00                      CS FOR SENATE BILL NO. 122(HSS)                                                                   
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 shall take the network requirements of this section into account when                                           
07 calculating the benefits of, or other contractual requirements applicable to, a covered                                 
08       person's health care insurance policy that, as determined by the director,                                        
09                 (1)  requires the covered person to use a limited network of health care                                
10       providers, as defined in regulation by the director; or                                                           
11                 (2)  creates a substantial financial or other incentive or disincentive for                             
12       the covered person to use a limited network of health care providers.                                             
13            (b)  A health care insurer's provider network must include each hospital,                                    
14       skilled nursing facility, or mental health or substance abuse facility licensed in the                            

01 state and each physician, physician assistant, or advanced practice registered nurse                                    
02 licensed in this state who is employed or contracted by one of these hospitals or                                       
03 facilities to provide medical care at the hospital or facility. A health care insurer's                                 
04 provider network must include each health care facility operated by an Alaska tribal                                    
05 health organization and each physician, physician assistant, or advanced practice                                       
06 registered nurse employed or contracted by the organization to provide medical care at                                  
07 that location. A physician, physician assistant, or advanced practice registered nurse                                  
08 who is employed or contracted by a hospital, skilled nursing facility, mental health or                                 
09 substance abuse facility, or Alaska tribal health organization to provide medical care is                               
10 not included when calculating the health care insurer's minimum network standards set                                   
11       out in (d) of this section.                                                                                       
12 (c)  A health care insurer's provider network must include a sufficient number                                          
13 of physicians, physician assistants, and advanced practice registered nurses in each                                    
14 contracting region in which the insurer provides coverage to meet the minimum                                           
15 network standards set out in (d) of this section. Only a physician, physician assistant,                                
16 or advanced practice registered nurse who is licensed in this state, meets the                                          
17 credentialling standards of the health care insurer, and whose principal practice                                       
18 location is physically located in the applicable contracting region may be included                                     
19 when determining whether a health care insurer meets the minimum network standards                                      
20 set out in (d) of this section. If an insurer treats the physician, physician assistant, or                             
21 advanced practice registered nurse as contracted for the purposes of all insurance                                      
22 benefit determinations, a health care insurer may include in the provider network a                                     
23 physician, physician assistant, or advanced practice registered nurse who is not a                                      
24 contracted network health care provider to meet the standards set out in (d) of this                                    
25 section. Each physician, physician assistant, or advanced practice registered nurse                                     
26 included in the health care insurer's provider network, including a physician, physician                                
27 assistant, or advanced practice registered nurse that is not a contracted network health                                
28 care provider, must be shown as an in-network provider in the insurer's directory of                                    
29       network providers.                                                                                                
30 (d)  For purposes of this section, the state is divided into six contracting                                            
31 regions: the Municipality of Anchorage; the Matanuska-Susitna Borough; the                                              

01 Fairbanks North Star Borough and Southeast Fairbanks Census Area; the Kenai                                             
02 Peninsula Borough; the City and Borough of Juneau, Ketchikan Gateway Borough,                                           
03 and City and Borough of Sitka; and the remainder of the state. A health care insurer                                    
04 that provides coverage in the Municipality of Anchorage contracting region must                                         
05 include in the insurer's provider network at least 70 percent of the total actively                                     
06 practicing physicians, physician assistants, and advanced practice registered nurses in                                 
07 each specialty recognized for a Medicare advantage plan network adequacy                                                
08 requirement for the Centers for Medicare and Medicaid Services physically located in                                    
09 the region and at least 70 percent of the provider groups in each specialty. A health                                   
10 care insurer that provides coverage in the Matanuska-Susitna Borough contracting                                        
11 region or the Fairbanks North Star Borough and Southeast Fairbanks Census Area                                          
12 contracting region must include in the insurer's provider network at least 75 percent of                                
13 the total actively practicing physicians, physician assistants, and advanced practice                                   
14 registered nurses in each specialty recognized for a Medicare advantage plan network                                    
15 adequacy requirement for the Centers for Medicare and Medicaid Services physically                                      
16 located in those regions and at least 75 percent of the provider groups in each                                         
17 specialty. A health care insurer that provides coverage in the Kenai Peninsula Borough                                  
18 contracting region, the City and Borough of Juneau, Ketchikan Gateway Borough, and                                      
19 City and Borough of Sitka contracting region, or the contracting region covering the                                    
20 remainder of the state must include in the insurer's provider network at least 80                                       
21 percent of the total actively practicing physicians, physician assistants, and advanced                                 
22 practice registered nurses in each specialty recognized for a Medicare advantage plan                                   
23 network adequacy requirement for the Centers for Medicare and Medicaid Services                                         
24 physically located in those regions and at least 80 percent of the provider groups in                                   
25       each specialty.                                                                                                   
26 (e)  A health care insurer may make a written request to the director for an                                            
27 exception to the minimum provider network standards set out under this section. The                                     
28 director may grant an exception only for a specified limited period not to exceed 36                                    
29 months. The director shall adopt regulations specifying the procedure for requesting                                    
30 an exception and the standards for granting an exception. The director shall require the                                
31 health care insurer to submit a plan to achieve the minimum network standards within                                    

01 the time frame of the exception granted by the director and submit annual progress                                      
02       reports to the director.                                                                                          
03 (f)  A health care insurer shall annually attest whether the insurer meets or                                           
04 exceeds the minimum provider network standards in this section for each contracting                                     
05 region in which the insurer provides coverage and provide to the director supporting                                    
06 documentation to demonstrate compliance as part of the insurer's required rate filings.                                 
07 If a health care insurer does not meet a specific standard, the insurer shall submit a                                  
08       plan for corrective action for consideration by the director.                                                     
09 (g)  The director may adopt regulations necessary to implement this section.                                            
10       The director may adopt in regulation minimum provider network standards by                                        
11       contracting region that exceed the minimum network standards set out in (d) of this                               
12       section.                                                                                                          
13    * Sec. 2. AS 21.07.020(3) is repealed.                                                                             
14    * Sec. 3. This Act takes effect January 1, 2026.