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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
House: HHS W/D | FMAE DP 4-3-0-0 |
HB 2940: AHCCCS; eligibility; verification; SNAP; contractors
Sponsor: Representative Gillette, LD 30
Caucus & COW
Overview
Establishes new requirements for benefit contracting, eligibility verification and reporting for the Arizona Health Care Cost Containment System and the Arizona Department of Economic Security Nutrition Assistance Program.
History
Established in 1981, the Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid program that oversees contracted health plans for the delivery of health care to individuals and families who qualify for Medicaid and other medical assistance programs. Through contracted health plans across the state, AHCCCS delivers health care to qualifying individuals including low-income adults, their children or people with certain disabilities. Members must meet certain financial and nonfinancial requirements to be eligible for AHCCCS (A.R.S. § 36-2901 et. seq).
SNAP is a federal program that provides food benefits to low-income families to supplement their grocery budget. To be eligible for SNAP benefits, an applicant must meet specific age, household, employment and income requirements. Arizona's SNAP program is administered by the Arizona Department of Economic Security (DES) and is known as the Arizona Nutrition Assistance (NA) Program (DES).
Provisions
AHCCCS Mandatory Contracting
1. Requires AHCCCS, notwithstanding any other law and subject to the approval of the Centers for Medicare & Medicaid Services (CMS), to contract with health benefit purchasing organizations to manage the provision of services to members. (Sec. 1)
2. Outlines that a health benefits purchasing organization may include:
a. a retailer;
b. a membership organization;
c. a cooperative;
d. a trade or fraternal association; and
e. any other health plan. (Sec. 1)
3. Requires a health benefits organization to be licensed pursuant to Title 20 (Insurance) and demonstrate solvency, maintain claims reserves, comply with all fraud controls and accept AHCCCS's published fixed benefit pricing. (Sec. 1)
4. States that, notwithstanding any other law and subject to the approval of CMS:
a. AHCCCS is required to publish and annually update a fixed benefit price list; and
b. each contractor is required to reimburse health care providers at or above the rates on the fixed benefits price list. (Sec. 1)
5. Requires each health care facility and health care provider that receives reimbursement pursuant to AHCCCS statute to disclose a fixed benefit price list based on billing codes for common services provided pursuant to AHCCCS statute. (Sec. 1)
6. Mandates that each AHCCCS member be mailed an explanation of benefits itemized by billing code after each service. (Sec. 1)
Required Eligibility Verification for All AHCCCS Programs
7. Prohibits AHCCCS from approving, renewing or continuing eligibility for any applicant or enrollee in any program administered by AHCCCS without affirmatively verifying all eligibility factors using documentary evidence or trusted electronic data sources, unless expressly required by federal law. (Sec. 3)
8. Requires eligibility verification for any program administered by AHCCCS to include, at a minimum, all of the following for each applicant or enrollee:
a. income;
b. residency and physical address;
c. citizenship or qualified immigration status;
d. household composition, when applicable;
e. incarceration status;
f. death records; and
g. all property ownership or transfer when reported or identified through data matching. (Sec. 3)
9. Directs AHCCCS to query multiple independent state and federal databases before approving or renewing an application. (Sec. 3)
10. Outlines specific authorized state and federal data sources. (Sec. 3)
11. Requires eligibility for a program administered by AHCCCS to be automatically reevaluated on detection or reporting of any of the following:
a. income or employment changes;
b. out-of-state residency indicators;
c. property acquisition or sale;
d. incarceration or release from incarceration; or
e. death record confirmation. (Sec. 3)
12. Requires AHCCCS, if data received appears to be conflicting, to place an application in pending status, deny the application or terminate the benefits until the conflict is resolved. (Sec. 3)
13. Mandates that cases qualifying as high-risk for benefits fraud be referred to the AHCCCS Office of the Inspector General. (Sec. 3)
14. Requires AHCCCS to maintain a system in which each query or action is saved separately and is not superseded by a subsequent query or action. (Sec. 3)
15. Specifies that the system must provide an audit log for the Auditor General that identifies outlined types of search and data information related to eligibility rules. (Sec. 3)
16. Outlines that any AHCCCS employee who has been found through the audit log to have willfully not complied with the eligibility verification requirements prescribed by the act must be immediately terminated and must forfeit all benefits under the Arizona State Retirement System (ASRS). (Sec. 3)
Requiring Reporting, Unified Eligibility Rules Engine for AHCCCS & DES
17. Directs AHCCCS and DES to jointly procure and operate a unified eligibility rules engine capable of at least the following:
a. real-time verification across all programs administered by both agencies;
b. identification of risk events that either increase or decrease the use of programs or spending on programs;
c. event-triggered reviews of eligibility; and
d. a full audit log access as previously outlined. (Sec. 3)
18. Specifies that the previously outlined procured rules engine is the authoritative eligibility source for AHCCCS and SNAP. (Sec. 3)
19. Directs AHCCCS and DES to submit quarterly reports to the Joint Legislative Audit Committee (JLAC) that detail:
a. program eligibility approvals and denials;
b. the frequency of data conflict flags;
c. improper payment estimates in the current fiscal year; and
d. the number and circumstances of referrals to law enforcement. (Sec. 3)
20. Allows the Auditor General to request audit logs from AHCCCS and DES without a subpoena. (Sec. 3)
21. Directs the Auditor General to provide JLAC with confidential briefings relating to the Auditor General's findings from the audit logs received. (Sec. 3)
Requiring the Application of new AHCCCS Eligibility Standards to DES
22. Requires DES to apply the same eligibility verification standards required to be used by AHCCCS, as introduced by the act, for all new and renewal applications for SNAP. (Sec. 4)
23. Prohibits DES from accepting any self-attestation during the eligibility verification process unless expressly required by federal law. (Sec. 4)
24. Mandates DES integrate the eligibility system for SNAP with the AHCCCS eligibility verification system as prescribed by the act and the Arizona Department of Revenue's wage databases. (Sec. 4)
25. Outlines that any DES employee who has been found through an audit log to have willfully not complied with the eligibility verification requirements as prescribed by the act must be immediately terminated and must forfeit all benefits under ASRS. (Sec. 4)
Miscellaneous
26. Makes a technical change. (Sec. 2)
27. Defines pertinent terms. (Sec. 3)
28. Contains a legislative findings and intent clause. (Sec. 5)
29. Cites the act as the Arizona Secure Benefits Integrity Act. (Sec. 6)
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33. Initials GG HB 2940
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