Legislature(2025 - 2026)BUTROVICH 205
03/27/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB95 | |
| SB121 | |
| SCR2 | |
| SB122 | |
| SJR15 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 122 | TELECONFERENCED | |
| += | SB 95 | TELECONFERENCED | |
| += | SB 88 | TELECONFERENCED | |
| += | SB 121 | TELECONFERENCED | |
| += | SCR 2 | TELECONFERENCED | |
| += | SJR 15 | TELECONFERENCED | |
SB 121-HEALTH INSURANCE ALLOWABLE CHARGES
3:40:37 PM
CHAIR DUNBR reconvened the meeting and announced the
consideration of SENATE BILL NO. 121 "An Act relating to
settlement of health insurance claims; relating to allowable
charges for health care services or supplies; and providing for
an effective date."
3:40:59 PM
CHAIR DUNBAR solicited a motion.
3:41:02 PM
SENATOR GIESSEL moved to adopt Amendment 1, work order 34-
LS0282\N.1.
34-LS0282\N.1
Wallace
3/12/25
A M E N D M E N T 1
OFFERED IN THE SENATE BY SENATOR GIESSEL
TO: SB 121
Page 2, line 14, following "rates":
Insert "for an allowable charge under (a) of this
section"
3:41:12 PM
CHAIR DUNBAR objected for purposes of discussion.
3:41:21 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, offered an explanation of the
amendments for SB 121. She noted that on page 2, line 14,
following the word "rates" was inserted "for an allowable
charge." She stated that the amendment establishes that out-of-
network providers receive the same reimbursement for the same
codes as in-network providers, while allowing in-network
providers to negotiate rates through contracts with insurers.
3:42:37 PM
SENATOR HUGHES sought verification of whether the amendment is
establishing a requirement.
3:42:47 PM
MS. CONWAY replied that the amendment would require the same
reimbursement for the same CPT code regardless of the provider.
3:43:11 PM
SENATOR HUGHES asked whether the amendment affected the ability
of in-network physicians to negotiate higher payment than other
clinician types for the same CPT code.
3:43:30 PM
MS. CONWAY replied yes, it is a possible.
3:43:41 PM
SENATOR HUGHES asked whether equal protection raised a legal
issue if an advanced nurse practitioner or physician assistant
(PA) in network received a lower negotiated payment than the
same clinician type out of network.
3:44:09 PM
MS. CONWAY replied the question is beyond her expertise.
3:44:29 PM
SENATOR GIESSEL stated that SB 121 addresses reimbursement for
out-of-network providers and does not affect negotiated in-
network contracts.
3:44:52 PM
CHAIR DUNBAR stated that the issue raised appeared practical
rather than constitutional and likely did not implicate equal
protection because the payments resulted from arms-length
negotiations.
3:45:15 PM
SENATOR CLAMAN said the legislation applies only to out-of-
network charges and does not affect in-network rates, which are
determined through contract negotiations, including any
differences in payment for different clinician types.
3:46:00 PM
SENATOR HUGHES stated that she is concerned that paying nurse
practitioners and PAs the same as physicians for the same
service may undervalue physicians' greater training and
expertise, reduce incentives for efficiency, and eliminate a
cost-saving advantage PAs and nurse practitioners provide in
rural care. She suggested a slightly lower rate for PAs and NPs
could be more appropriate.
3:48:28 PM
CHAIR DUNBAR removed his objection and asked whether there were
further questions.
3:48:40 PM
SENATOR HUGHES asked for a recap of the purpose for Amendment 1
(N.1).
3:49:09 PM
MS. CONWAY clarified that the purpose for Amendment 1 was that
legislation applies only to out-of-network providers and does
not affect in-network negotiations.
SENATOR CLAMAN stated that the amendment aligns the language
with the bill's original intent, ensuring consistency.
CHAIR DUNBAR asked if Senator Hughes maintained her objection.
3:49:43 PM
SENATOR HUGHES replied no.
3:49:48 PM
CHAIR DUNBAR found no further objection and Amendment 1 (N.1)
was adopted.
3:49:51 PM
CHAIR DUNBAR solicited a motion.
3:49:55 PM
SENATOR GIESSEL moved to adopt Amendment 2, work order 34-
LS0282\N.2.
34-LS0282\N.2
Wallace
3/12/25
A M E N D M E N T
OFFERED IN THE SENATE BY SENATOR GIESSEL
Page 1, line 14:
Delete "and must be the same across the state"
Insert ", must be the same across the state, and
be the greater of the allowable charge or 450 percent
of the federal Centers for Medicare and Medicaid
Services fee schedule for the state in effect at the
time of delivery of the health care service or supply"
Page 2, lines 4 - 7:
Delete "Allowable charges for primary care
providers must be the greater of the allowable charge
or 450 percent of the federal Centers for Medicare and
Medicaid Services fee schedule for the state in effect
at the time of delivery of the health care service or
supply."
3:50:01 PM
CHAIR DUNBAR objected for purposes of discussion.
3:50:06 PM
MS. CONWAY explained Amendment 2 (N.2). She said SB 121
specifies 450 percent of CMS Medicare rates, and the intent was
for all providers to have 450 percent floor as a minimum. To
achieve this, on page 1, line 14, "and must be the same across
the state" was deleted and inserted "must be the same across the
state and be greater of the allowable charge or 450 percent of
the CMS Medicare and Medicaid Services fee schedule in effect at
the time of service delivery." Consequently, page 2, lines 47,
was removed, which previously applied only to primary care,
since the floor now applies to all providers.
