Source: http://azahcccs.gov/reporting/state/proposedrules.aspx
Timestamp: 2013-06-19 22:43:48
Document Index: 364286154

Matched Legal Cases: ['§ 36', '§ 36', '§ 34', '§256', '§ 36', '§ 1396', '§\n1396', '§ 1396', '§ 1315', '§ 1315', '§ 36', '§ 36', '§ 2901', '§ 36', '§ 11']

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AHCCCS proposed rules are published in the Arizona Administrative Register (A.A.R.) for public
review. To compare the following Proposed Rule language to Final Rule, please see
corresponding topic when finalized at: http://www.azahcccs.gov/reporting/state/unpublishedrules.aspx
Nursing Facility Assessment Amendment
Hospital Rates and NonER transport copay
Benefit Limits Repromulgation
340B Pharmacy Pricing Rerun Nursing Facility (NF) Assessment
Agency with Choice (aka Community First Choice (CFC))
KidsCare II Program New Applications
340B FQHC Pharmacy Definition
Inpatient Burn Unit Exception
Trauma and ED Funds
SDAC - Insulin Provision
340B Pricing for FQHC Pharmacy Reimbursement (2nd Notice)
Non-ER Transportation Copay
Expansion Population (aka Childless Adult
or AHCCCS Care) Amended
340B Pricing for FQHC Pharmacy Reimbursement
Respite Service Limits
Federal Emergency Service (FES) Program Inpatient Limits
CMP – Civil Monetary Penalties
Adult Inpatient Limitations with Member Billing Outlier Reimbursement
Expansion Population Freeze (aka Childless
Adult or AHCCCS Care)
Transplant Restoration
Lifting PA requirement
MED Phase Out
Outpatient Rebase
Preadmission Screening (PAS) Tool rulemaking
SDAC – Self Directed Attendant Care
Adult Benefit Redesign
Costsharing/Copayments
Kids Care Premium Increase
Prior Quarter Eligibility |
42 CFR 435.914 requires the Administration to provide Prior Quarter (PQ) eligibility. A.R.S. § 36-2903 (A) provides reimbursement responsibility for care provided during an eligibility period. Currently, the Administration is waived from providing PQ eligibility. The waiver expires December 31, 2013. The Administration will need to implement prior quarter eligibility requirements effective January 1, 2014. Comment Period Ends: July 1, 2013, 5 p.m.
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [60KB]
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [46KB]
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 29. AHCCCS [44KB]
A.R.S. § 36-2999.52 authorizes the Administration to administer a provider assessment on health care items and services provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. The Administration is proposing an amendment to rule to describe the process for estimating and distributing supplemental payments to contractors for enhanced payments to eligible nursing facilities based on bed days paid for through managed care. The rule amendments also describe the process for calculating and distributing the enhanced payments to eligible nursing facilities by the Administration for bed days paid by the Administration. In addition, the rules clarify general requirements applicable to nursing facilities in order for them to qualify for the supplemental payments. Comment Period Ends: June 18, 2013, 5 p.m.
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [50KB]
The CRS program was administered by the Arizona Department of Health Services (ADHS) until SB1619 Arizona Laws 2011 Regular Session was enacted directing the Administration to administer the CRS program. SB1619 specified that the existing CRS program rules adopted by ADHS were left in effect "until superceded by rules adopted by [AHCCCS]." The Legislature enacted this change as part of a larger initiative by ADHS and AHCCCS to better integrate conditions provided to medically eligible with CRS related conditions while at the same time streamlining the administration of the program. Therefore, AHCCCS finalized rules to transition the ADHS requirements under AHCCCS as published in the Arizona Administrative Register August 24, 2012 and Arizona Laws 2011, Regular Session, Ch. 31, § 34, exempted AHCCCS from the requirements of A.R.S. Title 41, Ch.6., these rules were promulgated under exemption repealed, then repromulgated. SB1528 Laws 2012, Chapter 299, Section 7 repealed the rule-making exemption authority and Section 8 stipulated that rules adopted through the previous year’s authority would expire December 31, 2013, absent specific statutory authority for those rules. Comment Period Ends: June 10, 2013, 5 p.m.
