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REFERENCE TITLE: cost sharing; health coverage; report |
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State of Arizona House of Representatives Fifty-sixth Legislature First Regular Session 2023
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HB 2622 |
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Introduced by Representative Hendrix
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An Act
amending sections 20-181 and 20-182, Arizona Revised Statutes; relating to mandated health coverage.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-181, Arizona Revised Statutes, is amended to read:
20-181. Mandated health coverage; cost sharing restriction; report
An organization or individual advocating a legislative proposal that would mandate a health coverage or offering of a health coverage or that would place a restriction on the form or amount of cost sharing applied to a health plan benefit issued by an insurer, hospital, medical, dental or optometric service corporation, health care services organization or any other health care service contractor as a component of individual or group policies shall submit a report pursuant to section 20-183. The report shall assess both the social and financial impacts of such coverage, including the effectiveness of the treatment or service or cost sharing restriction proposed, according to the factors prescribed in section 20-182.
Sec. 2. Section 20-182, Arizona Revised Statutes, is amended to read:
20-182. Factors for assessing impact; certification of report
A. To the extent that information is available, the report prescribed by section 20-181 shall include, but not be limited to, the following, as applicable:
1. The social impact:
(a) The extent to which the treatment or service is generally utilized used by a significant portion of the population.
(b) The effectiveness of the treatment or service proposed.
(b) (c) The extent to which the insurance coverage is already generally available.
(c) (d) If coverage is not generally available, the extent to which the lack of coverage results in persons avoiding necessary health care treatments.
(d) (e) If the coverage is not generally available, the extent to which the lack of coverage results in unreasonable financial hardship to a patient.
(e) (f) The level of public demand for the treatment or service or the cost sharing restriction.
(f) (g) The level of public demand for insurance coverage of the treatment or service.
(g) (h) The level of interest of collective bargaining agents in negotiating privately for inclusion of this coverage or cost sharing restriction in group contracts.
2. The financial impact:
(a) The extent to which the coverage or cost sharing restriction will increase or decrease the cost of the treatment or service.
(b) The extent to which the coverage or cost sharing restriction will increase the appropriate use of the treatment or service.
(c) The extent to which the mandated treatment or service or the cost sharing restriction will be a substitute for a more expensive treatment or service.
(d) The extent to which the coverage or cost sharing restriction will increase or decrease the administrative expenses of insurers and the premium and administrative expenses of policyholders.
(e) The impact of this coverage or cost sharing restriction on the total cost of health care.
(f) The impact of this coverage or cost sharing restriction on other policyholders that do not use the treatment or service subject to the mandated coverage or cost sharing restriction.
(g) An analysis of whether this state will be required to defray the costs that a treatment or service may add to the federal marketplace subsidies pursuant to 42 United States Code section 18031(d)(3)(B).
B. An actuary who is a member of the American academy of actuaries shall prepare the financial impact analysis required by subsection A, paragraph 2 of this section and certify that the analysis is consistent with accepted actuarial techniques.
C. The report required by section 20-181 shall address the specific language of the proposed mandate or cost sharing restriction. A report on a similar proposal in a different jurisdiction is insufficient and does not meet the requirements of section 20-181.
D. An organization, individual or legislator that does not submit a report required by section 20-181 is not subject to any civil sanction or criminal penalty.