|
REFERENCE TITLE: American Indian health program; administration |
|
State of Arizona Senate Fifty-seventh Legislature Second Regular Session 2026
|
|
SB 1611 |
|
|
|
Introduced by Senators Werner: Angius, Rogers, Shope
|
AN ACT
Amending title 36, chapter 29, article 1, Arizona Revised Statutes, by adding section 36-2903.18; relating to the Arizona health care cost containment system.
(TEXT OF BILL BEGINS ON NEXT PAGE)
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 36-2903.18, to read:
36-2903.18. American Indian health program; administrative services contract; legislative review; definitions
A. Beginning October 1, 2027, the administration shall contract with a qualified contractor or other qualified entity to serve as the administrative services organization and to perform program integrity and care management functions for members enrolled in the American Indian health program. The contract must comply with all applicable federal and state requirements, including the protections for Indians, Indian health care providers and Indian managed care entities pursuant to 42 Code of Federal Regulations section 438.14.
B. The administration shall retain ultimate responsibility for administering the American Indian health program, including fee-for-service rate setting, claims payment authority and oversight of any administrative services organization contractor, and may not eliminate the American Indian health program as a fee-for-service option for eligible American Indian and Alaska native members.
C. Before issuing any request for proposals to procure an administrative services organization pursuant to subsection A of this section:
1. Not later than thirty days after the effective date of this section, the director shall request any necessary approvals from the centers for medicare and medicaid services to implement this section and to qualify for federal monies available under title XIX of the social security act or the section 1115 waiver.
2. Notwithstanding any law to the contrary:
(a) The administration shall present the proposed procurement strategy, minimum qualifications and evaluation factors to the senate and house of representatives health and human services committees, or their successor committees.
(b) The administration shall receive and consider written and oral comments from committee members and the public, including tribal governments, Indian health care providers and urban Indian organizations.
D. Notwithstanding any law to the contrary, for each procurement described in subsection C of this section:
1. The chairpersons of the senate and house of representatives health and human services committees, or their successor committees, may each designate one member of their respective committee to serve as a nonvoting observer to the source-selection evaluation committee convened by the administration.
2. The nonvoting observers designated pursuant to paragraph 1 of this subsection may attend evaluation meetings and review materials submitted by offerors but may not score proposals, participate in final ranking or make or direct an award decision.
E. Notwithstanding any law to the contrary, after the completion of proposal evaluations and before the execution of any contract described in subsection A of this section, the administration shall transmit and present to the senate and house of representatives health and human services committees, or their successor committees, a summary of evaluation results and the proposed award recommendation.
F. This section does not:
1. Transfer source-selection or contract-award authority from the administration to the legislature or any legislative committee.
2. Conflict with the Arizona procurement code or any applicable federal procurement requirement. The administration remains the awarding agency and shall comply with all applicable state and federal procurement laws and regulations.
G. Any administrative arrangement authorized under this section must preserve:
1. The right of eligible American Indian and Alaska native members to elect the American Indian health program fee-for-service coverage.
2. The right of American Indian and Alaska native members to voluntarily enroll in and disenroll from a managed care organization consistent with federal law.
3. The protections afforded to Indians and Indian health care providers under 42 Code of Federal Regulations section 438.14, including out-of-network access and appropriate payment requirements for Indian health care providers.
H. Any entity that is procured pursuant to this section to perform program integrity or care management functions for the American Indian health program shall be organized and operated as a qualified contractor.
I. For the purposes of this section:
1. "Administrative services organization" means a medicaid managed care organization that is a qualified contractor or other qualified entity that contracts with the administration to perform administrative functions, including program integrity, care management, provider network support, quality improvement and data analytics.
2. "American Indian health program" means the fee-for-service program operated by the administration for eligible American Indian and Alaska native members as required under federal law to preserve a fee-for-service option for American Indian and Alaska native beneficiaries.
3. "Qualified contractor" or "other qualified entity" means an entity that meets all applicable federal and state requirements to contract with the administration as a medicaid managed care organization, administrative services organization or similar entity.
Sec. 2. Legislative findings
The legislature finds and determines that immediate implementation of this act is necessary to strengthen program integrity and care management for American Indian and Alaska native members of the Arizona health care cost containment system, to protect those members from fraud and abuse and to preserve the public peace, health and safety.
Sec. 3. 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.