SB 129: "An Act relating to emergency services and balance billing; relating to the determination by an insurer of a final payment for a covered service or supply; and annulling regulations relating to determination by an insurer of a final payment for a covered service or supply based on geographical areas."
00 SENATE BILL NO. 129 01 "An Act relating to emergency services and balance billing; relating to the 02 determination by an insurer of a final payment for a covered service or supply; and 03 annulling regulations relating to determination by an insurer of 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: 06 * Section 1. AS 21.36 is amended by adding a new section to read: 07 Sec. 21.36.512. Emergency services; balance billing. (a) A health care 08 provider or health care facility that provides emergency services or treatment of an 09 emergency medical condition under AS 21.07.020 may not 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 of an emergency 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 or treatment of an emergency medical condition through a
01 network of health care providers that have entered into a contract with a health care 02 insurer. 03 (b) In this section, 04 (1) "emergency medical condition" has the meaning given in 05 AS 21.07.250; 06 (2) "health care facility" includes a hospital emergency room or stand- 07 alone emergency service facility; 08 (3) "health care insurer" has the meaning given in AS 21.54.500; 09 (4) "health care provider" has the meaning given in AS 21.07.250. 10 * Sec. 2. 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. 3 AAC 26.110(a)(2)(B) and (5)(A) are annulled.