Arizona Doctor’s Orders Act
ONE PAGE SUMMARY
ARIZONA DOCTOR'S ORDERS ACT (FINAL WITH FALLBACK PROVISION)
What is it?
A proposed Arizona law that stops insurance companies and out-of-state reviewers from overriding the medical judgment of your treating health care provider. This amended version explicitly covers physicians, nurses, nurse practitioners, physician assistants, and all other licensed providers. It creates an annual review process for licensing boards, grants those boards authority to expand scope of practice in line with current best practices subject to legislative veto, includes legal protections against federal preemption challenges, and provides a fallback standard when fewer than ten states have adopted a particular scope expansion.
Core Protections
Treating Provider Judgment Final
When your treating provider prescribes necessary treatment within the scope of their license, that judgment is final. No insurance company, out-of-state reviewer, or other third party can deny, delay, or override that treatment.
Explicit Coverage for All Licensed Providers
Covers any health care provider licensed under Title 32, including physicians, registered nurses, licensed practical nurses, nurse practitioners, physician assistants, pharmacists, dentists, optometrists, chiropractors, physical therapists, and all other licensed providers.
Scope of Practice Expansion Authority
Each licensing board may expand scope of practice to align with current state of the art medical knowledge and industry best practices. Expansions are adopted by board rule following public notice and comment.
Fallback Standard for Novel Procedures
If fewer than ten states have adopted a particular scope of practice, the board may rely on consensus standards from at least two relevant national accrediting bodies. This ensures that safe, innovative procedures are not blocked simply because few states have addressed them.
Mandatory Legislative Notice and 90 Day Response Period
Before any scope expansion takes effect, the board must notify legislative leadership. The Legislature has 90 days to pass a joint resolution disapproving the expansion. If no action is taken, the expansion takes effect automatically.
Supersession of Prior Conflicting Statutes
This act supersedes prior statutes that conflict with its provisions, specifically those that restrict board authority based on outdated standards. The supersession clause is narrowly tailored to avoid unintended repeal of unrelated statutes.
ERISA Protection and Attorney General Defense
The Attorney General is directed to defend this act against any claim of ERISA preemption and to seek any available administrative or judicial relief to maximize its application.
Annual Board Review Process
Each licensing board shall conduct an annual public review of provider complaints about insurance interference, prior authorization, utilization review, and other systemic issues. Boards report findings to the Governor and Legislature.
Penalties for Delays
Insurance companies that unreasonably delay or deny treatment face $10,000 per day penalties plus actual damages.
Fast Appeals Process
72 hour expedited appeal decided by an independent Arizona-licensed provider in the same field.
No Retaliation
Insurance companies cannot retaliate against providers who advocate for patients. Retaliation creates a rebuttable presumption of wrongdoing.
Private Right of Action
Patients and providers may sue and recover attorney's fees and costs.
Appropriation
$500,000 appropriated to the Arizona Department of Health Services for distribution to licensing boards.
Exceptions
Does not apply to unsafe, ineffective, or out-of-scope treatments, or where preempted by federal law.
Bottom Line
Your family's health decisions stay between you and the trusted professional who knows you best. This act protects that relationship, modernizes scope of practice, ensures legislative oversight, defends against federal overreach, and includes a common-sense fallback for innovative medical practices.
Read the full bill below.
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FULL BILL TEXT
ARIZONA DOCTOR'S ORDERS ACT
AN ACT AMENDING TITLE 20, CHAPTER 6, ARIZONA REVISED STATUTES, BY ADDING A NEW ARTICLE TO BE KNOWN AS ARTICLE 12, THE ARIZONA DOCTOR'S ORDERS ACT; AMENDING TITLE 32, ARIZONA REVISED STATUTES, RELATING TO ANNUAL REVIEW OF LICENSING BOARDS AND SCOPE OF PRACTICE EXPANSION AUTHORITY; PROVIDING FOR SUPERSESSION OF PRIOR CONFLICTING STATUTES; MAKING AN APPROPRIATION; AND DECLARING AN EMERGENCY
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ARIZONA
SECTION 1. SHORT TITLE
This act shall be known and may be cited as the Arizona Doctor's Orders Act.