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [99KB]
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [30KB]
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 31. AHCCCS [28KB]
After an evaluation of the Agency’s overall statutory authority regarding rates and copayments, AHCCCS has determined to repromulgate these rules specifying specific statutory authority to continue measures it previously enacted consistent with Laws 2012 Chapter 299 Section 8. The intent of the rulemakings has not changed as what was described in the rulemakings posted. Comment Period Ends: June 3, 2013, 5 p.m.
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [162KB]
After an evaluation of the Agency’s overall statutory authority regarding covered services, rates, and eligibility, AHCCCS has determined that it will re-promulgate certain rules implementing “program changes” made pursuant to Laws 2011, Chapter 31, Section 34 by identifying the specific statutory authority for the rules to ensure that the rules continue beyond December 31, 2013 in accordance with Laws 2012, Chapter 299, Section 8. Therefore, to ensure continuity of the rules previously adopted under Section 34, the AHCCCS Administration is re-promulgating the same rules which became effective October 1, 2011. No changes have been proposed to the language of the rules. Comment Period Ends: May 13, 2013, 5 p.m.
Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [39KB]
340B Pharmacy Pricing Rerun
Comment period ended - see Final Rule Fri January 24, 2013
Due to recent legislative direction within Laws 2012, Chapter 299, Section 7 of the bill repealed the rule-making authority and Section 8 stipulated that rules adopted through the previous year’s authority would expire December 31, 2013 without specific statutory authority. After an evaluation of our overall statutory authority regarding covered services, rates and eligibility, AHCCCS has determined that it requires statutory changes to continue measures it enacted under the Chapter 299 authority that prohibits AHCCCS from continuing after December 31, 2013 any “program changes” made pursuant to Section 34 of Senate Bill 1619. Therefore, the Administration is re-promulgating rules in regard to the 340B program. The Veterans Health Care Act of 1992 established the 340B program in section 340B of the Public Health Service Act (PHS Act). The 340B program requires drug manufacturers participating in Medicaid to provide discounted covered outpatient drugs to certain eligible health care entities, known as covered entities. Covered entities include disproportionate share hospitals, family planning clinics, and federally qualified health centers, among others as described under 42 U.S.C. §256b(a)(4). As of October 2010, approximately 15,000 covered-entity locations were enrolled in the 340B program.
The Health Resources and Services Administration (HRSA) administers the 340B program. In 2000, HRSA issued guidance directing covered entities to refer to State Medicaid agencies’ policies for applicable billing policies in regards to 340B claims. The Centers for Medicare and Medicaid Services (CMS), which administers the Medicaid program, does not require State Medicaid agencies to set 340B policies. Comment Period Ends: March 18, 2013, 5 p.m.
Notice of Proposed Rulemaking [45KB] Nursing Facility (NF) Assessment
A.R.S. § 36-2999.52 authorizes the Administration to administer a provider assessment on health care items and services provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. The Administration is proposing rule to delineate the method for imposing the assessment, the criteria for qualifying for supplemental payments, and the method for determining the amount of supplemental payments. Comment Period Ends: October 29, 2012, 5 p.m.
Public Hearing: October 29, 2012, 3 p.m.
Notice of Proposed Exempt Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [46KB] Comments on Nursing Facility Assessment Rules: Posted November 15, 2012 [20KB] Ambulance Rates
Tues August 21, 2012
The recently enacted Health Budget Reconciliation Bill, Senate Bill 1528 (Arizona Laws 2012, Chapter 299), amended ARS 36-2239 such that reimbursement of ambulances is no longer tied to rates established by the Arizona Department of Health Services (section 3). However, for the contract year beginning October 1, 2012, the bill requires that AHCCCS reimburse ambulance services at 68.59% of the rates established by ADHS (section 18). The bill also exempted rules regarding revisions to ambulance reimbursement from the rule-making requirements of ARS Title 41 (section 25). The bill becomes effective August 2, 2012.
As part of this rule-making, AHCCCS intends to describe the reimbursement methodology that the program will employ as of the effective date of the Health BRB. Comment Period Ends: September 21, 2012, 5 p.m.
