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HB2559 - 572R - I Ver
REFERENCE TITLE:
behavioral health services; insurance coverage
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HB 2559
Introduced by
Representatives
Contreras P: Aguilar, Cavero, Crews, Liguori, Simacek, Stahl Hamilton,
Villegas;� Senator Ortiz
AN
ACT
amending
title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14;
amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding
section 20-1057.21; amending title 20, chapter 6, article 4, Arizona
Revised Statutes, by adding section 20-1376.11; amending title 20,
chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11;
relating to health insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3,
Arizona Revised Statutes, is amended by adding section 20-841.14, to read:
START_STATUTE
20-841.14.
Behavioral health services; coverage; definitions
A. A hospital service corporation or
medical service corporation that issues, amends, delivers or renews a
subscription contract on or after January 1, 2027 shall provide coverage for
behavioral health services.
B. A hospital service corporation or
medical service corporation shall establish a documented procedure to assist a
subscriber with accessing an out-of-network behavioral health care
provider when an in-network behavioral health care provider is not
available within a timely manner.
C. If a subscriber is unable to
obtain covered behavioral health services from an in-network provider in
a timely manner, including through medically appropriate telehealth services,
the subscription contract must ensure coverage for behavioral health services
from an out-of-network provider and arrange a network exception
with a negotiated rate from an out-of-network
provider. The arrangement between the subscription contract and the
out-of-network provider shall hold the subscriber harmless for any
amount greater than the in-network cost sharing amount, including a
COPAYMENT, coinsurance and deductible, that the subscriber would have paid for
the same behavioral health service provided by an in-network provider.�
The subscription contract shall accept as payment in full the negotiated rate
for the network exception and the subscriber's in-network cost sharing
amount.� A subscriber may not pay more than the in-network cost sharing
amount for behavioral health services.
D. A hospital service corporation or
medical service corporation is not responsible if behavioral health services
are available within a timely manner and the subscriber chooses to schedule
behavioral health services outside of the timely manner requirements.
E. A subscription contract that MAKES
a payment to an out-of-network provider shall document the details
of the payment and make that information AVAILABLE to the Department not later
than twenty days from the date of request.
F. For the purposes of this section:
1. "Behavioral health
services" includes:
(
a
) mental
health services.
(
b
) Substance
use disorder services.
2. "Timely manner" means:
(
a
) Within
thirty days after the date a subscriber requests an appointment, service or
related behavioral health service, if the request is:
(
i
) For a
routine appointment.
(
ii
) Based on a
health care provider's referral.
(
iii
) For a new
treatment or medication.
(
iv
) For other
related services as determined by the department.
(
b
) WITHIn
seven days after the date a subscriber first attempts to receive BEHAVIORAL
health residential care or hospitalization.
(
c
) Within
twenty-four hours after the date and time the subscriber first attempts
to receive urgent, emergent or crisis behavioral health services.
END_STATUTE
Sec. 2. Title 20, chapter 4, article 9, Arizona
Revised Statutes, is amended by adding section 20-1057.21, to read:
START_STATUTE
20-1057.21.
Behavioral health services; coverage; definitions
A. A health care services
organization that issues, amends, delivers or renews an evidence of coverage on
or after January 1, 2027 shall provide coverage for behavioral health services.
B. A health care services
organization shall establish a documented procedure to assist an enrollee with
accessing an out-of-network behavioral health care provider when an
in-network behavioral health care provider is not available within a
timely manner.
C. If an enrollee is unable to obtain
covered behavioral health services from an in-network provider in a
timely manner, including through medically appropriate telehealth services, the
evidence of coverage must ensure coverage for behavioral health services from
an out-of-network provider and arrange a network exception with a
negotiated rate from an out-of-network provider.� The arrangement
between the evidence of coverage and the out-of-network provider
shall hold the enrollee harmless for any amount greater than the in-network
cost sharing amount, including a COPAYMENT, coinsurance and deductible, that
the enrollee would have paid for the same behavioral health service provided by
an in-network provider.� The evidence of coverage shall accept as payment
in full the negotiated rate for the network exception and the enrollee's in-network
cost sharing amount.� An enrollee may not pay more than the in-network
cost sharing amount for behavioral health services.
D. A health care services
organization is not responsible if behavioral health services are available
within a timely manner and the enrollee chooses to schedule behavioral health
services outside of the timely manner requirements.
E. An evidence of coverage that MAKES
a payment to an out-of-network provider shall document the details
of the payment and make that information AVAILABLE to the Department not later
than twenty days from the date of request.
F. For the purposes of this section:
1. "Behavioral health
services" includes:
(
a
) mental
health services.
(
b
) Substance
use disorder services.
2. "Timely
manner" means:
(
a
) Within thirty days after the date an enrollee requests an
appointment, service or related behavioral health service, if the request is:
(
i
) For a
routine appointment.
(
ii
) Based on a
health care provider's referral.