SECTION 2. FINDINGS AND DECLARATIONS
The Legislature finds and declares:
1. The relationship between a patient and their treating health care provider is fundamental to quality medical care.
2. Insurance companies and their contracted out-of-state reviewers increasingly override the medical judgment of treating providers who have examined the patient and know their medical history.
3. These denials and delays harm patients, increase overall health care costs, and undermine the practice of medicine in Arizona.
4. Nurses, nurse practitioners, physician assistants, and other licensed providers play an essential role in delivering health care, particularly in rural Arizona where physicians may not be available daily.
5. The medical judgment of any licensed treating provider who has examined the patient should be respected over the judgment of an out-of-state reviewer who has never met the patient.
6. Health care providers on the front lines of patient care are best positioned to identify systemic problems with insurance company interference, prior authorization requirements, and utilization review processes.
7. Regular, structured opportunities for providers to report these problems to their licensing boards will improve patient safety, ensure fair treatment of providers, and clarify standards for all parties.
8. Medical knowledge and best practices evolve rapidly. Licensing boards should have the authority to update scope of practice rules to reflect current state of the art without waiting for legislative action in every instance.
9. However, the Legislature retains the ultimate authority over scope of practice and must have an opportunity to review and reject any proposed expansion before it takes effect.
10. Arizona law already grants nurse practitioners full practice authority, including the ability to evaluate patients, diagnose, order and interpret diagnostic tests, and prescribe medications under the jurisdiction of the Arizona State Board of Nursing.
11. Nothing in this act shall be construed to restrict or diminish the existing full practice authority of nurse practitioners or any other licensed provider.
12. This act supersedes prior conflicting statutes only to the extent necessary to effectuate its purposes, consistent with Section 15 of this act.
13. The Legislature finds that this act regulates insurance practices that are traditionally within state authority and does not impermissibly relate to employee benefit plans for purposes of the Employee Retirement Income Security Act of 1974 (ERISA).
14. Nothing in this act shall be construed to require coverage of treatments that are unsafe, ineffective, or outside the treating provider's scope of license.
SECTION 3. DEFINITIONS
In this act:
1. Health care provider means any person or entity licensed, certified, or otherwise authorized to provide health care services under Title 32, Arizona Revised Statutes, including but not limited to:
a. Physicians licensed under Title 32, Chapter 13 or Chapter 17.
b. Registered nurses and licensed practical nurses licensed under Title 32, Chapter 15.
c. Nurse practitioners licensed under Title 32, Chapter 15.
d. Physician assistants licensed under Title 32, Chapter 25.
e. Pharmacists licensed under Title 32, Chapter 18.
f. Dentists licensed under Title 32, Chapter 11.
g. Optometrists licensed under Title 32, Chapter 22.
h. Chiropractors licensed under Title 32, Chapter 8.
i. Physical therapists licensed under Title 32, Chapter 19.
j. Any other person licensed to provide health care services under Title 32.
2. Treating provider means the health care provider who has primary responsibility for the patient's care and has conducted an in-person or telehealth examination of the patient within the scope of the provider's license.
3. Necessary treatment means health care services that a reasonable treating provider would prescribe based on accepted medical standards, community practice, and the individual patient's circumstances, provided that such treatment is within the treating provider's scope of license.
4. Out-of-state reviewer means any person who is not licensed to practice in Arizona and who reviews, denies, delays, or modifies treatment decisions for an insurance company, including but not limited to independent review organizations, utilization review agents, and any third party contractor.
5. Insurance company means any entity that provides health insurance, health benefit plans, managed care plans, or health care services in Arizona, including but not limited to entities regulated under Title 20, Chapter 4, Article 9 (health care services organizations) and Title 20, Chapter 6 (accident and health insurance).
6. Licensing board means any board, commission, or agency established under Title 32, Arizona Revised Statutes, that is responsible for licensing, regulating, or disciplining health care providers.
7. Scope of practice means the procedures, actions, and processes that a health care provider is permitted to undertake in keeping with the terms of their professional license.
8. Current state of the art means the level of medical knowledge, technology, and clinical practice that is generally accepted as standard for safe and effective patient care by the relevant national professional association or accrediting body, as reflected in peer-reviewed literature, clinical practice guidelines, or consensus statements published within the five years preceding the board's determination.
9. Industry best practices means those clinical practices that have been demonstrated through peer-reviewed evidence, professional consensus, or regulatory recognition to produce optimal patient outcomes.
