Official Summary Text
HB2182 - 572R - House Bill Summary
ARIZONA HOUSE OF REPRESENTATIVES
57th
Legislature, 2nd Regular Session
Majority Research Staff
House
: HHS DPA/SE 12-0-0-0
HB
2182
: emergency medical services; patient transport
S/E:
reporting; prior authorization; claims denial
Sponsor:
Representative Willoughby, LD 13
Caucus
& COW
Summary
of the Strike-Everything Amendment to HB 2182
Overview
Establishes
reporting requirements for the Department of Insurance and Financial
Institutions (DIFI) relating to claim denial practices and prior authorization
practices. Requires DIFI, by July 1, 2032, to hold a stakeholder meeting to
evaluate the usefulness of the collected data.
History
A
claim
is
a request for payment for an already provided diagnostic or therapeutic medical
or health care service, benefit or treatment. Statute prescribes and governs
the health care appeal process for members whose claim for a service has been
denied by an insurer (A.R.S. ��
20-2501
and
20-2531
).
Grievances
are any written complaint that
is subject to resolution through the insurer's internal system for resolving
payment disputes and other contractual grievances with health care providers
and submitted by a health care provider and received by the health care
insurer. Grievances do not include: 1) complaints by a noncontracted provider
regarding an insurer's decision to deny the noncontracted provider admission to
the insurer's network; 2) complaints about an insurer's decision to terminate a
health care provider from the insurer's network; and 3) complaints that are
subject of a health care appeal. Health care insurers are required to establish
an internal system for resolving payment disputes and other contractual
grievances with health care providers. Each health care insurer must provide a
summary of all records of health care provider grievances received during the
prior six months. The Director of DIFI may review the health care insurer's
internal system and examine the health care insurer if it find's a significant
number of grievances that have not been resolved (A.R.S. ��
20-3101
and
20-3102
).
A
prior
authorization requirement
is a practice implemented by a health care
services plan, or its utilization review agent, in which coverage of a health
care service is dependent on an approval from the health care services plan
before the service is performed, received or prescribed. It includes preadmission
review, pretreatment review, prospective review or utilization review
procedures conducted by a health care services plan or its utilization review
agent before providing a health care service and does not include case
management or step therapy protocols (A.R.S. �
20-3401
).
Provisions
Claim
Denial Practices Reporting Requirements
1.
Requires a
health care insurer, by July 1, 2027, and annually thereafter, to report to
DIFI the following aggregated data that relates to the health care insurer's
claims denial practices for the prior plan year:
a.
the total
number of claims requests, including the total number of claims requests that
were not submitted electronically;
b.
the total
number of claims requests that were denied;
c.
the total
number of appeals that were received;
d.
the total
number of adverse determinations that were reversed on appeal; and
e.
the top five
reasons why claims requests were denied. (Sec. 1)
Prior Authorization Practices
Reporting Requirements
2.
Requires a
health care insurer, by July 1, 2027, and annually thereafter, to report to
DIFI the following aggregated data that relates to the health care insurer's
prior authorization practices for the prior plan year:
a.
the total
number of prior authorization requests, including the total number of prior
authorization requests that were not submitted electronically;
b.
the total
number of prior authorization requests that were denied;
c.
the total
number of appeals that were received;
d.
the total
number of adverse determinations that were reversed on appeal;
e.
the top five
reasons why prior authorization requests were denied;
f.
the average
and median time that elapsed between the submission of a prior authorization
request and a determination by the issuer for standard prior authorizations;
g.
the average
and median time that elapsed between the submission of a prior authorization
request and a determination by the issuer for expedited prior authorizations.
(Sec. 3)
DIFI
3.
Requires
DIFI, by October 31, 2027, and each October 1 after, to aggregate the data for
both reports and:
a.
separate
each health care insurer that submitted data by name and write it in easily
understandable language;
b.
post the
reports on its publicly accessible website; and
c.
send a copy
of the reports to the Speaker of the Arizona House of Representatives and the
President of the Senate. (Sec 1)
4.
Requires DIFI,
by July 1, 2032, to convene a stakeholder meeting to determine the quality,
relevance usefulness of the collected data. (Sec. 4)
5.
Requires the
stakeholders meeting to include:
a.
health care insurers;
b.
health care services plans;
c.
licensed health care providers;
d.
businesses and consumers; and
e.
health care institutions that
are regulated by the Department of Health Services. ���(Sec. 4)
6.
Requires
DIFI, by October 31, 2032, to submit a report to the Governor, President of the
Senate and Speaker of the Arizona House of Representatives with recommendations
to amend, repeal or to make no change changes to the collected data. (Sec. 4)
7.
Requires
DIFI to maintain at least three years of the reports on its publicly accessible
website. (Sec 1 and 3)
8.
Changes the
date DIFI is required to post on its website information on grievances for the
prior fiscal year from annually on August 1 to October 1. (Sec. 2)
Miscellaneous
9.
Requires a
health care insurer to include in both reports the top 10 services that were
denied in each of the following categories:
a.
medical and
surgical procedures;
b.
diagnostic
tests and images;
c.
behavioral
health services;
d.
orthopedic
services; and
e.
outpatient
services. (Sec. 1 and 3)
10.
Makes the
legislation retroactive to July 1, 2026. (Sec. 5)
11.
12.
13.
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Current Bill Text
Read the full stored bill text
HB2182 - 572R - I Ver
PREFILED��� JAN 09 2026
REFERENCE TITLE:
emergency medical services; patient transport
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HB 2182
Introduced by
Representative
Willoughby
AN
ACT
Amending section 36-2219, Arizona
Revised Statutes; relating to emergency medical services.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 36-2219, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2219.
Emergency medical care technicians; requirements; transportation
A.
An
Each
emergency medical care technician shall
comply with
either emergency medical standards and protocols established by the regional
council or the medical direction for the local jurisdiction when considering
emergency transport, including the appropriate use of telecommunications.
B. An emergency medical care technician may not do
either of the following:
1. Provide a patient with a presumptive medical
diagnosis and use that medical diagnosis as the basis for counseling the
patient to decline emergency medical services transportation
,
unless requested by the patient or the patient's representative
.
2. Counsel a patient to decline emergency medical
services transportation, except as part of a specific alternate destination or
treat-and-refer program that includes quality management and
comprehensive medical direction oversight.
C.
An
Each
emergency medical care technician shall explain to a patient the risks and
consequences to the patient's health of not being transported.
D. It is not a violation of this section for an
emergency medical care technician to inform a patient of the patient's right to
accept or decline emergency medical services transportation, unless the
emergency medical care technician does so in an effort to coerce the patient to
decline emergency medical services.
END_STATUTE