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SB0122B -1- CSSB 122(HSS)
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CS FOR SENATE BILL NO. 122(HSS)
IN THE LEGISLATURE OF THE STATE OF ALASKA
THIRTY-FOURTH LEGISLATURE - FIRST SESSION
BY THE SENATE HEALTH AND SOCIAL SERVICES COMMITTEE
Offered: 4/7/25
Referred: Labor & Commerce
Sponsor(s): SENATOR GIESSEL BY REQUEST
A BILL
FOR AN ACT ENTITLED
"An Act relating to insurance; establishing standards for healt h insurance provider 1
networks; and providing for an effective date." 2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 3
* Section 1. AS 21.07 is amended by adding a new section to read: 4
Sec. 21.07.035. Minimum provider network standards. (a) A health care 5
insurer shall take the network r equirements of this section int o account when 6
calculating the benefits of, or other contractual requirements applicable to, a covered 7
person's health care insurance policy that, as determined by the director, 8
(1) requires the covered person to use a limited network of he alth care 9
providers, as defined in regulation by the director; or 10
(2) creates a substantial financial or other incentive or disi ncentive for 11
the covered person to use a limited network of health care providers. 12
(b) A health care insurer's provi der network must include each hospital, 13
skilled nursing facility, or mental health or substance abuse f acility licensed in the 14
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state and each physician, physician assistant, or advanced prac tice registered nurse 1
licensed in this state who is employed or contracted by one of these hospitals or 2
facilities to provide medical care at the hospital or facility. A health care insurer's 3
provider network must include each health care facility operate d by an Alaska tribal 4
health organization and each physician, physician assistant, or advanced practice 5
registered nurse employed or contracted by the organization to provide medical care at 6
that location. A physician, physic ian assistant, or advanced pr actice registered nurse 7
who is employed or contracted by a hospital, skilled nursing fa cility, mental health or 8
substance abuse facility, or Alaska tribal health organization to provide medical care is 9
not included when calculating the health care insurer's minimum network standards set 10
out in (d) of this section. 11
(c) A health care insurer's provi der network must include a su fficient number 12
of physicians, physician assistants, and advanced practice regi stered nurses in each 13
contracting region in which the i nsurer provides coverage to me et the minimum 14
network standards set out in (d) of this section. Only a physic ian, physician assistant, 15
or advanced practice registered nurse who is licensed in this s tate, meets the 16
credentialling standards of the health care insurer, and whose principal practice 17
location is physically located in the applicable contracting re gion may be included 18
when determining whether a health care insurer meets the minimum network standards 19
set out in (d) of this section. If an insurer treats the physic ian, physician assistant, or 20
advanced practice registered nur se as contracted for the purpos es of all insurance 21
benefit determinations, a health care insurer may include in th e provider network a 22
physician, physician assistant, or advanced practice registered n u r s e w h o i s n o t a 23
contracted network health care provider to meet the standards s et out in (d) of this 24
section. Each physician, physician assistant, or advanced pract ice registered nurse 25
included in the health care insurer's provider network, including a physician, physician 26
assistant, or advanced practice registered nurse that is not a contracted network health 27
care provider, must be shown as an in-network provider in the i nsurer's directory of 28
network providers. 29
(d) For purposes of this section, the state is divided into si x contracting 30
regions: the Municipality of Anc horage; the Matanuska-Susitna B orough; the 31
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Fairbanks North Star Borough and Southeast Fairbanks Census Are a; the Kenai 1
Peninsula Borough; the City and Borough of Juneau, Ketchikan Ga teway Borough, 2
and City and Borough of Sitka; a nd the remainder of the state. A health care insurer 3
that provides coverage in the M unicipality of Anchorage contrac ting region must 4
include in the insurer's provide r network at least 70 percent o f the total actively 5
practicing physicians, physician assistants, and advanced pract ice registered nurses in 6
each specialty recognized for a Medicare advantage plan network adequacy 7
requirement for the Centers for M edicare and Medicaid Services physically located in 8
the region and at least 70 percent of the provider groups in ea ch specialty. A health 9
care insurer that provides cove rage in the Matanuska-Susitna Bo rough contracting 10
region or the Fairbanks North Star Borough and Southeast Fairba nks Census Area 11
contracting region must include in the insurer's provider network at least 75 percent of 12
the total actively practicing physicians, physician assistants, and advanced practice 13
registered nurses in each specialty recognized for a Medicare a dvantage plan network 14
adequacy requirement for the Cen ters for Medicare and Medicaid Services physically 15
located in those regions and at least 75 percent of the provide r groups in each 16
specialty. A health care insurer that provides coverage in the Kenai Peninsula Borough 17
contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and 18
City and Borough of Sitka contracting region, or the contractin g region covering the 19
remainder of the state must incl ude in the insurer's provider n etwork at least 80 20
percent of the total actively practicing physicians, physician assistants, and advanced 21
practice registered nurses in each specialty recognized for a M edicare advantage plan 22
network adequacy requirement for t h e C e n t e r s f o r M e d i c a r e a n d Medicaid Services 23
physically located in those regions and at least 80 percent of the provider groups in 24
each specialty. 25
(e) A health care insurer may make a written request to the di r e c t o r f o r a n 26
exception to the minimum provider network standards set out und er this section. The 27
director may grant an exception only for a specified limited pe riod not to exceed 36 28
months. The director shall adopt r egulations specifying the pro cedure for requesting 29
an exception and the standards for granting an exception. The director shall require the 30
health care insurer to submit a plan to achieve the minimum net work standards within 31
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the time frame of the exception granted by the director and sub mit annual progress 1
reports to the director. 2
(f) A health care insurer shall annually attest whether the in surer meets or 3
exceeds the minimum provider network standards in this section for each contracting 4
region in which the insurer provides coverage and provide to th e director supporting 5
documentation to demonstrate compliance as part of the insurer' s required rate filings. 6
If a health care insurer does not meet a specific standard, the insurer shall submit a 7
plan for corrective action for consideration by the director. 8
(g) The director may adopt regulations necessary to implement this section. 9
The director may adopt in regulation minimum provider network s tandards by 10
contracting region that exceed the minimum network standards se t out in (d) of this 11
section. 12
* Sec. 2. AS 21.07.020(3) is repealed. 13
* Sec. 3. This Act takes effect January 1, 2026. 14