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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
health insurers; notice; providers
Purpose
Provides payment and notification requirements for health insurers and healthcare providers.
Background
To improve the efficiency and effectiveness of the healthcare system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) included administrative simplification provisions that required the U.S. Department of Health and Human Services to adopt national standards for electronic healthcare transactions and code sets, unique health identifiers and security (P.L. 104-191). At the same time, the U.S. Congress recognized that advances in electronic technology could erode the privacy of health information. Consequently, the U.S. Congress incorporated into HIPAA provisions that mandated the adoption of federal privacy protections for individually identifiable health information (HIPAA for Professionals).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Contractual Payment Requirements
1. Prohibits a contract between a health insurer and a healthcare provider, that is issued, amended or renewed on or after January 1, 2020, from restricting the method of payment from the health insurer to the healthcare provider in which the only acceptable payment method is a credit card payment or an electronic funds transfer payment.
2. Requires the health insurer, if that insurer initiates or changes payments to a healthcare provider using electronic funds transfer payments, to:
a) notify the healthcare provider if any fee is associated with the particular payment method; and
b) advise the healthcare provider of the available methods of payment and provide clear instructions to the healthcare provider as to how to select an alternative payment method.
3. Requires a health insurer that pays a healthcare provider by using electronic funds transfer payments, to remit with each payment the explanation of benefits.
4. Prohibits a health insurer that initiates or changes payment to a healthcare provider using the HIPAA standard automated clearinghouse network from applying any additional charge to the payment other than a charge imposed by the healthcare provider's bank.
Network Notification Requirements
5. Requires a health insurer, if that insurer acquires a healthcare provider network that includes healthcare providers that are not contracted directly with the health insurer, to:
a) notify each healthcare provider that is not contracted with the health insurer and that is in the network of the acquisition of the network; and
b) allow each healthcare provider that is not contracted with the health insurer and that is in the network to opt out of the network or contract with the health insurer.
Miscellaneous
6. Defines terms.
7. Becomes effective on the general effective date.
House Action
HHS 2/14/19 DPA 8-0-0-1
3rd Read 2/26/19 60-0-0
Prepared by Senate Research
March 4, 2019
CS/kja