Proposed Effective Date: October 1, 2012
Notice of Proposed Exempt Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [40KB] Agency with Choice (aka Community First Choice (CFC))
Thur August 2, 2012
The AHCCCS Administration is proposing rulemaking that provides elderly and disabled AHCCCS long-term care beneficiaries (AHCCCS beneficiary) flexibility and control with respect to the way in which attendant services and supports are provided in their homes or other community based settings. Attendant care services consist of nonprofessional assistance with activities of daily living and other services such as housekeeping. AHCCCS currently has a rule regarding this topic, Self-Directed Attendant Care (AAC R9-28-508), which was adopted as a final rule in 2011. Since that time, Congress adopted section 1915(k) of the Social Security Act, the Community First Choice (CFC) state plan option. AHCCCS plans to elect the “Agency with Choice” CFC state plan option. Both, Agency with Choice and Self-Directed Attendant Care are member-directed service models. The models are not a service, but rather a manner in which services are delivered. By way of example of the differences, under Self- Directed Attendant Care, the AHCCCS beneficiary or their legal guardian serves as the legal employer of the paid caregiver. Under Agency with Choice, the agency serves as the legal employer of the paid caregiver while AHCCCS beneficiaries or their individual representatives assume some of the employer-based responsibilities. Comment Period Ends: September 24, 2012, 5 p.m.
Public Hearing: September 24, 2012, 10 a.m.
Title 9. Health Services, Chapter 28. AHCCCS [67KB] Pubic Comment/AHCCCS Response Matrix 09/27/2012 [47KB]
Pubic Comment/AHCCCS Response Matrix 10/22/2012 [142KB]
Thur June 28, 2012
With the recent change in Arizona Law, AHCCCS now has direct legal responsibility
for the CRS program. As part of that legislative act, the existing CRS program rules
adopted by ADHS were left in effect "until superceded by rules adopted by [AHCCCS]."
The legislature enacted this change as part of a larger initiative by ADHS and AHCCCS
to better integrate the care provided to children eligible for Medicaid and CRS
related services while at the same time streamlining the administration of the program.
Therefore, AHCCCS is proposing rule to transition the ADHS requirements under AHCCCS.
Comment Period Ends: July 30, 2012, 5 p.m.
Proposed Effective Date: August 2, 2012
Title 9. Health Services, Chapter 22. AHCCCS [78KB] KidsCare II Program New Applications
Thur June 21, 2012
The AHCCCS Administration had offered every child on the waiting list the opportunity
to enroll in KidsCare under AAC R9-31-401. Based on the response from those households
and consistent with the Special Terms & Conditions of the Arizona Demonstration
Project approved by the federal government, the AHCCCS Administration has determined
that funding is sufficient to reopen KidsCare based on new applications for children
in households with income at or under 175% of the federal poverty level. This rule
expands R9-31-401 to permit new applications and describes how those applications
will be received and processed.
Comment Period Ends: July 21, 2012, 5 p.m.
Proposed Effective Date: August 1, 2012
Title 9. Health Services, Chapter 31. AHCCCS [29KB] Hospital Rates |
The purpose of this rule-making is to maintain reimbursement reductions for inpatient
and outpatient hospital services covered through the AHCCCS program that were instituted
last contract year (October 1, 2011 through September 30, 2012) and to eliminate
adjustments to those rates based on inflation.
Comment Period Ends: July 14, 2012, 5 p.m.
Proposed Effective Date: July 18, 2012
Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [65KB]
The AHCCCS Administration recently promulgated a rule which describes the reimbursement
methodology applicable to FQHCs and FQHC Look Alikes and their contacted pharmacies
for drugs that are subject to 340 B pricing. This rule became effective February
1, 2012. In response to questions regarding the scope of this rule, the AHCCCS Administration
found that further clarification was needed to define an FQHC and FQHC Look-Alike
pharmacy. Additionally, the proposed rule clarifies that contracted pharmacies shall
not submit claims for drugs dispensed under an agreement with a 340 B entity as
part of the 340 B drug pricing program the 340B drug discount federal law imposes
on drug manufacturers.
