into the space say it allows them to practice the kind of medicine that they went into medicine to begin with and reduces provider burnout as a result.
So I think it's a real promising opportunity to open the gateway to
Chair
Unverified
6:55
innovation going forward. All right. Thank you.
Senator Joyce Elliott
Unverified
6:59
any other questions go ahead cinderella
Senator Ricky Hill
Unverified
7:02
you're recognized um i am not holding you responsible for the future but i'm just i'm trying to think through thinking through this and thinking what it might mean for the overall health um health of the i had to say health industry but some kind of
health industry where it doesn't become so diluted because we've got this other thing going on over here and we have a bunch of really sick people all trying to get health insurance and that's going all crazy. I don't mean that as a negative. I'm just trying to think through what this means in the
Speaker 17
7:40
long run. Sure. Appreciate the question.
Speaker 19
7:42
I think this is exactly why this model is so important. Those with chronic conditions often get lost in the system. Their care isn't coordinated
and it becomes a question of what the insurance pays for or doesn't pay for. I think this model actually allows for those patients in particular and there's now studies out there. Milliman just put one out in the last year about direct primary care. How about it saves costs on emergency room visits. It helps gain an advocate for those patients to navigate when they have to use other services often these doctors will be on the phone with somebody as they're interacting with another physician or specialist and they're team-based working together saying I know this patient
really well here's their background this is the best appropriate way to move forward and they're finding an agreement I actually think that this deals with some of the concerns that you have in particular dealing with people who are very costly who are sick and turning our health care system into more of a preventative system instead of just dealing with the symptoms that we see when people get really sick. So I actually think it directly addresses some of your
Senator Ricky Hill
Unverified
8:45
concerns going forward. I just remember we tried that during HMOs and it kind of fell back from that. And what I'm
Senator Joyce Elliott
Unverified
8:51
just not comfortable with, and I don't even know where to go with this,
Senator Ricky Hill
Unverified
8:57
but there's something here that's going around in my head. What I'm not comfortable with is the notion that there, I can foresee there are likely to be a lot of people who don't have the $100 a month and they probably are some of the sickest people because they're some of the poorest people don't have the $75 don't have the $100 a month and they're still going to have to try to get to the doctor with Medicaid or whatever and we're just going to end up paying more and more and more that's just that's just kind of where I see it going and let's hope I'm completely wrong
because I like I said I'm not holding you responsible for that nor your bill but as a policymaker, you know, I think I have to think about things, you know, in the whole big scheme of things. So that's why I want you
Speaker 43
9:47
to understand that. Okay. That's it, Mr. Chair.
Speaker 45
9:52
Okay. Anybody else? Senator Hammer, can you close for
Senator Kim Hammer
Unverified
9:55
your bill? Anything else? No, I would just, well, I would say one
thing, and Senator Elliott, maybe this is addressing to your concern. As far as some people compare what's being done here to like concierge
service which people think that's just for the higher class and everybody else gets left out below that. I don't think that is what this is if that is your concern. I would say this I think that anything we can do to open it up to where we can allow for greater access to care but also try to bring the cost down for everybody and if if this adds another tool to the toolbox to do that I think it would create a good option for that. I just want to make sure that we don't compare because I actually ran a concierge bill back in 2015.
The reason I did it, Dr. Martindale and Benton came to me and said, you know, for $75 a month, I can do all this. But if I've got to go fight the insurance companies, it's going to cost all this and it's going to cost this. I see this as an avenue forward to where there can be that more direct care relationship with the provider and not necessarily eliminate the insurance company, but certainly add another tool to help try to drive the cost down. And that's what it's intended to do. So you think
Senator Joyce Elliott
Unverified
11:08
this is going to be available to the poorest people?
Senator Kim Hammer
Unverified
11:13
I think it creates an option that's not there for them now. And if I'm a primary care provider and I have that ability to direct deal with you, then I think it will create that option. On the other side of the coin, it's not going to do anything to prohibit people, such as what we're trying to deal through other avenues of being able to get service because they would be paid for by other providers, by the carriers. And trust me, Senator, I understand what you're saying. I've been on public health ever since I've been down here.
What your concern is would be my concern, and I wouldn't want to see that happen.
Representative David Ray
Unverified
11:53
All right. Thank you. All right. We've already had the question time, but you all just went ahead and asked some more.
