Page 2, line 18, strike "K" insert "N"
Page 4, between lines 13 and 14,
insert:
"J. A health care provider who receives direct payment
pursuant to this section shall provide the person making the direct payment
with a receipt that includes the following information:
1. The amount of the direct payment.
2. The applicable procedure and diagnosis codes for the
services rendered.
3. A clear notation that the services were subject to
direct payment under this section."
Reletter to conform
Line 21, after "insurer's" strike remainder of line
Strike line 22, insert "prevailing contracted commercial rate for the
enrollee's health care plan in this state for the service or services. If the
service or services do not match standard codes or bundled payment programs in
use in this state by the insurer, the amount applied to the in‑network
deductible shall be the amount paid directly. For the purposes of
this subsection, "prevailing contracted commercial rate" means the
most usual and customary rate that an insurer offers as payment for a specific
service under a specific health care plan, not including a plan offered under
medicare or medicaid or on a health insurance exchange.
L. If an enrollee is enrolled in a high deductible
plan that qualifies the enrollee for a health savings account as defined in 26
United States Code section 223, the health care system is not liable if the
enrollee submits a claim for deductible application of a direct pay amount
pursuant to subsection K of this section that jeopardizes the enrollee's status
as an individual eligible for favorable tax treatment of the health savings
account.
M. This section does not create any private right
or cause of action for or on behalf of any person against the health insurer.
This section provides solely an administrative remedy for any violation of this
section or any related rule."
Reletter to conform
Page 5, line 26, after the second
quotation mark insert ":
(a)"
Between lines 29 and 30,
insert:
"(b) Does not include a governmental plan as defined
in the employee retirement income security act of 1974 (P.L. 93‑406; 88
Stat. 829; 29 United States Code section 1002)."
Page 7, line 24, strike "L" insert "O"
Page 9,
between lines 17 and 18, insert:
"K. A health care facility that
receives direct payment pursuant to this section shall provide the person
making the direct payment with a receipt that includes the following
information:
1. The amount of the direct payment.
2. The applicable procedure and diagnosis codes for the
services rendered.
3. A clear notation that the services were subject to
direct payment under this section."
Reletter to conform
Line 25, after "insurer's" strike remainder of line
Strike line 26, insert "prevailing contracted commercial rate for the
enrollee's health care plan in this state for the service or services. If the
service or services do not match standard codes or bundled payment programs in
use in this state by the insurer, the amount applied to the in‑network
deductible shall be the amount paid directly. For the purposes of
this subsection, "prevailing contracted commercial rate" means the
most usual and customary rate that an insurer offers as payment for a specific
service under a specific health care plan, not including a plan offered under
medicare or medicaid or on a health insurance exchange.
M. If an enrollee is enrolled in a high
deductible plan that qualifies the enrollee for a health savings account as
defined in 26 United States Code section 223, the health care system is not
liable if the enrollee submits a claim for deductible application of a direct
pay amount pursuant to subsection L of this section that jeopardizes the
enrollee's status as an individual eligible for favorable tax treatment of the
health savings account.
N. This section does not create any private right
or cause of action for or on behalf of any person against the health insurer.
This section provides solely an administrative remedy for any violation of this
section or any related rule."
Reletter to conform
Page 10, line 31, after the
second quotation mark insert ":
(a)"
Page 11, between lines 2 and 3,
insert:
"(b) Does
not include a governmental plan as defined in the employee retirement income
security act of 1974 (P.L. 93‑406; 88 Stat. 829; 29 United States Code
section 1002)."
Strike lines 10, 11 and 12, insert:
"Sec. 3. Repeal
Laws 2013, chapter 202, section 7 is
repealed.
Sec. 4. Effective date
Sections 32‑3216
and 36‑437, Arizona Revised Statutes, as amended by this act, are
effective from and after December 31, 2016 and apply to policies, contracts and
plans that are issued or renewed from and after December 31, 2016."
Amend title to conform
Bill
Number: H.B. 2417