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ARIZONA HOUSE OF REPRESENTATIVESFifty-seventh Legislature First Regular Session |
House: APPROP DP 11-7-0-0 |
HB 2953: health care; 2025-2026
Sponsor: Representative Livingston (with permission of committee on Rules), LD 28
Caucus & COW
Overview
Contains provisions relating to health care needed to implement the FY 2026 budget.
History
The Arizona Legislature adopts a budget for each fiscal year (FY) that contains general appropriations. Article IV, Section 20, Part 2, Constitution of Arizona, requires the General Appropriations Act (feed bill) to contain only appropriations for the different state departments, state institutions, public schools and interest on public debt. Statutory changes necessary to reconcile the appropriations made in the feed bill and other changes are drafted into separate budget bills. These bills are prepared according to subject area.
Provisions
Petitions for Court-Ordered Stabilization
1. Applies the court-ordered stabilization process to counties only with a population of more than 1,000,000 persons and less than 1,500,000 persons. (Sec. 3)
2. Allows a medical director of an evaluation agency (medical director) to file a petition for court-ordered stabilization of a person, if the medical director:
a) is in a county with a population of more than 1,000,000 persons and less than 1,500,000 persons; and
b) determines that the proposed patient is an impaired person after examining or evaluating the proposed patient. (Sec. 2)
3. Allows a medical director to file a petition for court-ordered stabilization of a person until December 31, 2027. (Sec. 2)
4. Entitles an impaired person who is involuntarily admitted for a stabilization period to all civil and legal rights as prescribed for mental health patients. (Sec. 3)
5. Makes all records pertaining to an impaired person and the information contained in those records confidential and not public records that can be disclosed. (Sec. 3)
6. Permits, until December 31, 2027, a petition for court-ordered stabilization to be filed by a medical director based on a personal assessment and review of the individual's medical record and be accompanied by an affidavit. (Sec. 3)
7. Specifies that the affidavit from the medical director must contain the following:
a) that the individual is an impaired person and the clinical facts that support that conclusion;
b) that the individual is either unable or unwilling to consent to voluntary admission;
c) the reasons why discharging the individual would be unsafe;
d) the reasons why the proceedings are inappropriate; and
e) the date the individual was initially involuntarily admitted to the evaluation agency. (Sec. 3)
8. Requires the petition for court-ordered stabilization to request that the court issue an order admitting the impaired person to the evaluation agency for a stabilization period of up to five calendar days after the date the individual was involuntarily admitted to the evaluation agency. (Sec. 3)
9. Forbids a petition for court-ordered stabilization from being filed solely to detain an individual who is at risk of using substances, but who is not currently intoxicated, in withdrawal or having substance-induced symptoms. (Sec. 3)
10. Instructs the court to deny a petition for court-ordered stabilization if the court determines that there is insufficient evidence presented in the petition to find that the individual is an impaired person. (Sec. 3)
11. Requires an evaluation agency to immediately release the impaired person if the court denied a petition for court-ordered stabilization. (Sec. 3)
12. Requires the court to grant a petition for court-ordered stabilization for a period of up to five calendar days after the date the individual was involuntarily admitted to the evaluation agency if it determines that there is reasonable cause to believe that the individual is an impaired person. (Sec. 3)
13. Requires a copy of any stabilization order issued by the court to be personally served, as prescribed by law, court rule or as ordered by the court, on the impaired person with a copy of the petition for court-ordered stabilization. (Sec. 3)
Treatment of Impaired Persons Under Court Order for Stabilization
14. Asserts that for each day an impaired person is detained under an order for stabilization, the impaired person must be offered treatment which the person may consent to. (Sec. 3)
15. Directs the evaluation agency to assess the impaired person each day to determine whether the person remains impaired. (Sec. 3)
16. Requires an evaluation agency, if the person no longer meets the definition of an impaired person, to either:
a) release the person from the court-ordered stabilization period and discharge the person from the facility; or
b) admit the person to the evaluation agency on a voluntary basis. (Sec. 3)
17. Directs the evaluation agency to comply with the quality of treatment requirements, as prescribed. (Sec. 3)