Comment Period Ends: July 9, 2012, 5 p.m
Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [40KB] Medicare Cost Sharing (MCS) |
The AHCCCS Administration is initiating this rulemaking for purposes of amending
its existing rules that define the scope of benefits for persons eligible for both
Medicaid and Medicare. In general, the Medicare program has primary responsibility
for the cost of care for these individuals, and Medicaid (that is, AHCCCS) is responsible
for paying for the cost of Medicare Part B premiums, and/or Medicare coinsurance,
copayments, and deductibles depending on the extent of the individual’s entitlement
under the Medicaid program to “Medicare Cost Sharing”.
AHCCCS has implemented several significant statutory and regulatory changes to benefits,
such as limitations of Inpatient hospital days for adults. With respect to persons
eligible for Medicare Cost Sharing, AHCCCS is responsible in many instances for
the cost of services that have been excluded or limited by AHCCCS but are still
covered by Medicare. In light of the recent changes in AHCCCS benefits, there is
a heightened need to ensure that the Medicare Cost Sharing rules clearly identify
the rights of persons eligible for MCS and the extent of AHCCCS’ responsibility
for payment for services. In addition, the Administration intends to update Medicare
Cost-Sharing regulations with any necessary technical changes to ensure clarity
and conciseness of the rule.
Comment Period Ends: July 31, 2012, 5 p.m
Public Hearing: July 31, 2012, 1 p.m. Notice of Proposed Rulemaking:
Title 9. Health Services, Chapter 29. AHCCCS [94KB] Inpatient Burn Unit Exception
Thur May 17, 2012
The Governor's Medicaid Reform Plan, as announced on March 15, 2011, includes proposals
to reduce nonfederal expenditures for the AHCCCS program by approximately $500 million
during state fiscal year 2012. To achieve some of these reductions, the AHCCCS Administration
promulgated limitations to covered inpatient days for adults and within these limitations
there were exceptions, such as hospitalizations due to severe burns. This rulemaking
was effective October 1, 2011. Based on comments obtained from the Center of Medicare
and Medicaid Services during the State Plan approval process, the Administration
is proposing a clarification to the description of the exception of hospitalizations
due to severe burns.
Burn center verification, a joint program of the American Burn Association and the
American College of Surgeons, is designed to ensure provision of optimal care to
burn patients from the time of injury through rehabilitation. In order to receive
this distinction of high quality patient care, the provider participates in a rigorous
review process, including an in depth site visit followed by a written report. It
is likely that burn victims requiring in excess of 25 days of inpatient treatment
would be transferred to an ACS verified burn center.
Comment Period Ends: June 18, 2012, 5 p.m.
Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [25KB]
Trauma and ED Funds |
AHCCCS anticipates conducting exempt rule making to modify the methodology for determining
uncompensated costs associated with trauma and emergency services to comply with
the terms and conditions for claiming federal matching funds for supplemental payments
to hospitals for the unrecovered cost of providing trauma and emergency services.
Following stakeholder input, the proposed exempt rules also establish a new allocation
of the federally matched tribal gaming funds between hospitals providing trauma
services and urban and rural hospitals providing emergency services.
Proposition 202 established A.R.S. 36-2903.07 which appropriates tribal gaming funds
for the purpose of making supplemental payments to Arizona hospitals for the cost
of unrecovered trauma and emergency services. Historically these funds have provided
approximately $20 million with 90% of the funds paid to 6 trauma facilities and
the remaining 10% spread among dozens of hospitals for uncovered emergency department
costs. To date, federal matching funds through the Medicaid program have not been
available for these supplemental payments for trauma and emergency services because
the proposed payments are intended to cover costs for care unassociated with Medicaid
eligible persons. In general, under 42 U.S.C. § 1396b, federal financial participation
in the State’s expenditure for medical coverage under Title XIX of the Social Security
Act (Medicaid) is limited to expenditures for services covered under 42 U.S.C. §
1396d for persons eligible under 42 U.S.C. § 1396a. However, the Secretary of the
United States Department of Health and Human Services (who oversees the federal
Medicaid program) has the authority under 42 U.S.C. § 1315 to allow the state to
claim federal financial participation for expenditures not explicitly listed in
the Medicaid Act so long as the expenditure, “in the judgment of the Secretary,
is likely to assist in promoting the objectives of title XIX.” On April 6, the Secretary,
under the authority of 42 U.S.C. § 1315, approved an amendment to the Arizona Demonstration
Project that permits Arizona to claim federal financial participation for supplemental
payments to hospitals for the unrecovered cost of trauma and emergency services.
