00 SENATE BILL NO. 122 01 "An Act relating to insurance; establishing standards for health insurance provider 02 networks; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04  * Section 1. AS 21.07 is amended by adding a new section to read: 05 Sec. 21.07.035. Minimum provider network standards. (a) A health care 06 insurer that offers a health care insurance policy providing for coverage of medical 07 care services through a provider network consisting of health care providers that have 08 entered into a contract with the insurer shall take the network requirements of this 09 section into account when calculating the benefits or other contractual requirements of 10 a covered person. 11 (b) A health care insurer's provider network must include each hospital, 12 skilled nursing facility, or mental health or substance abuse facility licensed in the 13 state and each physician, physician assistant, or advanced practice registered nurse 14 licensed in this state who is employed or contracted by one of these hospitals or 01 facilities to provide medical care at the hospital or facility. A health care insurer's 02 provider network must include each health care facility operated by an Alaska tribal 03 health organization and each physician, physician assistant, or advanced practice 04 registered nurse employed or contracted by the organization to provide medical care at 05 that location. A physician, physician assistant, or advanced practice registered nurse 06 who is employed or contracted by a hospital, skilled nursing facility, mental health or 07 substance abuse facility, or Alaska tribal health organization to provide medical care is 08 not included when calculating the health care insurer's minimum network standards set 09 out in (d) of this section. 10 (c) A health care insurer's provider network must include a sufficient number 11 of physicians, physician assistants, and advanced practice registered nurses in each 12 contracting region in which the insurer provides coverage to meet the minimum 13 network standards set out in (d) of this section. Only a physician, physician assistant, 14 or advanced practice registered nurse who is licensed in this state, meets the 15 credentialling standards of the health care insurer, and whose principle practice 16 location is physically located in the applicable contracting region may be included 17 when determining whether a health care insurer meets the minimum network standards 18 set out in (d) of this section. If an insurer treats the physician, physician assistant, or 19 advanced practice registered nurse as contracted for the purposes of all insurance 20 benefit determinations, a health care insurer may include in the provider network a 21 physician, physician assistant, or advanced practice registered nurse who is not a 22 contracted network health care provider to meet the standards set out in (d) of this 23 section. Each physician, physician assistant, or advanced practice registered nurse 24 included in the health care insurer's provider network, including a physician, physician 25 assistant, or advanced practice registered nurse that is not a contracted network health 26 care provider, must be shown as an in-network provider in the insurer's directory of 27 network providers. 28 (d) For purposes of this section, the state is divided into six contracting 29 regions: the Municipality of Anchorage; the Matanuska-Susitna Borough; the 30 Fairbanks North Star Borough and Southeast Fairbanks Census Area; the Kenai 31 Peninsula Borough; the City and Borough of Juneau, Ketchikan Gateway Borough, 01 and City and Borough of Sitka; and the remainder of the state. A health care insurer 02 that provides coverage in the Municipality of Anchorage contracting region must 03 include in the insurer's provider network at least 85 percent of the total actively 04 practicing physicians, physician assistants, and advanced practice registered nurses in 05 each specialty recognized for a Medicare advantage plan network adequacy 06 requirement for the Centers for Medicare and Medicaid Services physically located in 07 the region and at least 85 percent of the provider groups in each specialty. A health 08 care insurer that provides coverage in the Matanuska-Susitna Borough contracting 09 region or the Fairbanks North Star Borough and Southeast Fairbanks Census Area 10 contracting region must include in the insurer's provider network at least 90 percent of 11 the total actively practicing physicians, physician assistants, and advanced practice 12 registered nurses in each specialty recognized for a Medicare advantage plan network 13 adequacy requirement for the Centers for Medicare and Medicaid Services physically 14 located in those regions and at least 90 percent of the provider groups in each 15 specialty. A health care insurer that provides coverage in the Kenai Peninsula Borough 16 contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and 17 City and Borough of Sitka contracting region, or the contracting region covering the 18 remainder of the state must include in the insurer's provider network at least 95 19 percent of the total actively practicing physicians, physician assistants, and advanced 20 practice registered nurses in each specialty recognized for a Medicare advantage plan 21 network adequacy requirement for the Centers for Medicare and Medicaid Services 22 physically located in those regions and at least 95 percent of the provider groups in 23 each specialty. 24 (e) A health care insurer may make a written request to the director for an 25 exception to the minimum provider network standards set out under this section. The 26 director may grant an exception only for a specified limited period not to exceed 36 27 months. The director shall adopt regulations specifying the procedure for requesting 28 an exception and the standards for granting an exception. The director shall require the 29 health care insurer to submit a plan to achieve the minimum network standards within 30 the time frame of the exception granted by the director and submit annual progress 31 reports to the director. 01 (f) A health care insurer shall annually attest whether the insurer meets or 02 exceeds the minimum provider network standards in this section for each contracting 03 region in which the insurer provides coverage and provide to the director supporting 04 documentation to demonstrate compliance as part of the insurer's required rate filings. 05 If a health care insurer does not meet a specific standard, the insurer shall submit a 06 plan for corrective action for consideration by the director. 07 (g) The director may adopt regulations necessary to implement this section. 08 The director may adopt in regulation minimum provider network standards by 09 contracting region that exceed the minimum network standards set out in (d) of this 10 section. 11  * Sec. 2. AS 21.07.020(3) is repealed. 12  * Sec. 3. This Act takes effect January 1, 2026.