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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
Senate: HHS DPA 7-0-0-0 | ATT DPA 10-0-0-0 | Third Read 28-2-0-0
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SB 1630: home; community-based services; mental illness
Sponsor: Senator Angius, LD 30
Caucus & COW
Overview
Establishes a Home and Community-Based Service (HCBS) Program for adults who are seriously mentally ill (SMI). Requires the Arizona Health Care Cost Containment System (AHCCCS) to develop and request approval from the Centers for Medicare and Medicaid Services (CMS) to implement a dedicated HCBS benefit for adults who are determined to be SMI. Outlines coverage, eligibility, capacity and reporting requirements.
History
Established in 1981, 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.
The Arizona Long Term Care System (ALTCS) includes the management and delivery of hospitalization, medical care, institutional services and home and community-based services to members through AHCCCS, program contractors and providers. AHCCCS maintains the full operational responsibility for the system and those responsibilities are outlined in statute (A.R.S. § 36-2932).
Home and community-based services may be provided in a member's home, at an alternative residential setting or at other behavioral health alternative residential facilities licensed by the Arizona Department of Health Services (DHS) and approved by the Director of AHCCCS (Director). Under current law, home and community-based services include the following: 1) home health; 2) licensed health aide services; 3) homemaker; 4) personal care; 5) day care; 6) habilitation; 7) respite care; 8) transportation; and 9) other services or licensed or certified settings approved by the Director (A.R.S. §§ 36-2931 and 36-2939(B)).
Additionally, home and community-based services may be provided in a member's home, in an adult foster care home, in an assisted living home or assisted living center or in a level one or level two behavioral health alternative residential facility approved by the Director by program contractors to all members who do not have a developmental disability and are determined to need institutional services (A.R.S. § 36-2939(C)).
Seriously mentally ill means persons who, as a result of a mental disorder, exhibit emotional or behavioral functioning that is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration. In these persons mental disability is severe and persistent, resulting in a long-term limitation of their functional capacities for primary activities of daily living such as interpersonal relationships, homemaking, self-care, employment and recreation (A.R.S. § 36-550).
Provisions
HCBS Program
1. Establishes the HCBS Program for SMI adults. (Sec. 1)
2. Requires AHCCCS to develop and request authority from CMS to implement a dedicated HCBS benefit for adults who are determined to be SMI. (Sec. 1)
3. Directs AHCCCS, through the submission of the first annual report, to convene a stakeholder workgroup that includes representatives from behavioral health providers, counties, tribal nations, community organizations and family members, caregivers and guardians of SMI individuals to advise on HCBS for SMI Program design and implementation. (Sec. 1)
4. Requires stakeholder input to 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. (Sec. 1)
5. Requires AHCCCS to request approval from CMS for the HCBS Program no later than July 1, 2027, and begin implementing the program no later than one year after CMS approval. (Sec. 1)
6. Directs AHCCCS, until the HCBS for SMI Program is implemented, to provide semiannual implementation updates to the President of the Senate, the Speaker of the House of Representatives and the Chairpersons of the Health and Human Services Committees, or their successor committees. (Sec. 1)
Eligibility
7. Outlines eligibility as follows:
a. have been determined to be SMI;
b. meet the SMI long-term level of care adopted by AHCCCS;
c. require HCBS in order to avoid placement in a behavioral health residential facility or psychiatric institution; and
d. meet the financial eligibility requirements. (Sec. 1)
8. Declares an individual who meets the AHCCCS SMI long-term level of care financially eligible for the HCBS for SMI Program if the individual's income does not exceed 300% of the federal supplemental security income benefit rate. (Sec. 1)
9. Allows an individual whose income exceeds the rate standard to establish a qualified income trust to achieve eligibility. (Sec. 1)
10. Requires resource and spousal impoverishment standards to be the same as required for enrollees in the ALTCS HCBS Program. (Sec. 1)
11. Directs AHCCCS to adopt a SMI level of care specific to individuals who are SMI that is based on behavioral, functional and safety criteria, as outlined. (Sec. 1)
12. Prohibits the adopted SMI long-term level of care from requiring a nursing facility level of care, physical disability or physical impairment criteria and using a preadmission screening tool. (Sec. 1)
