PREFILED JAN 07 2021
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REFERENCE TITLE: insurance; optometrists; contracts; covered services |
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State of Arizona House of Representatives Fifty-fifth Legislature First Regular Session 2021
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HB 2047 |
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Introduced by Representative Weninger
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AN ACT
Amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20‑849; Amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20‑1057.18; Amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20‑1342.07; Amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding sections 20‑1402.05 and 20‑1404.05; relating to optometry.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-849, to read:
20-849. Contracts; optometrists; covered services; definition
A. EXCEPT AS PROVIDED IN SUBSECTION C of this section, a contract, entered into or renewed on or after January 1, 2022, between an optometric service corporation and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under a subscription contract based on a fee set by the optometric service corporation unless the service for which the fee applies is a covered service under the individual's subscription contract.
2. PROHIBIT AN OPTOMETRIST FROM OFFERING OR PROVIDING A VISION SERVICE THAT IS NOT A COVERED SERVICE TO A COVERED INDIVIDUAL AT A FEE DETERMINED BY THE OPTOMETRIST OR BY THE OPTOMETRIST AND THE COVERED INDIVIDUAL.
3. REQUIRE AN OPTOMETRIST TO USE ONE OR MORE SPECIFIC VENDORS TO REPLENISH THE OPTOMETRIST'S INVENTORY OF SPECTACLE LENSES AFTER THE OPTOMETRIST DISPENSES THE OPTOMETRIST'S INVENTORY TO ELIGIBLE MEMBERS OF THE VISION PLAN AS A COVERED VISION SERVICE.
B. THIS SECTION APPLIES TO AN ADMINISTRATOR PROVIDING THIRD-PARTY ADMINISTRATION SERVICES OR A PROVIDER NETWORK FOR A VISION PLAN.
C. THIS SECTION DOES NOT RESTRICT THE ABILITY OF AN OPTOMETRIC SERVICE corporation TO ENTER INTO A CONTRACT FOR AN OPTOMETRIST TO PARTICIPATE IN A DISCOUNT PROGRAM SPONSORED BY THE OPTOMETRIC SERVICE CORPORATION FOR SERVICES THAT ARE NOT COVERED if:
1. PARTICIPATION IN THE OPTOMETRIC SERVICE CORPORATION NETWORK IS NOT CONTINGENT ON PARTICIPATION IN THE SPONSORED DISCOUNT PROGRAM.
2. THE OPTOMETRIC SERVICE CORPORATION OFFERs EQUAL TREATMENT TO AN OPTOMETRIST WHO DOES NOT PARTICIPATE IN A SPONSORED DISCOUNT PROGRAM, REGARDING:
(a) PROMOTIONAL TREATMENT.
(b) MARKETING BENEFITS.
(c) MATERIALS.
(d) CONTRACT TERMS FOR PROVIDING A COVERED SERVICE.
D. Notwithstanding subsection C, paragraph 2, subdivision (d) of this section, an optometric service corporation, when providing a typically formatted list of optometrists in the optometric service corporation network, may identify whether an optometrist participates in a discount program for services not covered by the optometric service corporation if all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1, 2022, but not later than December 31, 2022.
F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a subscription contract without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.
Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.18, to read:
20-1057.18. Contracts; optometrists; covered services; definition
A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a health care services organization and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the service for which the fee applies is a covered service under the individual's evidence of coverage.
2. Prohibit an optometrist from offering or providing a vision service that is not a covered service to a covered individual at a fee determined by the optometrist or by the optometrist and the covered individual.
3. Require an optometrist to use one or more specific vendors to replenish the optometrist's inventory of spectacle lenses after the optometrist dispenses the optometrist's inventory to eligible members of the vision plan as a covered vision service.
B. This section applies to an administrator providing third-party administration services or a provider network for a vision plan.
C. This section does not restrict the ability of a health care services organization to enter into a contract for an optometrist to participate in a discount program sponsored by the health care services organization for services that are not covered if:
1. Participation in the health care services organization network is not contingent on participation in the sponsored discount program.
2. The health care services organization offers equal treatment to an optometrist who does not participate in a sponsored discount program, regarding:
(a) Promotional treatment.
(b) Marketing benefits.
(c) Materials.
(d) Contract terms for providing a covered service.
D. Notwithstanding subsection C, paragraph 2, subdivision (d) of this section, a health care services organization, when providing a typically formatted list of optometrists in the health care services organization network, may identify whether an optometrist participates in a discount program for services not covered by the health care services organization if all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1, 2022, but not later than December 31, 2022.
F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under an evidence of coverage without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.
Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1342.07, to read:
20-1342.07. Contracts; optometrists; covered services; definition
A. Except as provided in subsection c of this section, a contract, entered into or renewed on or after January 1, 2022, between a disability insurer and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under a disability insurance policy based on a fee set by the disability insurer unless the service for which the fee applies is a covered service under the individual's disability insurance policy.
2. Prohibit an optometrist from offering or providing a vision service that is not a covered service to a covered individual at a fee determined by the optometrist or by the optometrist and the covered individual.
3. require an optometrist to use one or more specific vendors to replenish the optometrist's inventory of spectacle lenses after the optometrist dispenses the optometrist's inventory to eligible members of the vision plan as a covered vision service.
b. this section applies to an administrator providing third-party administration services or a provider network for a vision plan.
c. this section does not restrict the ability of a disability insurer to enter into a contract for an optometrist to participate in a discount program sponsored by the disability insurer for services that are not covered if:
1. participation in the disability insurer network is not contingent on participation in the sponsored discount program.
2. the disability insurer offers equal treatment to an optometrist who does not participate in a sponsored discount program, regarding:
(a) promotional treatment.
(b) marketing benefits.
(c) materials.
(d) contract terms for providing a covered service.
d. notwithstanding subsection C, paragraph 2, subdivision (d) of this section, a disability insurer, when providing a typically formatted list of optometrists in the disability insurer network, may identify whether an optometrist participates in a discount program for services not covered by the disability insurer, provided that all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1, 2022, but not later than December 31, 2022.
F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a disability insurance policy without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.
Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding sections 20-1402.05 and 20-1404.05, to read:
20-1402.05. Contracts; optometrists; covered services; definition
A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a group disability insurer and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under a group disability insurance policy based on a fee set by the group disability insurer unless the service for which the fee applies is a covered service under the individual's group disability insurance policy.
2. Prohibit an optometrist from offering or providing a vision service that is not a covered service to a covered individual at a fee determined by the optometrist or by the optometrist and the covered individual.
3. Require an optometrist to use one or more specific vendors to replenish the optometrist's inventory of spectacle lenses after the optometrist dispenses the optometrist's inventory to eligible members of the vision plan as a covered vision service.
B. This section applies to an administrator providing third-party administration services or a provider network for a vision plan.
C. This section does not prohibit the ability of a group disability insurer to enter into a contract for an optometrist to participate in a discount program sponsored by the group disability insurer for services that are not covered if:
1. Participation in the group disability insurer network is not contingent on participation in the sponsored discount program.
2. The group disability insurer offers equal treatment to an optometrist who does not participate in a group disability insurer sponsored discount program, regarding:
(a) Promotional treatment.
(b) Marketing benefits.
(c) Materials.
(d) Contract terms for providing a covered service.
D. Notwithstanding subsection C, paragraph 2, subdivision (d) of this section, a group disability insurer, when providing a typically formatted list of optometrists in the group disability insurer network, may identify whether an optometrist participates in a discount program for services not covered by the group disability insurer provided that all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1, 2022, but not later than December 31, 2022.
F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a group disability insurance policy without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.
20-1404.05. Contracts; optometrists; covered services; definition
A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a blanket disability insurer and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under a blanket disability insurance policy based on a fee set by the blanket disability insurer unless the service for which the fee applies is a covered service under the individual's blanket disability insurance policy.
2. Prohibit an optometrist from offering or providing a vision service that is not a covered service to a covered individual at a fee determined by the optometrist or by the optometrist and the covered individual.
3. Require an optometrist to use one or more specific vendors to replenish the optometrist's inventory of spectacle lenses after the optometrist dispenses the optometrist's inventory to eligible members of the vision plan as a covered vision service.
B. This section applies to an administrator providing third-party administration services or a provider network for a vision plan.
C. This section does not prohibit the ability of a blanket disability insurer to enter into a contract for an optometrist to participate in a discount program sponsored by the blanket disability insurer for services that are not covered if:
1. Participation in the blanket disability insurer network is not contingent on participation in the sponsored discount program.
2. The blanket disability insurer offers equal treatment to an optometrist who does not participate in a blanket disability insurer sponsored discount program, regarding:
(a) Promotional treatment.
(b) Marketing benefits.
(c) Materials.
(d) Contract terms for providing a covered service.
D. Notwithstanding subsection C, paragraph 2, subdivision (d) of this section, a blanket disability insurer, when providing a typically formatted list of optometrists in the blanket disability insurer network, may identify whether an optometrist participates in a discount program for services not covered by the blanket disability insurer provided that all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1, 2022, but not later than December 31, 2022.
F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a blanket disability insurance policy without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.