Assigned to APPROP FOR
CAUCUS & FLOOR ACTION
ARIZONA STATE SENATE
Fifty-First Legislature, First Regular Session
REVISED
AMENDED
FACT SHEET FOR S.B. 1492
2013-2014; health; welfare; budget reconciliation
Purpose
Makes statutory and session law changes relating to health and welfare to reconcile the FY 2014 state budget.
Background
The Arizona Constitution prohibits substantive law from being included in the general appropriations, capital outlay appropriations and supplemental appropriations bills. However, it is often necessary to make statutory and session law changes to effectuate the budget. Thus, separate bills called budget reconciliation bills (BRBs) are introduced to enact these provisions. Because BRBs contain substantive law changes, the Arizona Constitution provides that they become effective on the general effective date, unless an emergency clause is enacted.
Provisions
Arizona Health Care Cost Containment System (AHCCCS)
Coverage for Adults without Dependent Children (childless adults)
1. Requires the AHCCCS Administration (Administration), within 30 days after the effective date of this act, to apply to the Centers for Medicare and Medicaid Services (CMS) for an amendment to the state's waiver to continue its authority that was in effect on January 1, 2013 to provide coverage for childless adults. Requires the application to request federal matching dollars for this population.
2. Requires the Administration within seven days after receipt of a written response from CMS to provide a copy of the response to the Directors of the Joint Legislative Budget Committee (JLBC), the Governor's Office of Strategic Planning and Budgeting (OSPB) and the Arizona Department of Administration (ADOA).
3. Appropriates the following in FY 2014 for childless adults, if CMS does not approve the waiver amendment:
a) $108,065,500 from the Budget Stabilization Fund to AHCCCS for medical services; reduces the federal Medicaid expenditure authority by a corresponding amount; and
b) $27,016,400 from the Budget Stabilization Fund to the Department of Health Services (DHS) for behavioral health services and reduces the federal Medicaid expenditure authority by a corresponding amount.
Disproportionate Share Hospital (DSH) Payments and Safety Net Care Pool (SNCP)
4. Requires the Maricopa County Special Health Care District (District) and the Arizona State Hospital (State Hospital) to each provide a Certified Public Expense (CPE) form for the amount of qualifying DSH expenditures to the Administration by May 1, 2014 for the District and March 31, 2014 for the State Hospital.
5. Establishes the FY 2014 DSH payments at the following amounts:
a) $89,877,700 attributed to the District, of which $4,202,300 is distributed to the District and the remaining federal portion is deposited into the state General Fund (GF);
b) $26,724,700 attributed to the State Hospital, of which the federal portion is deposited into the state GF; and
c) $9,284,800 for private qualifying DSH hospitals.
6. Requires the District to provide a CPE form for the amount of DSH payment authority remaining, if any, after SNCP payments are made and requires the Administration to deposit all federal funds in excess of $89,877,700 into the state GF.
7. Extends the time for political subdivisions to participate in SNCP from September 30, 2013 to December 31, 2013.
8. Continues to require the Administration to assist the District and State Hospital in determining the amount of qualifying expenditures and maintains reporting requirements and distribution procedures of received federal matching funds in FY 2014.
9. Continues to allow political subdivisions, tribal governments and public state universities to provide matching monies for DSH payments to designated hospitals, subject to federal law limitations in FY 2014.
County Contributions
10. Establishes county contributions for the Arizona Long-Term Care System (ALTCS) in FY 2014 totaling $244,696,100, increased from $243,220,500 in FY 2013. Continues the collection procedure by the State Treasurer of any costs exceeding the amount specified in the General Appropriations Act in FY 2014.
11. Continues to require the Administration to transfer to the counties the excess state match monies, if any, which is proportional to the counties' share of the state contribution in order to comply with the Patient Protection and Affordable Care Act. Requires the transfer to be made by December 31, 2014.
12. Sets total county contributions for acute care for FY 2014 at $47,851,000. Decreases Maricopa County's acute care contribution to $19,820,700, pursuant to the stated legislative intent that Maricopa County's contribution be reduced by an inflation index. Continues the FY 2014 acute care contributions and related requirements for all other counties at the FY 2013 levels.
13. Continues county contributions to AHCCCS in FY 2014 for the provision of hospitalization and medical care at FY 2013 levels, for a total amount of $2,646,200. Continues to exempt Maricopa County from these payments. Continues payment procedures and exclusions for counties from expenditure limitations.
