State SealARIZONA HOUSE OF REPRESENTATIVES

 

HB 2494: health insurers; notice; providers

PRIME SPONSOR: Representative Cobb, LD 5

BILL STATUS: Transmitted to Governor

 

 

Overview

Creates the statutory framework regarding electronic funds transfer payments and virtual credit card payment methods between a health care provider and a health insurer.☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note

History

Not currently addressed in statute.

Provisions

1.       Designates that a contract between a health insurer and health care provider issued, amended or renewed after January 1, 2020 for health care services of the health care insurer enrollees may not restrict the method of payment from the insurer to the provider in which the only acceptable payment method is a credit card. (Sec. 1)

2.       Requires a health insurer to do the following, if the insurer initiates or changes payments to a provider using electronic funds transfer payments, including virtual credit card payments:

a.       Notify the provider if any fee is associated with the payment method;

b.       Advise the provider of the available methods of payment and give clear instructions to the provider on how to select an alternative payment method; and

c.        Remit or associate with each payment the explanation of benefits. (Sec. 1)

3.       Stipulates a health insurer that initiates or changes payment to a provider using the health care electronic funds transfers and a remittance advice transaction pursuant to federal law may not charge a fee solely to transmit the payment to the provider unless the provider has consented to the fee. A provider agent may charge reasonable fees when transmitting an electronic funds transfer or automatic clearing house related to the transaction management, data management, portal services and other value-added services above and beyond the bank transmittal. (Sec. 1)

4.       Requires a health insurer that acquires a provider network of another health insurer, the health insurer that is contracted with a provider in the network that has been acquired must notify, consistent with the notification provisions of the provider contract, each health provider of the acquired network. (Sec. 1)

5.       Allows a provider that is in a provider network that is acquired to do any of the following:

a.       Continue the provider relationship with the insurer that acquired the network; 

b.       Terminate the provider relationship with the insurer that acquired the network in a time and manner consistent with the contract between the provider and the insurer that is contracted with the provider; and

c.        Enter into a contract directly with the insurer that acquired the provider network.  (Sec. 1)

6.       States this does not apply to acquisitions or arrangements that are disclosed in the network contract between a provider and an insurer and to which the provider has already agreed. (Sec. 1)

7.       Defines Terms. (Sec. 1)

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11.   Fifty-fourth Legislature                       HB 2494

12.   First Regular Session                            Version 5: Transmitted

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