See the Arizona Section 1115 Demonstration Project
Waiver page.
Proposed Effective Date: July 1, 2012
Title 9. Health Services, Chapter 22. AHCCCS [24KB] Contracts and RFP |
Thur Apr 26, 2012
A.R.S. § 36-2906 authorizes the Administration to adopt rules for the RFP process
and the award of contracts. The Administration is proposing a clearer application
of timeframes required for contract or proposal protests. In addition, the use of
the term “procurement file” instead of “contract record” and also clarifying sanctions
are monetary based rather than by percentage.
Public Hearing Date: June 18, 2012, 2 p.m.
Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [43KB]
Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [25KB]
SDAC - Insulin Provision |
Thu April 18, 2012
A.R.S. § 36-2951 authorizes the Administration to provide requirements for Self-Directed
Attendant Care (SDAC) services. The Administration is proposing a revision to the
rule language describing the administration of insulin. An Attendant Care Worker
may provide insulin and is not limited to only providing the insulin when using
Comment Period Ends: June 11, 2012, 5 p.m.
Proposed Effective Date: June 11, 2012, 10:00 a.m.
Title 9. Health Services Chapter 22. AHCCCS [28KB] KidsCare II Program |
AHCCCS anticipates conducting exempt rule making to establish the standards, methods,
and procedures for making a defined number of children on the KidsCare waiting list
eligible using SNCP funds.
Final rulemaking is contingent upon CMS approval of a waiver and availability of
political subdivision funding. In the event CMS does not approve the AHCCCS proposal
then a Notice of Terminated Rulemaking will be filed.
Comment Period Ends: April 20, 2012, 5 p.m.
Proposed Effective Date: May 1, 2012 Notice of Proposed Rulemaking:
Title 9. Health Services, Chapter 31. AHCCCS [33KB] 340B Pricing for FQHC Pharmacy Reimbursement
(2nd Notice) |
To address the inability of AHCCCS to claim the Medicaid drug rebate for these drugs
and the disparity between actual acquisition cost of drugs in the 340 pricing program
dispensed by FQHC and FQHC Look-Alike pharmacies and the current AHCCCS reimbursement
rate for those drugs, the AHCCCS Administration is proposing a rule to require a
reimbursement methodology specific to 340B drugs dispensed by FQHC and FQHC Look-Alike
Pharmacies. In addition, the rule specifies the reimbursement methodology applicable
to drugs dispensed by 340B covered entities that are not eligible for purchase under
the 340B pricing program and also describes the reimbursement to pharmacies that
contract with 340B covered entities to dispense drugs as part of that program. By
implementing this methodology, the potential for duplicate discounts will be eliminated,
340B covered entities and pharmacies that contract with them will receive reasonable
compensation taking into consideration their reduced acquisition cost, and AHCCCS
will not carry the cost of the 340B drug discount federal law imposes on drug manufacturers.
Comment Period Ends: January 2, 2012, 5 p.m.
Proposed Effective Date: February 1, 2012 Notice
of Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [73KB]
Non-ER Transportation Copay |
Comment period ended - see Final Rule.
The AHCCCS Administration has received a waiver from the Centers of Medicare and
Medicaid Services allowing the Administration to impose copayments for taxi transportation.
The copayment will be in the amount of $2 for each one-way trip for a member who
resides in Maricopa or Pima County. This copayment will be charged to AHCCCS members
who are adults that fall under the category "AHCCCS Care".
Comment Period Ends: December 18, 2011, 5 p.m.
