Arizona Regulatory Attachment Form

ARIZONA REGULATORY ATTACHMENT
As set forth in Sections 9.5 and 9.15 of the Agreement, the Parties agree to abide by the terms of the Agreement, and also agree to abide by the additional requirements applicable to the provision of services to Members enrolled in commercial (e.g., not Medicare Advantage) managed care plans in Arizona are set forth in this Exhibit. This Exhibit 3 amends the Agreement to comply with legislative and regulatory requirements of the State of Arizona regarding provider contracts with providers rendering health care services in the State of Arizona. To the extent that such laws and regulations are applicable but not preempted by applicable federal law, the provisions of this Exhibit shall apply and, to the extent of a conflict with a provision in the Agreement and this Exhibit, this Exhibit shall control. For purposes of this Exhibit, the term “Member” means an individual who is eligible under a plan insured and/or administered by Plan, and the term “Covered Services” means services that are covered under any such plan. References to Provider herein means the provider listed on the signature page of the Agreement to which this Exhibit relates.

1. To the extent that Covered Services are rendered by Provider to Members enrolled in a health care services organization (HMO) plan, the following provisions are hereby added to the Agreement to the extent required by law applicable to Provider: a. Nothing in the Agreement shall be construed to restrict or prohibit Provider’s good faith communication with a Member concerning the Member’s health care or medical needs, treatment options, health care risks, or benefits. Ariz. Rev. Stat. § 20-1061(B)(1). b. Plan shall not terminate or refuse to renew the Agreement solely because Provider in good faith (i) advocates in private or in public on behalf of a Member; (ii) assists a Member in seeking reconsideration of a decision to deny coverage for a health care service; or (iii) reports a violation of law to an appropriate authority. Ariz. Rev. Stat. § 20-1061(B)(2). c. The Agreement shall not contain a financial incentive plan that includes a specific payment made to or withheld from Provider as an inducement to deny, reduce, limit, or delay medically necessary care that is covered by a Member’s evidence of coverage for a specific disease or condition; provided, that this provision does not prohibit per diem or per case payments, diagnostic related grouping payments, or financial incentive plans, including capitation payments or shared risk arrangements that are not connected to specific medical decisions relating to a Member for a specific disease or condition. Ariz. Rev. Stat. § 20-1061(C). d. In the event that Plan is declared insolvent, Provider shall provide Covered Services to Members at the same rates of reimbursement and subject to the same terms and conditions established in the Agreement for the duration of the period after Plan is

declared insolvent, until the earliest of the following: i. The duration of the contract period under the Member’s health care plan or for sixty (60) days from the date that insolvency is declared, whichever is longer; or, if the Member is confined on the date of insolvency in an inpatient facility, until the Member’s discharge from such inpatient facility. ii. A notification from the receiver of Plan pursuant to Ariz. Rev. Stat. § 20- 1069(F) or a determination by the court that Plan cannot provide adequate assurance that it will be able to pay Provider’s claims for Covered Services that were rendered after Plan is declared insolvent. iii. A determination by the court that the insolvent Plan is unable to pay Provider’s claims for Covered Services that were rendered after Plan is declared insolvent. iv. A determination by the court that continuation of the Agreement would constitute undue hardship to Provider. v. A determination by the court that Plan has satisfied its obligations to all Members under its health care plans. Ariz. Rev. Stat. §§ 20-1074(B), 20-1069(A). e. In the event that Plan fails to pay Provider for Covered Services as set forth in the Agreement, the Member shall not be liable to Provider for any amounts owed by Plan to Provider and Provider shall not bill or otherwise attempt to collect from the Member any amount owed by Plan to Provider. Neither Provider nor any agent, trustee, or assignee of Provider shall maintain an action at law against a Member to collect any amounts owed by Plan to Provider. Ariz. Rev. Stat. § 20-1072.

2. To the extent required by applicable law, except in cases of fraud: (i) Plan or its designee shall not adjust the payment of a claim of a Member more than one (1) year after the date that Plan or its designee paid such claim; and (ii) Provider shall not request adjustment of the denial of a claim of a Member more than one (1) year after the date that Provider or its designee denied such claim. If the Agreement provides for a longer period of time to adjust or request adjustment of the payment or denial of a claim of a Member, that period shall be the same length of time for Plan or its designee and Provider. Ariz. Rev. Stat. § 20-3102(I).