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View metadata, citation and similar papers at core.ac.ukbrought to you byCOREprovided by ASU Digital RepositoryAHCCCS 2008 Legislative SummaryArizona Health Care Cost Containment SystemOffice of Intergovernmental Relations
AHCCCS- Initiated LegislationSB1133AHCCCS; DES; new hires directory (Senator Leff)DispositionEnacted; Chapter 79Effective DateSeptember 26, 2008Summary Conforms Arizona Revised Statutes to federal laws allowing AHCCCS to useinformation compiled in the Arizona New Hire Directory to verify eligibilityfor Medicaid programs.SB1223DispositionEffective DateSummaryinsurance; long-term care (Senator Allen)Enacted; Chapter 230July 1, 2009 SB1329Implements the requirements of the Deficit Reduction Act of 2005 into statestatute to allow AHCCCS to participate in Long-Term Care PartnershipPrograms with private insurance industry.AHCCCS; self-directed care services (Senator Allen)DispositionEnacted; Chapter 58Effective DateSeptember 26, 2008Summary Allows qualified members of the Arizona Long-Term Care System (ALTCS)who are participating in home and community-based services to appoint anattendant caregiver to provide specific services as designated in rule by theAdministration, in consultation with the Board of Nursing.Requires AHCCCS to report on utilization of the Self-Directed Care Programby January 1, 2011.2
AHCCCS- Related LegislationHB2166DispositionEffective DateSummaryAHCCCS; healthcare group; waiting period (Representative Prezelski)Failed to pass out of the HouseSeptember 26, 2008 HB2208DispositionEffective DateSummarygraduate medical education; federal match (Representative Burns)Enacted; Chapter 158September 26, 2008 HB2247DispositionEffective DateSummaryEliminates the bare period as a requirement to enroll in Healthcare GroupRequires AHCCCS to seek federal authorization to define certain activitiesassociated with administering graduate medical education programs in hospitalfacilities as “administrative activities” for the purpose of drawing downadditional federal matching funds.Indian Affairs Commission; legislative day (Representative Tom)Failed to pass out of the SenateSeptember 1, 2009 Adds the Director of AHCCCS as one of two non-voting members on theArizona Commission of Indian AffairsCombines the activities and authority of the Arizona Commission of IndianAffairs and the Advisory Council on Indian Health CareRequires AHCCCS to request a waiver from federal requirements that wouldenable tribal authorities who conduct TANF eligibility determinations to alsoconduct Medicaid eligibility determinationsUpon approval of the waiver, requires the State to provide matching funds forexpanded eligibility activitiesEstablishes a fund for revised Commission activities3
HB2326DispositionEffective DateSummaryAHCCCS; naturopathic services (Representative Stump)Failed to pass out of the HouseSeptember 26, 2008 HB2399DispositionEffective DateSummaryAHCCCS; healthcare group (Representative Farley)Failed to pass out of the HouseSeptember 26, 2008 HB2400DispositionEffective DateSummaryEffective DateSummaryExempts employer groups with five or more employees from the bare periodrequirementAHCCCS; member’s employers; reports (Representative Farley)Failed to pass out of the HouseSeptember 26, 2008 HB2401DispositionAdds naturopathic services to the list of covered services available toAHCCCS membersRequires AHCCCS to report by November 15th of each year to the Legislatureon the number of employers represented in Healthcare Group and how many ofeach businesses’ employees are enrolled in Healthcare Grouphealthcare businesses; consumer information (Representative Farley)Failed to pass out of the SenateSeptember 26, 2008 Requires healthcare businesses to disclose whether individually identifiableinformation is transmitted to a contractor outside of the United States4
HB2462DispositionEffective DateSummarys/e: healthcare group (Representative Burns)Failed to pass out of the SenateRevised enrollment limit effective August 1, 2008; Additional provisions have ageneral effective date HB2503DispositionEffective DateSummaryMakes numerous changes to Healthcare Group (HCG) enrollment and contractrequirementsEffective July 1, 2007, limits enrollment to no more than 10% of total enrolledemployer groupsEliminates the 180-day bare periodEliminates groups of one from those who are eligible to enroll in HCGProhibits HCG from reimbursing non-contract hospitals for non-emergencyservices and those not required for post-emergency stabilizationLimits HCG reimbursement to non-contracted hospitals to 114% of AHCCCSreimbursement rates for emergency and post-stabilization servicesRequires HCG to set premiums that, in the aggregate, cover the costs ofadministering the program based on an analysis conducted by an independentactuaryAllows HCG to consider health-related factors when establishing ratesRequires HCG to provide the following items to the Joint Legislative BudgetCommittee (JLBC):o Quarterly financial reportso Annual fiscal auditso Actuarial analysis used to establish premiumsdurable medical equipment; report (Representative Burns)Enacted; Chapter 180September 26, 2008 Requires AHCCCS to report the following items to the Legislature byNovember 15, 2008:o A list of vendors who provide durable medical equipment (DME) toAHCCCS and its contracted health planso The number of enrolled members utilizing DMEo The number and outcomes of grievances filed with the Administration andcontracted health plans related to DME provision and repair5
