Bill Text: AZ HB2400 | 2013 | Fifty-first Legislature 1st Regular | Introduced
Bill Title: Study committee; prior authorization
Spectrum: Slight Partisan Bill (Republican 9-5)
Status: (Engrossed - Dead) 2013-03-28 - Senate majority caucus: Do pass [HB2400 Detail]
Download: Arizona-2013-HB2400-Introduced.html
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REFERENCE TITLE: prior authorization; prescription drugs |
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State of Arizona House of Representatives Fifty-first Legislature First Regular Session 2013
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HB 2400 |
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Introduced by Representatives Carter, Larkin, Meyer, Senators Hobbs, Reagan: Representatives Borrelli, Boyer, Brophy McGee, Livingston, Lovas, Senators Bradley, Lopez, McComish, Ward
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AN ACT
Amending title 20, chapter 1, Arizona Revised Statutes, by adding article 5; amending section 36‑2906, Arizona Revised Statutes; relating to prior authorization for prescription drugs.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 1, Arizona Revised Statutes, is amended by adding article 5, to read:
ARTICLE 5. PRIOR AUTHORIZATION
20-192. Electronic prior authorization; requirement; prescription drugs; health care insurers; definitions
A. A health care insurer that provides prescription drug benefits shall develop and maintain a process when requiring prior authorization for prescription drug benefits that allows for the prior authorization request to be electronically submitted by a health care professional and allows for the approval or denial of the prior authorization request to be electronically submitted by a health care insurer to the health care professional who initiated the prior authorization request.
B. A health care professional may initiate the prior authorization request with a health care insurer and the health care professional or the authorized agent of the health care professional may confer and consult with a health care insurer regarding a prior authorization request.
C. For the purposes of this section:
1. "Authorized agent of a health care professional" means:
(a) An employee of the health care professional.
(b) A contract employee of the health care professional.
2. "Health care 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.
3. "Health care professional" means a health care professional who is licensed or certified under title 32 and who is authorized to prescribe prescription drugs.
Sec. 2. Section 36-2906, Arizona Revised Statutes, is amended to read:
36-2906. Qualified plan health services contracts; proposals; administration
A. The administration shall:
1. Supervise the administrator.
2. Review the proposals.
3. Award contracts.
B. The director shall prepare and issue a request for proposal, including a proposed contract format, in each of the counties of this state, at least once every five years, to qualified group disability insurers, hospital and medical service corporations, health care services organizations and any other qualified public or private persons, including county‑owned and operated health care facilities. The contracts shall specify the administrative requirements, the delivery of medically necessary services and the subcontracting requirements.
C. The director shall adopt rules regarding the request for proposal process that provide:
1. For definition of proposals in the following categories subject to the following conditions:
(a) Inpatient hospital services.
(b) Outpatient services, including emergency dental care, and early and periodic health screening and diagnostic services for children.
(c) Pharmacy services.
(d) Laboratory, x‑ray and related diagnostic medical services and appliances.
2. Allowance for the adjustment of such categories by expansion, deletion, segregation or combination in order to secure the most financially advantageous proposals for the system.
3. An allowance for limitations on the number of high risk persons that must be included in any proposal.
4. For analysis of the proposals for each geographic service area as defined by the director to ensure the provision of health and medical services that are required to be provided throughout the geographic service area pursuant to section 36‑2907.
5. For the submittal of proposals by a group disability insurer, hospital and medical service corporation, health care services organization or any other qualified public or private person intending to submit a proposal pursuant to this section. Each qualified proposal shall be entered with separate categories for the distinct groups of persons to be covered by the proposed contracts, as set forth in the request for proposal.
6. For the procurement of reinsurance for expenses incurred by any contractor or member or the system in providing services in excess of amounts specified by the director in any contract year. The director shall adopt rules to provide that the administrator may specify guidelines on a case by case basis for the types of care and services that may be provided to a person whose care is covered by reinsurance. The rules shall provide that if a contractor does not follow specified guidelines for care or services and if the care or services could be provided pursuant to the guidelines at a lower cost the contractor is entitled to reimbursement as if the care or services specified in the guidelines had been provided.
