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ARIZONA HOUSE OF REPRESENTATIVESFifty-fifth Legislature First Regular Session |
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HB 2119: health care insurance; amendments
Sponsor: Representative Bolick, LD 20
Committee on Commerce
Overview
Makes various changes to statute governing Health Care Insurers.
History
Hospital, medical, dental and optometric service corporations (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 (HCSO) 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
Service Organizations
1. Applies statute relating to assignment of benefits to a hospital and medical service corporation. (Sec. 3)
2. Applies laws governing insurance company holding systems to 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 an HCSO to submit quarterly, rather than monthly, to the Department of Insurance and Financial Institutions, a list of all provider contracts that have been terminated during the previous three months, rather than the previous month. (Sec. 8)
Accountable Health Plans
5. Expands the definition of COBRA continuation provision to include statute relating to small group health plan continuation coverage. (Sec. 9)
6. Excludes a policy or contract made available to persons eligible for AHCCCS from the definition of creditable coverage. (Sec. 9)
7. Excludes a small employer who obtains a health benefits plan that is subject to and complies with federal from statute governing accountable health care plan premium rate practices. (Sec. 10)
8. Repeals laws relating to basic health benefit plans and exchange of information 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 federal rule. (Sec. 13)
Miscellaneous
11. Repeals laws relating to contracts and forms in effect prior to January 1, 1955. (Sec. 1)
12. Clarifies statute relating to prohibitive actions of a person applies to Service Corporations and HCSOs. (Sec. 2)
13.
Makes a conforming
change. (Sec. 5, 7, 9, 14)
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17. HB 2119
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