HB2505DispositionEffective DateSummarychild support; medical insurance (Representative Barto)Enacted; Chapter 181September 26, 2008 HB2541DispositionEffective DateSummaryAHCCCS; breast cancer treatment (Representative Sinema)Failed to pass out of the HouseSeptember 26, 2008 HB2669DispositionEffective DateSummaryFailed to pass out of the SenateSeptember 26, 2008 HB2703Effective DateSummaryRequires AHCCCS to provide breast cancer treatment to eligible membersregardless of where they obtained their breast cancer screeningbehavioral health delivery system; study (Representative Barto) DispositionIn child custody cases, requires the Court to determine whether or not eitherparent has access to health coverage or has AHCCCS coverageIf neither parent has health-care coverage, requires the court to determinewhether additional financial support is necessary to ensure medical coveragefor the childEstablishes the 19 member Behavioral Health Task Force to study the State’sbehavioral health service delivery systemRequires the Task Force to report on its progress to the Governor and theLegislature by December 15, 2008large employers; AHCCCS; reimbursement (Representative Alvarez)Failed to pass out of the HouseSeptember 26, 2008 Requires an employer with 100 or more employees to reimburse AHCCCS forthe cost of covering an employed individual who is enrolled in the program6
HB2777DispositionEffective DateSummaryAHCCCS; DES; fraud reduction (Representative Crump)Failed to pass out of the SenateSeptember 26, 2008 HB2840DispositionEffective DateSummaryhealth care; high risk program (Representative Adams)Failed to pass out of the HouseEffective January 1, 2010 HCR2044DispositionSummaryRequires AHCCCS and DES to conduct a pilot project with a vendor on fraudreduction technologyRequires AHCCCS and DES to enter into a contract with a vendor forprescribed fraud reduction technology measuresEstablishes the Healthcare Group High Risk Program to provide medicalcoverage for individuals who are unable to obtain medical coverage in theprivate sectorEstablishes a Board of Directors to implement and administer the HealthcareGroup High Risk ProgramProvides that funding for the Healthcare Group High Risk Program shall beallocated from member premiums that are limited to 150%-200% of thestandard rate and surplus premium tax revenues collected from private insurersRepeals Healthcare Group effective January 1, 2011voter-protection; temporary budget suspension (Representative Pearce)Failed to pass out of the Senate A ballot initiative that proposes to suspend voter-approved spendingrequirements in the event that both JLBC and OSPB provide written findingsthat the fiscal year is projected to end with a deficit7
SB1072DispositionEffective DateSummaryAHCCCS; proof of citizenship (Senator Harper)Failed to pass out of the SenateSeptember 26, 2008 Requires AHCCCS to report individuals who have been identified to be illegalimmigrants to immigration authoritiesStipulates that employees and supervisors who do not comply with thisrequirement are guilty of a Class 2 MisdemeanorProhibits AHCCCS employees from accepting state or locally-issuedidentifying documentation from an individual unless the person’s citizenshipstatus has been verifiedEstablishes a cause of action for any individual who has discovered a violationof these requirementsSB1093DispositionEffective DateSummaryinsurance providers; long-term care (Senator Allen)Failed to pass out of the Senate; language enacted on SB1223 (Chapter 230)July 1, 2009 SB1234DispositionEffective DateSummaryAHCCCS; occupational therapy; speech therapy (Senator Allen)Failed to pass out of the SenateOctober 1, 2008 SB1250DispositionEffective DateSummaryImplements the requirements of the Deficit Reduction Act of 2005 into statestatute to allow AHCCCS to participate in Long-Term Care PartnershipPrograms with private insurance industryAdds outpatient occupational and speech therapy to the list of covered servicesavailable to AHCCCS membersprescription marketing costs; full disclosure (Senator Burton Cahill)Failed to pass out of the SenateFebruary 1, 2009 Requires prescription drug manufacturers or labels to submit an annual reportof their marketing costs in Arizona to AHCCCSRequires AHCCCS to biennially report on prescription drug marketingactivities to the Governor and Legislature beginning October 1, 20108
