reglab/statecodes huggingface dataset:
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2903.12 - Hospital charge master transparency; joint annual report

36-2903.12.
Hospital charge master transparency;  joint annual report
On or before January 2,  2020 and each year thereafter,  the director of the Arizona health care cost containment system administration and the director of the department of health services shall submit a joint report on hospital charge master transparency to the governor,  the speaker of the house of representatives and the president of the senate and shall provide a copy to the secretary of state. The report shall do all of the following:
1. Summarize the current charge master reporting process and hospital billed charges compared to costs.
2. Provide examples of how charge masters or hospital prices are reported and used in other states.
3. Include recommendations to improve this state's use of hospital charge master information,  including reporting and oversight changes.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2903.13 - Inpatient psychiatric treatment; annual report

36-2903.13.
Inpatient psychiatric treatment;  annual report
A. On or before January 2,  2020 and each year thereafter,  the director of the Arizona health care cost containment system administration shall submit a report to the director of the joint legislative budget committee on the availability of inpatient psychiatric treatment both for adults and for children and adolescents who receive services from the regional behavioral health authorities. The report shall include all of the following information:
1. The total number of inpatient psychiatric treatment beds available and the occupancy rate for those beds.
2. Expenditures on inpatient psychiatric treatment.
3. The total number of individuals in this state who are sent out of state for inpatient psychiatric treatment.
4. The prevalence of psychiatric boarding or holding psychiatric patients in emergency rooms for at least twenty-four hours before transferring the patients to a psychiatric facility.
B. The report shall provide the information specified in subsection A of this section separately for adults who are at least twenty-one years of age and for children and adolescents who are twenty years of age or younger.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.01 - Inpatient hospital reimbursement program; large counties

36-2905.01.
Inpatient hospital reimbursement program;  large counties
A. Notwithstanding any other law,  beginning on October 1,  2003,  pursuant to this chapter the administration shall establish and operate a program for inpatient hospital reimbursement in each county with a population of more than five hundred thousand persons.
B. Beginning on October 1,  2003,  the director shall require contractors to enter into contracts with one or more hospitals in these counties and to reimburse those hospitals for services provided pursuant to this chapter based on the reimbursement levels negotiated with each hospital and specified in the contract and under the terms on which the contractor and the hospital agree and under all of the following conditions:
1. The director may review and approve or disapprove the reimbursement levels and the terms agreed on by the contractor and the hospital.
2. If the contractor implements an electronic claims submission system it may adopt procedures requiring documentation of the system.
3. Payment received by a hospital from a contractor is considered payment in full by the contractor. A hospital may collect any unpaid portion of its bill from other third party payors or in situations covered by title 33,  chapter 7,  article 3.
C. If a contractor and a hospital do not enter into a contract pursuant to subsection B of this section,  the reimbursement level for inpatient services provided on dates of admission on or after October 1,  2003 for that hospital is the reimbursement level prescribed in section 36-2903.01 multiplied by ninety-five per cent.
D. For outpatient hospital services provided under the program prescribed in this section,  a contractor may reimburse a hospital either pursuant to rates and terms negotiated in a contract between the contractor and the hospital or pursuant to section 36-2903.01,  subsection G,  paragraph 3.
E. Contracts established pursuant to this section shall specify that arbitration may be used in lieu of the grievance and appeal procedure prescribed in section 36-2903.01,  subsection B,  paragraph 4 to resolve any disputes arising under the contract.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.02 - Inpatient reimbursement; rural hospitals; definition

36-2905.02.
Inpatient reimbursement;  rural hospitals;  definition
A. If monies are appropriated for rural hospitals,  the Arizona health care cost containment system administration shall request the centers for medicare and medicaid services to approve federal matching medicaid funding for the purposes specified in this section.
B. The administration shall distribute the available monies to increase inpatient reimbursement for qualifying rural hospitals. At no time shall the reimbursement exceed the cost of providing care. The administration may make supplemental payments to qualifying rural hospitals based on utilization or adjust rates,  established pursuant to section 36-2903.01,  subsection G,  for qualifying rural hospitals. No adjustments to inpatient reimbursement under section 36-2903.01,  subsection G to hospitals other than rural hospitals may be made as a result of this section.
C. For the purposes of this section,  " rural hospital"  means either:
1. A health care institution that is licensed as an acute care hospital,  that has one hundred or fewer beds and that is located in a county with a population of less than five hundred thousand persons.
2. A health care institution that is licensed as a critical access hospital.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.03 - Behavioral health inpatient facilities; lack of contract; reimbursement

