AHCCCS; reimbursement; noncontracting providers

Plain English Breakdown

Checked against official source text during the last sync.

HB2585: AHCCCS Payments and Referrals

This law requires AHCCCS contractors to pay outside providers for lab work when a patient is referred by an inside provider, bans prior authorization for diagnostic services, and stops retaliation against doctors who make these referrals.

What This Bill Does

• Requires AHCCCS contractors to reimburse noncontracting providers for laboratory services if the member was referred by a contracted provider.
• Prohibits contractors from requiring prior authorization for diagnostic services.
• Stops contractors from taking or threatening retaliatory action against contracted providers who refer members to noncontracted providers.

Who It Names or Affects

• AHCCCS insurance contractors
• Contracted healthcare providers in Arizona
• Noncontracting (outside) healthcare providers
• Members enrolled with AHCCCS contractors

Terms To Know

AHCCCS

Arizona Health Care Cost Containment System, the state's health care program.

Contractor

An organization that manages health plans for AHCCCS members.

Noncontracting provider

A doctor, lab, or clinic without a direct contract with the AHCCCS contractor but who can still treat patients.

Limits and Unknowns

• The official text does not state when this law will officially take effect.
• The source material does not define specific penalties for contractors who break these rules.

Official Summary Text

HB2585 - AHCCCS; reimbursement; noncontracting providers

Current Bill Text

HB2585 - 572R - I Ver

REFERENCE TITLE:
AHCCCS; reimbursement; noncontracting providers

State of Arizona

House of Representatives

Fifty-seventh Legislature

Second Regular Session

2026

HB 2585

Introduced by

Representative
Biasiucci

AN
ACT

Amending title 36, chapter 29, article 1,
Arizona Revised Statutes, by adding section 36-2905.05; relating to the
Arizona health care cost containment system.

(TEXT OF BILL BEGINS ON NEXT PAGE)

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

Section 1. Title 36, chapter 29, article 1,
Arizona Revised Statutes, is amended by adding section 36-2905.05, to read:

START_STATUTE
36-2905.05.

Contractors; reimbursement; noncontracting providers;
prohibitions

A. Notwithstanding any other law to
the contrary:

1. A contractor shall reimburse a
noncontracting provider for laboratory services rendered to a member who is
enrolled with the contractor if the member was referred by a contracted
provider of the contractor.

2. A contractor may not require prior
authorization for diagnostic services.

B. A contractor may not take or
threaten to take retaliatory action against a contracted provider for referring
a member to a noncontracted provider.
END_STATUTE