SB 122 — An Act relating to insurance; establishing standards for health insurance provider networks; and providing for an effective date.

34-LS0281\G34-LS0281\N CS FOR SENATE BILL NO.

122(HSS)122 IN THE LEGISLATURE OF THE STATE OF ALASKA THIRTY-FOURTH LEGISLATURE - FIRST SESSION BY THESENATOR SENATEGIESSEL HEALTHBY ANDREQUEST SOCIALIntroduced: SERVICES COMMITTEE Referred:

Labor3/5/25 &Referred: Commerce Sponsor(s):

SENATORHealth GIESSELand BYSocial REQUESTServices, Labor and Commerce A BILL FOR AN ACT ENTITLED "An Act relating to insurance;

(a) A health care insurer shallthat takeoffers thea networkhealth requirementscare ofinsurance thispolicy sectionproviding intofor accountcoverage whenof calculatingmedical thecare benefitsservices of,through ora otherprovider contractualnetwork requirementsconsisting applicableof to, a covered person's health care insuranceproviders policythat that,have asentered determinedinto bya contract with the director,insurer (1)shall requirestake the coverednetwork personrequirements toof usethis asection limitedinto networkaccount ofwhen healthcalculating carethe providers,benefits asor definedother incontractual regulationrequirements byof thea director;covered person.

or(b) (2)A createshealth acare substantialinsurer's financialprovider network must include each hospital, skilled nursing facility, or othermental incentivehealth or disincentivesubstance forabuse facility licensed in the coveredstate personand toeach usephysician, aphysician limitedassistant, networkor advanced practice registered nurse licensed in this state who is employed or contracted by one of healththese hospitals or SB0122A -1- SB 122 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0281\N facilities to provide medical care providers.at the hospital or facility.

(b) A health care insurer's provider network must include each hospital, skilled nursing facility, or mental health or substance abuse facility licensed in the SB0122B -1- CSSB 122(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS0281\G state and each physician, physician assistant, or advanced practice registered nurse licensed in this state who is employed or contracted by one of these hospitals or facilities to provide medical care at the hospital or facility.

Only a physician, physician assistant, or advanced practice registered nurse who is licensed in this state, meets the credentialling standards of the health care insurer, and whose principalprinciple practice location is physically located in the applicable contracting region may be included when determining whether a health care insurer meets the minimum network standards set out in (d) of this section.

the CSSB 122(HSS) -2- SB0122B New Text Underlined [DELETED TEXT BRACKETED] 34-LS0281\G Fairbanks North Star Borough and Southeast Fairbanks Census Area;

the City and Borough of Juneau, Ketchikan Gateway Borough, SB 122 -2- SB0122A New Text Underlined [DELETED TEXT BRACKETED] 34-LS0281\N and City and Borough of Sitka;

A health care insurer that provides coverage in the Municipality of Anchorage contracting region must include in the insurer's provider network at least 7085 percent of the total actively practicing physicians, physician assistants, and advanced practice registered nurses in each specialty recognized for a Medicare advantage plan network adequacy requirement for the Centers for Medicare and Medicaid Services physically located in the region and at least 7085 percent of the provider groups in each specialty.

A health care insurer that provides coverage in the Matanuska-Susitna Borough contracting region or the Fairbanks North Star Borough and Southeast Fairbanks Census Area contracting region must include in the insurer's provider network at least 7590 percent of the total actively practicing physicians, physician assistants, and advanced practice registered nurses in each specialty recognized for a Medicare advantage plan network adequacy requirement for the Centers for Medicare and Medicaid Services physically located in those regions and at least 7590 percent of the provider groups in each specialty.

A health care insurer that provides coverage in the Kenai Peninsula Borough contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and City and Borough of Sitka contracting region, or the contracting region covering the remainder of the state must include in the insurer's provider network at least 8095 percent of the total actively practicing physicians, physician assistants, and advanced practice registered nurses in each specialty recognized for a Medicare advantage plan network adequacy requirement for the Centers for Medicare and Medicaid Services physically located in those regions and at least 8095 percent of the provider groups in each specialty.

The director shall require the health care insurer to submit a plan to achieve the minimum network standards within SB0122B -3- CSSB 122(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS0281\G the time frame of the exception granted by the director and submitsumit annual progress reports to the director.

SB0122A -3- SB 122 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0281\N (f) A health care insurer shall annually attest whether the insurer meets or exceeds the minimum provider network standards in this section for each contracting region in which the insurer provides coverage and provide to the director supporting documentation to demonstrate compliance as part of the insurer's required rate filings.

CSSBSB 122(HSS)122 -4- SB0122BSB0122A New Text Underlined [DELETED TEXT BRACKETED]