36-2905.03.
Behavioral health inpatient facilities;  lack of contract;  reimbursement
If a behavioral health inpatient facility,  as defined in rule by the director of the department of health services,  and a contractor or regional behavioral health authority do not enter into a contract,  the reimbursement level for behavioral health services provided on dates of admission on or after July 1,  2018 for that behavioral health inpatient facility is the capped fee-for-service schedule adopted by the administration,  multiplied by ninety percent.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.04 - Eligibility by fraud; penalties; enforcement; classification

36-2905.04.
Eligibility by fraud;  penalties;  enforcement;  classification
A. A person shall not provide or cause to be provided false or fraudulent information to the state as part of an application for the system under section 36-2901,  paragraph 6,  subdivision (a).
B. A person who violates subsection A of this section,  who is determined eligible for the system and who would have been ineligible for the system if the person had provided true and correct information is subject,  in addition to any other penalties that may be prescribed by federal or state law,  to a civil penalty of not to exceed the amount incurred by the system,  including capitation payments,  on behalf of the person. In addition,  the person's eligibility may be discontinued in accordance with rules adopted by the director.
C. In addition to the requirements in state law,  the medicaid fraud and abuse controls that are enacted under federal law apply to all persons eligible for the system and all contractors,  noncontracting providers and subcontracted providers that provide services to persons who are eligible for the system.
D. The director shall make the determination to assess a civil penalty and is responsible for collection of the penalty. The director may adopt rules that prescribe procedures for the determination and collection of civil penalties. The director may compromise civil penalties imposed under this section in accordance with criteria established in rules.
E. The director shall adopt rules providing for the appeal of a decision by a person adversely affected by a determination made by the director under this section. The director's final decision is subject to judicial review in accordance with title 12,  chapter 7,  article 6.
F. Amounts paid by the state and recovered under this section shall be deposited in the state general fund,  and any applicable federal share shall be returned to the United States department of health and human services.
G. If a civil penalty imposed pursuant to subsection D of this section is not paid,  the state or the administration may file an action to collect the civil penalty in the superior court in Maricopa county. Matters that were raised or could have been raised in a hearing before the director or in an appeal pursuant to title 12,  chapter 7,  article 6 may not be raised as a defense to the civil action. An action brought pursuant to this subsection shall be initiated within six years after the date the claim is presented.
H. The department and contractors,  subcontracted providers and noncontracting providers shall cooperate with the administration to prevent,  discover and prosecute eligibility fraud.
I. A person who knowingly aids or abets another person pursuant to section 13-301,  13-302 or 13-303 in the commission of an offense under this section or section 13-3713 is guilty of a class 5 felony.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.05 - Eligibility redetermination; prohibitions

36-2905.05.
Eligibility redetermination;  prohibitions
(Rpld. 1/1/25)
A. On or before December 31,  2023,  the administration shall issue decisions on redeterminations for all members who have not been redetermined for eligibility since December 1,  2022 and who were identified as factually ineligible through the administration's auto-renewal process based on information provided electronically from federal and state databases that provide financial and other eligibility information.
B. The administration may not:
1. Establish procedural requirements to complete redeterminations or removals beyond the minimum procedures required to establish a good faith effort or any other minimum requirements under federal law.
2. Follow,  conform to or submit to any federal guidance that is contrary to the requirements of this section,  follow any other timelines or deadlines or limit,  divide or disburse the initiation or completion of redeterminations or removals,  unless required to do so under federal law.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.06 - Finger imaging; requirements; exemption

36-2905.06.
Finger imaging;  requirements;  exemption
A. To prevent multiple enrollment for services provided by the system,  the administration shall work with the department of economic security to expand that department's finger imaging eligibility program to specific programs that are selected by the director of the administration and that provide services pursuant to this chapter.
B. By July 1,  2001,  the administration shall make the following subject to finger imaging during the enrollment process:
1. All programs where enrollment and eligibility screening occur at a department of economic security facility.
2. Any program that provides members with pharmaceutical benefits.
3. Any other program selected by the director of the administration.
C. The director of the administration shall adopt rules to implement the requirements of subsections A and B of this section,  including rules to exempt children,  the elderly and any other group that the director determines would be unduly burdened by a finger imaging requirement.
D. Any pregnant woman who is eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a) or who is receiving federal emergency services pursuant to section 36-2903.03 is not subject to finger imaging.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2905.08 - Nicotine replacement therapies; tobacco use medications

