Assigned to HEALTH                                                                                                                      FOR COMMITTEE

ARIZONA STATE SENATE

Fiftieth Legislature, First Regular Session

FACT SHEET FOR S.B. 1357

AHCCCS; missed appointments; provider remedy

Purpose

            Allows a physician or primary care provider (PCP) to prohibit a member of the Arizona Health Care Cost Containment System (AHCCCS) from rescheduling an appointment until the AHCCCS member pays a missed appointment fee, if the appointment was not cancelled in advance.

Background

            The AHCCCS Administration is responsible for administering Arizona’s Medicaid program, which includes both acute medical care and long-term care services.  For its acute care members, the AHCCCS Administration contracts with health plans to provide coverage.  The health plans, in turn, negotiate rates of service and contract with physicians and other providers to deliver care.

            Federal Medicaid requirements limit the level and type of cost-sharing that providers may charge to AHCCCS members. AHCCCS Administration rules outline standards for payments and charges (R9-22-702).  The rules currently state that an AHCCCS provider may not charge more than the actual, reasonable cost of providing a service.  Additionally, a provider may charge, submit a claim to or demand or collect payment from an AHCCCS member only as follows: a) to collect an authorized copayment; b) to recover a duplicative payment made by a third party, if payment is not assigned to the health plan contractor; and c) to obtain payment from a member for medical expenses incurred during a period when the member intentionally withheld information or provided inaccurate information that caused payment to the provider to be reduced or denied.

            To date, the AHCCCS Administration has been advised by the Centers for Medicare and Medicaid Services (CMS) that charging a fee for a missed appointment is in conflict with federal law that prohibits the imposition of cost-sharing on traditional Medicaid populations.

            The fiscal impact associated with this legislation is unknown.

Provisions

1. Authorizes physicians or PCPs who provide acute care services to AHCCCS members to charge a $25 fee to an AHCCCS member if the member misses an appointment and does not cancel the appointment in advance.

2. Permits the physician or PCP to prohibit the AHCCCS member from rescheduling until the $25 fee is paid.

3. Becomes effective on the general effective date.

Prepared by Senate Research

February 14, 2011

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