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REFERENCE TITLE: health plans;
providers; payment reporting |
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State of
Arizona House of
Representatives Fifty-fourth
Legislature Second Regular
Session 2020 |
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HB 2294 |
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Introduced by Representative Kern |
AN ACT
Amending Title 36,
chapter 1, article 1.1, Arizona Revised Statutes, by adding section 36‑125.01;
relating to uniform reporting.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 1, article 1.1, Arizona Revised Statutes, is amended by adding section 36-125.01, to read:
36-125.01. Health plans; health care providers; reporting requirements; relative prices; rules; definitions
A. Each health plan shall report to
the department all of the following:
1. The relative price paid to each
health care provider by provider type, with hospital inpatient and outpatient
relative prices listed separately, and by health plan product type.
2. The annual rate of growth stated
as a percentage of the average relative price by provider type and product type
for the health plan's participating health care providers, and whether that rate
exceeds the rate of growth of the applicable producer price index as reported
by the United States department of labor, bureau of labor statistics.
3. A comparison of relative prices
for the health plan's participating health care providers by provider type that
shows the average relative price and the extent of variation in price stated as
a percentage and that identifies health care providers who are paid more than
ten percent, fifteen percent and twenty percent above the average relative
price and more than ten percent, fifteen percent and twenty percent below the
average relative price.
B. Health plans may not provide
claims information or contract prices to the department, but shall report only
relative prices.
C. Each health plan that uses an alternative
payment contract to pay health care providers shall disclose to the department
the relative value of the alternative payment contract and nonclaim payments
pursuant to rules adopted by the department.
D. The department shall issue an
annual report on relative prices paid by health plans and received by health
care providers. The department shall present the report in a manner
that does not disclose actual prices paid and that identifies price variation
among health care providers, by health plan and by provider type. The
department's report shall include all of the following:
1. Baseline information about price
variation among health care providers by each health plan, including
identifying health care providers that are paid more than ten percent above or
more than ten percent below the average relative price and identifying health
plans that have entered into alternative payment contracts that vary by more
than ten percent.
2. The annual change in price
variation by health plan among the health plan's participating providers.
3. Factors that contribute to price
variation in the health care system.
4. The impact of price variations on
disproportionate share hospitals and other safety net providers.
E. Data collected by the department
under this section is not a public record and shall be held in confidence by
the department except as necessary to produce the reports required by this
section.
F. The department may adopt rules
necessary to implement this section.
G. For the purposes of this section:
1. "Alternative
payment contract" means any contract between a provider or provider
organization and a private health care health plan that uses alternative
payment methodologies.
2. "Alternative
payment methodologies":
(a) Means methods of
payment that are not based solely on fee‑for‑service
reimbursements.
(b) Includes:
(i) Shared savings
arrangements.
(ii) Bundled payments.
(iii) Global payments.
(iv) Fee‑for‑service
payments that are settled or reconciled with a bundled or global payment.
3. "Fee-for-service"
means a payment mechanism in which all reimbursable health care activity is
described and categorized into discrete and separate units of service and a
health care provider is separately reimbursed for each discrete service rendered
to a patient.
4. "Health
care" and "health care provider" have the same meanings
prescribed in 45 Code of Federal Regulations section 160.103.
5. "Health plan":
(a) Means a
health care services organization, a hospital service organization, a medical
service organization and a hospital, medical, dental and optometric service
organization authorized to transact insurance business pursuant to title 20.
(b) Does not
include an insurer or plan that provides benefits pursuant to chapter 29, article
1 of this title.
6. "Relative
price" means the contractually negotiated amount that is paid to a health
care provider by each private health plan for health care, including both fee‑for‑service
payments and nonclaims-related payments, and that is expressed in the aggregate
relative to the health plan's network‑wide average amount paid to
providers, as calculated under subsection A or C of this section and rules
adopted by the department.