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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AMENDED
technical
correction; open pit mining
(NOW: health insurance; patient steering; prohibition)
Purpose
Prohibits health care providers, health care institutions and drug manufacturers from paying enrollee health insurance premiums or steering enrollees to change plans based on health status and establishes related criminal penalties.
Background
Arizona law prohibits certain patient brokering practices related to sober living homes and substance use disorder treatment facilities. Specifically, a person, including a health care provider, behavioral health professional, health care institution or sober living home, may not offer, pay, solicit or receive any commission, bonus, rebate, kickback or bribe, directly or indirectly, or engage in any split-fee arrangement, in any form whatsoever, in return for: 1) referring patients or clients to or from a sober living home or a substance use disorder treatment facility; or 2) accepting or acknowledging the enrollment of a patient or client for substance use disorder services at a sober living home.
A person who commits unlawful patient brokering as outlined is guilty of: 1) a class 3 felony if the consideration has a value of $1,000 or more; 2) a class 4 felony if the consideration has a value of more than $100 but less than $1,000; or 3) a class 6 felony if the consideration has a value of $100 or less (A.R.S. § 13-3730).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Declares 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.
2. 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.
3. Exempts 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 acting within their scope of licensure or registration while assisting individuals with enrollment in a health benefits plan and not knowingly providing or facilitating false or fraudulent information on an application submitted to a health benefits exchange; and
b) case management, care coordination and patient consultation activities performed in the ordinary course of business.
4. Subjects a person convicted of violating health plan enrollment and referral restrictions to a civil penalty of at least $1,000 per violation and doubles the penalty for serial offenders.
5. 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.
6. Prohibits health care institution licensees, directly or indirectly through staff, from advising a patient to enroll in or disenroll from a specific health plan unless the licensee or staff member is a licensed insurance producer, but specifies that this does not prohibit:
a) a licensee from discussing network status with a specific insurance provider, plan or policy; or
b) health insurance navigators or certified application counselors acting within their scope of licensure or registration from assisting individuals with enrolling in a health insurance policy or plan.
7. Subjects a person who offers, pays, solicits or receives remuneration related to health plan enrollment or patient referrals to:
a) a class 3 felony if the consideration has a value of $1,000 or more;
b) a class 4 felony if the consideration has a value of more than $100 but less than $1,000; or
c) a class 6 felony if the consideration has a value of $100 or less.
8. Prohibits insurance producers from offering or receiving any commission or kickback in return for referring a patient to a sober living home or from a sober living home to another health care institution.
9. Prohibits life or disability insurance rebates from including direct or indirect payment of an enrollee's health insurance premiums or subscription fees by a health care professional, health care institution or drug manufacturer.
10. Expands the definition of solicit under insurance producer statutes to include, when done in the regular course of business, steering, advising, recommending or encouraging persons with a known health condition to terminate their existing health benefit plan or allow their coverage to lapse and purchase a replacement or alternative plan or policy from an insurer.
11. Defines terms
12. Makes technical and conforming changes.
13. Becomes effective on the general effective date.
Amendments Adopted by Committee
· Adopted the strike everything amendment.
Amendments Adopted by Committee of the Whole
1. Prohibits insurance producers from offering or receiving any commission or kickback in return for referring a patient to or from a sober living home.
2. Removes restrictions on health care providers, health care institutions and drug manufacturers steering, advising or encouraging a health plan enrollee to terminate or change health plans.
3. Prohibits insurance producers from knowingly submitting false or fraudulent information to enroll an individual in the Arizona Health Care Cost Containment System or a health benefits plan, establishes civil penalties for violations and exempts health insurance navigators and certified application counselors acting within their scope of practice.
4. 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.
5. Prohibits health care institution licensees, directly or indirectly through staff, from advising a patient to enroll in or disenroll from a specific health plan unless the licensee or staff member is a licensed insurance producer, but specifies that this does not prohibit:
a) a licensee from discussing network status with a specific insurance provider, plan or policy; or
b) health insurance navigators or certified application counselors acting within their scope of licensure or registration from assisting individuals with enrolling in a health insurance policy or plan.
6. Makes technical and conforming changes.
Senate Action
HHS 2/19/26 DPA/SE 4-3-0
Prepared by Senate Research
March 9, 2026
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