Every year the American Hospital Association works with
state hospital association partners
to recognize Grassroots Champions with an award. The award recognizes a
hospital leader from an AHA member institution in each state for their work
cultivating relationships with lawmakers and their staff, then effectively
leveraging those relationships to advocate tirelessly on behalf of patients, hospitals,
and their communities.
This year, AzHHA chose Danny Smith at Mt. Graham Regional Medical Center for
this prestigious award. Danny was instrumental in efforts to hold health plans
accountable during this most recent legislative session through the Health
Insurance Accountability bill.
The Health Insurance Accountability bill amends existing Arizona Revised
Statutes related to health insurance, specifically focusing on health care
claim denials, disputes, and provider credentialing processes. The bill
introduces new requirements for health care insurers when denying claims, such
as providing contact information for someone who can answer questions about the
denial and detailed reasons for denials based on lack of medical necessity. It
also outlines the rights of health care providers to appeal and dispute such
denials, including the process for requesting a hearing with the Department of
Insurance and Financial Institutions (DIFI) if grievances are unresolved. Additionally,
the bill changes the credentialing process for health care providers, reducing
the time frame for insurers to complete credentialing from 100 to 45 days after
receiving a complete application. It also mandates that insurers pay claims for
covered services retroactively to the date of the provider’s complete
credentialing application, provided the provider has a fully executed contract
with a network plan. The bill defines various terms related to the
credentialing process and removes the ability of a health care insurer’s
designee to credential providers.
The Health Insurance Accountability bill, HB2035, passed the House of
Representatives, Arizona Senate Health and Human Services Committee advancing
further than it ever has. Danny’s connections within the business community and
with legislators proved a crucial step to help push our bill twice as far as
the year before. This bills advancement “marks a significant step in the right
direction towards holding health insurance companies accountable by improving
transparency on claim denials,” said AzHHA CEO Ann-Marie Alameddin.
“This bill underscores our commitment to prioritizing people and patients
first. We believe that every Arizonan deserves access to affordable and
high-quality healthcare, and this legislation is a great start to accomplishing
that goal.”
