Arizona Laws 36-2906.01. Qualified commercial carriers; administration; contracts
A. Entities, including insurers as defined in section 20-104, hospital, medical, dental and optometric service corporations as defined in Title 20, Chapter 4, Article 3 and health care services organizations as defined in section 20-1051, are prohibited from contracting with the administration as a system contractor unless the entity establishes an affiliated corporation whose only authorized business is to provide services or coverage pursuant to a contract with the administration to persons defined as eligible in section 36-2901, paragraph 6, subdivisions (a), (f) and (g).
Terms Used In Arizona Laws 36-2906.01
- Action: includes any matter or proceeding in a court, civil or criminal. See Arizona Laws 1-215
- Administration: means the Arizona health care cost containment system administration. See Arizona Laws 36-2901
- Contract: A legal written agreement that becomes binding when signed.
- Contractor: means a person or entity that has a prepaid capitated contract with the administration pursuant to section 36-2904 or chapter 34 of this title to provide health care to members under this article or persons under chapter 34 of this title either directly or through subcontracts with providers. See Arizona Laws 36-2901
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Department: means the department of economic security. See Arizona Laws 36-2901
- Director: means the director of the Arizona health care cost containment system administration. See Arizona Laws 36-2901
- including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
- Member: means an eligible person who enrolls in the system. See Arizona Laws 36-2901
- System: means the Arizona health care cost containment system established by this article. See Arizona Laws 36-2901
B. If there is an insufficient number of, or an inadequate member capacity in, contracts awarded to contractors, the director may request that the director of the department of insurance and financial institutions grant a temporary exemption from the requirements of subsection A of this section for an entity regulated by the department of insurance and financial institutions, and otherwise qualified to be a system health plan, in order for that entity to enter into an arrangement with the administration to provide services to persons defined as eligible in section 36-2901, paragraph 6, subdivisions (a), (f) and (g). On a written request from the administration, the director of the department of insurance and financial institutions may grant a onetime exemption to an entity for a period not to exceed one year. During the temporary exemption, the entity must comply with all applicable provisions of both this article and the applicable chapter or article of title 20 under which the entity is licensed to operate.
C. With respect to entities that have been granted an exemption pursuant to subsection B of this section, the provisions of section 36-2903, subsection M, relating to the direct operation of a provider, shall not apply. If the director determines that the operations of the entity would otherwise meet the circumstances specified in contract under which the administration could operate the entity directly or that the public health, safety or welfare require emergency action relative to the entity, the director shall notify the director of the department of insurance and financial institutions and may request that the department of insurance and financial institutions take appropriate actions.