Bill Text: AZ HB2294 | 2020 | Fifty-fourth Legislature 2nd Regular | Introduced

Bill Title: Health plans; providers; payment reporting

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2020-01-27 - House read second time [HB2294 Detail]

Download: Arizona-2020-HB2294-Introduced.html




REFERENCE TITLE: health plans; providers; payment reporting





State of Arizona

House of Representatives

Fifty-fourth Legislature

Second Regular Session





HB 2294


Introduced by

Representative Kern





Amending Title 36, chapter 1, article 1.1, Arizona Revised Statutes, by adding section 36‑125.01; relating to uniform reporting.





Be it enacted by the Legislature of the State of Arizona:

Section 1.  Title 36, chapter 1, article 1.1, Arizona Revised Statutes, is amended by adding section 36-125.01, to read:

START_STATUTE36-125.01.  Health plans; health care providers; reporting requirements; relative prices; rules; definitions

A.  Each health plan shall report to the department all of the following:

1.  The relative price paid to each health care provider by provider type, with hospital inpatient and outpatient relative prices listed separately, and by health plan product type.

2.  The annual rate of growth stated as a percentage of the average relative price by provider type and product type for the health plan's participating health care providers, and whether that rate exceeds the rate of growth of the applicable producer price index as reported by the United States department of labor, bureau of labor statistics.

3.  A comparison of relative prices for the health plan's participating health care providers by provider type that shows the average relative price and the extent of variation in price stated as a percentage and that identifies health care providers who are paid more than ten percent, fifteen percent and twenty percent above the average relative price and more than ten percent, fifteen percent and twenty percent below the average relative price.

B.  Health plans may not provide claims information or contract prices to the department, but shall report only relative prices.

C.  Each health plan that uses an alternative payment contract to pay health care providers shall disclose to the department the relative value of the alternative payment contract and nonclaim payments pursuant to rules adopted by the department.

D.  The department shall issue an annual report on relative prices paid by health plans and received by health care providers.  The department shall present the report in a manner that does not disclose actual prices paid and that identifies price variation among health care providers, by health plan and by provider type. The department's report shall include all of the following:

1.  Baseline information about price variation among health care providers by each health plan, including identifying health care providers that are paid more than ten percent above or more than ten percent below the average relative price and identifying health plans that have entered into alternative payment contracts that vary by more than ten percent.

2.  The annual change in price variation by health plan among the health plan's participating providers.

3.  Factors that contribute to price variation in the health care system.

4.  The impact of price variations on disproportionate share hospitals and other safety net providers.

E.  Data collected by the department under this section is not a public record and shall be held in confidence by the department except as necessary to produce the reports required by this section.

F.  The department may adopt rules necessary to implement this section.

G.  For the purposes of this section:

1.  "Alternative payment contract" means any contract between a provider or provider organization and a private health care health plan that uses alternative payment methodologies.

2.  "Alternative payment methodologies":

(a)  Means methods of payment that are not based solely on fee‑for‑service reimbursements.

(b)  Includes:

(i)  Shared savings arrangements.

(ii)  Bundled payments.

(iii)  Global payments.

(iv)  Fee‑for‑service payments that are settled or reconciled with a bundled or global payment.

3.  "Fee-for-service" means a payment mechanism in which all reimbursable health care activity is described and categorized into discrete and separate units of service and a health care provider is separately reimbursed for each discrete service rendered to a patient.

4.  "Health care" and "health care provider" have the same meanings prescribed in 45 Code of Federal Regulations section 160.103.

5.  "Health plan":

(a)  Means a health care services organization, a hospital service organization, a medical service organization and a hospital, medical, dental and optometric service organization authorized to transact insurance business pursuant to title 20.

(b)  Does not include an insurer or plan that provides benefits pursuant to chapter 29, article 1 of this title.

6.  "Relative price" means the contractually negotiated amount that is paid to a health care provider by each private health plan for health care, including both fee‑for‑service payments and nonclaims-related payments, and that is expressed in the aggregate relative to the health plan's network‑wide average amount paid to providers, as calculated under subsection A or C of this section and rules adopted by the department. END_STATUTE