Arizona 2024 Regular Session

Arizona Senate Bill SB1553 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	REFERENCE TITLE: health care sharing; requirements; appropriations State of Arizona Senate Fifty-sixth Legislature Second Regular Session 2024 SB 1553 Introduced by Senator Mendez An Act amending title 20, chapter 1, article 1, Arizona Revised Statutes, by adding section 20-111; relating to health care costs. (TEXT OF BILL BEGINS ON NEXT PAGE)
2	2
3	3
4	4
5	5
6	6
7	7
8	8
9	9	REFERENCE TITLE: health care sharing; requirements; appropriations
10	10	State of Arizona Senate Fifty-sixth Legislature Second Regular Session 2024
11	11	SB 1553
12	12	Introduced by Senator Mendez
13	13
14	14	REFERENCE TITLE: health care sharing; requirements; appropriations
15	15
16	16
17	17
18	18
19	19
20	20
21	21
22	22
23	23
24	24	State of Arizona
25	25
26	26	Senate
27	27
28	28	Fifty-sixth Legislature
29	29
30	30	Second Regular Session
31	31
32	32	2024
33	33
34	34
35	35
36	36
37	37
38	38
39	39
40	40	SB 1553
41	41
42	42
43	43
44	44	Introduced by
45	45
46	46	Senator Mendez
47	47
48	48
49	49
50	50
51	51
52	52
53	53
54	54
55	55
56	56
57	57
58	58
59	59
60	60
61	61
62	62
63	63
64	64	An Act
65	65
66	66
67	67
68	68	amending title 20, chapter 1, article 1, Arizona Revised Statutes, by adding section 20-111; relating to health care costs.
69	69
70	70
71	71
72	72
73	73
74	74	(TEXT OF BILL BEGINS ON NEXT PAGE)
75	75
76	76
77	77
78	78	Be it enacted by the Legislature of the State of Arizona: Section 1. Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding section 20-111, to read: START_STATUTE20-111. Health care sharing plan or arrangement; reporting; deficiency notice; public posting; cease and desist order; exceptions A. On or before December 1, 2024 and each June 1 thereafter, a person that is not AUTHORIZED to transact insurance in this state but that offers or intends to offer a health care sharing plan or arrangement to facilitate payment or reimbursement of health care costs or services for residents of this state, regardless of whether the person is domiciled in this state or another state, shall submit to the department: 1. All of the following information: (a) The TOTAL number of individuals and households that participated in the plan or arrangement in this state in the immediately preceding calendar year. (b) the total number of employer groups that participated In the plan or arrangement in this state in the immediately Preceding calendar year and shall include the total number of individuals who participated in the plan or arrangement for each participating employer group. (c) if the person offers a plan or arrangement in other States, the total number of participants in the plan or Arrangement nationally. (d) any contracts the person has entered into with Providers in this state that provide health care services to plan Or arrangement participants. (e) the total amount of fees, dues or other payments Collected by the person in the immediately preceding calendar Year from individuals, employer groups or others who Participated in the plan or arrangement in this state and shall specify The percentage of fees, dues or other payments retained by the Person for administrative expenses. (f) the total dollar amount of requests for Reimbursement of health care costs or services submitted in this State in the immediately preceding calendar year by either participants In the plan or arrangement or providers that provided Health care services to plan or arrangement participants. (g) the total dollar amount of requests for Reimbursement of health care costs or services that were Submitted in this state and that qualified for Reimbursement under the plan or arrangement in the immediately preceding calendar year. (h) the total amount of payments made to providers in This state in the immediately preceding calendar year for Health care services provided to or received by a plan or Arrangement participant. (i) The total amount of health care services provided to or received by plan or arrangement participants in this state in the immediately preceding calendar year. (j) the total number of requests for reimbursement of Health care costs or services submitted in this state in the Immediately preceding calendar year that were either: (i) Denied, expressed by a percentage of the total REIMBURSEMENT request amount. (ii) Appealed. (k) the total amount of health care expenses submitted in This state by plan or arrangement participants or providers in the Immediately preceding calendar year that qualify for Reimbursement pursuant to the plan or arrangement criteria but that have not been reimbursed at the end of the calendar year, excluding any costs that PARTICIPANTs must pay before receiving reimbursement. (l) the estimated number of plan or arrangement Participants in this state in the next Calendar year and shall specify the estimated number of individuals, Households, employer groups and employees. (m) the specific counties in this state in which the person: (i) offered a plan or arrangement in the immediately Preceding calendar year. (ii) intends to offer a plan or arrangement in the next Calendar year. (n) A list of the other states in which the person offers a plan or Arrangement. (o) a list of any third parties, other than a producer, that Are associated with or that assisted the person in offering or enrolling Participants in the plan or arrangement in this state in the immediately preceding calendar year and shall provide copies of Training materials provided to a third party, if any, and a detailed Accounting of any commissions or other fees or remuneration paid To a third party for either: (i) marketing, promoting