Bill Amendment: AZ HB2045 | 2013 | Fifty-first Legislature 1st Regular
Bill Title: AHCCCS; hospital reimbursement methodology
Status: 2013-06-19 - Governor Signed [HB2045 Detail]
Download: Arizona-2013-HB2045-CONFERENCE_ADOPTED_AMENDMENT_Conference_Committee.html
Fifty-first Legislature CORRECTED
First Regular Session 5/13/2013
FREE CONFERENCE COMMITTEE AMENDMENTS TO H.B. 2045
(Reference to Senate engrossed House bill)
Page 1, line 7, strike "common" insert "commonly provided"
Line 10, strike "document or online posting" insert "direct pay prices"; after "annually" insert "and must be based on the services from a twelve‑month period that occurred within the eighteen‑month period preceding the annual update"
Line 11, strike "diagnosis"
insert "TREATMENT PROVIDED";
strike
"Any" insert
"the cost of treatment for"
Between lines 14 and 15, insert:
"b. subsection a of this section does not apply to emergency services."
Reletter to conform
Line 19, strike "b" insert "d"
Line 38, after "F." insert "Except as provided in subsection J of this section,"; strike "accepts" insert "receives"
Line 39, after "full" insert "if the entire fee for the service is paid"
Line 42, after "lien" insert "for customary charges"
Line 45, after the period insert "This subsection does not require a health care provider to refund or adjust any capitated payment, bundled payment or other form of prepayment or global payment made by a health care system to the health care provider for lawful health care services to be provided by the health care provider for the person who makes, or on whose behalf an employer makes, direct payment to the health care provider."
Page 2, lines 3 and 12, strike "A member" insert "an enrollee"
Line 38, strike "accepts" insert "receives"
Line 39, strike "F" insert "h"
Page 3, line 5, after "may" insert "accept direct payment from a person or employer or may"
Line 7, strike "F" insert "h"
Line 11, after "which" insert "both"
Page 3, strike lines 13 through 18, insert:
"k. a health care provider who does not comply with the requirements of this section commits unprofessional conduct. any disciplinary action taken by the health professional's licensing board may not include revocation of the health care provider's license."
Line 22, after "paid" insert "in full"
Line 24, after "employer" insert "and that does not prohibit a provider from establishing a payment plan with the person paying directly for services"
Between lines 24 and 25, insert:
"2. "emergency services" means lawful health care services needed to evaluate and stabilize an emergency medical condition as defined in 42 united states code section 1396u-2(b)(2)(c).
3. "Enrollee" means a person who is enrolled in a health care plan provided by a health insurer."
Renumber to conform
Line 25, strike "has the same meaning prescribed in section"; strike line 26, insert "means a policy, contract or evidence of coverage issued to an enrollee. Health care plan does not include limited benefit coverage as defined in section 20-1137."
Between lines 31 and 32, insert:
“7. “health insurer” means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation as defined in title 20.”
Renumber to conform
Strike lines 36 and 37
Renumber to conform
Page 4, line 5, after "facility" insert "with more than fifty inpatient beds"
Line 10, strike "document or online"; line 11, strike "posting" insert "direct pay prices"; after "annually" insert "based on the services from a twelve‑month period that occurred within the eighteen‑month period preceding the annual update"
Page 4, line 12, strike "diagnosis" insert "treatment provided"; strike "Any" insert "the cost of treatment for"
Between lines 13 and 14, insert:
"B. A health care facility with fifty or fewer inpatient beds must make available on request or online the direct pay price for at least the thirty‑five most used diagnosis-related group codes, if applicable, for the facility and at least the thirty‑five most used outpatient service codes if applicable, for the facility. The services may be identified by a common procedural terminology code or by a plain-english description. The health care facility must update the direct pay prices at least annually based on the services fROm a twelve-month period that occurred within the eighteen-month period preceding the annual update. The direct pay price must be for the standard treatment provided for the service and may include the cost of treatment for complications or exceptional treatment.
c. subsections a and b of this section do not apply if a discussion of the direct pay price would be a violation of the federal emergency medical treatment and labor act."
Reletter to conform
Line 22, strike "subsection A" insert "subsections a and B"; strike "does" insert "do"
Line 28, strike "or filing"
Line 39, after "F." insert "Except as provided in subsection K of this section,"; strike "accepts" insert "receives"
Line 40, after "full" insert "if the entire fee for the service is paid"
Line 43, after "lien" insert "for customary charges"
Page 5, line 2, after the period insert "This subsection does not require a health care facility to refund or adjust any capitated payment, bundled payment or any other form of prepayment or global payment made by a health care system to the health care facility for lawful health care services to be provided by the health care facility for the person who makes, or on whose behalf an employer makes, direct payment to the health care facility."
Lines 5 and 14, strike "a member" insert "an enrollee"
Page 5, line 40, strike "accepts" insert "receives"
Line 41, strike "F" insert "i"
Page 6, line 6, after "may" insert "accept direct payment from a person or employer or may"
Line 8, strike "F" insert "i"
Line 17, strike "subsection a of"
Line 20, after "the" insert "entire"
Line 22, after "paid" insert "in full"
Line 24, after "employer" insert "and that does not prohibit a facility from establishing a payment plan with the PERSON paying directly for services"
Between lines 24 and 25, insert:
"2. "Enrollee" means a person who is enrolled in a health care plan provided by a health insurer."
Renumber to conform
Line 28, strike "has the same meaning prescribed in section"; strike line 29, insert "means a policy, contract or evidence of coverage issued to an enrollee. Health care plan does not include limited benefit coverage as defined in section 20-1137.
5. "health care provider" means a person who is licensed pursuant to chapter 7, 8, 13, 16, 17, 19 or 34 of title 32."
Renumber to conform
Between lines 32 and 33, insert:
“7. “health insurer” means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation as defined in title 20.”
Renumber to conform
Strike lines 37 and 38
Renumber to conform
Page 19, line 11, strike "2020" insert "2021"
Page 19, between lines 11 and 12, insert:
"Sec. 8. Effective date
Sections 32-3216 and 36-437, Arizona Revised Statutes, as added by this act, are effective from and after December 31, 2013."
Renumber to conform
Amend title to conform