18. Forbids an impaired person from being treated for impairment without the impaired person's express consent, except that seclusion and mechanical or pharmacological restraints may be employed as emergency measures for the safety of the impaired person or others. (Sec. 3)
19. Prohibits the use of seclusion or mechanical or pharmacological restraints on an impaired person undergoing stabilization, except in the case of an emergency for the safety of the impaired person or others, or as part of a prescribed written stabilization plan that is prepared by staff members responsible for the person's care and pursuant to rules of the Arizona Department of Health Services (DHS). (Sec. 3)
20. Requires any instance of seclusion or restraint to be properly recorded in the impaired person's medical record. (Sec. 3)
21. Stipulates that the use of any restraint or seclusion measure must be governed by written procedures of the applicable evaluation agency and is subject to DHS rules. (Sec. 3)
22. Requires each impaired person undergoing stabilization care to receive physical care and treatment in a manner that allows the person's family or guardian to participate in the care and treatment, when appropriate, for the full period during which the impaired person is detained. (Sec. 3)
23. Directs an evaluation agency that provides care and treatment to impaired persons to keep a clinical record for each impaired person that details all medical evaluations, care and treatment received by the impaired person. (Sec. 3)
24. Requires an evaluation agency that administers observation or inpatient stabilization care and treatment of an impaired person, in conjunction with the community treatment agency if applicable, and before the release of the impaired person to:
a) prepare a plan for the impaired person's care after release; and
b) provide the plan to the impaired person's guardian, if applicable. (Sec. 3)
25. Prohibits an impaired person who is undergoing a court-ordered stabilization period from being detained for more than five calendar days after the date that the impaired person is involuntarily admitted to the evaluation agency. (Sec. 3)
26. Permits an impaired person who is admitted for a stabilization period to be released at any time if release is appropriate in the opinion of the medical director. (Sec. 3)
27. Specifies that the medical director is not civilly liable for any act committed by an impaired person who was released if the medical director has in good faith followed the prescribed requirements for court-ordered stabilization of impaired persons. (Sec. 3)
28. Allows an impaired person to continue care and treatment on a voluntary basis at any time and be provided the opportunity for voluntary admission each day. (Sec. 3)
29. Specifies that, if an impaired person who is admitted for a stabilization period is released, the petition for court-ordered stabilization must be retained with a written statement by the medical director that states why the release was appropriate. (Sec. 3)
Attorney Duties and Financial Responsibility for Court-Ordered Stabilization
30. Requires the court to appoint counsel for the impaired person at the time of issuing an order for stabilization. (Sec. 3)
31. Directs the attorney who is appointed to represent the impaired person to confer with the impaired person within 24 hours of being appointed and to inform the impaired person of their rights. (Sec. 3)
32. Instructs the appointed attorney for an impaired person who is involuntarily detained for stabilization to inform the impaired person of the right to:
a) a hearing to determine whether the impaired person should be involuntarily detained for stabilization; and
b) be represented by an attorney at the hearing. (Sec. 3)
33. Requires the court to schedule a hearing at its earliest opportunity if the impaired person requests a hearing to determine whether there is a reasonable basis for the detention. (Sec. 3)
34. Requires the county attorney for the county in which a petition for court-ordered stabilization is filed by a physician or other person on behalf of an evaluation agency, to represent the person who filed the petition or the evaluation agency in any judicial proceeding for court-ordered stabilization and to defend all challenges to the detention of an impaired person. (Sec. 3)
35. Directs the costs of court proceedings and services provided relating to the court-ordered stabilization process to be charged to Arizona Health Care Containment System (AHCCCS) or to another third-party payor, if available. (Sec. 3)
36. Prohibits an impaired person from being charged for services related to the court-ordered stabilization treatment of the person. (Sec. 3)
37. Stipulates that the evaluation agency is not financially responsible for serving the stabilization order and copy of the petition for court-ordered stabilization on the impaired person. (Sec. 3)
