SB 129 — An Act relating to the determination by an insurer of a final payment for a covered service or supply; annulling regulations relating to determination by an insurer of a final payment for a covered service or supply based on geographical areas; and providing for an effective date.

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"An Act relating to emergencythe servicesdetermination andby balancean billing;insurer of a final payment for a covered service or supply;

annulling regulations relating to the determination by an insurer of a final payment for a covered service or supply;supply based on geographical areas;

and annullingproviding regulationsfor relating to determination by an insurereffective ofdate." aSPONSOR finalSUBSTITUTE paymentFOR for a covered service or supply based on geographical areas." SENATE BILL NO.

129 01 "An Act relating to emergencythe servicesdetermination andby balancean billing;insurer of a final payment for a covered 02 service or supply;

annulling regulations relating to the 02 determination by an insurer of a 03 final payment for a covered service or supply;supply based on geographical areas;

and 0304 annullingproviding regulationsfor relating to determination by an insurereffective ofdate." a final payment for a 04 covered service or supply based on geographical areas." 05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:

AS 21.3621.42.205 is amended by adding a new section to read:

21.36.512.21.42.205.

EmergencyCoordination services;of benefits and determination of final 08 payment for a covered service or supply.

balance(a) billing.Unless prohibited by federal law, an 09 insurer authorized under AS 21.09 to offer, issue for delivery, deliver, or renew an 10 individual or group health insurance policy for major medical coverage on an expense 11 incurred basis;

(a)a A health caremaintenance 08organization providerauthorized or health care facility that provides emergency services or treatment of an 09 emergency medical condition under AS 21.07.02021.86 mayto notoffer balance bill for services 10 that results in a covered person's incurring greater out-of-pocket costs, including 11 copayment, deductible, or coinsurance amounts, for emergency services or treatment 12 ofcontract anto emergencyprovide major medical condition from a non-network health care provider than the 13 covered person would have incurred from a health care provider that furnishes 14 emergency services oron treatment of an emergency medical condition through a networkprepaid ofbasis; health care providers that have entered into a contract with a health care 02 insurer.

03or (b)a Inservice this13 section,corporation 04authorized (1)under "emergencyAS 21.87 to offer or renew an individual or group 14 subscriber's contract for major medical condition"coverage hasshall the(1) meaninginclude givena coordination of benefits provision in 05a ASmajor 21.07.250;medical 02 policy or contract;

06and 03 (2) "healthdetermine carethe facility"final includespayment for a hospitalcovered emergencyservice room or stand-supply 0704 alonebased emergencyon an amount that is at least 300 percent of the amount reimbursed by 05 Medicare for that service facility;or supply under an applicable Medicare fee schedule 06 for the state.

07 (b) The director may adopt regulations to implement this section, except that 08 (3)the "healthdirector caremay insurer"not hasadopt a regulation that establishes the meaningfinal givenpayment infor ASa 21.54.500;09 covered service or supply.

09 (4) "health care provider" has the meaning given in AS 21.07.250.

AS 21.42.205 is amended to read:

11 Sec.

21.42.205.

Coordination of benefits and determination of final 12 payment for a covered service or supply.

(a) Unless prohibited by federal law, an 13 insurer authorized under AS 21.09 to offer, issue for delivery, deliver, or renew an 14 individual or group health insurance policy for major medical coverage on an expense 15 incurred basis;

a health maintenance organization authorized under AS 21.86 to offer a 16 contract to provide major medical health care services on a prepaid basis;

or a service 17 corporation authorized under AS 21.87 to offer or renew an individual or group 18 subscriber's contract for major medical coverage shall 19 (1) include a coordination of benefits provision in a major medical 20 policy or contract;

and 21 (2) determine the final payment for a covered service or supply 22 based on an amount that is at least 200 percent of the amount reimbursed by 23 Medicare for that service or supply under an applicable Medicare fee schedule 24 for the state.

25 (b) The director may adopt regulations to implement this section, except that 26 the director may not adopt a regulation that establishes the final payment for a 27 covered service or supply.

28 * Sec.

3.

11 * Sec.

3.

The uncodified law of the State of Alaska is amended by adding a new section to 12 read:

13 TRANSITION:

IMPLEMENTATION.

The determination for final payment for a 14 covered service or supply under AS 21.42.205(a), as amended by sec.

1 of this Act, applies to 15 contracts or agreements entered into by an insurer, health maintenance organization, or 16 service corporation on or after the effective date of this Act.

17 * Sec.

4.

This Act takes effect immediately under AS 01.10.070(c).