Senator Kim Hammer
Unverified
11:58
So, Senator Hammer, do you want to close again for your bill? I think I'm closed. And thank you, Mr. Chair, members of the committee. Appreciate a positive vote. All right. What's the will of the
Representative David Ray
Unverified
12:08
committee? Got a motion? Do pass? Second. Any further discussion? All in favor of the motion, say aye. Aye. Congratulations, Senator.
Pass your bill. Thank you, Mr. Chair, members of the committee. All right. Senator Letting, you want to come down with Senate Bill 290? And there is an amendment, I think, to add a sponsor that staff's passing out right now. I'VE GOT A MOTION TO ADOPT THE AMENDMENT. SECOND. ALL IN FAVOR SAY AYE. AMENDMENT IS ADOPTED. SENATOR LETTING, YOU'RE RECOGNIZED TO EXPLAIN YOUR BILL.
Senator Greg Leding
Unverified
12:47
THANK YOU, MR. CHAIR. THE AMENDMENT, AS YOU CAN SEE, IS ONLY ADDING CO-SPONSORS ON BOTH ENDS IN THE SENATE AND THE HOUSE. Just real quick, we worked with Susan G. Komen on this piece of legislation. Breast cancer is the most common form of cancer among women. Here in Arkansas, more than 2,000 women a year are diagnosed with breast cancer, and there's generally about 400 deaths. Right now, women can get access to free preventative screenings, but of the 12% of women who are told that there's something detected there and they need to do a more advanced diagnostic examination,
a lot of women end up foregoing that examination because of the cost involved. obviously we want to catch cancer as quickly as possible as soon as possible and so the fact that some women are foregoing this option and in some cases even foregoing the free screening because they don't want to chance learning that there might be a next step they need to take that they can't afford what we're trying to do here is provide coverage for that diagnostic screening I
Speaker 32
13:43
could talk more okay any questions for the from the committee so
Representative David Ray
Unverified
13:51
So, Senator, when you say provide more, does this require the insurance to cover
Senator Greg Leding
Unverified
14:02
it? It would become another essential health benefit just like the initial screening. Okay. So it would, but likely they're not opposed because
Speaker 55
14:09
it's going to save them in the long run to detect it earlier? That's my understanding. Yes, nobody has reached out in
Senator Greg Leding
Unverified
14:19
opposition. We did get one question from Melissa Rust, as you all know, with the University of Arkansas system.
They just had questions about, like, how many times a woman might need to avail herself of this process in a year. Coleman didn't happen to have that data. All we know is that about 12% of the women who have that initial screening go on to have or should go on to
Senator Missy Irvin
Unverified
14:46
have that next diagnostic examination. Okay. Senator Irvin, you recognize? Yeah. So, I mean, I co-sponsor this bill with you.
So, but I, one of the things I'm just wanting to verify is, is there a certain age that starts at?
Because I know you have a baseline mammogram for an insured woman who is 35 to 40 years of age. And
Speaker 60
15:09
then the annual mammogram for the insured woman who is 40 or older.
Senator Missy Irvin
Unverified
15:13
And that's, that's current language, right? That's not, you're not adding. Right.
Senator Greg Leding
Unverified
15:18
And in that next paragraph below there in C, you can see upon recommendation of a woman's physician without regard to age, if the physician believes
Speaker 52
15:26
that there's reason to believe that it's a necessary
Senator Missy Irvin
Unverified
15:30
procedure. Right. That's current language in our current code.
So you're not changing the ages. No. So you're just making sure that their individual's cost-sharing requirement. No, let's move on. Okay. So you're really trying to address the cost-sharing aspect of this is what it
looks like to me. To make it more affordable to more women. Right, right. Because
Senator Greg Leding
Unverified
16:04
The average patient cost for a mammogram is about $234, and for a breast MRI, it can be over $1,000. Right. For a lot of women,
Senator Missy Irvin
Unverified
16:13
that's just out of reach. Right. But what may be out of reach is the cost-sharing portion of that as well because of the deductible. Okay.
Senator Jimmy Hickey, Jr
Unverified
16:32
All right. Thank you. Any other questions? Okay. Senator Hickey, you're recognized. Mine's more about just the structure of the bill. On page five, lines 13 through 15, I mean, I see where we added the health care insurer now is going to be required to use this coding system. There's not any problem with us taking those other ones out, is there?
You know, I didn't know, so I understand we're going to have the insurer, but are we also going to have a health maintenance organization or an accident or health provider that might still need to do
it under that code? I don't know. I don't know if perhaps the health care insurer is just a catch-all for that other language and they're just trying to simplify it. I can certainly talk to BLR.
