|
House Engrossed Senate Bill |
|
State of Arizona Senate Fiftieth Legislature First Regular Session 2011
|
|
SENATE BILL 1591 |
|
|
|
|
AN ACT
amending title 20, Arizona Revised Statutes, by adding chapter 22; relating to reporting of claims information.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, Arizona Revised Statutes, is amended by adding chapter 22, to read:
CHAPTER 22
REPORTING OF CLAIMS INFORMATION
ARTICLE 1. GENERAL PROVISIONS
20-4001. Definitions
In this chapter, unless the context otherwise requires:
1. "Employer" means any person acting directly as an employer, or indirectly in the interest of an employer, in relation to an employee benefit plan and includes a group or association of employers acting for an employer in such capacity.
2. "Governmental entity" means this state or a political subdivision of this state.
3. "Group health plan" has the same meaning prescribed in 45 Code of Federal Regulations section 160.103 but does not include disability income or long‑term care insurance.
4. "Health insurance issuer" means an insurance institution, or insurance support organization that is authorized to transact insurance in this state.
5. "Insurance institution" has the same meaning prescribed in section 20-2102.
6. "Insurance support organization" has the same meaning prescribed in section 20-2102.
7. "Plan" means an employee welfare benefit plan as defined in 29 United States Code section 1002.
8. "Plan administrator" means an administrator as defined in 29 United States Code section 1002.
9. "Plan sponsor" has the same meaning prescribed in 29 United States code section 1002.
10. "Political subdivision" means a county, city, town, school district or special taxing district.
11. "Protected health information" has the meaning prescribed in 45 code of federal regulations section 160.103.
20-4002. Applicability
A. This chapter applies to a governmental entity or an employer that enters into a contract with a health insurance issuer that results in the health insurance issuer delivering, issuing for delivery or renewing a group health plan.
B. For the purposes of this chapter, a health insurance issuer shall treat a governmental entity or an employer described by Subsection a as a plan sponsor or plan administrator.
C. A health insurance issuer may agree with a plan sponsor to provide information as specified in this section. The provision of information is not required except pursuant to a mutual agreement between the health insurance issuer and the plan sponsor. A health insurer is not required to provide any information if the disclosure is prohibited by law.
20-4003. Report of claim information
A. Pursuant to terms mutually agreed upon between the health insurance issuer and the plan sponsor, a health insurance issuer may provide a report of aggregate claim information to a plan sponsor or plan administrator.
B. A health insurance issuer may provide the report of claim information in a format mutually agreed upon by the health insurance issuer and plan sponsor.
C. A health insurance issuer may not disclose protected health information in a report of claim information provided under this section if the health insurance issuer is prohibited from disclosing that information under state or federal law that imposes more stringent privacy restrictions than those imposed under the health insurance portability and accountability act of 1996 (P.L. 104-191). If the insurer determines that it must withhold information under this section after previously agreeing to provide this information, the insurer shall identify the type of information being withheld and explain the basis for withholding that information.
D. If the health insurance issuer and the plan sponsor mutually agree to share protected health information, the plan sponsor is entitled to receive the information only after the authorized representative of the plan sponsor provides the health insurance issuer with a certification substantially similar to the following:
I hereby certify that the plan documents comply with the requirements of 45 Code of Federal Regulations section 164.504(f)(2) and that the plan sponsor will safeguard and limit the use and disclosure of protected health information that the plan sponsor may receive from the group health plan to perform the plan administration functions.
E. A plan sponsor that does not provide the certification required by subsection D of this section is not entitled to receive the protected health information but may receive other information as mutually agreed upon.
F. A report of claim information provided under this section to a governmental entity is confidential and exempt from public disclosure under title 39, chapter 1.