SB1376DispositionEffective DateSummaryAHCCCS; hospital reimbursement (Senator O’Halleran)Failed to pass out of the HouseSeptember 26, 2008 (Some provisions have a delayed effective date) SB1389DispositionEffective DateSummaryEstablishes a Hospital Reimbursement Advisory Council to overseecompliance with AHCCCS timely pay requirementsMakes numerous changes to AHCCCS contract health plan timely payrequirements and revises late payment penalties for health plans in violation oftimely pay requirementsEstablishes rule-making and administrative requirements for AHCCCS relatedto revised timely pay requirementsRequires that the Administration convene a workgroup to consider severalissues including “date received” and supplemental recoupment and transmittalrequirementsRequires the Director to establish a process and timeline to sanction contracthealth plans that do not meet revised timely pay requirementshealthcare group; health plans; information (Senator Chuevront)Failed to pass out of the HouseRevised enrollment limit effective August 1, 2008; Additional provisions have ageneral effective date Makes numerous changes to Healthcare Group (HCG) enrollment and contractrequirementsLimits enrollment to no more than 10% of total enrolled employer groupsEliminates the 180-day bare periodEliminates groups of one from those who are eligible to enroll in HCGProhibits HCG from reimbursing non-contract hospitals for non-emergencyservices and those not required for post-emergency stabilizationLimits HCG reimbursement to non-contracted hospitals to 114% of AHCCCSreimbursement rates for emergency and post-stabilization servicesRequires HCG to set premiums that, in the aggregate, cover the costs ofadministering the program based on an analysis conducted by an independentactuaryAllows HCG to consider health-related factors when establishing ratesRequires HCG to provide the following items to the Joint Legislative BudgetCommittee (JLBC):o Quarterly financial reportso Annual fiscal auditso Actuarial analysis used to establish premiums9
SB1418DispositionEffective DateSummarytobacco cessation; coverage; AHCCCS (Senator Leff)Enacted; Chapter 131October 1, 2008 Allows AHCCCS and its contracted health plans to offer tobacco-cessationmedications and nicotine replacement therapies to enrolled Medicaid (TitleXIX) membersStipulates that funding for these services shall not come from the General Fund10
Budget LegislationHB2043DispositionEffective DateSummaryFY 2007-2008 state hiring; moratorium (Representative Robson)VetoedEmergency Measure HB2209DispositionProhibits state agencies from hiring or promoting employees through FY 20072008general appropriations act; 2008-2009 (Representative Burns)Enacted; Chapter 285Effective Date Emergency MeasureSummary Makes appropriations to state agencies for the administration of activities in FY2008-2009AHCCCS APPROPRIATIONSAgency Lump Sum Reduction: 1MAdministration- 210.9M Operating Budget- 70.1M DOA Data Center Charges- 5.7M Indian Advisory Council- 233K DES Eligibility- 55.7M DES Title XIX Pass-Thru- 358K Healthcare Group & Reinsurance- 11.5M Office of Administrative Hearings- 271K Kidscare Administration- 9.4M Prop. 204 AHCCCS Administration- 11.4M Prop. 204 DES Eligibility- 43.6M DES Eligibility System Upgrade- 2.6MAcute Care- 4.8B Capitation 2.1B Reinsurance 134.2M Fee-for-Service: 573.4M Medicare Premiums: 96.3M GME: 45M Prior Year TMC Reconciliation: 3.2M Dual Eligible: 1M11
DSH: 30.4MCritical Access Hospitals: 1.7MBreast & Cervical Cancer: 1.5MTicket to Work: 8.9MProp 204- Capitation: 1.2BProp 204- Reinsurance: 130MProp 204- Fee-for-Service: 243.4MProp 204- Medicare Premiums: 31.3MProp 204- County Hold Harmless: 4.8MKidscare Children: 145.3MKidscare Parents: 35MRural Hospital Reimbursement: 12.2MMedicare Clawback Payments: 29MALTCS- 1.2B Program Lump Sum: 1.2B Medicare Clawback: 20.7M Dual Eligible: 470K Board of Nursing: 210KAHCCCS POLICY PROVISIONSDisproportionate Share Stipulates that the 30.4M appropriation for disproportionate share payments for FY 20082009 includes 4.2M for Maricopa County Healthcare District and 26.1 M for privatequalifying disproportionate share hospitalsProposition 204 County Hold Harmless Outlines distributions to counties under the Prop. 204 county hold harmless line-item asfollowsTemporary Medical Coverage Reconciliation Stipulates that prior year temporary medical coverage program reconciliation shall be used topay claims with dates of service prior to July 1, 2008HB2275DispositionEffective DateSummarynow: budget reconciliation; health (Representative Hershberger)Enacted; Chapter 288September 26, 2008 Establishes policy guidance related to the administration of healthprograms in FY 2008-2009Provides the following policy guidelines for AHCCCS:12
