Bill Text: AZ SB1105 | 2019 | Fifty-fourth Legislature 1st Regular | Chaptered
Bill Title: Direct primary care agreements
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Passed) 2019-04-17 - Chapter 108 [SB1105 Detail]
Download: Arizona-2019-SB1105-Chaptered.html
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House Engrossed Senate Bill |
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State of Arizona Senate Fifty-fourth Legislature First Regular Session 2019
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CHAPTER 108
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SENATE BILL 1105 |
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AN ACT
Amending section 20‑103, Arizona Revised Statutes; repealing section 20‑123, Arizona Revised Statutes; amending section 44‑1521, Arizona Revised Statutes; repealing title 44, chapter 11, article 25, Arizona Revised Statutes; amending title 44, chapter 11, Arizona Revised Statutes, by adding a new article 25; relating to the regulation of particular businesses.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-103, Arizona Revised Statutes, is amended to read:
20-103. Definition of insurance; exceptions
A. For the purposes of this title, except as otherwise provided, "insurance" is a contract by which one undertakes to indemnify another or to pay a specified amount upon determinable contingencies.
B. Private ambulance service contracts or private fire protection service contracts are not insurance, and this title does not apply to those contracts.
C. Charitable gift annuities that are issued pursuant to section 20‑119 are not insurance and, except as provided in section 20‑119, this title does not apply to agreements for those annuities.
D. Collision damage waivers are not insurance, and this title does not apply to those waivers.
E. Direct primary care provider plans that are issued pursuant to title 44, chapter 11, article 25 agreements as defined in section 44‑1799.91 are not insurance, and this title does not apply to those plans agreements.
Sec. 2. Repeal
Section 20-123, Arizona Revised Statutes, is repealed.
Sec. 3. Section 44-1521, Arizona Revised Statutes, is amended to read:
44-1521. Definitions
In this article, unless the context otherwise requires:
1. "Advertisement" includes the attempt by publication, dissemination, solicitation or circulation, oral or written, to induce directly or indirectly any person to enter into any obligation or acquire any title or interest in any merchandise.
2. "Attorney general" means the attorney general of Arizona or the attorney general's authorized delegate.
3. "Authorized delegate" means any attorney, investigator or administrative personnel employed by the attorney general and so designated, and, if requested by the county attorney and authorized by the attorney general, may include similar personnel employed by the several county attorneys of this state.
4. "Examine" means the inspection, study or copying of any account, book, document, merchandise, paper or record.
5. "Merchandise" means any objects, wares, goods, commodities, intangibles, real estate or services, including direct primary care provider plans as defined in section 20‑123.
6. "Person" means any natural person or the person's legal representative, any partnership, or domestic or foreign corporation, any company, trust, business entity, or association, or any agent, employee, salesman, partner, officer, director, member, stockholder, associate or trustee.
7. "Sale" means any sale, offer for sale or attempt to sell any merchandise for any consideration, including sales, leases and rentals of any real estate subject to any form of deed restriction imposed as part of a previous sale.
Sec. 4. Repeal
Title 44, chapter 11, article 25, Arizona Revised Statutes, is repealed.
Sec. 5. Title 44, chapter 11, Arizona Revised Statutes, is amended by adding a new article 25, to read:
ARTICLE 25. DIRECT PRIMARY CARE AGREEMENTS
44-1799.91. Definitions
In this article, unless the context otherwise requires:
1. "Direct primary care agreement" means a contract between a primary care provider and an individual patient or the patient's legal representative in which the primary care provider agrees to provide primary care services to the individual patient for an agreed periodic fee and period of time.
2. "Direct primary care patient" means a patient who enters into a direct primary care agreement with a primary care provider.
3. "Direct primary care provider" means a primary care provider who enters into a direct primary care agreement with a patient or the patient's legal representative.
4. "Primary care provider":
(a) Means:
(i) A physician who is licensed pursuant to title 32, chapter 13 or 17 and who specializes in family medicine, internal medicine or pediatrics or otherwise treats patients for chronic conditions requiring regular treatment.
(ii) A physician assistant who is licensed pursuant to title 32, chapter 25 and who practices with a physician who specializes in family medicine, internal medicine or pediatrics.
