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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
Senate: HHS DP 4-3-0-0 | Third Read 17-9-4-0 |
SB 1115: AHCCCS; remote work; prohibition
S/E: administration; American Indian health program
Sponsor: Senator Werner, LD 4
Committee on Health & Human Services
Summary of the Strike-Everything Amendment to SB 1115
Overview
An emergency measure that requires the Arizona Health Care Cost Containment System (AHCCCS) to contract with an administrative services organization (ASO) to perform specified administrative functions for members enrolled in the American Indian Health Program (AIHP) beginning October 1, 2027.
History
American Indians and Alaska Natives (AI/AN) enrolled in Arizona Health Care Cost Containment System (AHCCCS) or the Children's Health Insurance Program may elect to receive services through AIHP or an AHCCCS-contracted managed care plan. Members who select the AIHP receive services through a fee-for-service delivery system administered directly by AHCCCS, which reimburses registered providers for covered services.
Behavioral health services, including mental health care, substance use treatment and crisis services, are covered when provided at Indian Health Service or Tribal facilities, or by AHCCCS-registered providers. Referrals are not required to obtain behavioral health services.
Covered services under the AIHP include: 1) inpatient services in a hospital or other facilities; 2) partial care; 3) individual, group and family counseling and therapy; 4) emergency and crisis services; 5) behavior management; 6) evaluation and diagnosis; 7) medicine and monitoring of medicine; 8) psychosocial rehabilitation; 9) laboratory and radiology services; 10) screening; 11) emergency and non-emergency transportation; and 12) limited respite care (AHCCCS AIHP Guide).
Provisions
1. Directs AHCCCS, beginning October 1, 2027, to contract with a qualified contractor or other qualified entity to serve as the ASO to perform specified functions for members enrolled in AIHP, excluding services provided to AI/AN members through a tribal health program. (Sec. 1)
2. Specifies that the contract must comply with all federal and state requirements, including the protections for Indians, Indian health care providers and Indian managed care entities. (Sec. 1)
3. Directs AHCCCS to retain ultimate responsibility for administering the AIHP, including fee-for-service rate setting and oversight of any ASO contractor. (Sec. 1)
4. Prohibits AHCCCS from eliminating the AIHP as a fee-for-service option for eligible AI/AN members. (Sec. 1)
5. Directs AHCCCS to require each offeror to demonstrate a proven history of competency and experience in providing robust case management and complaint services to AI/AN populations in coordination with tribal health programs as part of any request for proposals for an ASO. (Sec. 1)
6. Specifies that before AHCCCS issues any request for proposals for an ASO, it must complete meaningful and timely tribal consultation and urban confer regarding implementation of the ASO requirements and subsequently, within 30 days, submit any necessary state plan amendment or waiver to the U.S. Centers for Medicare and Medicaid Services. (Sec. 1)
7. Requires AHCCCS to transmit 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 (HHS Committees), before issuing any request for proposals for an ASO. (Sec. 1)
8. Requires AHCCCS to receive, thoughtfully consider and meaningfully and timely respond to written and oral comments from committee members and the public, including tribal governments, Indian health care providers and urban Indian organizations, before issuing any request for proposals for an ASO. (Sec. 1)
9. Allows each federally recognized Indian tribe in Arizona to appoint one nonvoting observer to the AHCCCS source-selection evaluation committee and requires that each observer be a member of a different tribe. (Sec. 1)
10. Allows the 22 designated nonvoting tribal member observers to attend evaluation meetings, review materials submitted by offerors, ask questions and make statements, but may not score proposals, participate in final ranking or make or direct an award decision. (Sec. 1)
11. Requires AHCCCS to transmit a summary of evaluation results and the proposed award recommendation to the Senate and House of Representatives HHS Committees after completing proposal evaluations and before executing a contract. (Sec. 1)
12. Clarifies that the ASO requirements for the AIHP do not:
a. transfer source-selection or contract-award authority from AHCCCS to the Legislature, any legislative committee or any tribal government;
b. conflict with the Arizona procurement code or any applicable federal procurement requirement. (Sec. 1)
13. Specifies that AHCCCS remains the awarding agency and requires AHCCCS to comply with all applicable state and federal procurement laws and regulations. (Sec. 1)
14. Authorizes any AIHP administrative arrangement to preserve:
a. the rights of eligible AI/AN members to elect the AIHP fee-for-service coverage;
b. the rights of AI/AN members to voluntarily enroll in and disenroll from a managed care organization consistent with federal law; and
c. the protections afforded to Indians and Indian health care providers under federal law, including out-of-network access and appropriate payment requirements for Indian health care providers. (Sec. 1)
15. Requires any entity procured to perform administrative functions for the AIHP to be organized and operated as a qualified contractor. (Sec. 1)
16. Stipulates that the ASO's performance of program integrity functions does not supersede the AHCCCS Office of Inspector General's authority to investigate fraud. (Sec. 1)
17. Requires the ASO and AHCCCS to establish a streamlined provider screening and registration process to ensure only qualified providers are issued a valid AHCCCS provider identification number and prohibits the ASO from requiring any additional registration. (Sec. 1)
18. Clarifies that AHCCCS and the ASO are not prohibited from monitoring providers to ensure compliance with applicable laws, rules and policies. (Sec. 1)
19. Forbids the ASO from requiring prior authorization for services provided to an AIHP member when the member is referred from a tribal health program to a nontribal provider or facility, except for circumstances in which there is clear and convincing evidence of fraud or imminent harm to a member. (Sec. 1)
20. Prohibits AHCCCS and the ASO from requiring prior authorization for services provided to an AIHP member by a nontribal provider or facility in a manner that is different from the AHCCCS policy in effect on January 1, 2026. (Sec. 1)
21. Prohibits any changes to prior authorization requirements or policy affecting the AIHP from being implemented until after the quarterly tribal consultation, except for circumstances in which there is clear and convincing evidence of fraud or imminent harm to a member. (Sec. 1)
22. Requires the ASO to conduct its duties in a corrective, efficient, competent, state-of-the-art and culturally informed manner. (Sec. 1)
23. Directs the ASO, if an AIHP member receives services from a nontribal health program due to a referral, to:
a. coordinate care management and utilization management activities with the tribal health programs, when appropriate; and
b. facilitate communication regarding referrals, authorizations and claims processing and payment issues. (Sec. 1)
24. Forbids the ASO from interfering with or overriding the clinical determinations or care management decisions of a referring tribal health program. (Sec. 1)
25. Directs the ASO to establish an office of tribal relations and requires the office to:
a. coordinate and communicate with the federally recognized Indian tribes in Arizona, tribal members and tribal health programs;
b. serve as the primary point of contact between the ASO and tribal governments and tribal health programs; and
c. participate in tribal consultation and stakeholder meetings as requested by tribal governments or AHCCCS. (Sec. 1)
26. Directs AHCCCS and the ASO to consult quarterly with the Governor or the Governor's designee, tribal health programs, representatives of Arizona's federally recognized Indian tribes, AHCCCS providers and AIHP members to evaluate the ASO's performance and data analytics gathered during the previous quarter to ensure tribal members are receiving quality, safe and appropriate care. (Sec. 1)
27. Defines terms. (Sec. 1)
28. Contains legislative findings. (Sec. 2)
29. Contains an emergency clause. (Sec. 3)
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33. Initials AG SB 1115
34. 3/12/2026 Page 0 Health & Human Services
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