38. Requires an applicable county that utilizes the court-ordered stabilization process to report specified information to the Governor, Health and Human Services Committees or their successor committees in the Senate and the House of Representatives by January 1, 2028. (Sec. 3)
39. Lists the type of information to be included in the county's court-ordered stabilization report. (Sec. 3)
40. Requires the applicable county to provide a copy of their report to the Secretary of State. (Sec. 3)
41. Directs the Health and Human Services Committees or their successor committees to review the report and determine whether the court-ordered stabilization process should be continued, modified or discontinued. (Sec. 3)
42. Contains a delayed repeal date of January 1, 2029. (Sec. 4)
AHCCCS Member Eligibility
43. Requires AHCCCS to enter into a data matching agreement with Arizona Department of Revenue (DOR) to identify members who have lottery or gambling winnings of $3,000 or more and directs AHCCCS to review this information at least once a month. (Sec. 6)
44. Requires AHCCCS, if a member fails to disclose winnings of $3,000 or more and is identified through the database match, to consider the member’s failure to disclose the information a violation of the system's terms of eligibility. (Sec. 6)
45. Requires AHCCCS, at least once a month, to:
a) receive and review death record information from the Department of Health Services concerning its members and to adjust system eligibility accordingly; and
b) review information concerning members indicating a change in circumstances that may affect eligibility, including changes in residency as identified by out-of-state electronic benefit transfer card transactions. (Sec. 6)
46. Directs AHCCCS, at least once a quarter, to:
a) receive and review information from the Department of Economic Security that indicates a change in members' circumstances that may affect eligibility, including changes to unemployment benefits, employment status or wages; and
b) receive and review information from DOR that indicates a change in members' circumstances that may affect eligibility, including potential changes in income, wages or residency as identified by tax records. (Sec. 6)
47. Prohibits AHCCCS, unless required by federal law, from accepting self-attestation of income, residency, age, household composition, caretaker or relative status or receipt of other health insurance coverage without independent verification before enrollment. (Sec. 6)
48. Restricts AHCCCS from requesting the authority to waive or decline to periodically check any available income-related data sources to verify eligibility. (Sec. 6)
49. Prohibits AHCCCS from accepting eligibility determinations of the system from a federally facilitated exchange established in accordance with federal law. (Sec. 6)
50. Allows AHCCCS to accept assessments from a federally facilitated exchange established in accordance with federal law but must independently verify eligibility and make eligibility determinations. (Sec. 6)
51. States that if AHCCCS receives information concerning a member that indicates a change in the member's circumstances that may affect eligibility, AHCCCS must review that member's eligibility. (Sec. 6)
52. Requires AHCCCS to implement quarterly redeterminations for continued eligibility, subject to approval by the Centers of Medicare and Medicaid Services (CMS). (Sec. 6)
53. Specifies that AHCCCS's quarterly redeterminations for continued eligibility does not apply to a member with a disability. (Sec. 6)
54. Permits AHCCCS to:
a) execute a memorandum of understanding with any other department of this state for information required to be shared in accordance with the eligibility verification requirements; and
b) contract with one or more independent vendors to provide additional data or information that may indicate a change in circumstances and affect an individual’s eligibility. (Sec. 6)
55. Requires AHCCCS to submit to CMS any waiver requests necessary to implement the eligibility verification requirements by April 1, 2026. (Sec. 6)
AHCCCS Presumptive Eligibility Determinations
56. Requires AHCCCS to request approval from CMS for a Section 1115 wavier to eliminate mandatory hospital presumptive eligibility and restrict presumptive eligibility determinations to only children and pregnant women eligibility groups. (Sec. 5)
57. Requires AHCCCS, if approval for the Section 1115 waiver is denied, to resubmit a subsequent request for approval within 12 months after each denial. (Sec. 5)
58. Prohibits AHCCCS, unless required by federal law, from designating itself as a qualified health entity for the purpose of making presumptive eligibility determinations or for any other purpose not expressly authorized by statute. (Sec. 6)
59. Requires a qualified hospital, when making presumptive eligibility determinations to do all the following:
a) notify AHCCCS of each presumptive eligibility determination within five working days after the date the determination is made;
