AK
Alaska Senate Bill SB122

Alaska 2025-2026 Regular Session

Alaska Senate Bill SB122 Compare Versions

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10-CS FOR SENATE BILL NO. 122(HSS)
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11+ SENATE BILL NO. 122
1112
1213 IN THE LEGISLATURE OF THE STATE OF ALASKA
1314
1415 THIRTY-FOURTH LEGISLATURE - FIRST SESSION
1516
16-BY THE SENATE HEALTH AND S OCIAL SERVICES COMMITTEE
17+BY SENATOR GIESSEL BY REQUEST
1718
18-Offered: 4/7/25
19-Referred: Labor & Commerce
19+Introduced: 3/5/25
20+Referred: Health and Social Services, Labor and Commerce
2021
21-Sponsor(s): SENATOR GIESSEL BY REQUEST
22+
2223 A BILL
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2425 FOR AN ACT ENTITLED
2526
2627 "An Act relating to insurance; establishing standards for health insurance provider 1
2728 networks; and providing for an effective date." 2
2829 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 3
2930 * Section 1. AS 21.07 is amended by adding a new section to read: 4
3031 Sec. 21.07.035. Minimum provider network standards. (a) A health care 5
31-insurer shall take the network requirements of this section into account when 6
32-calculating the benefits of, or other contractual requirements applicable to, a covered 7
33-person's health care insurance policy that, as determined by the director, 8
34-(1) requires the covered person to use a limited network of health care 9
35-providers, as defined in regulation by the director; or 10
36-(2) creates a substantial financial or other incentive or disincentive for 11
37-the covered person to use a limited network of health care providers. 12
38-(b) A health care insurer's provider network must include each hospital, 13
39-skilled nursing facility, or mental health or substance abuse facility licensed in the 14 34-LS0281\G
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32+insurer that offers a health care insurance policy providing for coverage of medical 6
33+care services through a provider network consisting of health care providers that have 7
34+entered into a contract with the insurer shall take the network requirements of this 8
35+section into account when calculating the benefits or other contractual requirements of 9
36+a covered person. 10
37+(b) A health care insurer's provider network must include each hospital, 11
38+skilled nursing facility, or mental health or substance abuse facility licensed in the 12
39+state and each physician, physician assistant, or advanced practice registered nurse 13
40+licensed in this state who is employed or contracted by one of these hospitals or 14 34-LS0281\N
41+SB 122 -2- SB0122A
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43-state and each physician, physician assistant, or advanced practice registered nurse 1
44-licensed in this state who is employed or contracted by one of these hospitals or 2
45-facilities to provide medical care at the hospital or facility. A health care insurer's 3
46-provider network must include each health care facility operated by an Alaska tribal 4
47-health organization and each physician, physician assistant, or advanced practice 5
48-registered nurse employed or contracted by the organization to provide medical care at 6
49-that location. A physician, physician assistant, or advanced practice registered nurse 7
50-who is employed or contracted by a hospital, skilled nursing facility, mental health or 8
51-substance abuse facility, or Alaska tribal health organization to provide medical care is 9
52-not included when calculating the health care insurer's minimum network standards set 10
53-out in (d) of this section. 11
54-(c) A health care insurer's provider network must include a sufficient number 12
55-of physicians, physician assistants, and advanced practice registered nurses in each 13
56-contracting region in which the insurer provides coverage to meet the minimum 14
57-network standards set out in (d) of this section. Only a physician, physician assistant, 15
58-or advanced practice registered nurse who is licensed in this state, meets the 16
59-credentialling standards of the health care insurer, and whose principal practice 17
60-location is physically located in the applicable contracting region may be included 18
61-when determining whether a health care insurer meets the minimum network standards 19
62-set out in (d) of this section. If an insurer treats the physician, physician assistant, or 20
63-advanced practice registered nurse as contracted for the purposes of all insurance 21
64-benefit determinations, a health care insurer may include in the provider network a 22
65-physician, physician assistant, or advanced practice registered nurse who is not a 23
66-contracted network health care provider to meet the standards set out in (d) of this 24
67-section. Each physician, physician assistant, or advanced practice registered nurse 25
68-included in the health care insurer's provider network, including a physician, physician 26
69-assistant, or advanced practice registered nurse that is not a contracted network health 27
70-care provider, must be shown as an in-network provider in the insurer's directory of 28
