The proposed bill, HB2599, seeks to reform the health care appeals process by eliminating the minimum dollar threshold for claims, replacing the formal appeals process with a voluntary internal appeal, and mandating that initial appeals regarding medical appropriateness be conducted by licensed health care professionals. Insurers will be required to provide written determinations that detail the basis for their decisions and share any new evidence with members prior to final adverse determinations. The bill also extends the timeframe for expedited medical reviews from one business day to 72 hours and reduces the determination period for external independent reviews from 30 days to 10 days.
Additionally, the bill introduces new definitions and clarifies existing ones, such as changing "adverse decision" to "adverse determination" and expanding the definition of "provider" to include advanced practice registered nurses. It enhances member rights by allowing expedited reviews and ensuring transparency in the review process. The bill also establishes a record-keeping requirement for insurers and independent review organizations for three years post-appeal and sets an effective date of January 1, 2025. Overall, HB2599 aims to improve the clarity, efficiency, and fairness of the health care appeals process in Arizona.
Statutes affected: Introduced Version: 20-2501, 20-2530, 20-2532, 20-2533, 20-2534, 20-2535, 20-2536, 20-2537, 20-2542, 36-3231, 20-2538, 41-1092.08, 12-908
House Engrossed Version: 20-2501, 20-2532, 20-2533, 20-2534, 20-2535, 20-2536, 20-2537, 20-2542, 20-3404, 20-2530, 32-1601, 20-2538, 41-1092.08, 12-908
Chaptered Version: 20-2501, 20-2532, 20-2533, 20-2534, 20-2535, 20-2536, 20-2537, 20-2542, 20-3404, 20-2530, 32-1601, 20-2538, 41-1092.08, 12-908