Page 1, between lines 1 and 2,
insert:
"Section 1. Title 32, chapter 32, article
1, Arizona Revised Statutes, is amended by adding section 32-3216, to read:
32-3216. Health care providers; charges; public
availability; direct payment; notice; definitions
A. A health
care provider must make available on request or online the direct pay price for
at least the twenty-five most common services, if applicable, for the health
care provider. The services may be identified by a common procedural
terminology code or by a plain‑English description. The document or
online posting must be updated at least annually. The direct pay price must be
for the standard diagnosis for the service and may include any complications or
exceptional treatment. Health care providers who are owners or
employees of a legal entity with fewer than three licensed health care
providers are exempt from the requirements of this subsection.
b. the health care
services provided by health care providers in veterans administration
facilities, health facilities on military bases, indian health services
hospitals and other indian health service facilities, tribal owned clinics, the
arizona state hospital and any health care facility determined to be exempt pursuant
to section 36-437, subsection b, are exempt from the requirements and
provisions of this section.
c. Subsection
A of this section does not prevent a health care provider from offering either
additional discounts or additional lawful health care services for an
additional cost to a person or an employer paying directly.
d. A health
care provider is not required to report the direct pay prices to a government
agency or department or to a government-authorized or government‑created
entity for review or filing. A government agency or department or
government-authorized or government‑created entity may not approve, disapprove
or limit a health care provider's direct pay price for services. A government
agency or department or government‑authorized or government‑created
entity may not approve, disapprove or limit a health care provider's ability to
change the published or posted direct pay price for services.
e. A health
care system may not punish a person or employer for paying directly for lawful
health care services or a health care provider for accepting direct payment
from a person or employer for lawful health care services.
f. A
health care provider who accepts direct payment from a person or employer for a
lawful health care service is deemed paid in full and shall not submit a claim
for payment or reimbursement for the service to any health care system. This
subsection does not prevent a health care provider from pursuing a health care
lien pursuant to title 33. This subsection does not affect the ability of a
health care provider to submit claims for the same service provided on other
occasions to the same or a different person if no direct payment occurs.
g. Before
a health care provider who is contracted as a network provider for a health
care system accepts direct payment from a person or an employer, and the person
is a member of the same health care system, the health care provider shall
obtain the person's or employer's signature on a notice in a form that is
substantially similar to the following:
Important notice about direct
payment
for your health care services
The Arizona
Constitution permits you to pay a health care provider directly for health care
services. Before you make any agreement to do so, please read the following
important information:
If you are a member
of a health care system (more commonly referred to as a health insurance plan)
and your health care provider is contracted with the health insurance plan, the
following apply:
1. You may
not be required to pay the health care provider directly for the services
covered by your plan, except for cost share amounts that you are obligated to
pay under your plan, such as copayments, coinsurance and deductible amounts.
2. Your
provider's agreement with the health insurance plan may prevent the health care
provider from billing you for the difference between the provider's billed
charges and the amount allowed by your health insurance plan for covered
services.
3. If you
pay directly for a health care service, your health care provider will not be
responsible for submitting claim documentation to your health insurance plan
for that claim. Before paying your claim, your health insurance plan may
require you to provide information and submit documentation necessary to
determine whether the services are covered under your plan.
4. If you
do not pay directly for a health care service, your health care provider may be
responsible for submitting claim documentation to your health insurance plan
for the health care service.
Your signature below
acknowledges that you received this notice before paying directly for a health
care service.
h. A health care
provider who accepts direct payment for a lawful health care service and who
complies with subsection F of this section is not responsible for submitting
documentation of any kind for purposes of reimbursement to any health care
system for that claim if the failure to submit such documentation does not
conflict with the terms of any federal or state contracts to which the health
care system is a party and the health care provider has agreed to serve
patients under or with applicable state or federal programs in which a health
care provider and health care system participate.
i. This
section does not impair the provisions of a health care system's private health
care network provider contract, except that a health care provider may decline
to bill the health care system directly for services paid directly by a person
or employer if the health care provider has complied with subsection F of this
section and the health care provider's receipt of direct payment and the
declination to bill the health care system do not conflict with the terms of
any federal or state contract to which the health care system is a party and
the health care provider has agreed to serve patients under or with applicable
state or federal programs in which a health care provider and health care
system participate.