14. Continues to exclude county contributions for Proposition 204 administrative costs from county expenditure limitations in FY 2014.
Medicare Liability Waiver
15. Continues the Administration's ability to participate in any Special Disability Workload 1115 Demonstration Waiver offered by CMS, and requires any credits provided by the waiver process to be used in the fiscal year when those credits are made available to fund the state share of medical assistance expenditures for participation under the Medicaid program.
16. Requires the Administration to report the receipt of any credits to the JLBC Director by December 31, 2013 and June 30, 2014.
AHCCCS Miscellaneous
17. Eliminates as permanent law, the exclusion of the following nonexperimental transplants for eligible persons:
a) pancreas after kidney transplants;
b) lung transplants;
c) hemopoetic cell allogenic unrelated transplants;
d) heart transplants for non-ischemic cardiomyopathy; and
e) liver transplants for diagnosis of hepatitis C.
18. Allows the Administration, in contract year (CY) 2014, to continue the risk contingency rate setting and funding for all managed care organizations, at the levels imposed in CY 2011.
19. Requires, for CY 2014, the Administration to reimburse ambulance service providers at a rate of 68.59 percent of the amounts prescribed by DHS.
20. Requires the Administration to report by December 1, 2013 to the Directors of JLBC and OSPB on the use of emergency departments for nonemergency purposes by AHCCCS enrollees.
21. Sets as permanent law, the inpatient hospital prospective tiered per diem payment rates, to the rates effective on October 1, 2011, which are the current payment rates.
22. States it is the Legislature's intent for the Administration:
a) to implement a program within the available appropriation for FY 2014;
b) to comply with the Federal False Claims Act, to maximize savings and continue to consider the best available technologies in detecting fraud; and
c) not to exceed a three percent capitation rate increase in FY 2015 and FY 2016.
Department of Health Services (DHS)
23. Continues to require, for FY 2014, counties to reimburse DHS for 50 percent of the costs for commitment to the State Hospital of individuals determined by the court to be sexually violent persons (SVP) and maintains reimbursement procedures.
24. Continues to require, for FY 2014, cities or counties to reimburse DHS 100 percent of defendant inpatient restoration to competency (RTC) treatment costs at the State Hospital and maintains reimbursement procedures.
25. Continues to allow, for FY 2014, a county to meet reimbursement requirements for SVP and RTC costs from any source of county revenue, including funds of any countywide special taxing district in which the board of supervisors serves as the board of directors.
26. Continues to allow DHS to use monies in the Health Research Account as specified in the General Appropriations Act for Alzheimer's disease research.
27. Transfers all monies remaining in the Hearing and Speech Professionals Fund on the effective date of this act to the Health Services Licensing Fund.
Department of Economic Security (DES)
28. Continues the ability of DES to reduce the maximum income eligibility levels for child care assistance in FY 2014 in order to manage within appropriated and available monies. Requires DES to notify JLBC within 15 days of making a change.
29. Continues, in FY 2014, the requirement that DES screen and test adult Cash Assistance recipients who DES has reasonable cause to believe engage in the illegal use of controlled substances. Renders a recipient who tests positive for a non-prescribed controlled substance ineligible for benefits for one year.
30. Continues to allow DES to use monies in the Department Long-Term Care System Fund (LTCS Fund) for any operational or programmatic expenses in FY 2014 and allows the ADOA to use monies in the LTCS Fund for distribution to counties for operational expenses in FY 2014.
Reporting Requirements
31. Requires the Directors of JLBC, OSPB and DES to report by September 1, 2013 to the Governor and Legislature recommendations for consolidating outlined DES reports. The report shall consider the frequency of reports, may include input from stakeholder groups, and shall address the merit of adding the following accountability factors:
a) the average time from which a child enters emergency or residential placement until the child's initial court case;
b) the number of children moved from emergency and residential placement to foster care by age groupings;
c) the number of CPS staff hired and leaving, by classification level;
d) the number of new and closed foster care receiving homes, including total number of placements by age groupings; and
e) cohort and behavioral health data.