(
iii
) For a new
treatment or medication.
(
iv
) For other
related services as determined by the department.
(
b
) WITHIn
seven days after the date an enrollee first attempts to receive BEHAVIORAL
health residential care or hospitalization.
(
c
) Within
twenty-four hours after the date and time the enrollee first attempts to
receive urgent, emergent or crisis behavioral health services.
END_STATUTE
Sec. 3. Title 20, chapter 6, article 4, Arizona
Revised Statutes, is amended by adding section 20-1376.11, to read:
START_STATUTE
20-1376.11.
Behavioral health services; coverage; definitions
A. A disability insurer that issues,
amends, delivers or renews a policy on or after January 1, 2027 shall provide
coverage for behavioral health services.
B. A disability insurer shall
establish a documented procedure to assist an insured with accessing an out-of-network
behavioral health care provider when an in-network behavioral health care
provider is not available within a timely manner.
C. If an insured is unable to obtain
covered behavioral health services from an in-network provider in a
timely manner, including through medically appropriate telehealth services, the
policy must ensure coverage for behavioral health services from an out-of-network
provider and arrange a network exception with a negotiated rate from an out-of-network
provider. The arrangement between the policy and the out-of-network
provider shall hold the insured harmless for any amount greater than the in-network
cost sharing amount, including a COPAYMENT, coinsurance and deductible, that
the insured would have paid for the same behavioral health service provided by
an in-network provider. The policy shall accept as payment in
full the negotiated rate for the network exception and the insured's in-network
cost sharing amount.� An insured may not pay more than the in-network
cost sharing amount for behavioral health services.
D. A disability insurer is not
responsible if behavioral health services are available within a timely manner
and the insured chooses to schedule behavioral health services outside of the
timely manner requirements.
E. A policy that MAKES a payment to
an out-of-network provider shall document the details of the
payment and make that information AVAILABLE to the Department not later than
twenty days from the date of request.
F. For the purposes of this section:
1. "Behavioral health
services" includes:
(
a
) mental
health services.
(
b
) Substance
use disorder services.
2. "Timely manner" means:
(
a
) Within
thirty days after the date an insured requests an appointment, service or
related behavioral health service, if the request is:
(
i
) For a
routine appointment.
(
ii
) Based on a
health care provider's referral.
(
iii
) For a new
treatment or medication.
(
iv
) For other
related services as determined by the department.
(
b
) WITHIn
seven days after the date an insured first attempts to receive BEHAVIORAL
health residential care or hospitalization.
(
c
) Within
twenty-four hours after the date and time the insured first attempts to
receive urgent, emergent or crisis behavioral health services.
END_STATUTE
Sec. 4. Title 20, chapter 6, article 5, Arizona
Revised Statutes, is amended by adding section 20-1406.11, to read:
START_STATUTE
20-1406.11.
Behavioral health services; coverage; definitions
A. A group
or blanket disability insurer that issues, amends, delivers or renews a policy
on or after January 1, 2027 shall provide coverage for behavioral health
services.
B. A group or blanket disability
insurer shall establish a documented procedure to assist an insured with
accessing an out-of-network behavioral health care provider when an
in-network behavioral health care provider is not available within a
timely manner.
C. If an insured is unable to obtain
covered behavioral health services from an in-network provider in a
timely manner, including through medically appropriate telehealth services, the
policy must ensure coverage for behavioral health services from an out-of-network
provider and arrange a network exception with a negotiated rate from an out-of-network
provider. The arrangement between the policy and the out-of-network
provider shall hold the insured harmless for any amount greater than the in-network
cost sharing amount, including a COPAYMENT, coinsurance and deductible, that
the insured would have paid for the same behavioral health service provided by
an in-network provider. The policy shall accept as payment in
full the negotiated rate for the network exception and the insured's in-network
cost sharing amount.� An insured may not pay more than the in-network
cost sharing amount for behavioral health services.
D. A group or blanket disability
insurer is not responsible if behavioral health services are available within a
timely manner and the insured chooses to schedule behavioral health services
outside of the timely manner requirements.
E. A policy that MAKES a payment to
an out-of-network provider shall document the details of the
payment and make that information AVAILABLE to the Department not later than
twenty days from the date of request.
F. For the purposes of this section:
1. "Behavioral health
services" includes:
(
a
) mental
health services.
(
b
) Substance
use disorder services.
2. "Timely manner" means:
(
a
) Within
thirty days after the date an insured requests an appointment, service or
related behavioral health service, if the request is:
(
i
) For a
routine appointment.
(
ii
) Based on a
health care provider's referral.
(
iii
) For a new
treatment or medication.
(
iv
) For other
related services as determined by the department.
(
b
) WITHIn
seven days after the date an insured first attempts to receive BEHAVIORAL
health residential care or hospitalization.
(
c
) Within
twenty-four hours after the date and time the insured first attempts to
receive urgent, emergent or crisis behavioral health services.
END_STATUTE