or enrolling participants in a Plan or arrangement offered by the person in this state. (ii) operating, managing or administering a plan or Arrangement offered by the person in this state. (p) the total number of producers that are associated With or that assisted the person in offering or enrolling participants in the plan or arrangement in This state and the total number of Participants enrolled in the plan or arrangement through a Producer in the immediately preceding calendar year for marketing, promoting or enrolling participants in a plan or arrangement offered by the person in this State. (q) copies of any consumer-facing and marketing Materials that are used in this state in promoting the person's plan or Arrangement and that include: (i) the plan or arrangement. (ii) the benefit descriptions. (iii) Any other materials that explain the plan or arrangement. (r) the name, mailing address, email address and Telephone number of an individual who serves as a contact person for The person in this state. (s) a list of any parent companies, subsidiaries and other Names that the person has operated under at any time within the Immediately preceding five calendar years. (t) an organizational chart for the person and a list of The officers and directors of that person. 2. a certification that, to the Best of the person's good-faith knowledge and belief, the Information submitted is accurate and satisfies the requirements prescribed in paragraph 1 of this subsection. B. if a person who is subject to the requirements prescribed in subsection A of this section fails to submit the REQUIRED information or Certification, the submission is deemed incomplete. the director shall determine whether the submission is complete within forty-five days after receiving the submission. If the director finds that the submission does not contain the required information, the director shall issue a notice of deficiencies within forty-five days and, If the director does not notify the person of any deficiencies within forty-five days, the submission is considered complete. C. if the director determines that a person failed to Comply with the requirements prescribed in subsection A of this section, the director: 1. Shall notify the person that the submission is incomplete and Enumerate each deficiency found in the person's submission. 2. Shall allow the person thirty days to correct any submission deficiency after receipt of the notice of deficiencies. 3. if the person does not remedy the deficiency or deficiencies within the Thirty-day period, may impose a civil penalty in an amount of not more than $5,000 per day. 4. if the person does not remedy the deficiency or Deficiencies within thirty days after imposition of the initial civil penalty, may issue a cease and desist order in accordance subsection F of this section. D. on or before april 1, 2025 and each october 1 thereafter, the director shall do all of the following: 1. prepare a written report that summarizes the information Submitted by persons pursuant to subsection A of this section. 2. post on the department's website both of the following: (a) The report that contains accurate And evidence-based information about the persons who submitted Information pursuant to subsection A of this SECTION. (b) Information on how consumers may file a complaint. E. the department may adopt rules to Implement this section. F. the director may issue an ex parte emergency cease and desist order if the director believes that: 1. an unauthorized person is engaging in the business of insurance In violation of this section or any rule adopted by the department. 2. a person is failing to remedy or has not remedied any Deficiency in the submission. G. a PERSON THAT IS NOT AUTHORIZED TO TRANSACT INSURANCE IN THIS STATE BUT THAT OFFERS OR INTENDS TO OFFER A HEALTH CARE SHARING PLAN OR ARRANGEMENT AND A HEALTH CARE INSURER THAT OFFERS BOTH A HEALTH CARE SHARING PLAN OR ARRANGEMENT AND HEALTH INSURANCE COVERAGE ARE REQUIRED TO EXPLAIN, VERBALLY AND IN WRITING, THE FOLLOWING INFORMATION TO PROSPECTIVE CUSTOMERs: 1. The differences between a health care sharing plan or ARRANGEMENT and health insurance coverage. 2. that A health care sharing plan or arrangement does not guarantee payment of medical claims. 3. tHE ELIGIBILITY REQUIREMENTS FOR AFFORDABLE HEALTH CARE TAX CREDITS. h. this section does not apply to: 1. direct primary care agreements as defined in section 44-1799.91. 2. other consumer payment arrangements that are identified by the director by rule, including consumer payment plans offered Directly by a provider to a patient or the party responsible for Payment on behalf of the patient. END_STATUTE
79	79
80	80	Be it enacted by the Legislature of the State of Arizona:
81	81
82	82	Section 1. Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding section 20-111, to read:
83	83
84	84	START_STATUTE20-111. Health care sharing plan or arrangement; reporting; deficiency notice; public posting; cease and desist order; exceptions
85	85
86	86	A. On or before December 1, 2024 and each June 1 thereafter, a person that is not AUTHORIZED to transact insurance in this state but that offers or intends to offer a health care sharing plan or arrangement to facilitate payment or reimbursement of health care costs or services for residents of this state, regardless of whether the person is domiciled in this state or another state, shall submit to the department:
87	87
88	88	1. All of the following information:
89	89
90	90	(a) The TOTAL number of individuals and households that participated in the plan or arrangement in this state in the immediately preceding calendar year.
