 |
ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AMENDED
AHCCCS; noncontracting providers; reimbursement
Purpose
Requires contractors with the Arizona Health Care Cost Containment System (AHCCCS) to reimburse noncontracting providers for laboratory services under specified conditions and prohibits contractors from imposing restrictions or taking retaliatory actions relating to noncontracting provider referrals.
Background
AHCCCS contracts with health plans to
provide medically necessary health and medical services to eligible members.
AHCCCS contractors are required to provide services and supplies including but
not limited to: 1) inpatient and outpatient hospital services; 2) laboratory
and X-ray services; 3) prescription medications; 4) medical supplies, durable
medical equipment, insulin pumps and prosthetic devices; 5) medical treatment
of eye conditions; 6) early and periodic health screening and diagnostic
services; 7) family planning services; 8) podiatry services;
9) nonexperimental transplants; 10) emergency dental care; 11) ambulance and
nonambulance transportation; 12) hospice care; 13) orthotics; 14) chiropractic
services; 15) diabetes outpatient
self-management training services; and 16) traditional healing services, as
specified (A.R.S. § 36-2907).
Contractor means a person or entity that has a prepaid capitated
contract with AHCCCS to provide health care to members either directly or
through subcontracts with providers (A.R.S.
§ 36-2901).
If there is a cost associated with limiting AHCCCS's ability to require prior authorization and requiring contractors to reimburse noncontracting providers for specified services, there may be a fiscal impact to the state General Fund.
Provisions
1. Requires an AHCCCS contractor to reimburse a noncontracting provider for laboratory services rendered to a member who is enrolled with the contractor if the member was referred by a contracted provider.
2. Prohibits a contractor from reimbursing a noncontracting provider at a rate exceeding the reimbursement rate for contracting providers.
3. Prohibits a contractor from requiring prior authorization for diagnostic services.
4. Prohibits a contractor from taking or threatening to take retaliatory action against a contracted provider for referring a member to a noncontracted provider.
5. Contains a statement of legislative intent.
6. Becomes effective on the general effective date.
Amendments Adopted by Committee
· Prohibits a contractor from reimbursing a noncontracting provider at a rate exceeding the reimbursement rate for contracting providers.
Senate Action
HHS 2/11/26 DPA 4-2-1
ATT 3/2/26 W/D
Prepared by Senate Research
March 4, 2026
MM/MS/hk