36-2905.08.
Nicotine replacement therapies;  tobacco use medications
A. Notwithstanding section 36-2989,  for contract years beginning October 1,  2008,  the administration may expend monies to provide nicotine replacement therapies and tobacco use medications to members eligible pursuant to this article or article 2 or 3 of this chapter.
B. The administration shall not use monies from the state general fund for the purposes of this section.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2906.01 - Qualified commercial carriers; administration; contracts

36-2906.01.
Qualified commercial carriers;  administration;  contracts
A. Entities,  including insurers as defined in section 20-104,  hospital,  medical,  dental and optometric service corporations as defined in title 20,  chapter 4,  article 3 and health care services organizations as defined in section 20-1051,  are prohibited from contracting with the administration as a system contractor unless the entity establishes an affiliated corporation whose only authorized business is to provide services or coverage pursuant to a contract with the administration to persons defined as eligible in section 36-2901,  paragraph 6,  subdivisions (a),  (f) and (g).
B. If there is an insufficient number of,  or an inadequate member capacity in,  contracts awarded to contractors,  the director may request that the director of the department of insurance and financial institutions grant a temporary exemption from the requirements of subsection A of this section for an entity regulated by the department of insurance and financial institutions,  and otherwise qualified to be a system health plan,  in order for that entity to enter into an arrangement with the administration to provide services to persons defined as eligible in section 36-2901,  paragraph 6,  subdivisions (a),  (f) and (g). On a written request from the administration,  the director of the department of insurance and financial institutions may grant a onetime exemption to an entity for a period not to exceed one year. During the temporary exemption,  the entity must comply with all applicable provisions of both this article and the applicable chapter or article of title 20 under which the entity is licensed to operate.
C. With respect to entities that have been granted an exemption pursuant to subsection B of this section,  the provisions of section 36-2903,  subsection M,  relating to the direct operation of a provider,  shall not apply. If the director determines that the operations of the entity would otherwise meet the circumstances specified in contract under which the administration could operate the entity directly or that the public health,  safety or welfare require emergency action relative to the entity,  the director shall notify the director of the department of insurance and financial institutions and may request that the department of insurance and financial institutions take appropriate actions.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.01 - Eosinophilic gastrointestinal disorder; formula

36-2907.01.
Eosinophilic gastrointestinal disorder;  formula
A. Any coverage that is offered by a contractor providing services to persons eligible pursuant to section 36-2901 and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if:
1. The person has been diagnosed with an eosinophilic gastrointestinal disorder.
2. The person is under the continuous supervision of a physician who is licensed pursuant to title 32,  chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32,  chapter 15.
3. There is risk of a mental or physical impairment without the use of the formula.
B. This section does not apply to limited benefit coverage as defined in section 20-1137.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.02 - Benchmark benefit package

36-2907.02.
Benchmark benefit package
A. The administration shall establish a benchmark benefit package pursuant to section 6044 of the deficit reduction act of 2005 and section 1937 of the social security act.
B. Enrollment in the benchmark benefit package is mandatory for persons who are eligible pursuant to:
1. Section 36-2901.01 as covered under the section 1115 waiver and who are not covered under the state plan.
2. Section 36-2924.
C. Enrollment in the benchmark benefit package is optional for all other title XIX eligible persons.
D. This section shall be implemented subject to approval of the benchmark benefit package from the centers for medicare and medicaid services and on the condition that any changes to health benefits under this section would not jeopardize the state's ability to receive any enhanced federal matching rate.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.04 - Family planning services

36-2907.04.
Family planning services
A woman whose eligibility under section 36-2901,  paragraph 6,  subdivision (a),  item (ii) ended no earlier than March 1,  1995 and who is not otherwise enrolled in the system is eligible to receive voluntary family planning services for two years,  if approval of the waiver requesting family planning services pursuant to this section is approved by the United States department of health and human services. This two year period begins on the first day following the end of that woman's sixty day federal eligibility period that begins on the last day of her pregnancy. Family planning services under this section are limited to those available pursuant to section 36-2907,  subsection A,  paragraph 8.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.07 - Tobacco tax program evaluations

