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SENATE BILL NO. 122
IN THE LEGISLATURE OF THE STATE OF ALASKA
THIRTY-FOURTH LEGISLATURE - FIRST SESSION
BY SENATOR GIESSEL BY REQUEST
Introduced: 3/5/25
Referred: Health and Social Services, Labor and Commerce
A BILL
FOR AN ACT ENTITLED
"An Act relating to insurance; establishing standards for health 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 that offers a health care insurance policy providing for coverage of medical 6
care services through a provider network consisting of health care providers that have 7
entered into a contract with the insurer shall take the network requirements of this 8
section into account when calculating the benefits or other contractual requirements of 9
a covered person. 10
(b) A health care insurer's provider network must include each hospital, 11
skilled nursing facility, or mental health or substance abuse facility licensed in the 12
state and each physician, physician assistant, or advanced practice registered nurse 13
licensed in this state who is employed or contracted by one of these hospitals or 14 34-LS0281\N
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facilities to provide medical care at the hospital or facility. A health care insurer's 1
provider network must include each health care facility operated by an Alaska tribal 2
health organization and each physician, physician assistant, or advanced practice 3
registered nurse employed or contracted by the organization to provide medical care at 4
that location. A physician, physician assistant, or advanced practice registered nurse 5
who is employed or contracted by a hospital, skilled nursing facility, mental health or 6
substance abuse facility, or Alaska tribal health organization to provide medical care is 7
not included when calculating the health care insurer's minimum network standards set 8
out in (d) of this section. 9
(c) A health care insurer's provider network must include a sufficient number 10
of physicians, physician assistants, and advanced practice registered nurses in each 11
contracting region in which the insurer provides coverage to meet the minimum 12
network standards set out in (d) of this section. Only a physician, physician assistant, 13
or advanced practice registered nurse who is licensed in this state, meets the 14
credentialling standards of the health care insurer, and whose principle practice 15
location is physically located in the applicable contracting region may be included 16
when determining whether a health care insurer meets the minimum network standards 17
set out in (d) of this section. If an insurer treats the physician, physician assistant, or 18
advanced practice registered nurse as contracted for the purposes of all insurance 19
benefit determinations, a health care insurer may include in the provider network a 20
physician, physician assistant, or advanced practice registered nurse who is not a 21
contracted network health care provider to meet the standards set out in (d) of this 22
section. Each physician, physician assistant, or advanced practice registered nurse 23
included in the health care insurer's provider network, including a physician, physician 24
assistant, or advanced practice registered nurse that is not a contracted network health 25
care provider, must be shown as an in-network provider in the insurer's directory of 26
network providers. 27
(d) For purposes of this section, the state is divided into six contracting 28
regions: the Municipality of Anchorage; the Matanuska-Susitna Borough; the 29
Fairbanks North Star Borough and Southeast Fairbanks Census Area; the Kenai 30
Peninsula Borough; the City and Borough of Juneau, Ketchikan Gateway Borough,
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and City and Borough of Sitka; and the remainder of the state. A health care insurer 1
that provides coverage in the Municipality of Anchorage contracting region must 2
include in the insurer's provider network at least 85 percent of the total actively 3
practicing physicians, physician assistants, and advanced practice registered nurses in 4
each specialty recognized for a Medicare advantage plan network adequacy 5
requirement for the Centers for Medicare and Medicaid Services physically located in 6
the region and at least 85 percent of the provider groups in each specialty. A health 7
care insurer that provides coverage in the Matanuska-Susitna Borough contracting 8
region or the Fairbanks North Star Borough and Southeast Fairbanks Census Area 9
contracting region must include in the insurer's provider network at least 90 percent of 10
the total actively practicing physicians, physician assistants, and advanced practice 11
registered nurses in each specialty recognized for a Medicare advantage plan network 12
adequacy requirement for the Centers for Medicare and Medicaid Services physically 13
located in those regions and at least 90 percent of the provider groups in each 14
specialty. A health care insurer that provides coverage in the Kenai Peninsula Borough 15
contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and 16
City and Borough of Sitka contracting region, or the contracting region covering the 17
remainder of the state must include in the insurer's provider network at least 95 18
percent of the total actively practicing physicians, physician assistants, and advanced 19
practice registered nurses in each specialty recognized for a Medicare advantage plan 20
network adequacy requirement for the Centers for Medicare and Medicaid Services 21
physically located in those regions and at least 95 percent of the provider groups in 22
each specialty. 23
(e) A health care insurer may make a written request to the director for an 24
exception to the minimum provider network standards set out under this section. The 25
director may grant an exception only for a specified limited period not to exceed 36 26
months. The director shall adopt regulations specifying the procedure for requesting 27
an exception and the standards for granting an exception. The director shall require the 28
health care insurer to submit a plan to achieve the minimum network standards within 29
the time frame of the exception granted by the director and sub
mit annual progress 30
reports to the director. 31 34-LS0281\N
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(f) A health care insurer shall annually attest whether the insurer meets or 1
exceeds the minimum provider network standards in this section for each contracting 2
region in which the insurer provides coverage and provide to the director supporting 3
documentation to demonstrate compliance as part of the insurer's required rate filings. 4
If a health care insurer does not meet a specific standard, the insurer shall submit a 5
plan for corrective action for consideration by the director. 6
(g) The director may adopt regulations necessary to implement this section. 7
The director may adopt in regulation minimum provider network standards by 8
contracting region that exceed the minimum network standards set out in (d) of this 9
section. 10
* Sec. 2. AS 21.07.020(3) is repealed. 11
* Sec. 3. This Act takes effect January 1, 2026. 12