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BILL # SB 1122 |
TITLE: AHCCCS; prior authorization; behavioral health |
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SPONSOR: Werner |
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PREPARED BY: Brian Belakovsky |
STATUS: As Amended by Senate HHS & ATT |
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The bill would prohibit the Arizona Health Care Cost Containment System (AHCCCS) from mandating 100% pre-payment review for behavioral health providers when delivering services to tribal healthcare members, unless the healthcare provider is noncompliant or otherwise not engaged with an implemented corrective action plan.
Estimated Impact
The bill may impact AHCCCS' administrative workload to the extent that it results in AHCCCS providing review of fewer behavioral health claims compared to the agency's current practice. It may also impact the costs of AHCCCS' fee-for-service program to the extent that prepayment review reduces the total amount of claims paid. We cannot, however, determine the fiscal estimate of this bill without additional information from the agency.
We have asked AHCCCS for an estimate of the bill's fiscal impact, but we have not yet received a response.
Our estimated impact is based on the following assumptions and data sources:
1) Under the current guidelines of the fee-for-service (FFS) provider billing manual, AHCCCS may impose sanctions due to "fraudulent or abusive conduct" or other violations "on the part of the provider." AHCCCS has the discretion to institute 100% prepayment review as a sanction on a provider as part of this policy.
2) While under 100% prepayment review, every claim submitted by a provider to AHCCCS is reviewed by the Division of Fee for Service Management (DFSM) before being paid.
3) AHCCCS claims data would be required to assess the impact of changes to prepayment review procedures on administrative and claims spending.
2/20/26