SECTION 4. TREATING PROVIDER JUDGMENT FINAL
A. When a treating provider prescribes necessary treatment for a patient, that judgment shall be final and binding on the patient's insurance company.
B. No insurance company, out-of-state reviewer, or other third party may deny, delay, modify, or override the treating provider's judgment regarding necessary treatment.
C. Any denial, delay, modification, or override of a treating provider's judgment regarding necessary treatment is prohibited and shall be subject to the penalties set forth in this act.
D. This section applies to all health care providers regardless of whether the provider is employed by, contracted with, or otherwise affiliated with the insurance company.
SECTION 5. PROHIBITION ON OUT-OF-STATE REVIEWERS
A. No insurance company may require or permit an out-of-state reviewer to make any determination regarding the medical necessity, appropriateness, or coverage of treatment prescribed by a treating provider.
B. Any utilization review, prior authorization, or similar process must be conducted by a health care provider licensed in Arizona who has active clinical experience in the same field as the treating provider.
C. The reviewing Arizona-licensed provider may not override the treating provider's judgment unless the reviewing provider:
1. Has examined the patient or reviewed the patient's complete medical record.
2. Identifies specific, verifiable medical evidence that the prescribed treatment is unsafe or ineffective for this particular patient.
3. Documents that evidence in writing to the treating provider and the patient.
SECTION 6. STRICT PENALTIES FOR DELAYS AND DENIALS
A. Any insurance company that violates Section 4 or Section 5 of this act shall be liable for:
1. A civil penalty of $10,000 per violation.
2. Actual damages suffered by the patient, including the cost of any delayed or denied treatment.
3. Reasonable attorney's fees and costs incurred by the patient or treating provider.
B. Each day that a denial or delay continues after the treating provider's prescription constitutes a separate violation.
C. The Attorney General may bring an action to enforce this section and may recover additional civil penalties of up to $50,000 per violation for patterns of misconduct.
SECTION 7. FAST APPEALS PROCESS
A. An insurance company shall establish an expedited appeals process for any patient or treating provider whose prescribed treatment is denied, delayed, or modified.
B. The expedited appeal shall be decided within 72 hours of receipt.
C. The appeal shall be reviewed by an independent health care provider:
1. Licensed in Arizona.
2. With active clinical experience in the same field as the treating provider.
3. Who has no financial relationship with the insurance company.
D. The treating provider's judgment shall be upheld unless the independent reviewer finds by clear and convincing evidence that the prescribed treatment is unsafe or ineffective for this particular patient.
SECTION 8. NO RETALIATION AGAINST PROVIDERS
A. No insurance company may terminate, non-renew, reduce reimbursement for, or otherwise retaliate against a health care provider who advocates for a patient's treatment under this act.
B. Any adverse action taken against a provider within 12 months of the provider advocating for a patient under this act creates a rebuttable presumption of retaliation.
C. A provider subjected to retaliation may bring an action in superior court and recover:
1. Actual damages, including lost reimbursement or contract value.
2. Treble damages for willful retaliation.
3. Reasonable attorney's fees and costs.
4. Reinstatement to any terminated contract or network.
SECTION 9. PRIVATE RIGHT OF ACTION
A. Any patient or treating provider aggrieved by a violation of this act may bring an action in superior court.
B. The court shall award reasonable attorney's fees and costs to the prevailing patient or treating provider.
C. The court may award injunctive relief to prevent future violations.
SECTION 10. ANNUAL BOARD REVIEW PROCESS FOR PROVIDER COMPLAINTS
A. Each licensing board shall conduct an annual public review of complaints, concerns, and recommendations raised by health care providers regarding insurance company interference with medical judgment, prior authorization requirements, utilization review processes, and any other systemic issues affecting patient safety, provider fairness, or clarity of standards.
B. The annual review process shall include the following:
1. Notice. Each licensing board shall publish notice of the annual review on its website at least sixty days before the scheduled public hearing. The notice shall include the date, time, location, and instructions for submitting written comments.
2. Written submissions. Any health care provider licensed by the board may submit written complaints, concerns, or recommendations to the board. Submissions shall be accepted beginning ninety days before the public hearing and ending thirty days after the public hearing.