b) assist individuals who are determined presumptively eligible under the system with completing and submitting a full application for AHCCCS eligibility;
c) notify each applicant, in writing and on all relevant forms with plain language and large print, that if the applicant does not file a full application for system eligibility with AHCCCS before the last day of the following month, presumptive eligibility coverage will end of on last day of the following month; and
d) notify each applicant that if the applicant files a full application for system eligibility with AHCCCS before the last day of the following month, presumptive eligibility coverage will continue until an eligibility determination is made on the application that was filed. (Sec. 6)
60. Directs AHCCCS to apply the following standards to establish and ensure the accurate presumptive eligibility determinations are made by each qualified hospital whether:
a) the qualified hospital submitted to AHCCCS the presumptive eligibility card within five working days after the determination date;
b) a full application for system eligibility was received by AHCCCS before the expiration of the presumptive eligibility period; and
c) the individual was found to be eligible under the system if a full application was received by AHCCCS. (Sec. 6)
61. Requires AHCCCS to provide notice to a qualified hospital that fails to meet the established standards for any presumptive eligibility determinations within five days after the determination, including:
a) for the first violation, both:
i. a description of the standard that was not met and an explanation of why it was not met; and
ii. confirmation that a second finding will require all applicable hospital staff to participate in mandatory training by AHCCCS on hospital presumptive eligibility rules.
b) for the second violation:
i. a description of the standard that was not met and an explanation of why it was not met;
ii. confirmation that all applicable hospital staff are required to participate in mandatory training by AHCCCS on hospital presumptive eligibility rules and the date, time and location of the training as determined by AHCCCS;
iii. a description of available appellate procedures by which a qualified hospital may dispute the finding and remove it from the hospital's record by providing clear and convincing evidence that the standards were met; and
iv. confirmation that if the qualified hospital subsequently fails to meet any of the standards for presumptive eligibility the hospital will no longer be qualified to make presumptive eligibility determinations under the system.
c) for the third violation:
i. a description of the standard that was not met and an explanation of why it was not met;
ii. a description of available appellate procedures by which a qualified hospital may dispute the finding and remove it from the hospital's record by providing clear and convincing evidence the standards were met; and
iii. confirmation that, effective immediate, the hospital is no longer qualified to make presumptive eligibility determinations under the system. (Sec. 6)
62. Specifies that AHCCCS eligibility for any eligible person is the first day of the month once a full application is submitted to AHCCCS, subject to CMS approval. (Sec. 6)
63. Requires AHCCCS, by April 1, 2026, to submit to CMS any waiver request necessary to implement the eligibility date requirement. (Sec. 6)
64. Contains an effective date of January 1, 2026. (Sec. 21)
AHCCCS Speech Therapy and Cochlear Implant Coverage
65. Requires AHCCCS to cover the costs of speech therapy and cochlear implants for eligible persons who are at least 21 years old. (Sec. 7)
66. Prohibits Hospital Assessment Fund monies from being used to provide speech therapy in an outpatient setting and cochlear implants to eligible persons who are at least 21 years old. (Sec. 7)
Dementia Awareness
67. Requires DHS to distribute monies appropriated in the General Appropriations Act for a nonprofit organization to implement a public education campaign that increases awareness of Alzheimer's disease and dementia in rural and underserved urban areas in Arizona. (Sec. 9)
68. Requires DHS to distribute the monies to a nonprofit organization that:
a) demonstrates expertise in memory loss, dementia and Alzheimer's disease;
b) hosts a 24-hour, 7 days a week toll-free hotline, with interpreter service if needed, staffed by master's level consultants to provide education on Alzheimer's signs and symptoms, decision-making support, dementia crisis assistance, treatment options and referrals to local community resources;
c) provides care and support for those affected by Alzheimer's and other dementias; and
d) demonstrates experience in marketing and public awareness campaigns. (Sec. 9)
69. Requires DHS to submit a report on the impact of the public awareness campaign to the Governor, President of the Senate and Speaker of the House of Representatives by November 1, 2026 and a copy to the Secretary of State. (Sec. 9)
