REFERENCE TITLE: AHCCCS; comprehensive claims audit

State of Arizona

House of Representatives

Fifty-seventh Legislature

Second Regular Session

2026

HCR 2058

Introduced by

Representative Rivero

A CONCURRENT RESOLUTION

enacting and ordering the submission to the people of a measure relating to the Arizona health care cost containment system.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it resolved by the House of Representatives of the State of Arizona, the Senate concurring:

1. Under the power of the referendum, as vested in the Legislature, the following measure, relating to the Arizona health care cost containment system, is enacted to become valid as a law if approved by the voters and on proclamation of the Governor:

AN ACT

requiring a comprehensive audit of this state's medicaid program administered by the Arizona health care cost containment system.

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

Section 1. Arizona health care cost containment system; comprehensive audit; request for proposals; negotiated settlements; reporting requirements; delayed repeal; definitions

A. The joint legislative budget committee director shall issue a request for proposals from qualified audit vendors within one hundred eighty days after the effective date of this measure for a comprehensive claim-level audit of this state's medicaid program administered by the Arizona health care cost containment system.

B. The audit must look at each payment the Arizona health care cost containment system or its contractors made under this state's medicaid program in the three years before the audit. The audit must be coordinated with the centers for medicare and medicaid services. The audit report must categorize misappropriations by provider type and managed care organization.  The auditor shall redact from any public report any personal identifying information and confidential commercial information.

C. The joint legislative budget committee director and the Arizona health care cost containment system shall jointly negotiate settlements for all misappropriated claims within ninety days after the audit report is issued.  Any matter that is not settled shall be referred to the attorney general.  The attorney general shall file suit within sixty days after receiving a referral pursuant to this subsection. 

D. This state shall pay for the audit costs through recoveries made from misappropriated claims.  The remaining state share of the monies recovered shall be deposited in the state general fund.

E. Within nine months after the audit report is issued, the joint legislative budget committee director shall report the total amount of the misappropriated claims and monies recovered to the governor, the speaker of the house of representatives and the president of the senate and shall provide a copy of the report to the secretary of state.

F. This section is repealed from and after December 31, 2030.

G. For the purposes of this section:

1. "Comprehensive claim-level audit" means a one hundred percent verification of each payment, including a review of unbundling, upcoding and services that were not medically necessary.

2. "Misappropriated claim" means an improper payment, including a duplicate payment, incorrect coding and payment for ineligible services.

3. "Qualified audit vendor" means an entity with medicaid audit experience and proprietary technology platforms.

2. The Secretary of State shall submit this proposition to the voters at the next general election as provided by article IV, part 1, section 1, Constitution of Arizona.