71-network providers. 29
72-(d) For purposes of this section, the state is divided into six contracting 30
73-regions: the Municipality of Anchorage; the Matanuska-Susitna Borough; the 31 34-LS0281\G
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44+facilities to provide medical care at the hospital or facility. A health care insurer's 1
45+provider network must include each health care facility operated by an Alaska tribal 2
46+health organization and each physician, physician assistant, or advanced practice 3
47+registered nurse employed or contracted by the organization to provide medical care at 4
48+that location. A physician, physician assistant, or advanced practice registered nurse 5
49+who is employed or contracted by a hospital, skilled nursing facility, mental health or 6
50+substance abuse facility, or Alaska tribal health organization to provide medical care is 7
51+not included when calculating the health care insurer's minimum network standards set 8
52+out in (d) of this section. 9
53+(c) A health care insurer's provider network must include a sufficient number 10
54+of physicians, physician assistants, and advanced practice registered nurses in each 11
55+contracting region in which the insurer provides coverage to meet the minimum 12
56+network standards set out in (d) of this section. Only a physician, physician assistant, 13
57+or advanced practice registered nurse who is licensed in this state, meets the 14
58+credentialling standards of the health care insurer, and whose principle practice 15
59+location is physically located in the applicable contracting region may be included 16
60+when determining whether a health care insurer meets the minimum network standards 17
61+set out in (d) of this section. If an insurer treats the physician, physician assistant, or 18
62+advanced practice registered nurse as contracted for the purposes of all insurance 19
63+benefit determinations, a health care insurer may include in the provider network a 20
64+physician, physician assistant, or advanced practice registered nurse who is not a 21
65+contracted network health care provider to meet the standards set out in (d) of this 22
66+section. Each physician, physician assistant, or advanced practice registered nurse 23
67+included in the health care insurer's provider network, including a physician, physician 24
68+assistant, or advanced practice registered nurse that is not a contracted network health 25
69+care provider, must be shown as an in-network provider in the insurer's directory of 26
70+network providers. 27
71+(d) For purposes of this section, the state is divided into six contracting 28
72+regions: the Municipality of Anchorage; the Matanuska-Susitna Borough; the 29
73+Fairbanks North Star Borough and Southeast Fairbanks Census Area; the Kenai 30
74+Peninsula Borough; the City and Borough of Juneau, Ketchikan Gateway Borough,
75+31 34-LS0281\N
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77-Fairbanks North Star Borough and Southeast Fairbanks Census Area; the Kenai 1
78-Peninsula Borough; the City and Borough of Juneau, Ketchikan Gateway Borough, 2
79-and City and Borough of Sitka; and the remainder of the state. A health care insurer 3
80-that provides coverage in the Municipality of Anchorage contracting region must 4
81-include in the insurer's provider network at least 70 percent of the total actively 5
82-practicing physicians, physician assistants, and advanced practice registered nurses in 6
83-each specialty recognized for a Medicare advantage plan network adequacy 7
84-requirement for the Centers for Medicare and Medicaid Services physically located in 8
85-the region and at least 70 percent of the provider groups in each specialty. A health 9
86-care insurer that provides coverage in the Matanuska-Susitna Borough contracting 10
87-region or the Fairbanks North Star Borough and Southeast Fairbanks Census Area 11
88-contracting region must include in the insurer's provider network at least 75 percent of 12
89-the total actively practicing physicians, physician assistants, and advanced practice 13
90-registered nurses in each specialty recognized for a Medicare advantage plan network 14
91-adequacy requirement for the Centers for Medicare and Medicaid Services physically 15
92-located in those regions and at least 75 percent of the provider groups in each 16
93-specialty. A health care insurer that provides coverage in the Kenai Peninsula Borough 17
94-contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and 18
95-City and Borough of Sitka contracting region, or the contracting region covering the 19
96-remainder of the state must include in the insurer's provider network at least 80 20
97-percent of the total actively practicing physicians, physician assistants, and advanced 21
98-practice registered nurses in each specialty recognized for a Medicare advantage plan 22
99-network adequacy requirement for the Centers for Medicare and Medicaid Services 23
100-physically located in those regions and at least 80 percent of the provider groups in 24
101-each specialty. 25
102-(e) A health care insurer may make a written request to the director for an 26