36-2907.07.
Tobacco tax program evaluations
A. Subject to the availability of monies,  the administration may enter into an intergovernmental agreement pursuant to title 11,  chapter 7,  article 3 to contract with the auditor general to conduct or cause to conduct program evaluations of programs that both receive tobacco tax monies pursuant to section 36-774 and are administered by the department of health services.
B. If the administration contracts for the annual program evaluations:
1. The auditor general shall establish a schedule for periodic reviews of the programs. The auditor general shall notify the joint legislative audit committee of the schedule for the periodic reviews of the programs. The joint legislative audit committee shall review the schedule and may approve or modify it.
2. The evaluations shall examine the effectiveness of the programs,  the organizational structure of the programs and the efficiency of the programs.
3. The evaluations shall include but are not limited to the following utilization information:
(a) The level and scope of services being offered.
(b) The type of services being used.
(c) The frequency of services being used.
(d) The personal characteristics of the program participants who receive services.
(e) The demographic characteristics of the program participants who receive services.
4. The evaluations shall include but are not limited to:
(a) Information on the number of the program participants.
(b) Information on program contractors and program service providers.
(c) Information on program revenues and expenditures.
(d) Information on the average cost for each program participant receiving services and information on the average cost of providing each service.
(e) Information on the administrative costs to operate each program.
(f) An evaluation of the methods used by the department of health services for selecting eligible contractors.
(g) An estimate of the benefits and effects of providing health care services to persons who cannot afford those services or for whom there would otherwise be no coverage.
5. The department of health services shall provide data necessary to complete the evaluations.
6. The auditor general shall submit an annual report to the director of the joint legislative budget committee regarding the evaluations no later than November 1 of each year.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.09 - Direct service contracts; reporting

36-2907.09.
Direct service contracts;  reporting
(Conditionally Rpld.)
The director of the department of health services shall provide to the legislature the following information for services provided pursuant to sections 36-2907.06 and 36-2907.08:
1. The number of members served.
2. The number of encounters and the average cost for each encounter.
3. The number of services and the average cost for each service.
4. The actual year to date expenditures and projected annual expenditures.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.10 - Transplants; extended eligibility

36-2907.10.
Transplants;  extended eligibility
A. If during a redetermination process for eligibility pursuant to this article a person who is enrolled and who is eligible pursuant to this article for a medically necessary and appropriate transplant pursuant to section 36-2907,  subsection A,  paragraph 10 is determined ineligible for coverage pursuant to section 36-2901.04 due to excess income or ineligible for coverage pursuant to section 36-2901,  paragraph 6,  subdivision (a),  item (i),  (ii) or (iii) and that person has not yet received the transplant,  the person may extend the person's eligibility based on the total spend down requirement for the household divided by the number of persons in the household.
B. In order to extend eligibility the person shall enter into a contractual agreement with a hospital to pay the amount of excess income determined pursuant to this section. The hospital shall only be reimbursed by the administration at the contracted rate of the transplantation surgery,  including up to one hundred days of posttransplantation care. The administration shall deduct the amount of excess income that the person agrees to pay the hospital before payment is made to the hospital for transplant services authorized by this section. The amount of excess income shall not be changed once the extended period of eligibility begins. The administration is not responsible to pay any of the spend down amount if the person does not pay the hospital. The contracting hospital shall submit a copy of the person's contractual agreement with the hospital to the administration.
C. The administration shall authorize extended eligibility services only for transplant candidates.
D. Extended eligibility pursuant to this section is for one twelve-month continuous period of time and is funded only pursuant to section 36-2907.12.
E. This section does not prohibit a person from applying for eligibility pursuant to any other applicable law.
F. If the administration and a hospital that performed a transplant surgery on a person who is eligible pursuant to this section do not have a contracted rate,  the administration shall not reimburse the hospital more than the contracted rate established by the administration.
G. A person who has extended eligibility pursuant to section 36-2907.11 is not eligible for services pursuant to this section.
H. The extended eligibility of a person who is determined to be no longer medically eligible for a transplant terminates at the end of the month in which it is determined the person is not medically eligible for the transplant unless the person is otherwise eligible for services pursuant to section 36-2901,  paragraph 6,  subdivision (a).
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.12 - Transplants; tobacco tax allocation