(iii) A registered nurse practitioner who is licensed pursuant to title 32, chapter 15 and who is certified in family practice, adult health, gerontology, women's health or pediatrics.
(iv) A dentist who is licensed pursuant to title 32, chapter 11 and who provides dental services.
(b) Includes a group, entity or practice of primary care providers.
5. "Primary care services" means routine, periodic health care procedures that are ordered and supervised by a primary care provider, including medical visits, laboratory testing, imaging, pathology testing, prescribing and administering medication, diagnosing, treating and managing acute and chronic conditions and other health care procedures provided to patients on a routine, periodic basis that may be performed or supervised by a primary care provider with training and experience in that procedure, or dental services that may be performed or supervised by a dentist who is licensed pursuant to title 32, chapter 11.
44-1799.92. Direct primary care agreements; requirements; notice
A direct primary care agreement shall meet all of the following requirements:
1. Be in writing.
2. Be signed by the primary care provider or an agent of the primary care provider and the individual patient or the patient's legal representative. A copy of the agreement shall be provided to the individual patient or the patient's legal representative.
3. Allow either party to terminate the agreement on a thirty-day written notice to the other party. the agreement shall include terms for relocation and military duty.
4. Describe the scope of primary care services that are covered by the periodic fee.
5. Specify the periodic fee for the agreement and any additional fees outside of the periodic fee for ongoing care under the agreement.
6. Specify the duration of the agreement and any automatic renewal periods.
7. Provide a prominent written disclaimer that the agreement is not health insurance and that reads, in substantially the following form:
Notice: The organization facilitating the direct primary care agreement is not an insurance company and the direct primary care company guidelines and agreement are not an insurance policy. Participation in the direct primary care agreement or a subscription to any of its documents should not be considered to be a health insurance policy. Regardless of whether you receive treatment for health care issues through the direct primary care agreement, you are always personally responsible for paying any additional health care expenses you may incur. If you have health insurance, it may include, at no additional charge, some of the preventive services that are also available under this direct primary care agreement. The primary care provider may not bill your health insurance for primary care services provided under this direct primary care agreement.
44-1799.93. Direct primary care provider; acceptance and discontinuance of patients
A. A direct primary care provider may not decline to accept a new direct primary care patient or discontinue care to an existing patient solely because of the patient's health status. A direct primary care provider may not charge different fees for comparable services based on a patient's health status or gender.
B. A direct primary care provider may decline to accept a patient if the provider has reached maximum capacity or if the patient's medical condition is such that the provider is unable to provide the appropriate level and type of primary care services the patient requires.
C. A direct primary care provider may discontinue care for a direct primary care patient in any of the following circumstances:
1. The patient fails to pay the periodic fee.
2. The patient has performed an act of fraud.
3. The patient repeatedly fails to adhere to the recommended treatment plan.
4. The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct primary care provider.
5. The direct primary care provider discontinues practicing as a direct primary care provider.
6. The direct primary care provider changes the services offered or the scope of practice provided to patients.
7. The direct primary care provider gives a thirty‑day written notice to the patient terminating the direct primary care agreement.
44-1799.94. Direct primary care agreements; fees
A. A direct primary care agreement may not require more than twelve months of the periodic fee to be paid in advance. On discontinuing the agreement all payments prepaid for months following termination of the agreement shall be returned to the patient.
B. A direct primary care agreement shall prohibit the direct primary care provider from submitting a claim for reimbursement to the patient's health care insurer for primary care services that are provided to the patient and that are covered under the direct primary care agreement.
C. A direct primary care agreement may allow the periodic fee and any additional fees for ongoing care under the agreement to be paid by a health care insurer or other third party.
44-1799.95. Direct primary care agreements; dentists
A direct primary care agreement for dental services is limited to services provided within a single professional practice and may not include services offered by dentists in other practice entities.
44-1799.96. Direct primary care agreements; regulation
A direct primary care agreement for medical or dental services does not constitute the transaction of insurance business or a health care services organization in this state for the purposes of regulation under title 20.
APPROVED BY THE GOVERNOR APRIL 17, 2019.
FILED IN THE OFFICE OF THE SECRETARY OF STATE APRIL 17, 2019.
