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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AHCCCS; prior authorization; behavioral health
Purpose
Prohibits, beginning January 1, 2027, the Arizona Health Care Cost Containment System Administration (AHCCCS) from requiring prior authorization for behavioral health services provided to a member under the American Indian Health Plan (AIHP) by a behavioral health provider unless outlined conditions apply.
Background
AHCCCS serves as
Arizona's Medicaid agency, which offers qualifying Arizona residents access to
healthcare programs, including behavioral health. AHCCCS contracts with health
professionals to provide medically necessary health and medical services to
eligible members. AHCCCS provides both inpatient and outpatient behavioral
health services, including but not limited to: 1) all behavioral health
services, medical detoxification, accommodations and staffing, supplies and
equipment, if provided under the direction of a physician of a
Medicare-certified, inpatient facility; 2) screenings provided by a behavioral
health professional or technician; 3) a behavioral health assessment provided
by a behavioral health professional or technician;
4) counseling, including individual therapy, group therapy and family therapy
provided by a behavioral health professional or technician; 5) behavior
management services; and
6) psychosocial rehabilitation services. Inpatient behavioral health services,
other than outlined emergency services, are not covered unless prior
authorization is obtained (A.R.S.
§ 36-2907; A.A.C.
R9-22-1205).
American Indians
and Alaska Natives enrolled in AHCCCS or the Children's Health Insurance
Program may choose to receive coverage through the AIHP or an AHCCCS-contracted
managed health plan. AHCCCS covers behavioral health services, including mental
health, substance use treatment and crisis services, provided at Indian Health
Service-covered Tribal facilities or at an AHCCCS registered provider.
Recipients do not need a referral to receive behavioral health services. Under
the AIHP, AHCCCS coverage includes: 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).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Prohibits, beginning January 1, 2027, AHCCCS from requiring prior authorization for behavioral health services provided to a member under the AIHP by a behavioral health provider unless, after meeting with the provider, AHCCCS implements a corrective action plan and the provider has not complied within 90 days after the implementation date of the corrective action plan.
2. Becomes effective on the general effective date.
Prepared by Senate Research
January 16, 2026
MM/SDR/hk