Well, I'm not looking to stop the bill over the thing, but, you know, it might just, after this, if it passes, if you could just check and then we could bring it back for a modification. That kind of
Speaker 55
17:37
just catches my eye. Thank you, sir. I've circled that and we'll make a note of it, and I'll get an answer
Senator Missy Irvin
Unverified
17:45
for you. Okay. Senator Irvin, you recognize. Yeah, I'm sorry. I go back to that page five. So you're actually saying that a breast ultrasound, I'm on page 5, lines 27 through 29.
Okay. A breast ultrasound shall not be subject to a deductible or any applicable copayment. So actually the copayment would be going to the institution that's doing the ultrasound. So the insurance isn't really being affected. that's what i read well i'm just i'm just curious about the co-payment portion of that
so i'm just because that's really not
Representative David Ray
Unverified
18:38
it looks like it's not subject to co-payment now doesn't it and aren't they lying out but they're just adding the deductible
Senator Missy Irvin
Unverified
18:46
part or any i mean no because you're striking on lines 27 and 28 you're striking a breast ultrasound may be subject to any applicable co-payment as required under a health benefit plan shall not be but shall not be subject to a deductible so that's that's the key here so you're saying that like a hospital
could not collect a co-payment so the insurance company's out not out the money it's actually the person that's performing the ultrasound because they're not able to collect the co-payment so i just i'm i mean i guess that's where i'm confused by i mean because i understand all the additions and what's in here is health care insurer but why don't why don't we do this i think
Representative David Ray
Unverified
19:39
we're meeting again Thursday and since we're only running with the committee. No, no, no. You're a co-sponsor of the bill. I want to make sure that your concerns
Speaker 32
19:50
are addressed. I'm sorry. Thank you, Senator. No, you have other questions there, Senator? No, no. Because let's now let anything we need to
Senator Ricky Hill
Unverified
19:57
fix, let Greg know. Senator Elliott, you got a question? Actually, no, I don't think I do now, but I just wanted to just be thinking about, did we mean for the woman not to have to pay anything at all to get that ultrasound? Is that because I read it like that's kind of what we're meaning to do.
That is Coleman's goal, yes. That's right. So that needs to be figured into whatever we are thinking about. All right. Thank you. Because you said from the very beginning, there are women who won't even go for fear. I mean, we used to have something that covered breast care because they got left out somehow out of Arkansas Works and what the private option or whatever. And I don't know whatever happened to that fund. It was dwindling away, so it might be gone by now.
But the whole point of that kind of was to make sure women who couldn't afford, you know, that copay didn't have to forego an ultrasound or whatever it was. In this case, it was just a breast exam, period. So, okay.
Speaker 41
20:54
So, all right. So, we might want to clear all that up,
Representative David Ray
Unverified
20:58
too. Yeah, I think so. And I think Senator Elliott's right there. I know we had a source of revenue for the Breast Cancer Awareness Fund or whatever, and that got changed with Arkansas Works. I'm just surprised, again, if it were really impacting the providers,
you would think they would have let us know. But between now and Thursday, I'm certain we can get it sorted out. Thank you very much. Okay. And we do have an even better quorum now. Is there anyone here to run House Bill 1027? Okay. All right. So we're going to defer House Bill 1027, and we'll come back and look at Senate Bill 290 on Thursday. Plus, I think we already have a couple other bills going to be added. So I know you may not get out of here as early Thursday afternoon as you'd like,
but we'll get our calendar clear. Anything else before we finish? All right, we'll stand adjourned. You
Agenda
Call to Order
SB168 K. Hammer TO MODIFY THE EXEMPTIONS OF CERTAIN ENTITIES FROM INSURANCE REGULATION.
SB290 G. Leding CONCERNING COVERAGE OF DIAGNOSTIC EXAMINATIONS FOR BREAST CANCER UNDER CERTAIN HEALTH BENEFIT PLANS.
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — INSURANCE & COMMERCE - SENATE, Feb 9, 2021 | Agenda | 1 | Official source ↗ |
Speakers
Representative David Ray
Unverified
Senator Kim Hammer
Unverified
Chair
Unverified
Senator Ricky Hill
Unverified
Senator Joyce Elliott
Unverified
Speaker 15
Speaker 17
Speaker 19
Speaker 20
Speaker 30
Senator Missy Irvin
Unverified
Speaker 43
Speaker 45
Senator Greg Leding
Unverified
Speaker 32
Speaker 55
Speaker 60
Speaker 52
Speaker 63
Senator Jimmy Hickey, Jr
Unverified
Speaker 41