SB1115 - 511R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 32, chapter 32, article 1, Arizona Revised Statutes, is amended by adding section 32-3216, to read:

START_STATUTE32-3216. 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. 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.

c. 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.

D. 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.

E. 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.

F. 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, 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.

G. 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.

H. 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.

I. If a health care provider fails to comply with this section, the penalty shall not include revocation of the license to deliver lawful health care services.

J. 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 provider" means a person who is licensed pursuant to chapter 7, 8, 13, 16, 17, 19 or 34 of this title.

3. "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.

4. "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.

5. "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. END_STATUTE

Sec. 2. Title 36, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 36-437, to read:

START_STATUTE36-437. 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. 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.

C. 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.

D. 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.

E. 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.

F. 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, 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.

G. 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.

H. 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.

I. If a health care provider fails to comply with this section, the penalty shall not include revocation of the license to deliver lawful health care services.

J. 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.

5. "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. 3. 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. 4. 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.