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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
health care institutions; licensing; complaints
Purpose
Prohibits the Arizona Health Care Cost Containment System (AHCCCS) from duplicating the health care institution monitoring and compliance functions of the Department of Health Services (DHS) and establishes procedures for compliance inspections and complaint investigations.
Background
DHS is the
agency responsible for licensing and oversight of all health care institutions
in Arizona, including enforcing statutes, rules and regulations governing
health care institutions. DHS may review and approve plans and specifications,
access books and records and conduct inspections and investigations to
determine compliance with licensing standards. DHS may also develop facility
manuals and guides to health care institutions and the general public (A.R.S.
§ 36-406).
AHCCCS serves as Arizona's Medicaid agency which offers qualifying Arizona residents access to healthcare programs. AHCCCS contracts with health professionals to provide medically necessary health and medical services to eligible members and may establish eligibility and enrollment processes and implement systems related to fraud prevention, quality assurance and contractor compliance (A.R.S. § 36-2903).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires DHS to license and monitor the operation of health care institutions to ensure compliance with applicable statutes.
2. Prohibits AHCCCS from duplicating the monitoring and compliance functions of DHS.
3. Requires AHCCCS to accept DHS decisions concerning compliance with licensing standards.
4. Allows DHS to conduct an off-site preliminary review of a complaint or self-report using written or verbal communication or documentation from the licensee to determine whether an on-site compliance inspection or complaint investigation is necessary.
5. Requires DHS to close a complaint without further investigation if a review confirms that the licensee has:
a) implemented systems and processes reducing the likelihood of further violations; and
b) provided sufficient evidence of compliance.
6. Specifies that, if a complaint or allegation of noncompliance is received more than 12 months after an incident occurred, DHS is not required to conduct a compliance inspection or complaint investigation and must close the complaint.
7. Becomes effective on the general effective date.
Prepared by Senate Research
January 26, 2026
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