36-2907.12.
Transplants;  tobacco tax allocation
Subject to the availability of monies in the medically needy account established by section 36-774,  the administration shall withdraw the amount necessary to pay the state share of costs for providing eligibility for transplant recipients who agree to enter into contractual agreements with hospitals pursuant to section 36-2907.10 or 36-2907.11.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.13 - Arizona health care cost containment system; teledentistry

36-2907.13.
Arizona health care cost containment system;  teledentistry
In addition to services provided pursuant to section 36-2907,  subsection A,  paragraph 7,  the Arizona health care cost containment system administration shall implement teledentistry services for enrolled members who are under twenty-one years of age.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2907.15 - Opioid use disorder treatment; standards; centers of excellence; annual report

36-2907.15.
Opioid use disorder treatment;  standards;  centers of excellence;  annual report
A. On or before December 31,  2019,  the administration and the department of health services shall establish standards for designating centers of excellence for treating opioid use disorder statewide. The director of the Arizona health care cost containment system shall publish the draft standards on the administration's public website and hold at least two public hearings to receive input before implementing the standards. The administration shall publish the final standards for designating centers of excellence for treating opioid use disorder on its public website.
B. At a minimum,  the standards established pursuant to subsection A of this section shall include:
1. Information regarding opioid treatment program providers and facilities.
2. Information regarding office-based opioid agonist treatment providers.
3. Parameters to ensure coordination of care that includes behavioral health,  physical health and medication-assisted treatment for opioid use disorder.
4. Tracking and reporting requirements that identify:
(a) Treatment capacity.
(b) Quantitative metrics related to quality of care and patient outcomes.
(c) Qualitative metrics related to patient satisfaction.
5. An annual evaluation by a third-party auditor of the accuracy and completeness of data provided by the centers of excellence.
C. The administration shall establish a statewide learning collaborative to share best practices and establish peer-to-peer support between centers of excellence.
D. The administration shall maintain an accurate list of designated centers of excellence,  including contact information,  on its website.
E. Designated centers of excellence shall:
1. Increase capacity for treating opioid use disorder in opioid treatment programs and office-based opioid agonist treatment statewide.
2. Demonstrate effective delivery of medication-assisted treatment for opioid use disorder using evidence-based practices as defined by the substance abuse and mental health services administration,  a federally designated accreditation agency for rehabilitation facilities and the administration.
3. Comply with all tracking,  reporting and evaluation requirements.
4. Participate in the statewide learning collaborative.
F. On or before January 15 of each year,  the administration shall submit a report to the governor,  the president of the senate and the speaker of the house of representatives,  and shall provide a copy to the secretary of state,  outlining:
1. The standards for designating centers of excellence.
2. The statewide list of designated centers of excellence.
3. A summary of the performance of the centers of excellence.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2908 - Provision of emergency and specialty services; reimbursement

36-2908.
Provision of emergency and specialty services;  reimbursement
A. Subject to the provisions of section 36-2909,  services provided to members under this article who have been determined eligible but who have not yet enrolled in the system and who are in need of medical services on an emergency basis after they have been determined eligible,  irrespective of county of residence,  shall be reimbursed,  subject to subsection B of this section,  in accordance with rules adopted by the director if such services are not otherwise covered by a provider contract.
B. Services provided on an emergency basis to members or to persons after they have been determined eligible for such services but before they have enrolled in the system without a demonstrated emergency need in accordance with rules adopted by the director shall be reimbursed at no more than the rate for the service provided in other than an emergency services setting.
C. The director shall prescribe rules providing for the reimbursement of specialty services provided outside of the county of residence of the member if authorized by the member's primary care physician or primary care practitioner.
D. Services provided pursuant to this section shall be provided in accordance with rules adopted pursuant to section 36-2903.01,  subsection E.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2909 - Emergency hospital services; retroactive coverage; costs

