Bill > SB121

This bill establishes new standards for setting allowable charges in health insurance claims in Alaska. It requires the state insurance director to create regulations that mandate health care insurers use a statistically credible methodology for determining reimbursement rates when no specific contract exists between an insurer and a healthcare provider. The bill specifies that allowable charges must be based on the most current 12-month data of charges by healthcare providers in the state, and must be at least the greater of either the current charge or 450 percent of the federal Medicare and Medicaid fee schedule. Additionally, the charges cannot be less than the 75th percentile of statewide charges for a specific medical service, though the director may set a higher percentile. The bill mandates that insurers apply reimbursement rates uniformly across providers practicing within their license scope, requires periodic auditing of the methodology, and stipulates that allowable charges should be reviewed every three to five years. The legislation defines key terms like "allowable charge" and "health care provider" and includes a transitional provision for implementing these new standards, with the act taking effect on January 1, 2026. The goal appears to be creating more transparent and consistent healthcare reimbursement practices in Alaska.

Business and Industry, Health and Social Services

https://www.akleg.gov/basis/Bill/Detail/34?Root=SB121