|
|
ARIZONA HOUSE OF REPRESENTATIVESFifty-fourth Legislature Second Regular Session |
House: COM DPA 7-1-1-0 |
HB 2628: health care insurance; amendments
Sponsor: Representative Bolick, LD 20
House Engrossed
Overview
Makes various changes to statute governing Health Care Insurers.
History
Hospital, medical, dental and optometric service corporations is defined as corporations organized under the laws of this state for the purpose of establishing, maintaining and operating nonprofit hospital service or medical or dental or optometric service plans, or a combination of such plans, whereby hospital, medical or dental or optometric service may be provided by hospitals, physicians, podiatrists, dentists or optometrists with which the corporations have contracted for such purpose (A.R.S. § 20-822).
Health care services organization means any person that undertakes to conduct one or more health care plans. Unless the context otherwise requires, health care services organization includes a provider sponsored health care services organization (A.R.S. § 20-1051).
Utilization review means a system for reviewing the appropriate and efficient allocation of inpatient hospital resources, inpatient medical services and outpatient surgery services that are being given or are proposed to be given to a patient, and of any medical, surgical and health care services or claims for services that may be covered by a health care insurer depending on determinable contingencies, including without limitation outpatient services, in-office consultations with medical specialists, specialized diagnostic testing, mental health services, emergency care and inpatient and outpatient hospital services (A.R.S. § 20-2501).
Provisions
Hospital, Medical, Dental, and Optometric Service Organizations
1. Applies statute relating to assignment of benefits to a hospital and medical service corporation. (Sec. 3)
2. Specifies laws governing insurance company holding systems applies to a hospital, medical, dental and optometric service corporations. (Sec. 4)
3. Allows a corporation to pay any agent or employee any salary, compensation or emolument without preauthorization from the board of directors of the corporation. (Sec. 6)
Health Care Services Organizations
4. Requires a health care services organization to submit a quarterly, rather than monthly, list to the Department of Insurance (DOI) of all provider contracts that have been terminated during the previous three months, rather than the previous month. (Sec. 8)
Accountable Health Plans
5. Makes a conforming change. (Sec. 9)
6. Modifies the definition of creditable coverage. (Sec. 9)
7. Specifies statute governing premium rates does not apply to small employer who obtains a health benefits plan that is complies with federal law. (Sec. 10)
8. Repeals laws relating basic health benefit plans and submission of claims by electronic means. (Sec. 11)
Utilization Review
9. Exempts a person from specified laws relating to certification requirements provided certain criteria are met. (Sec. 12)
10. Allows a provider or enrollee to appeal a denial of a formulary exception for a plan covered by federal law through the process prescribed in the federal rule. (Sec. 13)
11. Requires a utilization review agent to file a specified notice regardless if the agent is exempt from certification requirements. (Sec. 14)
Miscellaneous
12. Repeals laws relating to contracts and forms in effect prior to January 1, 1955. (Sec. 1)
13. Specifies person includes a hospital, medical, dental and optometric service corporations and a health care services organization relating to prohibitive actions. (Sec. 2)
14. Makes a conforming change. (Sec. 5, 7)
15.
16.
17. ---------- DOCUMENT FOOTER ---------
18. Initials PRB House Engrossed
19.
20. ---------- DOCUMENT FOOTER ---------