------------------------------------------------ ¦ REFERENCE TITLE: AIDS; HIV; standing referrals ¦ ------------------------------------------------ ¦ ¦ ¦ ¦ ¦ ¦ ¦ State of Arizona ¦ ¦ House of Representatives ¦ ¦ Forty-fifth Legislature ¦ ¦ First Regular Session ¦ ¦ 2001 ¦ ¦ ¦ ------------------------------------------------ ¦ HB 2410 ¦ ------------------------------------------------ ¦ Introduced by ¦ ¦ Representative May ¦ ------------------------------------------------
AN ACT
AMENDING SECTIONS 20-841.04, 20-936.01 AND 20-1057.01, ARIZONA REVISED STATUTES; RELATING TO HEALTH CARE INSURANCE.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-841.04, Arizona Revised Statutes, is amended to read:
20-841.04. Standing referrals to network health care professionals; definition
A. Any corporation that offers a health benefits plan shall establish a procedure by which a subscriber may apply for a standing referral to a network health care professional. The corporation shall provide a subscriber with a standing referral if all of the following conditions are met:
1. The subscriber is a covered member of that corporation.
2. The subscriber has a disease or condition that is life threatening, degenerative, chronic or disabling, INCLUDING THE HUMAN IMMUNODEFICIENCY VIRUS OR THE ACQUIRED IMMUNE DEFICIENCY VIRUS.
3. The subscriber's primary care physician in conjunction with a network health care professional determines that the subscriber's health care requires a network health care professional's expertise.
4. The subscriber's primary care physician determines that the subscriber's disease or condition will require ongoing medical care for an extended period of time.
5. The standing referral is made by the subscriber's primary care physician to a network health care professional who is responsible for providing and coordinating the subscriber's specialty care.
6. The network health care professional is authorized by the corporation to provide the services under the standing referral.
B. The corporation may limit the number of visits and time period for which a subscriber may receive a standing referral.
C. If the subscriber receives a standing referral or any other referral from the subscriber's primary care physician, that referral remains in effect even if the primary care physician leaves the corporation's network.
D. If the treating health care professional leaves the network or the subscriber ceases to be a covered member, the standing referral expires.
E. This section does not apply to any corporation that holds a certificate of authority to operate either as a dental service corporation or an optometric service corporation.
F. For the purposes of this section, "network health care professional" means a practitioner of a health profession as defined in section 32-3101 who is under written contract with the corporation to provide services in a specialty discipline that is recognized by an American medical specialty board OR TO PROVIDE EXPERT SERVICES IN TREATING THE HUMAN IMMUNODEFICIENCY VIRUS OR THE ACQUIRED IMMUNE DEFICIENCY VIRUS.
Sec. 2. Section 20-936.01, Arizona Revised Statutes, is amended to read:
20-936.01. Standing referrals to network health care professionals; definition
A. A benefit insurer shall establish a procedure by which an insured may apply for a standing referral to a network health care professional. The benefit insurer shall provide an insured with a standing referral if all of the following conditions are met:
1. The insured is a covered member of that benefit insurer.
2. The insured has a disease or condition that is life threatening, degenerative, chronic or disabling, INCLUDING THE HUMAN IMMUNODEFICIENCY VIRUS OR THE ACQUIRED IMMUNE DEFICIENCY VIRUS.
3. The insured's primary care physician in conjunction with a network health care professional determines that the insured's health care requires a network health care professional's expertise.
4. The insured's primary care physician determines that the insured's disease or condition will require ongoing medical care for an extended period of time.
5. The standing referral is made by the insured's primary care physician to a network health care professional who is responsible for providing and coordinating the insured's specialty care.
6. The network health care professional is authorized by the benefit insurer to provide the services under the standing referral.
B. The benefit insurer may limit the number of visits and time period for which an insured may receive a standing referral.
C. If the insured receives a standing referral or any other referral from the insured's primary care physician, that referral remains in effect even if the primary care physician leaves the benefit insurer's network.
D. If the treating health care professional leaves the network or the insured ceases to be a covered member, the standing referral expires.
E. For the purposes of this section, "network health care professional" means a practitioner of a health profession as defined in section 32-3101 who is under written contract with the benefit insurer to provide services in a specialty discipline that is recognized by an American medical specialty board OR TO PROVIDE EXPERT SERVICES IN TREATING THE HUMAN IMMUNODEFICIENCY VIRUS OR THE ACQUIRED IMMUNE DEFICIENCY VIRUS.
Sec. 3. Section 20-1057.01, Arizona Revised Statutes, is amended to read:
20-1057.01. Standing referrals to network health care professionals; definition
A. A health care services organization shall establish a procedure by which an
enrollee may apply for a standing referral to a network health care professional. The
health care services organization shall provide an insured ENROLLEE with a
standing referral if all of the following conditions are met:
1. The enrollee is a covered member of that health care services organization.
2. The enrollee has a disease or condition that is life threatening, degenerative, chronic or disabling, INCLUDING THE HUMAN IMMUNODEFICIENCY VIRUS OR THE ACQUIRED IMMUNE DEFICIENCY VIRUS.
3. The enrollee's primary care physician in conjunction with a network health care professional determines that the enrollee's health care requires a network health care professional's expertise.
4. The enrollee's primary care physician determines that the enrollee's disease or condition will require ongoing medical care for an extended period of time.
5. The standing referral is made by the enrollee's primary care physician to a network health care professional who is responsible for providing and coordinating the enrollee's specialty care.
6. The network health care professional is authorized by the health care services organization to provide the services under the standing referral.
B. The health care services organization may limit the number of visits and time period for which an enrollee may receive a standing referral.
C. If the enrollee receives a standing referral or any other REFERRAL from the enrollee's primary care physician, that referral remains in effect even if the primary care physician leaves the health care services organization's network.
D. If the treating health care professional leaves the network or the enrollee ceases to be a covered member, the standing referral expires.
E. For the purposes of this section, "network health care professional" means a practitioner of a health profession as defined in section 32-3101 who is under written contract with the health care services organization to provide services in a specialty discipline that is recognized by an American medical specialty board OR TO PROVIDE EXPERT SERVICES IN TREATING THE HUMAN IMMUNODEFICIENCY VIRUS OR THE ACQUIRED IMMUNE DEFICIENCY VIRUS.