3. Public hearing. Each licensing board shall hold at least one public hearing per year to receive testimony from providers. The hearing may be held in person, by teleconference, or by video conference. The board shall ensure that providers from rural Arizona have reasonable access to participate.
4. Confidentiality. A provider may request that their submission remain confidential if disclosure would subject them to retaliation. The board shall grant such requests unless disclosure is required by law.
5. No retaliation. No insurance company or employer may retaliate against a provider for participating in the annual review process. Any adverse action taken against a provider within twelve months of participation creates a rebuttable presumption of retaliation. A provider subjected to retaliation may bring an action under Section 8 of this act.
C. At the conclusion of each annual review, the licensing board shall:
1. Identify specific process improvements, rule amendments, or other actions that would:
a. Improve patient safety.
b. Ensure fair treatment of providers.
c. Clarify standards for providers, insurance companies, and patients.
2. Submit a written report to the Governor, the President of the Senate, and the Speaker of the House of Representatives no later than sixty days after the public hearing.
3. Publish the report on the board's website.
4. Include in the report a response to each significant complaint or recommendation received, explaining whether the board will take action and, if not, the reasons for declining to act.
D. The joint reports required under this section shall be compiled by the Arizona Department of Health Services and submitted to the Legislature as a single omnibus report no later than December 31 of each year. The omnibus report shall include:
1. A summary of all complaints and recommendations received by each licensing board.
2. A summary of actions taken or proposed by each board.
3. Recommendations for legislative action, if any.
E. The annual review process established in this section is in addition to any other complaint or disciplinary process available to providers. Participation in the annual review does not waive any other rights or remedies available to a provider.
SECTION 11. SCOPE OF PRACTICE EXPANSION AUTHORITY
A. Each licensing board is hereby granted the authority to adopt rules that expand the scope of practice for its licensees to align with current state of the art medical knowledge and industry best practices.
B. In exercising this authority, the board shall consider:
1. Peer-reviewed medical literature and clinical evidence.
2. Standards adopted by relevant national accrediting bodies.
3. The education, training, and examination requirements for the license.
4. The experience and demonstrated competency of licensees.
5. The potential risks and benefits to patient safety.
6. The availability of other licensed providers to perform the same or similar functions.
7. The impact on access to care, particularly in rural and underserved areas of Arizona.
C. Any scope of practice expansion adopted under this section shall require the licensee to possess appropriate qualifications, including any necessary education, training, certification, or examination, as determined by the board.
D. A board may adopt different levels or tiers of expanded scope based on additional education, training, or experience.
E. Nothing in this section shall be construed to require any individual licensee to perform any procedure or function outside their personal competence or the scope of their employer's authorization.
SECTION 12. MANDATORY LEGISLATIVE NOTICE AND RESPONSE PERIOD
A. Before any scope of practice expansion adopted under Section 11 of this act takes effect, the licensing board shall submit a written notice to the President of the Senate and the Speaker of the House of Representatives.
B. The notice shall include:
1. The full text of the proposed scope of practice expansion rule.
2. The board's findings and conclusions supporting the expansion, including the evidence relied upon.
3. A statement of the qualifications required for licensees to perform the expanded functions.
4. An analysis of the anticipated impact on patient safety, access to care, and health care costs.
5. Any dissenting opinions or minority views from board members.
C. The proposed scope of practice expansion shall not take effect until ninety days after the date the notice is received by the President of the Senate and the Speaker of the House of Representatives.
D. During the ninety day period, the Legislature may pass a joint resolution disapproving the proposed scope of practice expansion. If the Legislature passes a joint resolution of disapproval, the expansion shall not take effect.
E. If the Legislature takes no action to disapprove the proposed expansion within the ninety day period, the expansion shall take effect automatically on the ninety-first day after notice was received.
F. The board may withdraw a proposed expansion at any time before it takes effect.
G. A board may resubmit a proposed expansion that was previously disapproved only if the board provides new evidence or changed circumstances that materially address the Legislature's stated objections, or if two years have passed since the disapproval, whichever occurs first.
H. Nothing in this section shall be construed to limit the Legislature's authority to pass legislation at any time to modify, restrict, or repeal any scope of practice expansion, whether or not the expansion has taken effect.
