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REFERENCE TITLE: home; community-based services; mental illness |
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State of Arizona Senate Fifty-seventh Legislature Second Regular Session 2026
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SB 1630 |
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Introduced by Senators Angius: Fernandez, Finchem, Gabaldón, Miranda, Shope, Werner
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AN ACT
Amending title 36, ARTICLE 29, Arizona Revised Statutes, by adding article 3.1; 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, Arizona Revised Statutes, is amended by adding article 3.1, to read:
ARTICLE 3.1. HOME AND COMMUNITY-BASED SERVICES FOR PERSONS
WITH SERIOUS MENTAL ILLNESS
36-2979. Definitions
In this article, unless the context otherwise requires:
1. "Administration" means the Arizona health care cost containment system administration.
2. "Behavioral health residential facility" means a health care institution that is licensed pursuant to this title to provide level I or II behavioral health residential services.
3. "High-acuity seriously mentally ill individual" means a person who meets a serious mental illness level of care and one or more priority criteria listed in section 36-2979.04, subsection B.
4. "Home and community-based services":
(a) means services authorized under one or more medicaid state plan authorities, waivers or demonstration authorities, including those authorized under 42 United States Code section 1315 or 1396n, that support individuals in the community as an alternative to institutionalization.
(b) includes services that provide assistance with activities of daily living, medication administration, supervision and structured supports comparable to assisted living models.
5. "Member" means a person who is enrolled in the program.
6. "Program" means the home and community-based service program for adults who are seriously mentally ill.
7. "Qualified income trust" means a trust as described in 42 United States Code section 1396p(d)(4)(B).
8. "Seriously mentally ill" has the meaning prescribed in section 36-550.
9. "Serious mental illness level of care" means the behavioral health institutional level of care adopted by the administration pursuant to section 36-2979.02.
36-2979.01. Home and community-based service program for adults who are seriously mentally ill; request for federal approval; stakeholder workgroup; quarterly updates
A. The home and community-based service program for adults who are seriously mentally ill is established. The administration shall develop and request authority from the centers for medicare and medicaid services to implement a dedicated home and community-based services benefit for adults who are determined to be seriously mentally ill.
B. The administration shall convene a stakeholder workgroup that includes representatives from behavioral health providers, family members, caregivers and guardians of individuals who are seriously mentally ill, counties, tribal nations and community organizations to advise on program design and implementation. Stakeholder input shall specifically address the needs of individuals who require complex medication management, enhanced monitoring and structured community-based supports, including assisted living-type models, to promote medication continuity and safety.
C. The administration shall request approval from the centers for medicare and medicaid services for the program not later than July 1, 2027 and shall begin implementing the program not later than one year after the approval by the centers for medicare and medicaid services.
D. Until the program is implemented, the administration shall provide quarterly implementation updates to the president of the senate, the speaker of the house of representatives and the chairpersons of the senate and house of representatives health and human services committees, or their successor committees.
36-2979.02. Eligibility; financial eligibility; serious mental illness level of care; criteria
A. To be eligible for the program, an individual must meet all of the following:
1. have been determined to be seriously mentally ill.
2. meet the serious mental illness level of care adopted by the administration pursuant to subsection C of this section.
3. require home and community-based services in order to avoid placement in a behavioral health residential facility or psychiatric institution.
4. meet the financial eligibility requirements pursuant to subsection b of this section.
B. An individual who meets the Serious mental illness level of care adopted by the administration pursuant to subsection C of this section is financially eligible for the program if the individual's income does not exceed three hundred percent of the federal supplemental security income benefit rate. An individual whose income exceeds this standard may establish a qualified income trust to achieve eligibility. Resource and spousal impoverishment standards shall be the same as required pursuant to article 2 of this chapter for enrollees in the Arizona long-term care system home and community-based services.
C. The administration shall adopt a serious mental illness level of care specific to individuals who are seriously mentally ill that is based on behavioral, functional and safety criteria, which may include any of the following:
1. Current or recent court-ordered treatment.
2. Legal guardianship due to psychiatric incapacity.
3. Recent discharge from a jail or prison, the state hospital or a behavioral health residential facility.
4. Repeated psychiatric hospitalizations or crisis episodes.
5. Impaired judgment, disorganization or inability to perform activities of daily living due to psychiatric symptoms.
6. Documented safety risks, including elopement, fire or water misuse, aggression, delusional behavior or exploitation risk.
