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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
Senate: HHS DPA/SE 4-3-0-0 |Third Read 16-13-1-0-0 |
SB 1494: health insurance; patient steering; prohibition
Sponsor: Senator Werner, LD 4
Committee on Health & Human Services
Overview
Prohibits health care providers, health care institutions and drug manufacturers from receiving any sort of benefit from an enrollee, paying premiums or guiding a person to change insurance plans.
History
The Department of Insurance and Financial Institutions regulates the business of insurance and enforces laws governing insurance policies issued in Arizona. Health insurers must comply with statutory requirements relating to policy forms, coverage provisions and consumer protections (A.R.S. §§ 20-142, 20-1110).
Health insurance coverage may be offered by disability insurers, hospital service corporations, medical service corporations and health care services organizations. These entities are regulated under separate provisions governing the issuance and administration of health coverage and must comply with applicable laws relating to policy benefits, limitations and exclusions (A.R.S. §§ 20-822, 20-841, 20-1057, 20-1376).
Currently, the following is unlawful for a person, including a health care provider, behavioral health professional, health care institution or sober living home, to offer, pay, solicit or receive any commission, bonus, rebate, kickback or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for either referring patients or clients to or from a sober living home or substance use disorder treatment facility or accepting or acknowledging the enrollment of a patient or client for substance use disorder services at a sober living home. (A.R.S. §13-3730)
Provisions
1. Adds insurance producer to the list of persons and entities that are not allowed to receive any benefit from referring patients or clients to a sober living home or from a sober living home to any other health care institution. (Sec. 1)
2. Prohibits a health care provider, institution or drug manufacturer from paying the premiums or subscription fees for an enrollee under any health benefits plan issued by a health care insurer in Arizona. (Sec. 1)
3. Prohibits a person who is licensed in Arizona from knowingly providing false or fraudulent information through employees or representatives regarding a person's eligibility for or their enrollment status in Arizona Health Care Cost Containment System. (Sec. 1)
4. Exempts specific instances from the restrictions, provided they are being paid in a not prohibited way, to includes the following:
a. health insurance navigators and certified application counselors who act within the scope of their license or registration while assisting persons enroll in health benefits plan and do not knowingly provide false or fraudulent information; and
b. case management, coordination of care and patient consultation activities that are preformed during normal process. (Sec. 1)
5. Allows the court to order a person who is convicted of a violation to pay a civil penalty of not less than $1,000 per violation and additionally allows the court to double the civil penalty if the person is a serial offender. (Sec. 1)
6. Modifies the definition of solicit to include steering, advising, recommending or encouraging a person in Arizona with a preexisting health condition to terminate or allow their existing health benefits plan or coverage to lapse. (Sec. 2)
7. Clarifies that a prohibited rebate includes payment, directly or indirectly by a health care provider, institution or manufacture of the premiums or subscription fees for an enrollee under any health benefits plan issued by a health care insurer in Arizona. (Sec. 3)
8. Adds to the definition of unprofessional conduct to include advising a patient, directly or indirectly, to enroll in or disenroll from a specific health insurance policy or plan issued by an insurance company unless the licensee or staff member is a licensed insurance produce in Arizona. (Sec. 4, 5, 6)
9. Clarifies that a licensee can still discuss with patients if the licensee is in network or out of network for the specific insurance company or under a specific insurance policy or plan. (Sec. 4, 5, 6)
10. Prohibits the licensee from advising a patient, directly or indirectly, from enrolling or disenrolling from a specific health insurance policy or plan issued by a specific insurance company unless licensee or staff member is a licensed insurance provider in Arizona, includes exclusions for the following:
a. prohibiting or preventing a licensee from discussing with patients if the licensee is in or out of network with any specific insurance company or under a specific insurance policy or plan; or
b. prohibiting or preventing health insurance navigators or certified application counselors acting within the scope of their license or registration from assisting individuals in enrollment in a health insurance policy or plan. (Sec. 7)
11. Defines key terms. (Sec. 1, 2, 3)
12. Makes technical changes. (Sec. 1,2, 3, 5, 7)
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16. Initials TM SB 1494
17. 3/17/2026 Page 0 Health & Human Services
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