HB2945 - 571R

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

Section 1. Title 36, chapter 29, Arizona Revised Statutes, is amended by adding article 2.1, to read:

ARTICLE 2.1. PARENTS AS PAID CAREGIVERS

START_STATUTE36-2970. Definitions

In this article, unless the context otherwise requires:

1. "Administration" means the Arizona health care cost containment system administration.

2. "Department" means the department of economic security.

3. "Parent" means a parent of or the legally responsible individual for the minor child.

4. "Program" means the parents as paid caregivers program approved by the centers for medicare and medicaid services to this state's section 1115(a) demonstration waiver on fEBRUARY 16, 2024.END_STATUTE

START_STATUTE36-2970.01. Verification and billing; direct care services; assessment

A. The department shall implement the following:

1. An electronic visit verification system that delineates that a parent or a nonparent provider is providing the direct care services.

2. unique modifiers for delineating both:

(a) whether a parent or nonparent provided the direct care services.

(b) Attendant care services and habilitation services.

B. A parent may not bill for attendant care services provided while the minor child is not present, including while the minor child is at school, or when the minor child is in inpatient care or receiving care in a clinical setting. A parent caregiver may not bill for attendant care services for housekeeping, laundry or meal preparation that WOULD ordinarily be performed by a parent of a minor child who does not have a disability.

C. The administration and the department shall provide to the staff of the joint legislative budget committee at the end of each calendar quarter a report on the utilization of attendant care services and habilitation services by parent caregivers under the parents as paid caregivers program. The report shall also include all of the following:

1. The annual growth in the number of parents and members enrolled in the program.

2. The number of emergency department visits and inpatient hospitalizations in the calendar quarter.

3. The approved annual hours delineated by primary diagnosis.

4. How long a member who receives care under the parents as paid caregivers program has been enrolled in the Arizona long-term care system.

D. on or before october 1, 2025, The administration shall adopt and the department shall implement a strengthened standardized assessment tool to determine the need for extraordinary care for minor children under the program. The assessment tool shall separate household tasks that would ordinarily be performed by a parent of a minor child who does not have a disability.END_STATUTE

START_STATUTE36-2970.02. Provision of care

A. Except as otherwise provided in the minor child's plan of care, a parent may provide attendant care services and habilitation services under the program only between 6:00 a.m. and 10:00 P.M.

B. A parent may be employed by only a single agency to provide attendant care services and habilitation services under the program.END_STATUTE

Sec. 2. Title 36, Arizona Revised Statutes, is amended by adding chapter 33, to read:

CHAPTER 33

WAIVERS

ARTICLE 1. REQUIREMENTS

START_STATUTE36-3301. Definitions

In this chapter, unless the context otherwise requires:

1. "Administration" means the Arizona health care cost containment system administration.

2. "Department" means the department of economic security. END_STATUTE

START_STATUTE36-3302. Waiver proposal; legislative approval required; notification

A. The administration may not submit to the centers for medicare and medicaid services, or the successor agency, a new amendment proposal for a demonstration waiver under section 1115 of the social security act, or include any new proposed provision in a section 1115 waiver extension, unless the proposed amendment or provision has been authorized by the legislature in the form of a statute, if the waiver does any of the following:

1. Expands eligibility for Title XIX or Title XXI coverage to populations not authorized by chapter 29 of this title as of January 1, 2025.

2. Adds new categories of covered services or benefits not authorized by chapter 29 of this title as of January 1, 2025.

3. Will, as a result of the changes being proposed, lead to an annual increase in utilization greater than ten percent for specific services affected by the proposed amendment or provision above what the utilization would have been without the proposed amendment or provision.

B. Before submitting a new amendment proposal for a demonstration waiver under section 1115 of the social security act or including a new PROPOSED provision in a waiver extension, the administration shall determine whether the proposed changes are subject to subsection A of this section. Any proposed changes that are subject to subsection A of this section shall be reviewed by the health and human services committees of reference, or their successor committees of reference, and the committees of reference shall forward their recommendation to the senate and house of representatives on whether to approve the proposed changes.

C. If the administration determines the proposed changes are not subject to subsection A of this section, the administration shall monitor changes in annual utilization specific to the services impacted by the new waiver changes for three years after the implementation of the changes to determine whether the changes led to an annual increase in utilization greater than ten percent for the specific services affected by the waiver change above what the utilization would have been without the waiver change.

D. If the monitoring required by subsection C of this section demonstrates that the changes led to an annual increase in utilization greater than ten percent for the specific services affected by the waiver change above what the utilization would have been without the waiver change, the administration shall notify the president of the senate, the speaker of the house of representatives and the chairperson of the joint legislative budget committee and, if the legislature has not enacted a statute authorizing the specific waiver change that led to the increased utilization within one year after the administration's notification pursuant to this subsection, the administration shall submit a request to the centers for medicare and medicaid services, or the successor agency, to terminate the new waiver changes that were not authorized by the legislature.