Proposed Effective Date: April 1, 2012 Notice of Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [73KB]
(aka "Childless Adults" or "AHCCCS Care") Amended
The Administration is amending this rule to conform to the recently approved Demonstration
Project under section 1115 of the Social Security Act with respect to medical coverage
for the Medicaid expansion population sometimes referred to as "Childless Adults"
or "AHCCCS Care."
Comment Period Ends: December 3, 2011, 5 p.m.
Proposed Effective Date: July 8, 2011
Title 9. Health Services, Chapter 22. AHCCCS [38KB] For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [14KB]
The AHCCCS Administration is proposing a rule to require a specific reimbursement
methodology for drugs subject to the 340B pricing program dispensed by Federally
Qualified Health Centers (FQHCs) and FQHC Look-Alikes and their contracted pharmacies.
Unlike other drugs paid for by AHCCCS and its Medicaid Managed Care Contractors,
the State is not entitled, under 42 USC 1396r-8, to rebates from drug manufacturers
for drugs purchased under the 340B pricing program. Instead drug manufacturers are
required under federal law to provided deep discounted to entities that participate
in the 340B program including FQHCs and FQHC Look-Alikes. This rule is intended
to provide reasonable compensation to FQHCs and FQHC Look-Alikes for the cost of
dispensing the drug while requiring the FQHC and FQHC Look-Alikes to pass some of
the ingredient cost savings of the 340B program on to AHCCCS when those drugs are
dispensed to AHCCCS eligible members.
Comment Period Ends: October 23, 2011
Proposed Effective Date: January 1, 2012
Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [44KB] For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [95KB]
Respite Service Limits |
Thur Jul 21, 2011
The AHCCCS Administration is proposing an approximate 15 percent reduction in the
annual limit for respite hours. Respite services are provided to members receiving
Behavioral Health services in an Acute care setting and to members in the ALTCS
program. The respites services are not delineated under the State Plan, however,
they are a covered service under the 1115 Waiver.
Comment Period Ends: August 21, 2011, 5 p.m.
Proposed Effective Date: October 1, 2011.
of Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [37KB]
of Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [33KB]
For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [17KB]
Federal Emergency Service (FES) Program Inpatient
Thur Aug 04, 2011
The Administration initially proposed a revision to rule R9-22-210 to exclude the
use of CPT code 99281 for facility services provided in an emergency department.
As a result of feedback from the Center for Medicare and Medicaid Services (CMS),
the Administration will not proceed with exclusion of CPT code 99281. Therefore,
the Administration has limited the rulemaking to the change provided under R9-22-217
which cross references the promulgated Inpatient Limit rule R9-22-204 effective
Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [28KB] CMP – Civil Monetary Penalties
The Administration has initiated the following rulemaking regarding Civil Monetary
Penalties as result of a 5-year-rule-review approved by the Governor’s Regulatory
Review Council on December 2, 2008.
Comment Period Ends: August 29, 2011, 5 p.m.
Public Hearing Date: August 29, 2011, 11 a.m.
Title 9. Health Services, Chapter 22. AHCCCS [47KB] Adult Inpatient Limitations with Member
Thur Jun 23, 2011
is proposing limitations to covered inpatient days for adults. In addition, this
rule-making proposes changes to current rules regarding limitations on providers
charging members for services.
Comment Period Ends: July 23, 2011, 5 p.m.
Proposed Effective Date: October 1, 2011
of Proposed Exempt Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [84KB] For this topic, click here to view Public Comments/AHCCCS Responses:
Comments/Responses [24KB] Outlier Reimbursement
The purpose of the proposed rule making is to implement changes to the methodology
for qualifying and paying claims for inpatient hospital services with extraordinary
operating costs per day, commonly referred to as “outlier” claims. Specifically,
the agency proposes to increase the thresholds used to qualify claims by 5% and
to reduce the cost-to-charge ratios used to qualify and pay outliers by 5% plus
by a like percentage of any increase in a hospital’s charge master as filed with
the Arizona Department of Health Services. In addition, the rule making clarifies
that all inpatient services provided by out of state hospitals are not paid using
the tiered per diem methodology, but are paid by multiplying billed charges by a
cost-to-charge ratio. As such, there is no outlier methodology for payments to out
of state hospitals.