Student Registered Nurse Anesthetist Clinical Rotation Program (Program)
70. Establishes the Program within the Arizona State Board of Nursing (AZBN) for FY 2026 to expand the capacity of preceptor training programs at health care institutions for registered nurse anesthetist students. (Sec. 10)
71. Requires the AZBN to develop a grant program to distribute appropriated Program monies for FY 2026 to licensed health care institutions to pay for the direct and indirect costs to expand or develop clinical training placements for nurse anesthetist students, with preference given to expanding or developing clinical rotations in obstetrics, pediatrics, cardiovascular, thoracic and neurological care. (Sec. 10)
72. States the grant program monies are intended to supplement and not supplant existing training program expenses covered by the health care institution grantee. (Sec. 10)
73. Permits grant monies to be used to fund a clinical training placement through:
a) an anesthesia provider group who is contracted with a health care institution;
b) an authorized preceptor; or
c) a health care institution directly. (Sec. 10)
74. Prohibits more than 20% of a grant award from being spent on the indirect costs of expanding or developing clinical training placements. (Sec. 10)
75. Requires grant monies be distributed to grantees before the expenses for expanding or developing clinical rotations are incurred. (Sec. 10)
76. Directs grantees to return all monies to the AZBN that are not spent on the direct and indirect costs related to expanding or developing clinical rotations. (Sec. 10)
77. Requires the AZBN to establish an application process for Program grants and to consider the following factors when determining grant awards:
a) the geographic and population distribution;
b) the number of nurse anesthetist students expected to be trained and retained; and
c) the cost of the proposal for the number of nurse anesthetist students expected to participate and be retained, compared to other proposals. (Sec. 10)
Health Care Interoperability Grant Program
78. Continues, for FYs 2026 through 2028, the requirement that the Arizona Department of Administration (ADOA) administer a competitive grant program that provides a single company that licenses an interoperability software technology solution to support acute care for rural hospitals, health care providers and trauma centers with resources to further treatment and care coordination with a focus on reducing public and private health care costs and unnecessary transportation costs. (Sec. 11)
79. Prohibits the grant recipient from using a third-party vendor to comply with any of the grant program requirements. (Sec. 11)
80. Requires ADOA to award the grant by September 30, 2025. (Sec. 11)
81. Requires AHCCCS to work with ADOA to supplement the grant monies by identifying and applying to receive federal matching monies. (Sec. 11)
82. Requires the grant program to enable the implementation of a single licensed interoperability software technology solution that is shared by hospitals and health care providers to benefit patients, before and after discharge from the provider's care, and that is accessible to current and future providers via a mobile, native smartphone application. (Sec. 11)
83. Requires the software to be made available to rural hospitals, health care providers and trauma centers that wish to participate by enabling a hospital's electronic medical records system to interface with interoperability technology and other electronic medical records systems and providers to promote mobile connectivity between hospital systems and facilitate increased communication between hospital staff and providers that use different or distinctive online and mobile platforms and information systems when treating acute patients. (Sec. 11)
84. Tasks ADOA to award one grant for an interoperability software technology solution that, at a minimum:
a) complies with the federal Health Insurance Portability and Accountability Act (HIPAA) privacy standards;
b) captures and forwards clinical data, including laboratory results and images, and provides synchronous patient clinical data to health care providers regardless of geographic location;
c) provides a synchronous data exchange, that is not batched or delayed, at the point the clinical data is captured and available in the hospital's electronic record system;
d) is capable of providing proactive alerts to health care providers on their smartphones or a smart device;
e) allows synchronous and asynchronous communication via a native smartphone application;
f) is mobile technology, can be used on multiple electronic devices and includes the industry standard built-in application for the two most popular operating systems and a built-in application available to all users;
g) has patient-centric communication and is tracked with date and time stamping; is connected to the appropriate physician resources; and
