AHCCCS; noncontracting providers; reimbursement

Plain English Breakdown

The official source material does not provide specific details on how this bill will affect overall healthcare costs in Arizona.

AHCCCS; Noncontracting Providers Reimbursement

This bill requires AHCCCS contractors to reimburse noncontracting providers for laboratory services under certain conditions and prohibits them from imposing restrictions or taking retaliatory actions related to referrals.

What This Bill Does

• Requires AHCCCS contractors to pay noncontracting providers for lab tests if a member is referred by a contracted provider at the same rate as contracting providers.
• Prohibits contractors from requiring prior authorization for diagnostic services.
• Prevents contractors from punishing contracted providers who refer patients to noncontracted providers.

Who It Names or Affects

• AHCCCS contractors
• Noncontracting providers
• Contracted providers

Terms To Know

AHCCCS

Arizona Health Care Cost Containment System, a program that provides health care to eligible Arizonans.

Noncontracting provider

A healthcare provider who does not have a direct contract with AHCCCS but can still provide services under certain conditions.

Limits and Unknowns

• The bill does not specify the exact amount of additional costs that will be generated due to increased reimbursement for noncontracted providers and diagnostic service utilization.
• It is unclear how this legislation will impact overall healthcare costs in Arizona.

Official Summary Text

SB1086 - 572R - Senate Fact Sheet

Assigned to
HHS������������������������������������������������������������������������������������������������ AS
PASSED BY COMMITTEE

ARIZONA STATE SENATE

Fifty-Seventh
Legislature, Second Regular Session

REVISED

AMENDED

FACT SHEET FOR
S.B. 1086

AHCCCS;
noncontracting providers; reimbursement

Purpose

Requires contractors with the Arizona Health Care Cost Containment System
(AHCCCS) to reimburse noncontracting providers for laboratory services under
specified conditions and prohibits contractors from imposing restrictions or
taking retaliatory actions relating to noncontracting provider referrals.

Background

AHCCCS contracts with health plans to
provide medically necessary health and medical services to eligible members.
AHCCCS contractors are required to provide services and supplies including but
not limited to: 1) inpatient and outpatient hospital services; 2) laboratory
and X-ray services; 3) prescription medications; 4) medical supplies, durable
medical equipment, insulin pumps and prosthetic devices; 5) medical treatment
of eye conditions; 6) early and periodic health screening and diagnostic
services; 7) family planning services; 8) podiatry services;

9) nonexperimental transplants; 10) emergency dental care; 11) ambulance and
nonambulance transportation; 12) hospice care; 13) orthotics; 14) chiropractic
services; 15) diabetes outpatient

self-management training services; and 16) traditional healing services, as
specified (
A.R.S. � 36-2907
).

Contractor
means a person or entity that has a prepaid capitated
contract with AHCCCS to provide health care to members either directly or
through subcontracts with providers (
A.R.S.

� 36-2901
).

The Joint Legislative Budget Committee fiscal note estimates that S.B.
1086 would generate additional costs due to increased reimbursement for non-contracted
providers and increased utilization of diagnostic services that would otherwise
require prior authorization, but there is insufficient information to determine
the magnitude of these costs (
JLBC fiscal
note
).

Provisions

1.

Requires
an AHCCCS contractor to 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.

2.

Prohibits
a contractor from reimbursing a noncontracting provider at a rate exceeding the
reimbursement rate for contracting providers.

3.

Prohibits
a contractor from requiring prior authorization for diagnostic services.

4.

Prohibits
a contractor from taking or threatening to take retaliatory action against a
contracted provider for referring a member to a noncontracted provider.

5.

Contains
a statement of legislative intent.

6.

Becomes
effective on the general effective date.

Amendments
Adopted by Committee

�

Prohibits a contractor from reimbursing a noncontracting provider
at a rate exceeding the reimbursement rate for contracting providers.

Revisions

�

Updates the fiscal impact statement.

Senate
Action

HHS��� 2/11/26����������� DPA��� 4-2-1

ATT���� 3/2/26������������� W/D

Prepared by Senate Research

April 2, 2026

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Current Bill Text

SB1086 - 572R - S Ver

Senate Engrossed

AHCCCS;
noncontracting providers; reimbursement

State of Arizona

Senate

Fifty-seventh Legislature

Second Regular Session

2026

SENATE BILL 1086

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.
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 AT A RATE THAT IS NOT MORE
THAN THE RATE THAT WOULD BE REIMBURSED TO A CONTRACTING PROVIDER.

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

Sec.
2.
2.
Legislative intent

The legislature intends to promote
cost controls through competition and to avoid monopolistic practices that
interfere with the free market.� Adequate oversight through rigorous audit
practices is the alternative.