Comment Period Ends: June 27, 2011, 5 p.m.
Proposed Exempt Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [68KB]
For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [18KB]
Freeze (aka Childless Adult or AHCCCS Care) |
Amended - See amended Proposed Rule
The AHCCCS Administration is initiating this proposed exempt rule-making to comply
with the legislative requirement that the Administration adopt rules regarding eligibility
necessary to implement a program within available appropriations. Specifically,
the Administration is proposing to establish through rule 1) closing all new eligibility
beginning July 1 for persons in AHCCCS Care not designated as eligible in the Arizona
State Plan under Title XIX of the Social Security Act 2) flexibility and a methodology
for the Director to: delay closure of the AHCCCS Care program, re-open the AHCCCS
Care program, or terminate coverage for some or all persons in the AHCCSC Care Program.
These changes will be predicated on the most current information and estimates of
available resources to support the Medicaid program. The proposed rule also sets
forth the means by which changes in eligibility and their effective dates will be
communicated to the public. Approval of this methodology by the Center for Medicare
and Medicaid Services is required. See the links below for additional information:
Comment Period Ends: June 20, 2011, 5 p.m.
Proposed Effective Date: July 1, 2011
Notice of Proposed Exempt
Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [49KB]
For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [58KB]
Transplant Restoration | Comment period ended - See final rule
Thur Apr 7, 2011
Governor Brewer’s Medicaid Reform Plan restores the transplants AHCCCS previously
covered for adult members age 21 and older effective April 1, 2011. See the links
Comment Period Ends: May 6, 2011, 5 P.M.
Proposed Effective Date: April 1, 2011
Exempt Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [27KB]
Lifting PA requirement | Comment period ended - See final rule
The proposed rules will eliminate the requirement for obtaining PA for services
such as, but not limited to: dialysis shunt placement, apnea management and training
for premature babies up to one year of life, certain eye surgeries, and hospitalizations
for labor and delivery not exceeding specific time parameters. In addition, technical
changes and striking of redundant rules will be made.
Comment Period Ends: May 10, 2011, 5 P.M.
Public Hearing Date: May 10, 2011, 2 P.M.
Title 9. Health Services, Chapter 22. AHCCCS [121KB]
Title 9. Health Services, Chapter 31. AHCCCS [76KB]
MED Phase Out | Comment period ended - See final rule
with the requirement that the Administration adopt rules regarding eligibility necessary
to implement a program within available appropriations. Specifically, the Administration
is proposing to phase out eligibility for Medical Expense Deduction (MED) coverage.
The Administration intends to stop all new approvals for persons under the MED program
with eligibility effective dates on or after May 1, 2011. Because any single period
of eligibility is limited to the remainder of the month in which eligibility is
determined plus five additional months under A.R.S. § 2901.04(F), no one will remain
eligible for the MED program after September 30, 2011. The AHCCCS Administration
does not intend to establish a waiting list for persons who would be eligible for
MED but for this rule.
Comment Period Ends: April 18, 2011, 5 P.M.
Proposed Effective Date: May 1, 2011
Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [30KB]
For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [78KB]
| Comment period ended - See final rule
The current rule requires that the fee schedule and the state-wide cost-to-charge
ratio be “rebased” using more current Medicare cost data every five years as described
in A.A.C. R9-22-712.40. In the five years since the original adoption of the current
rule, AHCCCS has also identified the need to consider a number of refinements to
the existing methodology to ensure proper cost containment and provide more equitable
compensation among hospitals. Some of the issues that have been identified include,
but are not limited to, adjustments to the peer group modifiers that are currently
fixed in rule and their application to certain charges, adjustment or elimination
of separate payment for outpatient observation, grouping charges by dates of service
as well as by procedure type, clarification of settings that qualify for payment
as outpatient hospital settings.
Comment Period Ends: March 22, 2011, 5 P.M.
Public Hearing: March 22, 2011, 10 A.M.