h) provides data to update cost reports to enhance emergency triage and to treat and transport patients. (Sec. 11)
85. Requires the grant recipient to demonstrate:
a) that its interoperability software technology solution meets all requirements at least 30 days before applying for the grant; and
b) proof of veteran employment. (Sec. 11)
86. Requires, for FYs 2026, 2027 and 2028, the grant recipient to provide ADOA a report that provides metrics and quantifies cost and time savings for using an interoperable software solution in health care that complies with HIPAA privacy standards. (Sec. 11)
87. Requires ADOA, by June 30 of each year, in coordination with AHCCCS, to provide a report on the allocation of grant funding and a compiled analysis of the reports provided by the grant recipient to the specified offices. (Sec. 11)
88. Specifies that monies appropriated for the grant program in the FY 2026 General Appropriations Act do not affect monies appropriated in FY 2024 for interoperability software technology solutions or any grant awarded to or contract with a grant recipient. (Sec. 11)
89. Repeals the grant program on January 1, 2029. (Sec. 11)
90. Sets the annual county Arizona Long Term Care System (ALTCS) contributions for FY 2026 at $409,537,600 and:
a) outlines each county's contribution;
b) requires the State Treasurer to recover the cost of any funding that was not provided; and
c) requires the State Treasurer to deposit monies received into the ALTCS fund. (Sec. 12)
91. Requires the counties' share of the state's contribution to comply with federal maintenance of effort requirements. (Sec. 12)
92. Requires, by December 31, 2026, for FY 2026, AHCCCS to transfer to the counties any portion necessary to comply with the Patient Protection and Affordable Care Act regarding the counties' proportional share of this state's contribution. (Sec. 14)
93. Sets the FY 2026 county acute care contributions at $42,814,200 and:
a) outlines each county's contribution;
b) outlines payment processes and requirements;
c) requires the State Treasurer to recover the cost of any funding that was not provided by a county from other funds owed to that county, excluding the Highway User Revenue Fund; and
d) states that the Legislature intends that the Maricopa County contribution be reduced in each subsequent year according to changes in the GDP price deflator. (Sec. 15)
94. Continues to exclude the Proposition 204 administration costs from the county expenditure limitations. (Sec. 16)
95. Exempts county expenditures for restoration to competency treatment from county expenditure limitation. (Sec. 17)
Disproportionate Share Hospital (DSH) Payment Session Law Provisions
96. Sets the annual DSH payment allotment to the Arizona State Hospital (ASH) at $28,474,900 for FY 2026 and:
a) requires ASH to provide a certified public expense form for qualifying DSH expenditures made to AHCCCS by March 31, 2026;
b) directs AHCCCS to:
i. assist ASH in determining the amount of qualifying DSH expenditures; and
ii. deposit the entire amount of federal financial participation in the state GF;
c) states that if the certification is less than $28,474,900, AHCCCS must:
i. notify the Governor and the Legislature; and
ii. deposit the entire amount of federal financial participation in the state GF; and
d) requires the certified public expense form to contain the total amount of qualifying DSH expenditures and the amount limited by the Social Security Act. (Sec. 13)
97. Establishes the annual DSH payment allotment for private qualifying DSH hospitals at $884,800 for FY 2026, consistent with the appropriation and the terms of the State plan and limits payments to hospitals that either:
a) meet the mandatory definition of DSH qualifying hospital under Section 1923 of the Social Security Act; or
b) are located in Yuma County and contain at least 300 beds. (Sec. 13)
98. Outlines the order of priority for DSH payment allotments for private qualifying hospitals once the preceding DSH distributions are made. (Sec. 13)
Miscellaneous
99. Allows the hospital assessment to fund a portion of the costs of behavioral health services for certain expansion populations on an ongoing basis. (Sec. 5)
100. Directs any unexpended and unencumbered monies remaining in the Collaborative Care Uptake Fund to be transferred to the state General Fund by July 1, 2027. (Sec. 8)
102. Requires AHCCCS to extend the existing acute care contracts with all contracted managed care organizations through September 30, 2028. (Sec. 19)
103. Continues to state that it is the intent of the Legislature for FY 2026 that AHCCCS implement a program within its available appropriation. (Sec. 20)
104. Defines pertinent terms. (Sec. 3, 5, 10, 11)
105. Makes technical and conforming changes. (Sec. 1, 5, 7)
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HB 2953
Initials AG Page 0 Caucus & COW
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