j. this
section may not prevent a professional regulatory board defined in title 32
from performing an investigation of a health care provider under the board's
powers and duties as defined in title 32. if a health care provider fails to
comply with subsection a of this section, the penalty shall not include the
revocation of the license to deliver lawful health care services.
k. For the
purposes of this section:
1. "Direct
pay price" means the price that will be charged by a health care provider
for a lawful health care service, regardless of the health insurance status of
the person, if the entire fee for the service is paid directly to a health care
provider by the person, including the person's health savings account, or by
the person's employer.
2. “health
care plan” has the same meaning prescribed in section 20-1051.
3. "Health care
provider" means a person who is licensed pursuant to chapter 7, 8, 13, 16,
17, 19 or 34 of this title.
4. "Health
care system" means a public or private entity whose function or purpose is
the management, processing or enrollment of individuals or the payment, in full
or in part, of health care services.
5. "Lawful
health care services" means any health‑related service or treatment,
to the extent that the service or treatment is permitted or not prohibited by
law or regulation, that may be provided by persons or businesses otherwise
permitted to offer the services or treatments.
6. "member"
means a person who is covered under a health care plan provided by a health
care system.
7. "Punish"
means to impose any penalty, surcharge or named fee with a similar effect that
is used to discourage the exercise of rights under this section.
Sec. 2. Title 36, chapter 4, article 3, Arizona
Revised Statutes, is amended by adding section 36-437, to read:
36-437. Health care facilities; charges;
public availability; direct payment; notice; definitions
A. A health
care facility must make available on request or online the direct pay price for
at least the fifty most used diagnosis-related group codes, if applicable, for
the facility and at least the fifty most used outpatient service codes, if
applicable, for the facility. The services may be identified by a
common procedural terminology code or by a plain-english description. The
health care facility must update the document or online posting at least
annually. The direct pay price must be for the standard diagnosis for the
service and may include any complications or exceptional treatment.
b. veterans
administration facilities, health facilities on military bases, indian health services hospitals and other indian health services facilities, tribal owned
clinics and the arizona state hospital are exempt from the requirements and
provisions of this section. if the director of the arizona department of
health services determines that a health care facility does not serve the
general public, the health care facility shall be exempt from the requirements
and provisions of this section if the facility does not serve the general
public.
c. Subsection
A of this section does not prevent a health care facility from offering either
additional discounts or additional lawful health care services for an
additional cost to a person or an employer paying directly.
d. A health
care facility is not required to report the direct pay prices to a government
agency or department or to a government-authorized or government‑created
entity for review or filing. A government agency or department or
government-authorized or government‑created entity may not approve,
disapprove or limit a health care facility's direct pay price for services. A
government agency or department or government‑authorized or government‑created
entity may not approve, disapprove or limit a health care facility's ability to
change the published or posted direct pay price for services.
e. A health
care system may not punish a person or employer for paying directly for lawful
health care services or a health care facility for accepting direct payment
from a person or employer for lawful health care services.
f. A
health care facility that accepts direct payment from a person or employer for
a lawful health care service is deemed paid in full and shall not submit a
claim for payment or reimbursement for the service to any health care system.
This subsection does not prevent a health care facility from pursuing a health
care lien pursuant to title 33. This subsection does not affect the ability of
a health care facility to submit claims for the same service provided on other
occasions to the same or a different person if no direct payment occurs.
g. Before
a health care facility that is contracted as a network provider for a health
care system accepts direct payment from a person or an employer, and the person
is a member of the same health care system, the health care facility shall
obtain the person's or employer's signature on a notice in a form that is
substantially similar to the following:
Important notice about direct payment
for your health care services
The Arizona
Constitution permits you to pay a health care facility directly for health care
services. Before you make any agreement to do so, please read the following
important information:
If you are a member
of a health care system (more commonly referred to as a health insurance plan)
and your health care facility is contracted with the health insurance plan, the
following apply:
1. You may
not be required to pay the health care facility directly for the services
covered by your plan, except for cost share amounts that you are obligated to
pay under your plan, such as copayments, coinsurance and deductible amounts.