32. Requires the Office of the Auditor General to provide the following reports to the Governor, Legislature, JLBC and OSPB on expenditures for the following DES children support services:
a) recruitment, retention, training, licensing and tracking of foster care families, including whether DES's current contract process of home recruitment study and supervision is the most appropriate means to provide these services. This report must also address the best performance measures for evaluation of service effectiveness;
b) transportation services, including descriptions and cost details; and
c) the special line item on emergency and residential placement, including a description of the reasons for the high usage of such placements, rather than foster homes, and the possible methods for reducing the use of emergency and residential placements.
d) Requires the first report to be submitted by October 15, 2013, the second report by March 15, 2014 and the final report by October 15, 2014.
Health Care Providers and Facilities Direct Pay Price
33. Requires a health care provider (provider) to make available on request or online, the provider’s direct pay price (price) for at least the 25 most commonly provided services, excluding emergency services, and allows the services to be identified by a common procedural terminology code or by a plain-English description.
34. Requires a health care facility (facility) to make available on request or online, the facility’s price for at least the 50 most used diagnosis-related group codes and at least the 50 most used outpatient service codes for a facility with more than 50 inpatient beds, if applicable for the facility. A facility with 50 or few inpatient beds must make at least the 35 most used codes available.
35. Stipulates a facility is not required to make prices available if a discussion of the direct pay price would be a violation of the Federal Emergency Medical Treatment and Labor Act (EMTALA).
36. Stipulates the price shall be for the standard treatment provided for the service and may include the cost of treatment for complications or exceptional treatment and requires the prices to be updated at least annually and based on the services from a 12-month period that occurred within the 18-month period preceding the update.
37. States that making prices available does not prevent a provider or facility from offering either additional discounts or services at an additional cost.
38. Stipulates a provider is not required to report prices for review or filing and a facility is not required to report prices for review to a government agency or department or to an entity authorized or created by the government, and prohibits such agency, department or entity from approving, disapproving or limiting a facility or provider’s price for services.
39. Stipulates a government agency, department or entity may not limit a provider or facility’s ability to change the published or posted prices.
40. Prohibits an insurer from punishing a person for paying directly or accepting payment for services.
41. Deems a provider or facility that accepts direct payment as paid in full if the entire fee for the service is paid and prohibits the provider or facility from submitting the claim to an insurer for payment, except as outlined. Clarifies a provider or facility is not prevented from pursuing a health care lien for customary charges.
42. Stipulates a provider or facility is not required to refund or adjust any capitated payment, bundled payment or other form of prepayment or global payment made by an insurer.
43. Requires a provider or facility that is contracted as a network provider, before accepting direct payment from a person or employer, to obtain the person’s (or employer’s) signature on a prescribed form (form).
44. States a provider or facility that accepts direct payment is not responsible for submitting a claim for reimbursement, if failure to submit such documentation does not conflict with contract terms or programs to which the provider or facility has agreed.
45. Stipulates this law does not impair an insurer’s private network provider contracts, except that a provider or facility may accept direct payment from a person or employer or may decline to bill an insurer for services directly paid for, if the provider or facility has complied with the requirements of the form and if declining to bill does not conflict as outlined.
46. Makes it an act of unprofessional conduct for a provider who does not comply with outlined requirements and stipulates that any disciplinary action taken by the health care provider's licensing board may not include revocation of license.
47. States the Department of Health Services (DHS) is not prevented from investigating facilities under DHS's jurisdiction and stipulates that if a facility fails to comply with requirements of making prices available, the penalty shall not include license revocation.
48. Exempts the following entities from the requirements of making prices available: a) Veterans Administration facilities; b) health facilities on military bases; c) Indian Health Services hospitals and facilities; d) tribal owned clinics; e) the Arizona State Hospital; f) any health care facility determined to be exempt as outlined, including those that do not serve the general public; and g) entities with fewer than three licensed health care providers.
49. Defines direct pay price, emergency services, enrollee, health care facility, health care insurer, health care plan, health care provider, health care system, health insurance plan, lawful health care services and punish.
50. Contains a severability clause, an effective date of January 1, 2014, and a delayed repeal date of January 1, 2022 for the sections related to the direct pay price.
Miscellaneous
51. Codifies Arizona Medical Board rules by requiring verification of an applicant's previous hospital affiliations and employment as outlined and of all licenses from other states where the applicant has held a medical license. Allows for electronic or hard copy verification.
52. Makes technical changes.
53. Becomes effective on the general effective date.
Amendments Adopted by Committee
Revised
Senate Action
APPROP 5/15/13 DPA 6-3-0-0
Prepared by Senate Research
May 16, 2013
MY/tf