ALASKA

---

As originally enacted, the Alaska State SBL, which took effect July 1, 2017, 3 Alaska Admin. Code § 26.110(a), provided that carriers maintain data as to charges on a geographic basis, which must be updated periodically, and that payments must reflect these geographic differences, and that payments can be no less than the 80th percentile of such charge data. This made the Alaska SBL very appealing because of its emphasis on UCR.

In the summer of 2023, however, this “80th Percentile” Rule was repealed and replaced by an INN standard of reimbursement. The Alaska state SBL has thus been rendered relatively unfriendly to the medical community.

Regarding bifurcation, CMS recognizes:

Alaska does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with the Alaska Division of Insurance staff, CMS understands that 3 Alaska Admin. Code § 26.110(a) is a specified state law that will apply for purposes of determining the out-of-network rate with respect to items and supplies furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Alaska by nonparticipating providers, nonparticipating emergency facilities or nonparticipating providers of air ambulance services. Therefore, the federal independent dispute resolution process under sections 2799A-1(c) and 2799A-2(b) of the PHS Act and 45 CFR 149.510 and 149.520 will not apply in those cases in Alaska.

CMS Letter to the Governor of Alaska dated February 15, 2022.