91	91
92	92	(b) the total number of employer groups that participated In the plan or arrangement in this state in the immediately Preceding calendar year and shall include the total number of individuals who participated in the plan or arrangement for each participating employer group.
93	93
94	94	(c) if the person offers a plan or arrangement in other States, the total number of participants in the plan or Arrangement nationally.
95	95
96	96	(d) any contracts the person has entered into with Providers in this state that provide health care services to plan Or arrangement participants.
97	97
98	98	(e) the total amount of fees, dues or other payments Collected by the person in the immediately preceding calendar Year from individuals, employer groups or others who Participated in the plan or arrangement in this state and shall specify The percentage of fees, dues or other payments retained by the Person for administrative expenses.
99	99
100	100	(f) the total dollar amount of requests for Reimbursement of health care costs or services submitted in this State in the immediately preceding calendar year by either participants In the plan or arrangement or providers that provided Health care services to plan or arrangement participants.
101	101
102	102	(g) the total dollar amount of requests for Reimbursement of health care costs or services that were Submitted in this state and that qualified for Reimbursement under the plan or arrangement in the immediately preceding calendar year.
103	103
104	104	(h) the total amount of payments made to providers in This state in the immediately preceding calendar year for Health care services provided to or received by a plan or Arrangement participant.
105	105
106	106	(i) The total amount of health care services provided to or received by plan or arrangement participants in this state in the immediately preceding calendar year.
107	107
108	108
109	109
110	110	(j) the total number of requests for reimbursement of Health care costs or services submitted in this state in the Immediately preceding calendar year that were either:
111	111
112	112	(i) Denied, expressed by a percentage of the total REIMBURSEMENT request amount.
113	113
114	114	(ii) Appealed.
115	115
116	116	(k) the total amount of health care expenses submitted in This state by plan or arrangement participants or providers in the Immediately preceding calendar year that qualify for Reimbursement pursuant to the plan or arrangement criteria but that have not been reimbursed at the end of the calendar year, excluding any costs that PARTICIPANTs must pay before receiving reimbursement.
117	117
118	118	(l) the estimated number of plan or arrangement Participants in this state in the next Calendar year and shall specify the estimated number of individuals, Households, employer groups and employees.
119	119
120	120	(m) the specific counties in this state in which the person:
121	121
122	122	(i) offered a plan or arrangement in the immediately Preceding calendar year.
123	123
124	124	(ii) intends to offer a plan or arrangement in the next Calendar year.
125	125
126	126	(n) A list of the other states in which the person offers a plan or Arrangement.
127	127
128	128	(o) a list of any third parties, other than a producer, that Are associated with or that assisted the person in offering or enrolling Participants in the plan or arrangement in this state in the immediately preceding calendar year and shall provide copies of Training materials provided to a third party, if any, and a detailed Accounting of any commissions or other fees or remuneration paid To a third party for either:
129	129
130	130	(i) marketing, promoting or enrolling participants in a Plan or arrangement offered by the person in this state.
131	131
132	132	(ii) operating, managing or administering a plan or Arrangement offered by the person in this state.
