PROPOSED
HOUSE OF REPRESENTATIVES AMENDMENTS TO H.B. 2726
Strike everything after the enacting clause and insert:
"Section 1. Section 20-841, Arizona Revised Statutes, is amended to read:
20-841. Prohibiting denial of certain contract benefits
A. Notwithstanding any provision of any subscription contract of a hospital and medical service corporation, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11, if the service performed is within the lawful scope of such person's license, and if the service is surgical, such person is a member of the staff of an accredited hospital, and if such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to title 32, chapter 13. reimbursement for the cost of the service shall be made directly to the person licensed or certified or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 7 or 11 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
B. If a subscription contract of a hospital and medical service corporation provides for or offers eye care services, the subscriber shall have freedom of choice to select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination, care, or treatment for which the subscriber is eligible and which that falls within the scope of practice of the optometrist or physician and surgeon. Unless such subscription contract otherwise provides, there shall be no reimbursement shall not be made for ophthalmic materials, lenses, spectacles, or eyeglasses, or for appurtenances thereto to these materials or items.
C. If any subscription contract of a hospital and medical service corporation is written to provide coverage for psychiatric, drug abuse or alcoholism services, reimbursement for such services shall be made in accordance with the terms of the contract without regard to whether the covered services are rendered in a psychiatric special hospital or general hospital. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 13 or 19.1 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
Sec. 2. Section 20-841.01, Arizona Revised Statutes, is amended to read:
20-841.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement
If a subscription contract of a hospital and medical service corporation provides for or offers reimbursement for any service which that is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such contract may select either a physician or duly certified or licensed chiropractor to provide the examination, care or treatment for which the subscriber is eligible and which that falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 8 or 13 who has a participation contract with the hospital and medical service corporation or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 8 or 13 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
Sec. 3. Section 20-841.03, Arizona Revised Statutes, is amended to read:
20-841.03. Prohibiting denial of contract benefits; nurses; reimbursement
If a subscription contract of a hospital and medical service corporation provides or offers reimbursement for any service which that is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nursing regarding extended nursing practice and licensed pursuant to title 32, chapter 15, the hospital and medical service corporation shall not deny benefits to a subscriber who receives the services of the certified registered nurse or registered nurse practitioner. The cost of the service may be reimbursed directly to the certified registered nurse or registered nurse practitioner if the certified registered nurse or registered nurse practitioner has a participation contract with the hospital and medical service corporation or to the subscriber and is payable to the certified registered nurse or registered nurse practitioner and the subscriber if another provider or health care institution was not reimbursed for the cost of the service.
Sec. 4. Section 20-1376, Arizona Revised Statutes, is amended to read:
20-1376. Prohibiting denial of certain contract benefits
A. Notwithstanding any provision of any disability insurance contract, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11, or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15, if the service performed is within the lawful scope of such person's license, and if the service is surgical, such person is a member of the staff of an accredited hospital, and if such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to title 32, chapter 13. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 7, 11 or 15 or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 7, 11 or 15 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
B. If any disability insurance contract provides for or offers eye care services, the subscriber shall have freedom of choice to select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination, care, or treatment for which the subscriber is eligible and that falls within the scope of practice of the optometrist or physician and surgeon. Unless such disability insurance contract otherwise provides, there shall be no reimbursement shall not be made for ophthalmic materials, lenses, spectacles, or eyeglasses or for appurtenances to these materials or items.
C. If any individual disability insurance contract is written to provide coverage for psychiatric, drug abuse or alcoholism services, reimbursement for such services shall be made in accordance with the terms of the contract without regard to whether the covered services are rendered in a psychiatric special hospital or general hospital. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 13 or 19.1 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
Sec. 5. Section 20-1376.01, Arizona Revised Statutes, is amended to read:
20-1376.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement
If a disability insurance contract provides for or offers reimbursement for any service which that is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such contract may select either a physician or chiropractor to provide the examination, care or treatment for which the subscriber is eligible and which that falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 8 or 13 or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 8 or 13 and to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
Sec. 6. Section 20-1376.03, Arizona Revised Statutes, is amended to read:
20-1376.03. Prohibiting denial of contract benefits; nurses; reimbursement
If a disability insurance contract provides or offers reimbursement for any service which that is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nursing regarding extended nursing practice and licensed pursuant to title 32, chapter 15, the contract benefits shall not be denied to a subscriber who receives the services of the certified registered nurse or registered nurse practitioner. The cost of the service may be reimbursed directly to the certified registered nurse or registered nurse practitioner or to the subscriber and is payable to the certified registered nurse or registered nurse practitioner and to the subscriber if another provider or health care institution was not reimbursed for the cost of the service.
Sec. 7. Section 20-1406, Arizona Revised Statutes, is amended to read:
20-1406. Prohibiting denial of certain contract benefits
A. Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11 or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15, if the service performed is within the lawful scope of such person's license, and if the service is surgical, such person is a member of the staff of an accredited hospital, and if such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to title 32, chapter 13.
B. If any group disability insurance contract or blanket disability insurance contract provides for or offers eye medical care services, whether by a network of health care providers or by the selection of a health care provider by the subscriber, the subscriber shall have freedom of choice to select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination, care or treatment for which the subscriber is eligible and which that falls within the scope of practice of the optometrist or physician and surgeon. This subsection does not require that any specific optometrist or physician, or number or percentage of optometrists or physicians, be included on an insurer's provider network. Unless a group disability insurance contract or blanket disability insurance contract otherwise provides, there shall be no reimbursement shall not be made for ophthalmic materials, lenses, spectacles or eyeglasses or for appurtenances thereto to these materials or items.
C. If any group disability insurance contract is written to provide coverage for psychiatric, drug abuse or alcoholism services, reimbursement for those services shall be made in accordance with the terms of the contract without regard to whether the covered services are rendered in a psychiatric special hospital or general hospital. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 13 or 19.1 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
Sec. 8. Section 20-1406.01, Arizona Revised Statutes, is amended to read:
20-1406.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement
If a group disability insurance contract or blanket disability insurance contract provides for or offers reimbursement for any service which that is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such contract may select either a physician or chiropractor to provide the examination, care or treatment for which the subscriber is eligible and which that falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 8 or 13 or to the subscriber and is payable to both the person licensed or certified pursuant to title 32, chapter 8 or 13 and the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.
Sec. 9. Section 20-1406.03, Arizona Revised Statutes, is amended to read:
20-1406.03. Prohibiting denial of contract benefits; nursing; reimbursement
If a group disability or blanket disability insurance contract provides or offers reimbursement for any service which that is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nursing regarding extended nursing practice and licensed pursuant to title 32, chapter 15, the contract benefits shall not be denied to the subscriber who receives the services of the certified registered nurse or registered nurse practitioner. The cost of the service may be reimbursed directly to the certified registered nurse or registered nurse practitioner or to the subscriber and is payable to the certified registered nurse or registered nurse practitioner and the subscriber if another provider or health care institution was not reimbursed for the cost of the service."
Amend title to conform