Title 9. Health Services, Chapter 22. AHCCCS [41KB]
For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [36KB]
Tool rulemaking | Comment
period ended - See final rule
Mon Aug 23, 2011
The AHCCCS Administration has reviewed the validity of the PAS tools used to evaluate
an individual’s medical and functional eligibility for the ALTCS Program. In order
to qualify for the ALTCS Program, individuals must require an institutional level
of care. The PAS tools are intended to reflect the current consensus of the medical
community and experts in developmental disability on best practices for reliably
assessing the need for institutional care. As the opinion of those experts advance,
the PAS tools should be updated to reflect the new consensus. A decision was made
last year to update and revise the PAS tool used for children with developmental
disabilities under age 6. The new tool has been developed and piloted and is now
being finalized. The developmental evaluation in the tool has been expanded and
updated. Developmental items on the tool are based on questions from several standardized,
up to date and commonly accepted assessment tools. The tool has been piloted in-house
and the analysis for a new scoring methodology has been completed. Because the current
rules very specifically describe the elements and scoring routine of the current
PAS tools, it is necessary to update the rules.
Comment Period Ended: October 12, 2010, 5 p.m.
Public Hearing: October 12, 2010, 1 p.m.
Title 9. Health Services, Chapter 28. AHCCCS [110KB]
For this topic, click here to view Public Comments/AHCCCS Responses: Comments/Responses [72KB]
SDAC – Self Directed
Attendant Care | Comment period ended - See final rule
Tues Nov 25, 2008
The legislature in SB 1329 created A.R.S. § 36-2951 to provide requirements for
self-directed attendant care (SDAC) services. The Administration is proposing rule
language to describe the requirements a person must follow in order to provide or
receive SDAC services.
Comment Period Ended: August 3, 2010, 5 p.m.
Public Hearing: October August 3, 2010, 3 p.m.
Title 9. Health Services, Chapter 28. AHCCCS [28KB]
| Comment period ended - See
Thur May 13, 2010
The AHCCCS Administration is proposing rule changes to delineate the service limitations/
exclusions as described in HB2010, Forty-ninth Legislature Seventh Special Session
of 2010. The AHCCCS Administration is exempt from the rule making requirements of
Title 41, Chapter 6, A.R.S., as described in HB2010, Forty-ninth Legislature Seventh
Special Session of 2010, Section 34.
Comment Period Ended: June 22, 2010, 5 p.m.
Public Hearing: October June 22, 2010, 2 p.m.
Notice of Exempt Proposed Rulemaking: Title 9. Health Services, Chapter 28. AHCCCS [29KB]
Proposed Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [126KB]
The DRA created section 1916A of Title XIX (42 U.S.C. 1396o-1) which permits states
to impose higher than nominal copayments on certain populations with incomes over
100% of the Federal Poverty Level (FPL). The AHCCCS Administration plans to move
forward using this authority to change the copayment requirements for those members
under the Transitional Medical Assistance (TMA) program with income over 100% of
the FPL and any other changes required to conform to 1916A of Title XIX.
Comment Period Ended: May 18, 2010, 5 p.m.
Public Hearing: October May 18, 2010, 11 a.m.
Rulemaking: Title 9. Health Services, Chapter 22. AHCCCS [51KB]
As described in SB1004, Forty-ninth Legislature First Special Session of 2009, the
monthly premiums must be charged up to the maximum amount allowed by federal law
to all populations of eligible persons who may be charged. The Administration is
proposing changes in premiums to Kids Care eligible children and Kids Care eligible
parents. The rules contained in this package are exempt from review by the Governor’s
Regulatory Review Council and the Attorney General under Laws 2009, Ch.4, § 11 until
Comment Period Ended: March 31, 2009, 5 p.m.
Public Hearing: October March 31, 2009, 10 a.m.
of Exempt Proposed Rulemaking: Title 9. Health Services, Chapter 31. AHCCCS
AHCCCS Public Hearing Locations
701 East Jefferson, Gold Room
1010 North Finance Center Drive, Suite 201
2717 N. 4th St. STE 130
Comments on proposed AHCCCS rules may be submitted in the following ways:
701 East Jefferson Street, Mail Drop 6200
Phone: (602) 417-4232
FAX: (602) 253-9115
E-mail: AHCCCSRules@azahcccs.gov