36-2909.
Emergency hospital services;  retroactive coverage;  costs
A. If a member receives emergency hospitalization and medical care on or after the date of eligibility determination or the eligibility effective date from a hospital that does not have a contract to care for the person,  the administration or the contractor is liable only for the costs of emergency hospitalization and medical care up to the time the person is discharged or until the time the person can be transferred. The administration or the contractor is also liable for further care in the following circumstances:
1. If the attending physician reasonably determines that the condition of the person receiving emergency hospitalization and medical care is such that it is medically inadvisable to transfer the person.
2. If the administration or the contractor does not transport the person from the hospital providing care after it has been determined that the person can be transferred.
B. Except for charges for services subject to section 36-2908,  subsection B,  all charges incurred by an eligible person who has not yet enrolled for hospitalization and medical care under subsection A of this section are payable by the administration pursuant to section 36-2903.01,  subsection G or as specified in contract by the contractor pursuant to the subcontracted rate or section 36-2904,  subsection H or I.
C. As a condition to receiving reimbursement pursuant to subsection B of this section,  a hospital that is not a contractor or subcontractor under the system must designate a primary care physician or primary care practitioner to act as a coordinator of the services provided to persons who have been determined eligible but have not yet enrolled,  before the persons' enrollment,  discharge or transfer.
D. Emergency hospitalization and medical care provided pursuant to this section shall be in accordance with rules adopted pursuant to section 36-2903.01,  subsection E in order to qualify for reimbursement.
E. The director shall adopt rules that provide that members who have been determined eligible shall be enrolled with contractors as soon as practicable.
F. This section does not prevent the director or the contractor from denying payment for hospitalization or medical care that is not authorized or deemed medically necessary in accordance with rules adopted by the director.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2910 - Notification to system of nonemergency services

36-2910.
Notification to system of nonemergency services
A. Except as otherwise specifically provided by this article,  the system is financially responsible for only the costs of care provided by contractors to members.
B. For purposes of eligibility determination and enrollment in the system,  the director may adopt rules to establish notification procedures for contractors and noncontracting providers of care provided to persons who may be eligible or who have been determined eligible. The director may condition payment for such services on the compliance of a contractor or noncontracting provider with the notification procedures. The director may adopt rules that establish procedures and notices for the transfer of members between contractors and noncontracting providers as the transfer relates to the system.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2911 - Payment of monthly premiums

36-2911.
Payment of monthly premiums
A. The administration shall pay medicare part B premiums pursuant to federal law for and on behalf of a member who is eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a),  item (i) or (ii) and who is enrolled pursuant to this article and article 2 of this chapter.
B. The administration shall pay the medicare part A hospital premium for each qualified person with a disability and working individual who is determined eligible pursuant to section 1905(s) of title XIX of the social security act. The administration shall determine the eligibility of all persons who are qualified with a disability and working individuals in accordance with section 6408(d) of the omnibus budget reconciliation act of 1989. The administration,  in accordance with federal law,  may require certain eligible qualified persons with a disability and working individuals to contribute to the cost of the monthly premium.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2914 - Medical care consortiums; lawful trade practices

36-2914.
Medical care consortiums;  lawful trade practices
Notwithstanding title 44,  chapter 10,  article 1,  actions taken by providers,  potential providers,  contractors and other bidders in specific accordance with this article in forming consortiums or in otherwise entering into contracts to provide medical care shall be deemed to be conducted at the direction of this state and shall be considered to be lawful trade practices.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2916 - Release of claim by injured person ineffective as to system; action to enforce lien; release of lien

36-2916.
Release of claim by injured person ineffective as to system;  action to enforce lien;  release of lien
A. A release of a claim on which a lien is imposed pursuant to section 36-2915 is not valid or effective as against the lien unless the director joins in the release or executes a release of the lien.
B. If any amount has been or is to be collected by the injured person or his legal representative from or on account of the person,  firm or corporation,  including insurance carriers liable for liability or indemnity damages by reason of a judgment,  settlement or compromise,  the director may enforce the lien by action against the patient or the person,  firm or corporation,  including insurance carriers,  liable for liability or indemnity damages. Such action shall be commenced and tried in the county in which the lien is filed,  unless the court orders that the action be removed to another county for cause. If the director prevails in the action,  the court may allow the administration its reasonable attorney fees and disbursements. Such an action shall be commenced within two years after the entry of the judgment or the making of the settlement or compromise.
C. Within thirty days after a lien established pursuant to section 36-2915 is satisfied,  the director shall issue a release of the lien to the person,  firm or corporation against which the lien was claimed. The release shall be a document which conforms to the requirements of section 11-480.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2917.01 - Clinical oversight review committee; duties; annual report

