|
|
ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
Senate: HHS DPA/SE 4-3-0-0 |Third Read 16-13-1-0-0House: HHS DP 8-1-1-2 |
SB 1494: health insurance; patient steering; prohibition
Sponsor: Senator Werner, LD 4
Caucus & COW
Overview
Prohibits health care providers, health care institutions and drug manufacturers from covering enrollees’ insurance premiums or directing them to switch plans based on their health condition and sets forth associated criminal penalties.
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. Deems it unlawful, unless expressly allowed by federal law, for health care providers, health care institutions or drug manufacturers to pay, directly or indirectly, health insurance premiums or subscription fees on behalf of a health plan enrollee. (Sec. 1)
3. Declares it unlawful for insurance producers to knowingly submitting false or fraudulent information, directly or through employees or representatives, about an individual's eligibility for or enrollment status in the Arizona Health Care Cost Containment System or a health benefits plan. (Sec. 1)
4. Allows the court to order a person who is convicted of violating health plan enrollment and referral restrictions to pay a civil penalty of no less than $1,000 per violation and allows the court to double the civil penalty if the person is a serial offender. (Sec. 1)
5. Excludes the following from limitations and prohibitions related to patient health plan enrollment and referrals if no prohibited remuneration relating to sober living home referrals is paid or received:
a. health insurance navigators and certified application counselors who act within the scope of their license or registration while assisting persons enroll in a health benefits plan and do not knowingly provide false or fraudulent information on an application submitted to a health benefits exchange; and
b. case management, coordination of care and patient consultation activities that are performed in the ordinary course of business. (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. Declares it an act of unprofessional conduct for a nurse or allopathic or osteopathic physician, directly or indirectly through staff, to advise a patient to enroll or disenroll from a specific health plan unless the licensee or staff member is a licensed insurance producer, but allows a licensee to discuss with a patient whether the licensee is in network or out of network with a specific insurance provider, plan or policy. (Sec. 4, 5)
9. Forbids health care institution licensees from advising a patient, directly or indirectly through staff, to enroll in or disenroll from a specific health plan unless the licensee or staff member is a licensed insurance provider in Arizona, but clarifies that this does not prohibit:
a. 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. 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. 4-7)
10. Defines terms. (Sec. 1, 2, 3)
11. Makes technical and conforming changes. (Sec. 1,2, 3, 5, 7)
12.
13.
14. ---------- DOCUMENT FOOTER ---------
15. Initials AG/TM SB 1494
16. 3/20/2026 Page 0 Caucus & COW
17.
18. ---------- DOCUMENT FOOTER ---------