3:51:31 PM
SENATOR HUGHES asked whether the original bill applied the 450
percent rate only to primary care, but as amended extends to all
medical care providers.
MS. CONWAY replied correct.
3:51:52 PM
SENATOR HUGHES said Amendment 2 is a very big expansion and said
she wanted to maintain her objection because an analysis is
needed on how the change would impact small businesses and 15
percent of the population. She stated her belief that rates
would increase considerably, impacting the cost of insurance.
3:52:26 PM
CHAIR DUNBAR removed his objection and asked if Senator Hughes
maintains objection.
3:52:36 PM
SENATOR HUGHES replied yes.
CHAIR DUNBAR asked for further discussion.
3:52:42 PM
SENATOR GIESSEL explained that after the repeal of the prior
reimbursement rule, no minimum payment floor was established,
leading to sharply reduced reimbursement rates for primary care
cliniciansdown to about 145 percent of Medicare, which is
already low and potentially declining further. As a result,
clinics are struggling to cover rising costs such as supplies,
staffing, and billing services, and some have had contracts
canceled or renegotiated at unsustainable rates. She said these
pressures are causing clinic closures, difficulty recruiting
physicians, and long-standing family-run practices becoming
unsellable. The purpose of establishing a 450 percent Medicare
floor is to stabilize reimbursement, keep primary care clinics
financially viable, and maintain access to healthcare for
Alaskans.
3:55:18 PM
SENATOR HUGHES stated that while the sponsor's goal is to ensure
adequate reimbursement for primary care, the expansion would
apply the floor to all medical providers, including specialists,
with unknown impacts on costs. She is concerned this could
increase premiums for insured Alaskans and cannot support SB
121.
3:56:26 PM
CHAIR DUNBAR found the objection was maintained and asked for a
roll call vote.
A roll call vote was taken. Senators Giessel, Tobin, Claman, and
Dunbar voted in favor of Amendment 2 (N.2) and Senator Hughes
voted against it. The vote was 4:1.
CHAIR DUNBAR announced that Amendment 2 was adopted on a vote of
4 yeas and 1 nay.
3:57:34 PM
CHAIR DUNBAR opened public testimony on SB 121; finding none, he
closed public testimony.
3:57:49 PM
CHAIR DUNBAR asked for closing comments.
3:58:01 PM
SENATOR CLAMAN said he viewed SB 121 as important. He expressed
frustration with the lack of transparency in how reimbursement
rates are set and disclosed by insurers and state agencies. He
noted difficulty obtaining meaningful rate information and
related this difficulty to the confusion over medical bills that
consumers face. He criticized the punitive nature of the current
185 percent Medicare out-of-network rate. He said he is
concerned about whether a 450 percent Medicare floor could
exceed existing contract rates, noting that supporters claim it
would not, but he lacks sufficient data to make an informed
decision.
4:00:53 PM
SENATOR CLAMAN said he is unconvinced that 450 percent of
Medicare is always below contract rates and wants clearer,
procedure-specific data to evaluate the impact. He supported the
bill's advancement and praising its design but stressed the need
for transparent rate comparisons to ensure out-of-network
payments do not exceed in-network rates. He cited broader
frustration with the lack of accessible healthcare cost
information.
4:02:16 PM
SENATOR HUGHES stated her concern that reinstating a
reimbursement floor so soon after repealing the 80th percentile
rule could again drive-up healthcare costs. She noted historical
cost increases and questioning how the percentile rule was
previously characterized. She emphasized that the affected
population is largely small business owners who already struggle
to provide insurance and warned that SB 121 lacks sufficient
data and clarity on several technical issues. She acknowledged
the need for providers and access to care, she argued the
proposal is premature, undermines free-market principles, and
could harm Alaskans without further analysis and dialogue among
insurers and providers.
4:06:06 PM
SENATOR GIESSEL noted that past analyses, including Milliman
studies, showed specialists such as orthopedists were reimbursed
well above Medicare without causing excess payments and that
high healthcare costs in Alaska are driven more by insurance
expenses than provider reimbursement. She argued SB 121 would
protect patients from high out-of-network bills, encourage
providers to join networks, and ultimately protect both
clinicians and consumers.
4:08:52 PM
CHAIR DUNBAR solicited the will of the committee.
4:08:55 PM
SENATOR GIESSEL moved to report SB 121, work order 34-LS0282\N,
as amended, from committee with individual recommendations and
attached fiscal note(s).
4:09:10 PM
CHAIR DUNBAR found no objection and CSSB 121(HSS) was reported
from the Senate Health and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 121 Support Emails Batch 2 3.25.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB 121 Support Batch 3 3.25.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB121 Opposition AK Chamber 3.20.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB 121 Opposition Olson 3.18.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB 121 Opposition NABIP AK 3.19.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB 121 Opposition Lamp 3.20.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB 121 Opposition Izer 3.20.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB 121 Comparison Then and Now.jmc.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| SB122 Health Insurance Networks Opposition Letter SHSS 3.25.25.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 122 |
| Alaska SB 122 Comment Letter Premera.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 122 |
| N.1.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |
| N.2.pdf |
SHSS 3/27/2025 3:30:00 PM |
SB 121 |