36-2917.01.
Clinical oversight review committee;  duties;  annual report
A. The director shall establish an internal clinical oversight review committee to review clinical data specific to agency initiatives and populations identified by the director,  including data on behavioral health services for persons receiving behavioral health services administered by the administration.
B. The committee shall include the director or the director's designee and experts within the administration in the areas of quality performance,  behavioral health,  operations,  finance and data analytics.
C. The committee shall do all of the following:
1. Meet at least once every three months.
2. Review clinical data specific to populations and initiatives being undertaken by the administration.
3. Analyze and review clinical quality performance metrics that are indicative of overall system performance and make recommendations on metrics that may enhance system performance,  clinical outcomes and member experience.
4. Advise the director on challenges,  successes and data trends and identify potential service delivery improvements.
5. For behavioral health services,  solicit additional information and perspectives related to the clinical data or clinical quality performance metrics reviewed by the committee from patients,  patient advocates and other informed parties.
D. The committee is a review committee of the system pursuant to section 36-2917 and its activities are subject to that section.
E. On or before February 1,  2018 and February 1 of each year thereafter,  the administration shall provide a report to the governor,  the president of the senate,  the speaker of the house of representatives,  the chairperson of the health and human services committee,  or its successor,  in the senate and the chairperson of the health committee,  or its successor,  in the house of representatives and shall provide a copy of this report to the secretary of state. The report shall include a summary of topics reviewed by the clinical oversight review committee in the preceding year and any recommendations relating to quality performance metrics stemming from the committee's activities.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2918.01 - Duty to report fraud or abuse; immunity

36-2918.01.
Duty to report fraud or abuse;  immunity
A. All contractors,  subcontracted providers of care and noncontracting providers shall notify the director or the director's designee immediately in a written report of any cases of suspected fraud or abuse. The director shall review the report and conduct a preliminary investigation to determine if there is sufficient basis to warrant a full investigation. If the findings of a preliminary investigation give the director reason to believe that an incident of fraud or abuse has occurred,  the matter shall be referred to the attorney general.
B. Any person making a complaint or furnishing a report,  information or records in good faith pursuant to this section is immune from any civil liability by reason of that action unless that person has been charged with or is suspected of the fraud or abuse reported.
C. Any contractor,  subcontracted provider of care or noncontracting provider who fails to report pursuant to this section commits an act of unprofessional conduct and is subject to disciplinary action by the appropriate professional regulatory board or department.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2919 - Absence of federal financial participation; effect on system operation

36-2919.
Absence of federal financial participation;  effect on system operation
If at any time federal monies as described in section 36-2903.01,  subsection B,  paragraph 5 are denied,  not renewed or become unavailable for any reason the provisions of this article relating to the operation of the system are suspended and the director shall notify each provider of that fact. Neither the administration nor a provider shall provide services otherwise authorized by this article or be liable for the cost of services provided after federal monies become unavailable.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2920 - Monthly financial report

36-2920.
Monthly financial report
A. The director shall submit a monthly report to the president of the senate and the speaker of the house of representatives of the following:
1. The actual year to date expenditures and projected annual expenditures.
2. The actual member months by rate code.
3. The actual caseload,  showing separately the caseload for title XIX and qualified medicare beneficiary populations.
4. The number of vacant positions,  by division.
5. Monies recovered monthly from third party payors.
6. Monies received under agreements pursuant to section 36-2925 and the actual year to date expenditures.
B. The report shall be submitted on or before the twenty-fifth day of the following month.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2922 - Medical services stabilization fund; definition

