SB0122B -1- CSSB 122(HSS)
New Text Underlined [DELETED TEXT BRACKETED]
34-LS0281\G
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 S OCIAL 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 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 shall take the network requirements of this section into 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 health care 9
providers, as defined in regulation by the director; or 10
(2) creates a substantial financial or other incentive or disincentive for 11
the covered person to use a limited network of health care providers. 12
(b) A health care insurer's provider network must include each hospital, 13
skilled nursing facility, or mental health or substance abuse facility licensed in the 14 34-LS0281\G
CSSB 122(HSS) -2- SB0122B
New Text Underlined [DELETED TEXT BRACKETED]
state and each physician, physician assistant, or advanced practice 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 operated 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, physician assistant, or advanced practice registered nurse 7
who is employed or contracted by a hospital, skilled nursing facility, 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 provider network must include a sufficient number 12
of physicians, physician assistants, and advanced practice registered nurses in each 13
contracting region in which the insurer provides coverage to meet the minimum 14
network standards set out in (d) of this section. Only a physician, physician assistant, 15
or advanced practice registered nurse who is licensed in this state, meets the 16
credentialling standards of the health care insurer, and whose principal practice 17
location is physically located in the applicable contracting region 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 physician, physician assistant, or 20
advanced practice registered nurse as contracted for the purposes of all insurance 21
benefit determinations, a health care insurer may include in the provider network a 22
physician, physician assistant, or advanced practice registered nurse who is not a 23
contracted network health care provider to meet the standards set out in (d) of this 24
section. Each physician, physician assistant, or advanced practice 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 insurer's directory of 28
network providers. 29
(d) For purposes of this section, the state is divided into six contracting 30
regions: the Municipality of Anchorage; the Matanuska-Susitna Borough; the 31 34-LS0281\G
SB0122B -3- CSSB 122(HSS)
New Text Underlined [DELETED TEXT BRACKETED]
Fairbanks North Star Borough and Southeast Fairbanks Census Area; the Kenai 1
Peninsula Borough; the City and Borough of Juneau, Ketchikan Gateway Borough, 2
and City and Borough of Sitka; and the remainder of the state. A health care insurer 3
that provides coverage in the Municipality of Anchorage contracting region must 4
include in the insurer's provider network at least 70 percent of the total actively 5
practicing physicians, physician assistants, and advanced practice registered nurses in 6
each specialty recognized for a Medicare advantage plan network adequacy 7
requirement for the Centers for Medicare and Medicaid Services physically located in 8
the region and at least 70 percent of the provider groups in each specialty. A health 9
care insurer that provides coverage in the Matanuska-Susitna Borough contracting 10
region or the Fairbanks North Star Borough and Southeast Fairbanks 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 advantage plan network 14
adequacy requirement for the Centers for Medicare and Medicaid Services physically 15
located in those regions and at least 75 percent of the provider 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 contracting region covering the 19
remainder of the state must include in the insurer's provider network 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 Medicare advantage plan 22
network adequacy requirement for the Centers for Medicare and 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 director for an 26
exception to the minimum provider network standards set out under this section. The 27
director may grant an exception only for a specified limited period not to exceed 36 28
months. The director shall adopt regulations specifying the procedure 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 network standards within 31 34-LS0281\G
CSSB 122(HSS) -4- SB0122B
New Text Underlined [DELETED TEXT BRACKETED]
the time frame of the exception granted by the director and submit annual progress 1
reports to the director. 2
(f) A health care insurer shall annually attest whether the insurer 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 the 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 standards by 10
contracting region that exceed the minimum network standards set 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