133	133
134	134	(p) the total number of producers that are associated With or that assisted the person in offering or enrolling participants in the plan or arrangement in This state and the total number of Participants enrolled in the plan or arrangement through a Producer in the immediately preceding calendar year for marketing, promoting or enrolling participants in a plan or arrangement offered by the person in this State.
135	135
136	136	(q) copies of any consumer-facing and marketing Materials that are used in this state in promoting the person's plan or Arrangement and that include:
137	137
138	138	(i) the plan or arrangement.
139	139
140	140	(ii) the benefit descriptions.
141	141
142	142	(iii) Any other materials that explain the plan or arrangement.
143	143
144	144	(r) the name, mailing address, email address and Telephone number of an individual who serves as a contact person for The person in this state.
145	145
146	146	(s) a list of any parent companies, subsidiaries and other Names that the person has operated under at any time within the Immediately preceding five calendar years.
147	147
148	148	(t) an organizational chart for the person and a list of The officers and directors of that person.
149	149
150	150	2. a certification that, to the Best of the person's good-faith knowledge and belief, the Information submitted is accurate and satisfies the requirements prescribed in paragraph 1 of this subsection.
151	151
152	152	B. if a person who is subject to the requirements prescribed in subsection A of this section fails to submit the REQUIRED information or Certification, the submission is deemed incomplete. the director shall determine whether the submission is complete within forty-five days after receiving the submission. If the director finds that the submission does not contain the required information, the director shall issue a notice of deficiencies within forty-five days and, If the director does not notify the person of any deficiencies within forty-five days, the submission is considered complete.
153	153
154	154	C. if the director determines that a person failed to Comply with the requirements prescribed in subsection A of this section, the director:
155	155
156	156	1. Shall notify the person that the submission is incomplete and Enumerate each deficiency found in the person's submission.
157	157
158	158	2. Shall allow the person thirty days to correct any submission deficiency after receipt of the notice of deficiencies.
159	159
160	160	3. if the person does not remedy the deficiency or deficiencies within the Thirty-day period, may impose a civil penalty in an amount of not more than $5,000 per day.
161	161
162	162	4. if the person does not remedy the deficiency or Deficiencies within thirty days after imposition of the initial civil penalty, may issue a cease and desist order in accordance subsection F of this section.
163	163
164	164	D. on or before april 1, 2025 and each october 1 thereafter, the director shall do all of the following:
165	165
166	166	1. prepare a written report that summarizes the information Submitted by persons pursuant to subsection A of this section.
167	167
168	168	2. post on the department's website both of the following:
169	169
170	170	(a) The report that contains accurate And evidence-based information about the persons who submitted Information pursuant to subsection A of this SECTION.
171	171
172	172	(b) Information on how consumers may file a complaint.
173	173
174	174	E. the department may adopt rules to Implement this section.
175	175
176	176	F. the director may issue an ex parte emergency cease and desist order if the director believes that:
177	177
178	178	1. an unauthorized person is engaging in the business of insurance In violation of this section or any rule adopted by the department.
179	179
180	180	2. a person is failing to remedy or has not remedied any Deficiency in the submission.
181	181
182	182	G. a PERSON THAT IS NOT AUTHORIZED TO TRANSACT INSURANCE IN THIS STATE BUT THAT OFFERS OR INTENDS TO OFFER A HEALTH CARE SHARING PLAN OR ARRANGEMENT AND A HEALTH CARE INSURER THAT OFFERS BOTH A HEALTH CARE SHARING PLAN OR ARRANGEMENT AND HEALTH INSURANCE COVERAGE ARE REQUIRED TO EXPLAIN, VERBALLY AND IN WRITING, THE FOLLOWING INFORMATION TO PROSPECTIVE CUSTOMERs:
183	183
184	184	1. The differences between a health care sharing plan or ARRANGEMENT and health insurance coverage.
185	185
186	186	2. that A health care sharing plan or arrangement does not guarantee payment of medical claims.
187	187
188	188	3. tHE ELIGIBILITY REQUIREMENTS FOR AFFORDABLE HEALTH CARE TAX CREDITS.
189	189
190	190	h. this section does not apply to:
191	191
192	192	1. direct primary care agreements as defined in section 44-1799.91.
193	193
194	194	2. other consumer payment arrangements that are identified by the director by rule, including consumer payment plans offered Directly by a provider to a patient or the party responsible for Payment on behalf of the patient. END_STATUTE