E. The administration shall notify the joint legislative budget committee in writing of any section 1115 waiver application or amendment submitted, regardless of whether legislative approval is required pursuant to subsection A of this section, at the time the application or amendment is posted for public comment. END_STATUTE

ARTICLE 2. WAIVERS

START_STATUTE36-3311. Parents as paid caregivers program; waiver amendment; implementation

Beginning from and after June 30, 2025, pursuant to the parents as paid caregivers program amendment approval by the centers for medicare and medicaid services to this state's section 1115(a) demonstration waiver dated February 16, 2024, the administration and the department shall IMPLEMENT THE forty hours of care services per week per child LIMIT. END_STATUTE

START_STATUTE36-3312. Parents as paid caregivers program; residency requirement

Subject to the approval by the centers for medicare and medicaid services, a parent must be a resident of this state for at least six months to be eligible to provide care under the parents as paid caregivers program.END_STATUTE

Sec. 3. Section 41-723, Arizona Revised Statutes, is amended to read:

START_STATUTE41-723. Governor's office of strategic planning and budgeting; duties

The director of the governor's office of strategic planning and budgeting shall:

1. Confer with officials of federal agencies concerning grants-in-aid generally, and particularly in regard to federal-aid programs in progress in this state.

2. On or before September 1 of each year or with the submission of budget estimates as provided in Section 35-113, report to the legislature at each regular session staff of the joint legislative budget committee findings and recommendations in the following areas:

(a) The total amount of federal grants-in-aid received by agencies of this state during the preceding fiscal year.

(b) The total amount of federal grants-in-aid available to agencies of this state during the preceding fiscal year, giving reasons for any difference between the amount of monies available to and the amount of monies accepted by agencies of this state in all federal grant-in-aid programs.

(a) Except for a university under the jurisdiction of the Arizona board of regents, the use of federal monies by any state agency that receives federal monies, THAT anticipates RECEIPT of federal monies or that administers a program supported by federal monies. A university shall submit an audited schedule of federal award spending for the preceding fiscal year to the staff of the joint legislative budget committee. The reports that all state agencies, except universities, are required to submit must:

(i) DELINEATE the FEDERAL monies received for the preceding fiscal year.

(ii) Delineate the federal monies to be used by the state agency for the CURRENT and upcoming fiscal year, including any programs supported by federal monies in which the loss of federal monies may IMPACT the CONTINUITY or delivery of services.

(iii) Identify the DATE, if known, on which federal monies are set to expire.

(iv) Identify any OBLIGATIONS, agreements, joint exercise of POWERS agreements, MAINTENANCE of efforts agreements or memoranda of understanding that may be impacted by federal or state decisions regarding federal RECEIPTS, including any state matching requirements.

(v) Calculate the percentage of federal monies from the total monies available for the state agency for the fiscal year.

(b) if any state agency received notice of a reduction in federal monies from a specific federal grant of fifty percent or more from the previous fiscal year's funding, identify the plan to either reduce or eliminate the services provided through the grant or to continue services without any increase to any state RESOURCES.

(d) (c) Federal grant-in-aid programs in which the this state does not participate.

(e) (d) Legislation necessary for activation of federal programs in which the this state does not participate.

(f) (e) Legislation necessary for improved operation of federal grant-in-aid programs in progress in the this state of Arizona.

(g) (f) The advisability of accepting new grant-in-aid programs or discontinuing programs already in progress.

3. Have access to the books, accounts, reports and vouchers and all other pertinent records of all state agencies for the purpose of carrying out the provisions of this section. END_STATUTE

Sec. 4. Special audit; delayed repeal

A. The auditor general shall conduct or contract for a special audit of the parents as paid caregivers program in the department of economic security. The special audit shall review the department of economic security's implementation of the strengthened standardized assessment tool that is required by section 36-2970.01, Arizona Revised Statutes, as added by this act, and that is used by support coordinators under the program, including a comparison of this state's parents as paid caregivers program components to best practices in other states of similar programs.

B. On or before August 1, 2026, the auditor general shall submit a report of its special audit, including any findings and recommendations, to the governor, the president of the senate and the speaker of the house of representatives and shall provide a copy of its report to the secretary of state.

C. The department of economic security and the Arizona health care cost containment system shall cooperate with and provide information necessary for the special audit in the time frame and format specified to facilitate the completion of the special audit.

D. This section is repealed from and after December 31, 2026.

Sec. 5. Supplemental appropriations; department of economic security; developmental disabilities program; auditor general; exemption

A. In addition to any other appropriations made in fiscal year 2024-2025, the following amounts from the following sources are appropriated in fiscal year 2024-2025 to the department of economic security for developmental disabilities medicaid program expenses:

1. $109,200,300 from the prescription drug rebate fund established by section 36-2930, Arizona Revised Statutes.

2. $403,000,000 from developmental disabilities medicaid expenditure authority.

B. In addition to any other appropriations made in fiscal year 2024-2025, the sum of $13,100,000 is appropriated from the prescription drug rebate fund established by section 36-2930, Arizona Revised Statutes, in fiscal year 2024-2025 to the department of economic security for developmental disabilities cost effectiveness study ─ client services.

C. In addition to any other appropriations made in fiscal year 2024-2025, the sum of $355,000 is appropriated from the prescription drug rebate fund established by section 36-2930, Arizona Revised Statutes, in fiscal year 2024-2025 to the auditor general for the special audit of the parents as paid caregivers program.

D. The appropriation made in subsection C of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations.

Sec. 6. Emergency

This act is an emergency measure that is necessary to preserve the public peace, health or safety and is operative immediately as provided by law.