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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
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HCR2058: AHCCCS; comprehensive claims audit
Sponsor: Representative Rivero, LD 27
Committee on Government
Overview
A constitutional amendment to audit Arizona's Medicaid Program, administered by the Arizona Health Care Cost Containment System (AHCCCS).
History
Established in 1981, AHCCCS is Arizona's Medicaid program. It is a federal health care program jointly funded by the federal and state governments that oversees contracted health plans that deliver health care services to individuals and families who qualify for Medicaid and other medical assistance programs. Through its contracted health plans, AHCCCS delivers health care to qualifying individuals, including low-income adults, their children or people with certain disabilities. Current statute outlines covered health and medical services offered to AHCCCS members (A.R.S. § 36-2907).
Provisions
1. Directs the Joint Legislative Budget Committee (JLBC) Director to issue a request for proposals from qualified audit vendors within 180 days of the effective date of this measure for a comprehensive claim-level audit of Arizona's Medicaid Program administered by AHCCCS.
2. Stipulates that the audit:
a. must look at each payment AHCCCS or its contractors made under Arizona's Medicaid Program in the three years prior to the audit; and
b. be coordinated with the Centers for Medicare and Medicaid Services.
3. Requires the audit report to categorize misappropriations by provider type and managed care organization.
4. Instructs the auditor to redact from any public report any identifying information and confidential commercial information.
5. Directs the JLBC Director and AHCCCS to negotiate settlements for all misappropriated claims within 90 days of the issuance of the audit report.
6. Details that any matter not settled must be referred to the Attorney General (AG) to file suit within 60 days of receiving the referral.
7. Prohibits Arizona from paying for audit costs through recoveries made from misappropriated claims.
8. States that the remaining monies recovered must be deposited in the state general fund.
9. Requires the JLBC Director to report the total amount of misappropriated claims and monies recovered to outlined government entities within nine months of the issuance of the audit report.
10. Repeals this act on December 31, 2030.
11. Defines comprehensive claim-level audit, misappropriated claim and qualified audit vendor.
12. Requires the Secretary of State to submit the proposition to the voters at the next general election.
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16. Initials ML HCR 2058
17. 2/14/2026 Page 0 Government
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