Redeterminations Establishes a six-month redetermination period for childless adults over 21 years of ageBudget Neutrality Compliance Fund In FY 2008-2009, requires counties with two million or more persons to transfer 24,168,400 toAHCCCS for deposit into the Budget Neutrality Compliance Fund Requires counties with more than eight hundred thousand, but less than two million persons totransfer 3,794,400 to AHCCCS for deposit into the Budget Neutrality Compliance Fund In FY 2008-2009, prohibits AHCCCS from transferring 17,830,500 to counties for refunds ofALTCS costs for FY 2006-2007 and FY 2007-2008 Requires AHCCCS to instead deposit 17,830,500 in the Budget Neutrality Compliance FundTemporary Medical Coverage Suspends the TMC program during FY 2008-2009Hospital Reimbursement Rates Effective October 1, 2008-September 30, 2009, AHCCCS is prohibited from increasing inpatienthospital per diem rates, inpatient hospital outlier thresholds and aggregate hospital fee schedulerates above levels in effect on September 30, 2008 Provides that AHCCCS may continue to phase-in outlier cost-to-charge ratios as prescribed inthe FY 2007-2008 budgetCounty Contributions and Withholding Outlines county Acute Care, ALTCS and hospital and medical care contribution levels Stipulates that if counties do not make their required contributions, the State Treasurer shallreduce the contribution (plus interest) from that county’s portion of state-shared revenues,excluding HURF Expresses Legislative intent that the Maricopa County’s Acute Care contribution shall bereduced each year in accordance with the GDP Price DeflatorDisproportionate Share Provides that FY 2008-2009 disproportionate share payments are:o 89.9M for a qualifying nonstate operated public hospitalo 28.6M for the Arizona State HospitalKidsCare Parents Establishes KidsCare Parents in statute (previously session law) at current eligibility levels Stipulates that eligibility and program administration are dependent upon the continuation ofenhanced federal matching funds Stipulates that the program ends on the expiration of the enhanced matching rate Requires individuals enrolled in the program to make monthly premiums as follows:o 100%-149% FPL: 3% household incomeo 150%-174% FPL: 4% household incomeo 175%-200% FPL: 5% household income13
Healthcare Group Allows HCG to establish a PPO only in counties with less than 500,000 persons Eliminates eligibility for groups of one (grandfathers currently enrolled groups of one) Shortens the bare period to 90 days Prohibits HCG from reimbursing non-contracted hospitals for non-emergency services Establishes the reimbursement rate for emergency services performed in a non-contractedhospital as follows:o Counties with 500,000 or more persons: 114% AHCCCS default rateso Counties with less than 500,000 persons: 125% AHCCCS default rates Eliminates the prohibition against the consideration of health-related factors when establishingpremium levels Requires HCG to adjust premiums in accordance with an analysis performed by an independentactuary Requires HCG to establish premiums that, in the aggregate, cover projected medical andadministrative costs for that contract period and that are consistent with generally acceptedprinciples and practices as determined by an independent actuary Prohibits a plan from providing services that are not part of the contract Requires HCG to establish utilization control standards for contractors that meet nationalstandards for utilization management control Prohibits HCG from enrolling more than 5% of the number of employer groups enrolled duringthe prior fiscal year Requires HCG to give priority to uninsured groups Requires HCG to report the following to JLBC:o Quarterly financial reportso Annual fiscal auditActuarial analysis used to adjust ratesHB2620budget adjustments; fiscal year 2007-2008 (Representative Boone)DispositionEnacted; Chapter 53Effective DateEmergency MeasureSummary Adjusts the enacted FY 2007-2008 budget to address the projected deficitAHCCCS CHANGES: Shifts 73.06 from AHCCCS Emergency Services to the General Fund Appropriates 4.7M from the General Fund in FY 2007-2008 to AHCCCS Reduces the FY 2007-2008 appropriation to AHCCCS from the Medically Needy Account by 13.1M Reduces the FY 2007-2008 appropriation from the Emergency Health Services Account toAHCCCS by 4.1M Requires counties with a population of two million or more persons to transfer 5.5M toAHCCCS for deposit in the Budget Neutrality Compliance Fund14
Requires counties with a population of less than two million persons to transfer 1.5M toAHCCCS for deposit in the Budget Neutrality Compliance FundAppropriates 7,026,800 from the Budget Neutrality Compliance Fund to AHCCCS.HB2857DispositionEffective DateSummaryfiscal year 2007-2008 budget adjustments (Representative Boone)VetoedEmergency Measure Prohibits state agencies from expending or encumbering various statefunds in anticipation of the FY 07-08 budget adjustment15
AHCCCS members . HB2399 . AHCCCS; healthcare group (Representative Farley) Disposition . . information is transmitted to a contractor outside of the United States . 4. HB2462 . s/e: healthcare group (Representative Burns) . of their marketing costs in Arizona to AHCCCS .