103-exception to the minimum provider network standards set out under this section. The 27
104-director may grant an exception only for a specified limited period not to exceed 36 28
105-months. The director shall adopt regulations specifying the procedure for requesting
106-29
107-an exception and the standards for granting an exception. The director shall require the 30
108-health care insurer to submit a plan to achieve the minimum network standards within 31 34-LS0281\G
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79+and City and Borough of Sitka; and the remainder of the state. A health care insurer 1
80+that provides coverage in the Municipality of Anchorage contracting region must 2
81+include in the insurer's provider network at least 85 percent of the total actively 3
82+practicing physicians, physician assistants, and advanced practice registered nurses in 4
83+each specialty recognized for a Medicare advantage plan network adequacy 5
84+requirement for the Centers for Medicare and Medicaid Services physically located in 6
85+the region and at least 85 percent of the provider groups in each specialty. A health 7
86+care insurer that provides coverage in the Matanuska-Susitna Borough contracting 8
87+region or the Fairbanks North Star Borough and Southeast Fairbanks Census Area 9
88+contracting region must include in the insurer's provider network at least 90 percent of 10
89+the total actively practicing physicians, physician assistants, and advanced practice 11
90+registered nurses in each specialty recognized for a Medicare advantage plan network 12
91+adequacy requirement for the Centers for Medicare and Medicaid Services physically 13
92+located in those regions and at least 90 percent of the provider groups in each 14
93+specialty. A health care insurer that provides coverage in the Kenai Peninsula Borough 15
94+contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and 16
95+City and Borough of Sitka contracting region, or the contracting region covering the 17
96+remainder of the state must include in the insurer's provider network at least 95 18
97+percent of the total actively practicing physicians, physician assistants, and advanced 19
98+practice registered nurses in each specialty recognized for a Medicare advantage plan 20
99+network adequacy requirement for the Centers for Medicare and Medicaid Services 21
100+physically located in those regions and at least 95 percent of the provider groups in 22
101+each specialty. 23
102+(e) A health care insurer may make a written request to the director for an 24
103+exception to the minimum provider network standards set out under this section. The 25
104+director may grant an exception only for a specified limited period not to exceed 36 26
105+months. The director shall adopt regulations specifying the procedure for requesting 27
106+an exception and the standards for granting an exception. The director shall require the 28
107+health care insurer to submit a plan to achieve the minimum network standards within 29
108+the time frame of the exception granted by the director and sub
109+mit annual progress 30
110+reports to the director. 31 34-LS0281\N
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112-the time frame of the exception granted by the director and submit annual progress 1
113-reports to the director. 2
114-(f) A health care insurer shall annually attest whether the insurer meets or 3
115-exceeds the minimum provider network standards in this section for each contracting 4
116-region in which the insurer provides coverage and provide to the director supporting 5
117-documentation to demonstrate compliance as part of the insurer's required rate filings. 6
118-If a health care insurer does not meet a specific standard, the insurer shall submit a 7
119-plan for corrective action for consideration by the director. 8
120-(g) The director may adopt regulations necessary to implement this section. 9
121-The director may adopt in regulation minimum provider network standards by 10
122-contracting region that exceed the minimum network standards set out in (d) of this 11
123-section. 12
124- * Sec. 2. AS 21.07.020(3) is repealed. 13
125- * Sec. 3. This Act takes effect January 1, 2026. 14
114+(f) A health care insurer shall annually attest whether the insurer meets or 1
115+exceeds the minimum provider network standards in this section for each contracting 2
116+region in which the insurer provides coverage and provide to the director supporting 3
117+documentation to demonstrate compliance as part of the insurer's required rate filings. 4
118+If a health care insurer does not meet a specific standard, the insurer shall submit a 5
119+plan for corrective action for consideration by the director. 6
120+(g) The director may adopt regulations necessary to implement this section. 7
121+The director may adopt in regulation minimum provider network standards by 8
122+contracting region that exceed the minimum network standards set out in (d) of this 9
123+section. 10
124+ * Sec. 2. AS 21.07.020(3) is repealed. 11
125+ * Sec. 3. This Act takes effect January 1, 2026. 12