7. For the awarding of contracts to contractors with qualified proposals determined to be the most advantageous to the state for each of the counties in this state. A contract may be awarded that provides services only to persons defined as eligible pursuant to section 36‑2901, paragraph 6, subdivision (b), (c), (d) or (e). The director may provide by rule a second round competitive proposal procedure for the director to request voluntary price reduction of proposals from only those that have been tentatively selected for award, before the final award or rejection of proposals.
8. For the requirement that any proposal in a geographic service area provide for the full range of system covered services.
9. For the option of the administration to waive the requirement in any request for proposal or in any contract awarded pursuant to a request for proposal for a subcontract with a hospital for good cause in a county or area including but not limited to situations when such hospital is the only hospital in the health service area. In any situation where the subcontract requirement is waived, no hospital may refuse to treat members of the system admitted by primary care physicians or primary care practitioners with hospital privileges in that hospital. In the absence of a subcontract, the reimbursement level shall be at the levels specified in section 36‑2904, subsection H or I.
D. Reinsurance may be obtained against expenses in excess of a specified amount on behalf of any individual for system covered emergency or inpatient services either through the purchase of a reinsurance policy or through a system self‑insurance program as determined by the director. Reinsurance, subject to the approval of the director, may be obtained against expenses in excess of a specified amount on behalf of any individual for outpatient services either through the purchase of a reinsurance policy or through a system self‑insurance program as determined by the director.
E. Notwithstanding the other provisions of this section, the administration may procure, provide or coordinate system covered services by interagency agreement with authorized agencies of this state or with a federal agency for distinct groups of eligible persons, including persons eligible for children's rehabilitative services and persons eligible for comprehensive medical and dental program services through the department of economic security.
F. Contracts shall be awarded as otherwise provided by law, except that in no event may a contract be awarded to any respondent that will cause the system to lose any federal monies to which it is otherwise entitled.
G. After contracts are awarded pursuant to this section, the director may negotiate with any successful proposal respondent for the expansion or contraction of services or service areas if there are unnecessary gaps or duplications in services or service areas.
H. Beginning October 1, 2014, a contractor that provides prescription drug benefits shall develop and maintain a process when requiring prior authorization for prescription drug benefits that allows for the prior authorization request to be electronically submitted by a subcontractor who is licensed or certified under title 32 and who is authorized to prescribe prescription drugs and allows for the approval or denial of the prior authorization request to be electronically submitted by a contractor to the subcontractor who initiated the prior authorization request.
Sec. 3. Uniform prior authorization form for prescription drugs committee; membership; duties; report; repeal
A. The uniform prior authorization form for prescription drugs committee is established in the department of insurance consisting of the following members:
1. The director of the department of insurance or the director's designee.
2. Four members who are representatives of different health care insurers as defined in section 20‑195, Arizona Revised Statutes, and who are appointed by the director of the department of insurance.
3. Four members who are health care professionals licensed or certified under title 32, Arizona Revised Statutes, who are authorized to prescribe prescription drugs and who are appointed by the director of the department of insurance.
4. One member who is a pharmacist licensed under title 32, Arizona Revised Statutes, and who is appointed by the director of the department of insurance.
5. One member of the public who is appointed by the director of the department of insurance.
B. Committee members shall serve at the pleasure of the director of the department of insurance and are not eligible to receive compensation or reimbursement for expenses.
C. On or before November 1, 2014, the committee shall develop recommendations regarding a uniform prior authorization form for prescription drugs to simplify the prior authorization process. The recommended prior authorization form shall be no more than two pages in length and shall be designed to permit its use as a written document and to be electronically available and transmissible.
D. On or before December 1, 2014, the committee shall prepare a report of its activities and recommendations for administrative or legislative action and submit a copy of the report to the governor, the president of the senate, the speaker of the house of representatives and the secretary of state.
E. This section is repealed from and after December 31, 2014.