2. Your
provider's agreement with the health insurance plan may prevent the health care
facility from billing you for the difference between the facility's billed
charges and the amount allowed by your health insurance plan for covered
services.
3. If you
pay directly for a health care service, your health care facility will not be
responsible for submitting claim documentation to your health insurance plan
for that claim. Before paying your claim, your health insurance plan may
require you to provide information and submit documentation necessary to
determine whether the services are covered under your plan.
4. If you
do not pay directly for a health care service, your health care facility may be
responsible for submitting claim documentation to your health insurance plan
for the health care service.
Your signature below
acknowledges that you received this notice before paying directly for a health
care service.
h. A
health care facility that accepts direct payment for a lawful health care
service and that complies with subsection F of this section is not responsible
for submitting documentation of any kind for purposes of reimbursement to any
health care system for that claim if the failure to submit such documentation
does not conflict with the terms of any federal or state contracts to which the
health care system is a party and the health care facility has agreed to serve
patients under or with applicable state or federal programs in which a health
care facility and health care system participate.
i. This
section does not impair the provisions of a health care system's private health
care network provider contract, except that a health care facility may decline
to bill the health care system directly for services paid directly by a person
or employer if the health care facility has complied with subsection F of this
section and the health care facility's receipt of direct payment and the
declination to bill the health care system do not conflict with the terms of
any federal or state contract to which the health care system is a party and
the health care facility has agreed to serve patients under or with applicable
state or federal programs in which a health care facility and health care
system participate.
j. THIS
SECTION MAY NOT PREVENT THE ARIZONA DEPARTMENT OF HEALTH SERVICES FROM
PERFORMING AN INVESTIGATION OF A HEALTH CARE FACILITY UNDER THE DEPARTMENT'S
POWERS AND DUTIES AS DEFINED IN TITLE 36. IF A HEALTH CARE FACILITY FAILS TO
COMPLY WITH SUBSECTION A of this section, THE PENALTY SHALL NOT INCLUDE THE
REVOCATION OF THE LICENSE TO DELIVER HEALTH CARE SERVICES.
k. For the
purposes of this section:
1. "Direct
pay price" means the price that will be charged by a health care facility
for a lawful health care service, regardless of the health insurance status of
the person, if the entire fee for the service is paid directly to a health care
facility by the person, including the person's health savings account, or by
the person's employer.
2. "Health
care facility" means a hospital, outpatient surgical center, health care
laboratory, diagnostic imaging center or urgent care center.
3. “health care plan”
has the same meaning prescribed in section 20-1051.
4. "Health
care system" means a public or private entity whose function or purpose is
the management, processing or enrollment of individuals or the payment, in full
or in part, of health care services.
5. "Lawful
health care services" means any health‑related service or treatment,
to the extent that the service or treatment is permitted or not prohibited by
law or regulation, that may be provided by persons or businesses otherwise
permitted to offer the services or treatments.
6. "member"
means a person who is covered under a health care plan provided by a health
care system.
7. "Punish"
means to impose any penalty, surcharge or named fee
with a similar effect that is used to discourage the exercise of rights under
this section."
Renumber to conform
Page 9, line 20, strike “AND” insert a comma; strike “OF”
insert “and diagnosis-related group
codes that are made publicly available by”; after "hospital" insert "pursuant to section 36-437"
Page 12, after line 31, insert:
"Sec. 5. Delayed repeal
Sections 32‑3216 and 36‑437, Arizona Revised Statutes, as added by this act, are repealed from and after December 31,
2020.
Sec. 6. Severability
If any provision or clause of sections 32‑3216 and 36‑437,
Arizona Revised Statutes, as added by this act, or the application of these
sections to any person or circumstance is held invalid, the invalidity does not
affect other provisions or applications of sections 32‑3216 and 36‑437,
Arizona Revised Statutes, as added by this act, that can be given effect
without the invalid provision or application, and to this end the provisions of
this act are severable."
Amend title to conform
Bill
Number: H.B. 2045