REFERENCE TITLE: insurance; provider rating; notice

State of Arizona

Senate

Fifty-sixth Legislature

First Regular Session

2023

SB 1458

Introduced by

Senator Shope

An Act

amending title 20, chapter 1, article 1, Arizona Revised Statutes, by adding section 20-127; relating to health insurers.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding section 20-127, to read:

START_STATUTE20-127. Health care provider rating; health care insurers; reconsideration process; notice; definition

A. A health care insurer may not rank or classify health care providers based on performance or publish provider-specific information that includes ranking, tiers, ratings or other comparisons of a health care provider's PERFORMANCE against standards, measures or other providers, unless all of the following apply:

1. The standards conform to nationally RECOGNIZED standards and guidelines as prescribed by the department.

2. The standards and measures are disclosed to each affected health care provider before any evaluation period begins.

3. Before any publication or other public dissemination, each affected health care provider is afforded an opportunity to dispute the ranking or classification through a process that, at a minimum, includes a fair and impartial review and reconsideration process that conforms to the following:

(a) A health care insurer provides at least forty-five days written notice to the health care provider of a proposed ranking, tiering, rating or other comparison, including the methodologies, data and other information used to make its ranking, tiering, rating or comparison decision.

(b) Within thirty days after receiving the notice prescribed by subdivision (a) of this paragraph, A health care provider may request reconsideration with the health care insurer. At the health care provider's option, The reconsideration proceeding may be held by teleconference or in-person at a day and time agreed on by the health care provider and the health care insurer. 

(c) At the reconsideration proceeding, The health care provider may:

(i) participate in and provide information.

(ii) have a representative participate in addition to or on behalf of the health care provider.

(iii) Submit documentation and written statements.

(d) A health care insurer shall notify the health care provider in writing of the reconsideration decision before publishing or disseminating any ranking, tiering, rating or comparison.  The reconsideration decision shall include specific reasons and facts as to how the decision was made.

B. For the purposes of this section, "health care insurer" means a hospital service corporation or medical service corporation pursuant to chapter 4, article 3 of this title, health care services organization pursuant to chapter 4, article 9 of this title, disability insurer pursuant to chapter 6, article 4 of this title or group or blanket disability insurer pursuant to chapter 6, article 5 of this title that offer, issues or renews a contract, evidence of coverage or policy covering health care services. END_STATUTE