Second Regular Session S.B. 1024
COMMITTEE ON HEALTH AND HUMAN SERVICES
SENATE AMENDMENTS TO S.B. 1024
(Reference to printed bill)
Strike everything after the enacting clause and insert:
"Section 1. Section 20-3111, Arizona Revised Statutes, is amended to read:
20-3111. Definitions
In this article, unless the context otherwise requires:
1. "Arbitration" means a dispute resolution process in which an impartial arbitrator determines the dollar amount a health care provider is entitled to receive for payment of a surprise out‑of‑network bill.
2. "Arbitrator" means an impartial person who is appointed to conduct an arbitration.
3. "Billing company" means any affiliated or unaffiliated company that is hired by a health care provider or health care facility to coordinate the payment of bills with health insurers and to generate or bill and collect payment from enrollees on the health care provider's or health care facility's behalf.
4. "Contracted provider" means a health care provider that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates.
5. "Cost sharing requirements" means an enrollee's applicable out‑of‑network coinsurance, copayment and deductible requirements under a health plan based on the adjudicated claim.
6. "Emergency services" has the same meaning prescribed in section 20‑2801.
7. "Enrollee" means an individual who is eligible to receive benefits through a health plan.
8. "Health care facility" has the same meaning prescribed in section 36‑437.
9. "Health care provider" means a person who is licensed, registered or certified as a health care professional under title 32 or a laboratory or durable medical equipment provider that furnishes services to a patient in a network facility and that separately bills the patient for the services.
10. "Health care services" means treatment, services, medications, tests, equipment, devices, durable medical equipment, laboratory services or supplies rendered or provided to an enrollee for the purpose of diagnosing, preventing, alleviating, curing or healing human disease, illness or injury.
11. "Health insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation or medical service corporation that provides health insurance in this state.
12. "Health plan" means a group or individual health plan that finances or furnishes health care services and that is issued by a health insurer.
13. "Network facility" means a health care facility that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates.
14. "Surprise out‑of‑network bill" means a bill for a health care service that was provided in a network facility by a health care provider that is not a contracted provider and that meets one of the requirements listed in section 20‑3113.
Sec. 2. Section 20-3112, Arizona Revised Statutes, is amended to read:
20-3112. Applicability
A. This article applies to a self‑funded or self‑insured employee benefit plan that is otherwise preempted from state regulation by the employee retirement income security act of 1974 (P.L. 93‑406; 88 Stat. 829; 29 United States Code section 1144(b)) if the entity that administers the plan enters into a written agreement with the department Pursuant to section 20‑3120 to voluntarily comply with the requirements of this article.
B. This article does not apply to:
1. Health care services that are not covered by the enrollee's health plan.
2. Limited benefit coverage as defined in section 20‑1137.
3. Charges for health care services that are subject to a direct payment agreement under section 32‑3216 or 36‑437.
4. Health plans that do not include coverage for out‑of‑network health care services, unless otherwise required by law.
5. State health and accident coverage for full‑time officers and employees of this state and their dependents that is provided pursuant to title 38, chapter 4, article 4.
6. 4. Except as provided in subsection A of this section, a self‑funded or self‑insured employee benefit plan if the regulation of that plan is preempted by the employee retirement income security act of 1974 (P.L. 93-406; 88 Stat. 829; 29 United States Code section 1144(b)).
Sec. 3. Title 20, chapter 20, article 2, Arizona Revised Statutes, is amended by adding section 20-3120, to read:
20-3120. Self-funded and self-insured employee benefit plans; voluntary compliance; fee
An entity that administers a self‑funded or self‑insured employee benefit plan that is otherwise preempted from state regulation by the employee retirement income security act of 1974 (P.L. 93‑406; 88 Stat. 829; 29 United States Code section 1144(b)) may enter into a written agreement with the department in which the entity agrees to comply with the requirements prescribed in this article and the department agrees to allow the plan's enrollees to participate in the dispute resolution and arbitration proceedings prescribed in this article. The department may charge the entity a fee for entering into a written agreement pursuant to this section in an amount to be determined by the director.
Sec. 4. Intent
The legislature intends that the fee the department of insurance and financial institutions charges pursuant to section 20‑3120, Arizona Revised Statutes, as added by this act, cover the costs of administering the dispute resolution and arbitration proceedings prescribed in title 20, chapter 20, article 2, Arizona Revised Statutes, as amended by this act, for entities that administer self‑funded or self‑insured employee benefit plans that are otherwise preempted from state regulation by the employee retirement income security act of 1974 (P.L. 93‑406; 88 Stat. 829; 29 United States Code section 1144(b)) and that choose to participate in the dispute resolution and arbitration proceedings prescribed in title 20, chapter 20, article 2, Arizona Revised Statutes, as amended by this act."
Amend title to conform