7. Homelessness or imminent risk of homelessness.
8. High-intensity or complex psychotropic medication regimens requiring enhanced monitoring to ensure adherence and to identify potential adverse effects.
9. Clinical needs that necessitate structured community-based supports, including assisted living-type supports, to maintain continuity of medication therapy, such as those at elevated risk of relapse, decompensation or hospitalization related to medication nonadherence.
D. The Serious mental illness level of care adopted pursuant to subsection C of this section may not require a nursing facility level of care or physical disability or physical impairment criteria and may not use a preadmission screening tool.
E. The administration may refine the assessment criteria and processes through rule or policy, consistent with legislative intent, including adjustment to assessment tools, thresholds or processes.
36-2979.03. Covered services; modification
A. Subject to the approval of the centers for medicare and medicaid services, the administration shall provide home and community-based services that are comparable to those authorized under article 2 of this chapter, with modifications appropriate for behavioral health needs. The home and community-based services shall include:
1. Attendant care and personal care.
2. Habilitation with behavior management.
3. Adult day health care with a behavioral health focus.
4. Supervised community living services, including assisted living-type supports.
5. Respite care.
6. Home-delivered meals.
7. Nursing, home health and medication administration services.
8. Nonemergency transportation.
B. The administration shall establish service descriptions and scope and staffing standards through rule or policy.
C. Home and community-based services may be delivered in any residential setting authorized under state law when an individual is subject to a valid court order, guardianship or involuntary treatment authority pursuant to this title, if:
1. Medicaid reimbursement under this article is limited to covered home and community-based services and does not include room, board, supervision for custody or enforcement of court orders.
2. The individual is afforded periodic review and planning for transition to a less restrictive setting when clinically appropriate.
D. The administration may add, modify or combine services consistent with federal approval and legislative intent.
36-2979.04. Program capacity; priority; emergency placements
A. Subject to the approval of the centers for medicare and medicaid services, enrollment in the program is limited to five hundred members, including temporary emergency placements.
B. When capacity is limited, the administration shall assign available slots based on the following order of priority:
1. Individuals under court-ordered treatment.
2. Individuals with legal guardianship due to psychiatric incapacity.
3. Individuals discharged from a jail or prison, the state hospital or a behavioral health residential facility.
4. Individuals who are homeless or at imminent risk of homelessness.
5. Individuals with repeated crisis episodes, psychiatric hospitalizations or public safety involvement.
6. Individuals presenting significant safety risks due to psychiatric symptoms.
7. Individuals with high-intensity or complex psychotropic medication regimens requiring enhanced monitoring to ensure adherence and to identify potential adverse effects.
C. A court may recommend participation in the program but may not compel the administration to exceed the enrollment cap.
D. The administration may reserve a portion of available capacity for emergency or priority placements.
36-2979.05. Provider requirements; enhanced reimbursement rates
A. Providers shall document behavioral interventions, crisis supports and staffing adjustments before initiating discharge.
B. A provider that receives reimbursement under the program shall implement eviction-prevention protocols and obtain regional behavioral health authority approval before issuing nonemergency notices to vacate.
C. The administration may adopt enhanced reimbursement rates for high-acuity seriously mentally ill individuals who are receiving home and community-based services.
D. This section does not limit the administration's authority to ensure the health and safety of participants.
E. This section does not require a provider to continue services when immediate and documented risks to health or safety cannot be mitigated through reasonable clinical interventions.
36-2979.06. Annual report
Beginning one year after program implementation and each year thereafter, the administration shall submit a report to the Governor, the President of the Senate and the Speaker of the House of Representatives that includes:
1. The number of enrolled members and the number of individuals who are on the waitlist.
2. The percentage of members who are under court-ordered treatment, guardianship or criminal justice supervision.
3. Housing stability outcomes for members.
4. Hospitalization, crisis service and jail utilization of members.
5. Provider denials and discharges and the reasons for the denials and discharges of members.
6. The fiscal impact of and estimated cost avoidance related to the program.
36-2979.07. Authority to seek and maintain federal approval; rules
A. The administration shall seek and maintain any necessary federal approvals and may operate the program pursuant to one or more approved medicaid state plan authorities, waivers or demonstration authorities, including those authorized under 42 United States Code section 1315 or 1396n.
B. The administration shall adopt rules to implement this article.
C. This article does not expand or modify standards for involuntary treatment under this title.