13. Permits AHCCCS to refine the assessment criteria and processes through rule or policy, consistent with legislative intent, including adjustment to assessment tools, thresholds or processes. (Sec. 1)
Covered Services
14. Requires AHCCCS, subject to CMS approval, to provide home and community-based (HCB) services that are comparable to current authorized HCB services, with modifications appropriate for behavioral health needs. (Sec. 1)
15. Requires the HCB services to include:
a. attendant care and personal care;
b. habilitation with behavior management;
c. adult day health care with a behavioral health focus;
d. supervised community living services, including assisted living-type supports;
e. respite care;
f. home-delivered meals;
g. nursing, home health and medication administration services; and
h. nonemergency transportation. (Sec. 1)
16. Directs AHCCCS to establish service descriptions, scope and staffing standards through rule or policy. (Sec. 1)
17. Permits HCB services to 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, if:
a. Medicaid reimbursement is limited to covered HCB services and does not include room, board, supervision for custody or enforcement of court orders; or
b. the individual is afforded periodic review and planning for transition to a less restrictive setting when clinically appropriate. (Sec. 1)
18. Allows AHCCCS to add, modify or combine services consistent with federal approval and legislative intent. (Sec. 1)
Program Capacity and Provider Requirements
19. Limits the HCBS Program to 250 members, including temporary emergency placements, subject to CMS approval. (Sec. 1)
20. Permits AHCCCS to increase enrollment above 250 members if data reported in the annual report demonstrates reduced utilization of high-cost services or cost avoidance in state-funded systems, subject to JLBC review. (Sec. 1)
21. Prohibits enrollment in the HCBS for SMI Program from exceeding 1,000 members unless authorized by the Legislature. (Sec. 1)
22. Outlines order of priority for AHCCCS to assign available slots when capacity is limited. (Sec. 1)
23. Allows a court to recommend participation in the HCBS Program, but may not compel AHCCCS to exceed the enrollment cap. (Sec. 1)
24. Permits AHCCCS to reserve a portion of available capacity for emergency or priority placements. (Sec. 1)
25. Requires providers to document behavioral interventions, crisis supports and staffing adjustments before initiating discharge. (Sec. 1)
26. Requires a provider that receives reimbursement under the HCBS Program to implement eviction-prevention protocols and obtain regional behavioral health authority approval before issuing nonemergency notices to vacate. (Sec. 1)
27. Enables AHCCCS to adopt enhanced reimbursement rates for high-acuity SMI individuals who are receiving HCB services. (Sec. 1)
28. Clarifies this does not:
a. limit AHCCCS's authority to ensure the health and safety of participants; or
b. require a provider to continue services when immediate and documented risks to health or safety cannot be mitigated through reasonable clinical interventions. (Sec. 1)
Miscellaneous
29. Requires AHCCCS, beginning one year after implementation of the HCBS Program for SMI adults, and each year thereafter, to submit an annual report to the Governor, President of the Senate and Speaker of the Arizona House of Representatives that includes:
a. the number of enrolled members and individuals who are on the waitlist;
b. the percentage of members who are under court-ordered treatment, guardianship or criminal justice supervision;
c. housing stability outcomes for members;
d. hospitalization, crisis service, jail, emergency department, evaluation agency and screening agency utilization of members;
e. provider denials and discharges and reasons for the denials and discharges; and
f. the fiscal impact and estimated cost avoidance related to the HCBS Program. (Sec. 1)
30. Directs AHCCCS to seek and maintain any necessary federal approvals and may operate the HCBS Program pursuant to one or more approved Medicaid state plan authorities, waivers or demonstration authorities, including those authorized under Medicaid waiver authority. (Sec. 1)
31. Requires AHCCCS, if CMS denies or does not approve a request necessary to implement the HCBS for SMI Program, to continue to pursue approval to the extent allowed by federal law through modifications, resubmissions or alternative federal authority. (Sec. 1)
32. Requires AHCCCS to report the status of approval efforts in the semiannual implementation updates. (Sec. 1)
33. Permits AHCCCS to adopt rules to implement the HCBS Program for SMI adults. (Sec. 1)
34. Clarifies this does not expand or modify standards for involuntary treatment. (Sec. 1)
35. Defines pertinent terms. (Sec. 1)
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Initials AG SB 1630
3/12/2026 Page 0 Caucus & COW
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