9 AAC 23.020. Negotiation request requirements

(a) Before each collective negotiation under this chapter, an authorized third party must submit to the attorney general a written request containing the information required by this section, along with the fee required by 9 AAC 23.030. The authorized third party must submit one original and one copy of each request to the Anchorage office of the attorney general.

(b) In a negotiation request, the authorized third party must include the following information, and must group and label the information by paragraph:

(1) information about the authorized third party, including the name, title, business address, and telephone number of the authorized third party and a description of

(A) the authorized third party's occupation, professional training, credentials and licenses, and experience in the health care field;

(B) the contracts for services to be performed by the authorized third party in connection with AS 23.50 and this chapter, including any compensation arrangements;

(C) the legal and business relationships between the authorized third party and the participating physicians, including any other contracting services provided by the authorized third party for any participating physician;

(D) the authorized third party's pecuniary interest, if any, in the contracts to be negotiated under AS 23.50 and this chapter; and

(E) any other physician groups the authorized third party has represented, is representing, or currently plans to represent;

(2) information about the negotiation group as follows:

(A) a complete list of the physicians represented, including the physical address of each physician's primary place of business;

(B) a description of each participating physician's specialties, primary practice areas, clinic affiliations, and active hospital staff privileges;

(C) a description of each independent practice association (IPA) to which each participating physician belongs, including the group's name, business address, type of legal organization, and approximate number of physician members;

(D) for each health benefit plan for which collective negotiations are proposed, a statement about whether any participating physician has contracted to be a provider for that health benefit plan through any IPA, and, if so, a statement that indicates which IPA is a party to that contract;

(E) a description of the type of legal organization, if any, of the negotiation group;

(F) for each health benefit plan for which collective negotiations are proposed, a representative copy of the most recent contract with the health benefit plan;

(G) a description of the geographic service area in which the negotiation group provides services, including a percentage estimate of the market share held by the negotiation group;

(H) a description of the different specialties in the geographic service area identified in (G) of this paragraph, and a listing of physicians who compete with the participating physicians in the geographic service area; if the participating physicians have multiple specialties, this information must be provided separately for each specialty;

(3) the name of each health benefit plan that the authorized third party will contact, including the name and phone number of the contact person of the health benefit plan;

(4) a plan of operation for the authorized third party; the plan of operation must include a procedure to manage communications between the authorized third party and the health benefit plans, between the authorized third party and the participating physicians, and among the participating physicians; the procedure must limit communications to matters, terms, and conditions that are not fee-related;

(5) a procedure to ensure that the health benefit plans remain free to contract with, or offer different contract terms and conditions to, individual competing physicians;

(6) a summary of the procedures that the authorized third party will use to ensure compliance with AS 23.50.020 ;

(7) a brief report that identifies the proposed subject matter of the collective negotiations with a health benefit plan; the report must include

(A) the specific contract terms and conditions to be negotiated;

(B) the proposed time line of the negotiations;

(D) the expected impact of the negotiations on competition;

(E) the expected impact of the negotiations on consumers;

(F) the benefits of a contract between the identified health benefit plan and physicians; and

(G) an explanation of the efficiencies or benefits expected to be achieved by the negotiations;

(8) a copy of each communication proposed to be sent to the health benefit plan.

(c) The authorized third party must sign each negotiation request submitted under this section. Copies of relevant supporting documents must be included. If the request contains data from a source other than the authorized third party or participating physicians, the source of the data must be identified, if any of the information required by (b) of this section is unavailable, the request must include an explanation of the efforts made to obtain the information, and must identify the sources from which the information was sought. If the participating physicians are contractually prohibited from disclosing requested information, the request must identify the information or documents subject to nondisclosure terms and the contract terms that prohibit disclosure.

(d) The attorney general will determine whether a negotiation request is complete. A negotiation request will not be considered filed until the attorney general receives a completed application and application fee in accordance with this section and 9 AAC 23.030. The attorney general will return an incomplete or unorganized application to the authorized third party and identify any deficiencies.

(e) An authorized third party may withdraw an application at any time by submitting a written notice of withdrawal to the attorney general.

History: Eff. 6/29/2003, Register 166

Authority: AS 23.50.020

AS 23.50.040

Editor's note: The address for submitting negotiation requests required by 9 AAC 23.020 is State of Alaska, Department of Law, Office of to Attorney General, Attention: Physician Negotiation Request, 1031 W. 4th Avenue, Suite 200, Anchorage, Alaska 99501.

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