REFERENCE TITLE: AHCCCS; provider participation; exclusions




State of Arizona

House of Representatives

Fifty-second Legislature

Second Regular Session




HB 2599


Introduced by

Representative Olson





Amending title 36, chapter 29, article 1, Arizona Revised Statutes, by adding section 36-2930.02; relating to the Arizona health care cost containment system.





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

Section 1.  Title 36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding section 36-2930.02, to read:

START_STATUTE36-2930.02.  Provider participation; grounds for exclusion

A.  The administration shall exclude a provider from participation in the system and shall terminate the provider's agreement with the administration pursuant to federal law on the occurrence of any of the following:

1.  The provider's conviction for a system-related crime.

2.  The provider's conviction related to patient abuse or neglect.

3.  The provider's felony conviction for health care fraud.

4.  The provider's felony conviction relating to controlled substances.

5.  The provider's termination for cause by the administration under the children's health insurance program or under title XVIII of the social security act.

B.  The administration may exclude, in its sole discretion, a provider from participation in the system pursuant to federal law and may terminate the provider's agreement with the administration if the provider has done any of the following:

1.  Submitted a claim for payment to the administration for excessive charges over the allowable reimbursements for such charges.

2.  Submitted a claim for payment to the administration for medically unnecessary services or services that failed to meet professionally recognized standards of health care.

3.  Submitted a claim for payment to the administration that the provider knew or should have known was fraudulent.

4.  Accepted a payment kickback or engaged in another activity that is prohibited under federal law.

5.  Submitted a claim for a provider that is controlled by a sanctioned provider.

6.  Failed to disclose required information, supply requested information or supply payment information to the administration.

7.  Made a false statement or misrepresentation of material fact.

8.  Failed to ensure that services or items are provided economically and only when and to the extent that is medically necessary.

9.  Failed to ensure that a service or item was of a quality that meets professionally recognized standards of health care and was supported by evidence of medical necessity and quality.

10.  been found liable for the neglect of a patient that results in death or injury.

11.  Engaged in the unlawful disposal of medical waste in violation of federal, state or local law.

12.  Submitted a claim for a procedure performed in association with an abortion in violation of federal or state law.

13.  Failed to segregate taxpayer dollars from abortions, including the use of taxpayer dollars for any overhead expenses attributable to abortions.

14.  Failed to comply with federal or state law requiring mandatory reporting of sexual abuse, sexual assault, child or sex trafficking or statutory rape.

C.  the delineation of grounds for exclusion pursuant to subsections A and B of this section does not exclude any other basis for exclusion pursuant to state law or policy as determined by the administration.

D.  The administration shall suspend payments under this article to any provider that is the subject of a credible allegation of fraud and against whom an investigation is pending under the system unless the administration finds that good cause exists not to suspend the payments. END_STATUTE

Sec. 2.  Short title

This act shall be known as the "Taxpayer Protection and Medicaid Integrity Act".

Sec. 3.  Severability

If a 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, and to this end the provisions of this act are severable.