HB2309 - 522R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 36-2982, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2982. Children's health insurance program; administration; nonentitlement; enrollment; eligibility

A. The children's health insurance program is established for children who are eligible pursuant to section 36‑2981, paragraph 6. The administration shall administer the program. All covered services shall be provided by health plans that have contracts with the administration pursuant to section 36‑2906, by a qualifying plan or by either tribal facilities or the Indian health service for Native Americans who are eligible for the program and who elect to receive services through the Indian health service or a tribal facility.

B. This article does not create a legal entitlement for any applicant or member who is eligible for the program. ~~Total enrollment is limited based on the annual appropriations made by the legislature and the enrollment cap prescribed in section 36‑2985.~~

C. The director shall take all steps necessary to implement the administrative structure for the program and to begin delivering services to persons within sixty days after approval of the state plan by the United States department of health and human services.

D. The administration shall perform eligibility determinations for persons applying for eligibility and annual redeterminations for continued eligibility pursuant to this article.

E. The administration shall adopt rules for the collection of copayments from members whose income does not exceed one hundred fifty per cent percent of the federal poverty level and for the collection of copayments and premiums from members whose income exceeds one hundred fifty per cent percent of the federal poverty level. The director shall adopt rules for disenrolling a member if the member does not pay the premium required pursuant to this section. The director shall adopt rules to prescribe the circumstances under which the administration shall grant a hardship exemption to the disenrollment requirements of this subsection for a member who is no longer able to pay the premium.

F. Before enrollment, a member, or if the member is a minor, that member's parent or legal guardian, shall select an available health plan in the member's geographic service area or a qualifying health plan offered in the county, and may select a primary care physician or primary care practitioner from among the available physicians and practitioners participating with the contractor in which the member is enrolled. The contractors shall only reimburse costs of services or related services provided by or under referral from a primary care physician or primary care practitioner participating in the contract in which the member is enrolled, except for emergency services that shall be reimbursed pursuant to section 36‑2987. The director shall establish requirements as to the minimum time period that a member is assigned to specific contractors.

G. Eligibility for the program is creditable coverage as defined in section 20‑1379.

H. On application for eligibility for the program, the member, or if the member is a minor, the member's parent or guardian, shall receive an application for and a program description of the premium sharing program.

I. H. Notwithstanding section 36‑2983, the administration may purchase for a member employer sponsored employer‑sponsored group health insurance with state and federal monies available pursuant to this article, subject to any restrictions imposed by the ~~federal health care financing administration~~ centers for medicare and medicaid services. This subsection does not apply to members who are eligible for health benefits coverage under a state health benefits plan based on a family member's employment with a public agency in this state. END_STATUTE

Sec. 2. Section 36-2985, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2985. Notice of program termination; spending limitation

A. If the director determines that monies may be insufficient for the program, the director shall immediately notify the governor, the president of the senate and the speaker of the house of representatives. After consulting with the governor, the administration shall stop processing new applications for the program until the administration is able to verify that funding is sufficient to begin processing applications and the governor agrees that the administration may begin processing applications.

B. If the federal government eliminates federal funding for the program or significantly reduces the federal funding below the estimated federal expenditures as specified in 42 United States Code section 1397ee, the administration shall immediately stop processing all applications and shall provide at least thirty days' advance notice to contractors and members that the program will terminate.

C. The total amount of state monies that may be spent in any fiscal year by the administration for health care provided under this article shall not exceed the amount appropriated or authorized by section 35‑173.

D. This article does not impose a duty on an officer, agent or employee of this state to discharge a responsibility or to create any right in a person or group if the discharge or right would require an expenditure of state monies in excess of the expenditure authorized by legislative appropriation for that specific purpose. END_STATUTE

Sec. 3. AHCCCS; children's health insurance program; state plan amendment; request for funding

Within five days after the effective date of this section, the Arizona health care cost containment system administration shall do both of the following:

1. Submit to the centers for medicare and medicaid services a state plan amendment for this state's title XXI children's health insurance program to resume enrollment in the program.

2. Project the enrollment rate for the children's health insurance program for the remainder of federal fiscal years 2015‑2016 and 2016‑2017 and request from the centers for medicare and medicaid services any additional allotment needed to resume enrollment in the children's health insurance program.

Sec. 4. Conditional enactment; notice

A. Sections 36-2982 and 36-2985, Arizona Revised Statutes, as amended by this act, do not become effective unless on or before July 1, 2017 the centers for medicare and medicaid services approve this state's state plan amendment to resume enrollment in the children's health insurance program.

B. The director of the Arizona health care cost containment system shall notify in writing the director of the Arizona legislative council on or before July 15, 2017 either:

1. Of the date on which the condition was met.

2. That the condition was not met.