Assigned to HHS FOR
COMMITTEE
Assigned to HHS FOR
COMMITTEE
ARIZONA STATE SENATE
Fifty-Third Legislature, Second Regular Session
patient referral inducements; prohibited compensation
Purpose
Prohibits a person, health care provider, health care facility or structured sober living home from offering or receiving any form of payment for the referral of patients, with certain exceptions.
Background
Structured sober living home means any premise, place or building that provides alcohol-free or drug-free housing, promotes independent living and life skill development and provides structured activities that are directed primarily toward recovery from substance use disorders in a supervised setting. The residents of a structured sober living home are a group of unrelated individuals who are recovering from drug or alcohol addiction and who are receiving outpatient behavioral health services for substance abuse or addiction treatment while living in the home (A.R.S. § 9-500.40).
Health care provider means a person or institution that is licensed or certified by this state to provide health care, medical services, nursing services or other health-related services (A.R.S. § 12-561). Additionally, health care facility means a hospital, outpatient surgical center, health care laboratory, diagnostic imaging center or urgent care center (A.R.S. § 36-437).
There anticipated fiscal impact to the state General Fund (GF) associated with this legislation is unknown.
Provisions
1. Prohibits a person, health care provider, health care facility, or structured sober living home from the following:
a) offering any form of payment to induce the referral of patients or patronage to or from a health care provider, health care facility or structured sober living home; and
b) soliciting or receiving any form of payment in return for referring patients or for accepting the treatment from another facility.
2. Provides exceptions for the following payments:
a) any form of payment to a nurse registry for referring a health care provider to clients of the nurse registry;
b) any discount or payment that is not prohibited by federal law;
c) any payment within a group practice if the payment is not to or from a person who is not a member of the group practice;
d) any commission or fee that is lawfully paid to an insurance agent;
e) payments by a health insurer for reimbursement of services under a health benefit plan;
f) payments to or by a health care provider, health care network or health care facility for goods or services that are covered by a health care plan;
g) insurance inducements that are not prohibited; and
h) payments by a health care provider or health care facility to an approved information service that provides enabling information to consumers about health care goods or services.
3. Establishes that a person who violates the prohibition is subject to a civil penalty of $25,000 if the violation involves 10 or less patients, $50,000 for violations involving 10 to 19 patients and $250,000 for violations involving 20 or more patients.
4. Permits the state to recover the costs of enforcing prohibitions regarding patient referrals from a person found to be in violation and requires that such payments be deposited in the state GF.
5. Becomes effective on the general effective date.
Prepared by Senate Research
February 14, 2018
CRS/NW/lat