 |
ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
REVISED
AMENDED
AHCCCS; prior authorization; behavioral health
Purpose
Prohibits, beginning January 1, 2027, the Arizona Health Care Cost Containment System Administration (AHCCCS) from requiring 100 percent prepayment review for behavioral health services provided to a member under the American Indian Health Program (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).
The Joint Legislative Budget Committee published a fiscal note stating that the fiscal impact of S.B. 1122 cannot be determined without additional information from AHCCCS, but notes that the bill may affect administrative workload and fee-for-service claim costs (JLBC fiscal note).
Provisions
1. Prohibits, beginning January 1, 2027, AHCCCS from requiring 100 percent prepayment review for behavioral health services provided to a member under the AIHP by a behavioral health provider unless AHCCCS implements a corrective action plan and the provider is noncompliant or not engaged in the corrective action plan.
2. Becomes effective on the general effective date.
Amendments Adopted by Committees
1. Prohibits AHCCCS from requiring 100 percent prepayment review, rather than prior authorization.
2. Removes specification of the timeline in which a corrective action plan must be implemented and considered noncompliant.
3. Makes technical changes.
Revisions
· Updates the fiscal impact statement.
Senate Action
HHS 1/15/26 DPA 7-0-0
ATT 2/11/26 DPA 10-0-0
Prepared by Senate Research
February 24, 2026
MM/SDR/hk