SECTION 13. QUALIFICATIONS FOR EXPANDED DUTIES
A. A licensee may perform duties authorized by a scope of practice expansion under this act only if the licensee:
1. Holds the relevant license in good standing.
2. Has completed any additional education, training, or certification required by the board.
3. Has demonstrated competency to the satisfaction of the board.
4. Acts within the bounds of their personal competence and the standard of care.
B. Each licensing board shall maintain a publicly accessible list of licensees who have qualified to perform expanded duties under this section.
C. Nothing in this section shall prevent a board from requiring continuing education or periodic recertification for licensees performing expanded duties.
SECTION 14. EXCEPTIONS
A. This act does not apply to treatment that:
1. Is unsafe for the particular patient based on specific, verifiable medical evidence.
2. Is ineffective for the particular patient based on specific, verifiable medical evidence.
3. Is outside the treating provider's scope of license as defined by Title 32, Arizona Revised Statutes, as that scope may be expanded under Section 11 of this act.
4. Is explicitly excluded from coverage under federal law, including but not limited to the Employee Retirement Income Security Act (ERISA) to the extent that ERISA preempts state law.
B. The insurance company bears the burden of proving that an exception under this section applies.
SECTION 15. SUPERSESSION OF PRIOR CONFLICTING STATUTES
A. This act supersedes any prior Arizona statute that conflicts with its provisions, but only to the extent necessary to effectuate the following specific purposes:
1. Any statute that explicitly prohibits a licensing board from adopting rules that would permit licensees to perform specific procedures or functions that are:
a. Within the scope of practice of the same license in at least ten other states, or
b. If fewer than ten states have such scope of practice, the board may rely on consensus standards from at least two relevant national accrediting bodies, or
c. Recognized as within the profession's standard of care by a relevant national accrediting body.
2. Any statute that requires legislative approval for scope of practice expansions beyond the ninety day notice and response period established in Section 12 of this act.
3. Any statute that limits the class of health care providers who may serve as treating providers for purposes of final judgment under Section 4 of this act.
B. To the extent that any provision of Title 32, Arizona Revised Statutes, as in effect before the effective date of this act, conflicts with the authority granted to licensing boards under Section 11 of this act, the provisions of this act shall govern, but only with respect to the specific conflicting provisions identified in subsection A of this section.
C. This act shall be liberally construed to effectuate its purposes of:
1. Protecting the treating provider's clinical judgment from insurance company interference.
2. Enabling licensing boards to keep scope of practice current with evolving medical knowledge and best practices.
3. Ensuring legislative oversight through the notice and response period established in Section 12.
D. Nothing in this act shall be construed to supersede any provision of Title 32 that is not in direct conflict with the specific provisions identified in subsection A of this section. All other provisions of Title 32 remain in full force and effect.
E. Nothing in this act shall be construed to supersede federal law or any provision of the Arizona Constitution.
SECTION 16. ERISA PROTECTION AND ATTORNEY GENERAL DEFENSE
A. The Attorney General is directed to defend this act against any claim of preemption under the Employee Retirement Income Security Act of 1974 (ERISA) or any other federal law.
B. The Attorney General shall seek any available administrative or judicial relief to maximize the application of this act, including but not limited to:
1. Seeking a declaratory judgment that this act regulates insurance practices traditionally within state authority and does not impermissibly relate to employee benefit plans.
2. Seeking a waiver from any relevant federal agency.
3. Intervening in any action challenging this act.
C. The Legislature finds that this act regulates insurance practices that are traditionally within state authority and does not impermissibly relate to employee benefit plans for purposes of ERISA preemption.
D. To the extent that any provision of this act is preempted by ERISA or other federal law, the remaining provisions shall be severable and shall remain in full force and effect as applied to plans not subject to such preemption.
SECTION 17. SEVERABILITY
If any provision of this act or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the act that can be given effect without the invalid provision or application. To this end, the provisions of this act are severable.
SECTION 18. APPROPRIATION
The sum of $500,000 is appropriated from the state general fund to the Arizona Department of Health Services for distribution to licensing boards to implement the annual review process and scope of practice rulemaking required by this act. The appropriation shall be allocated proportionally based on each board's number of licensees. Any unexpended balance remaining at the end of the fiscal year shall revert to the state general fund.
SECTION 19. EFFECTIVE DATE
This act shall become effective ninety days after the signature of the Governor or upon the expiration of the period for gubernatorial action as provided by law.
