Arizona law bars treatment referral payments and limits insurance advice

A person may not offer or receive payments in return for certain patient referrals or accepting a patient for substance use services at a sober living home. It covers referrals to or from sober living homes or substance use treatment facilities, referrals from a sober living home to another health care institution, and accepting or acknowledging a patient’s enrollment for substance use services at a sober living home. The rule covers commissions, bonuses, rebates, kickbacks, bribes, and split fees, whether paid directly or indirectly and in cash or other forms.

Health care providers, institutions, and drug manufacturers may not pay certain patients’ health plan premiums or subscription fees. The rule covers health care providers, health care institutions, and drug manufacturers paying premiums or subscription fees for their patients’ health coverage. Federal law may expressly allow a payment. Covered patients must receive health care services from the payer and be enrolled in a health plan; the definition excludes the payer’s employees and their dependents.

A health care licensee or staff member may not advise a patient to join or leave a specific insurer’s plan unless that adviser is a licensed insurance producer in Arizona. The provision applies to medical and nursing licensees, health care institutions, and their staff when advising patients about a specific health plan or insurance company. A licensee may still discuss whether they are in network with an insurer or plan. Health insurance navigators and certified application counselors may help people enroll when acting within their authorized roles.