BILL #    SB 1016	TITLE: AHCCCS; speech therapy
SPONSOR:    Shope	STATUS: As Introduced
PREPARED BY:    Maggie Rocker

Description

The bill would add outpatient speech therapy as an AHCCCS benefit for adults ages 21+. AHCCCS currently covers medically necessary inpatient speech therapy ordered by a physician. Outpatient speech therapy as a benefit is only available for KidsCare and ALTCS members as well as children under age 21 receiving Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services.

Estimated Impact

AHCCCS actuaries estimate the full-year cost of providing outpatient speech therapy for acute care adults within AHCCCS would be $139,500 General Fund ($746,200 Total Funds).

AHCCCS has not yet responded to our request for their assumptions and methodology.  As a result, we are unable to evaluate the reasonableness of their estimate.

Analysis

Speech therapy entails treatment for problems with language, speaking, or swallowing, including such services as lip reading, non-oral language training, and articulation training. Currently all populations within AHCCCS are eligible to receive medically necessary inpatient speech therapy ordered by a physician. Outpatient speech therapy, however, is only offered as a benefit for KidsCare members, ALTCS members, and children receiving EPSDT services.

In a Senate committee hearing, AHCCCS quoted a full-year implementation cost of $139,500 General Fund ($746,200 Total Funds), or $104,600 General Fund ($559,600 Total Funds) for the last 9 months of FY 2024. We are still awaiting additional information regarding their methodology.

Local Government Impact

None

2/1/23

Using data from Calendar Year 2020, AHCCCS assumes 6,654 acute adults would receive inpatient speech therapy in future years, and that 20% of those members (1,331) would receive outpatient speech therapy following the inpatient visit. Based on the average use of outpatient speech therapy by ALTCS adults, AHCCCS estimates an average annual cost of $414 for each user.

The number of eligible acute adults multiplied by the per member per year cost would result in an annual cost of approximately $550,600 Total Funds ($58,400 General Fund; $44,600 Hospital Assessment). AHCCCS's analysis assumes