The proposed bill would update current statutes by mandating health care services plans to report detailed claims denial and prior authorization data to the Department of Insurance and Financial Institutions (DIFI) annually, starting July 1, 2027. This new requirement includes metrics such as the total number of claims and prior authorization requests, the number of denials and appeals, and the reasons for denials. DIFI is tasked with aggregating this data into a standard report, which will be publicly accessible and maintained for at least three years. Additionally, the bill introduces new sections 20-2512 and 20-3408 to the Arizona Revised Statutes, enhancing the framework for accountability and oversight of health care services plans.

Moreover, the bill retroactively changes the deadline for posting grievance reports from August 1 to October 1, effective July 1, 2026, and allows the Director of DIFI to adopt rules for implementing these reporting requirements. It also requires DIFI to convene a meeting by July 1, 2032, to evaluate the quality and relevance of the reported data, with a follow-up report and recommendations due by October 31, 2032. Overall, these updates aim to improve transparency and accountability in the operations of health care services plans.

Statutes affected:
Introduced Version: 20-2512, 20-3102, 20-3408
Senate Engrossed Version: 20-2512, 20-3102, 20-3408, 20-3401