36-2922.
Medical services stabilization fund;  definition
A. Subject to the availability of monies,  the medical services stabilization fund is established. The administration shall administer the fund as directed by the joint legislative budget committee pursuant to subsection E of this section.
B. The fund shall be used only to offset increases in the cost of providing levels of services established pursuant to this article.
C. Notwithstanding chapter 6,  article 8 of this title,  the fund may also be used to offset increases in the cost of providing levels of services established pursuant to this article to persons eligible for those services pursuant to section 36-2901,  paragraph 6,  subdivision (a) if the increase results from a decrease in federal funding for levels of service including a decrease in the federal match rate for levels of service provided to persons eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a).
D. If,  during a fiscal year,  the administration determines that the amount the legislature appropriated for that fiscal year for services provided to persons who are determined to be eligible for services pursuant to section 36-2901,  paragraph 6,  subdivision (a) is insufficient to pay for unanticipated increases in the cost of providing those services,  the administration shall provide written notice of the deficiency to the chairperson of the joint legislative budget committee and the director of the governor's office of strategic planning and budgeting with evidence supporting the determination of deficiency.
E. On receiving notice under subsection D of this section,  the chairperson of the joint legislative budget committee shall call a public committee meeting to review the evidence of the deficiency presented by the administration. After reviewing the evidence,  the committee may recommend to the administration to withdraw an amount from the fund that is equal to the deficiency to pay the increases in the cost of providing levels of service.
F. For the purposes of this section,  " levels of service"  means the provider payment methodology,  eligibility criteria and covered services established pursuant to this article and in effect on July 1,  1993.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2924 - Child care and AHCCCS joint program

36-2924.
Child care and AHCCCS joint program
The department of economic security and the Arizona health care cost containment system administration shall establish and,  as provided in the empower waiver,  maintain a joint program that extends child care for twenty-four months and Arizona health care cost containment system benefits for twelve months beginning October 1,  2002 for current and former recipients of title XIX medicaid under the provisions of Public Law 104-193,  section 431 and cash assistance who are employed and meet federal requirements for such transitional benefits as defined in the family support act of 1988 (P.L. 100-485,  42 United States Code section 607).
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2925 - Information system; administrative services; agreements with other states; report

36-2925.
Information system;  administrative services;  agreements with other states;  report
A. Notwithstanding any other law,  the administration may enter into an agreement with other states to design,  develop,  install and operate an information system and related services or other administrative services.
B. An agreement entered into pursuant to this section shall require that the administration is compensated for all agreed on direct and indirect costs associated with providing the information system and services.
C. An agreement with another state entered into pursuant to this section shall include specific terms that hold the state harmless from the imposition of any damages,  sanctions or penalties or the withholding of any monies due the state for services provided,  with respect to any matter related to performance under that agreement.
D. The agreement must result in a cost savings to the administration that is designated in the agreement as a portion of the administration's operating costs that the contracting state agrees to pay.
E. All monies that are received by the administration and that are based on the agreement shall be deposited,  pursuant to sections 35-146 and 35-147,  in the administration's intergovernmental service fund established by section 36-2927.
F. The administration may enter into intergovernmental agreements with other agencies of this state to provide the facilities,  equipment or services that are necessary to fulfill an agreement entered into pursuant to this section. The intergovernmental agreement shall specify whether the payment for facilities,  equipment or services shall be made by the contracting state directly to the agency or through the intergovernmental service fund established by section 36-2927.
G. The administration shall submit all intergovernmental agreements entered into pursuant to this section to the governor for approval before it finalizes the agreement.
H. The administration shall report annually by January 1 on the status of any agreement with another state to the speaker of the house of representatives,  the president of the senate and the chairmen of the house and senate appropriations committees. The report shall include the status report of the specific projects that are subject to the agreement,  the financial status of the project and a description of any personnel initiatives that the administration has initiated with monies received from the agreement with another state.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2926 - Use of cost savings; preparation of budget recommendations; cooperation of other agencies

36-2926.
Use of cost savings;  preparation of budget recommendations;  cooperation of other agencies
A. The administration shall use the cost savings generated from agreements entered into pursuant to section 36-2925 to supplement monies that are appropriated by the legislature. The administration shall use the cost savings to:
1. Subject to title 41,  chapter 4,  article 4,  develop and operate employee recruitment and retention programs that may include creating positions,  special salary plans and pay practices and performance compensation programs approved by the director and the department of administration.
2. Implement technology projects to upgrade hardware or software used by the administration in the operation of the system.
B. The governor's office of strategic planning and budgeting and the joint legislative budget committee shall not recommend using the cost savings generated by section 36-2925 to supplant state or federal monies used for the operation or administration of the programs operated by the administration.
C. The department of administration shall assist the administration in developing and operating employee recruitment and retention programs specified in subsection A of this section.