Arizona Administrative Code › Title 6 - ECONOMIC SECURITY › Chapter 6 - DEPARTMENT OF ECONOMIC SECURITY - DEVELOPMENTAL DISABILITIES › Article 21 - DIVISION PROCUREMENT AND RATE SETTING - QUALIFIED VENDORS › Section R6-6-2114 - Rate Setting

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				The Division may establish a rate structure for community developmental
				disability services, including the rate structure for provider organizations,
				professional independent providers and individual independent providers. Each
				fiscal year, the Division shall review the reimbursement rates for Arizona
				long-term care services and state only programs and may update the rate
				structure.
1. The Division shall contract
				with an independent consulting firm for an annual review of the adequacy and
				appropriateness of reimbursement rates to providers of community developmental
				disability services.
2. The
				Division shall complete a study of reimbursement rates for each community
				developmental disability service contracted for by the Division no less than
				once every five years.
3. The
				Division may require, and Qualified Vendors and Individual Independent
				Providers shall provide, financial data to the Division in the form and format
				prescribed by the Division to assist in the annual review. The Division shall
				seek provider recommendations regarding the form and format.
4. The Division shall annually establish a
				schedule that identifies which community developmental disability services will
				be reviewed for adequacy and appropriateness, and which community developmental
				disability services will be included in the rate reimbursement study.
5. The Department shall determine if the
				independent consulting firm shall perform one or more of the following
				activities to measure the adequacy and appropriateness of the reimbursement
				rates:
a. Review the Department's current rate
				structure,
b. Conduct a provider
				cost survey,
c. Compare the
				Department's rates to rates for similar services used by other state agencies,
				and
d. Develop independent rate
				models for community developmental disabilities services.
6. The Assistant Director may consider
				evidence of the adequacy and appropriateness of the Division's reimbursement
				rates gathered from
				R6-6-2114(5)(a) through
				(d), the rate study, or other relevant data
				sources to determine whether a new rate needs to be created or an existing rate
				needs to be revised.
7. After
				considering the evidence in the adequacy and appropriateness review, the
				Assistant Director may establish a rate change for each service reviewed, based
				on the availability of funds.
8.
				After considering the evidence in the study of reimbursement rates and
				independent rate models, the Assistant Director may propose a new
				rate.
9. The Division shall provide
				public notice if rates for a community developmental disability service are to
				be established or revised. The Division shall include in the notice the
				proposed rate or rate change, the effective date of the rate change, where
				those rates shall be available for review and, if a rate for a service is being
				established for the first time, any phase-in schedule for the rate
				change.
10. The Division may
				provide a public comment period regarding the rate change.
11. The Assistant Director shall review any
				public comments received about the proposed rate, rate change or phase-in
				schedule, existing service history or current purchase of service information
				about the rates and any other information and may make adjustments to the
				proposed rate, rate change or phase-in schedule prior to finalizing the rate
				and the phase-in schedule.
12. The
				Division shall provide public notice of the final rates and phase-in
				schedule.
13. The Division shall
				adjust rates in accordance with legislatively mandated and appropriated
				increases or decreases.
14. The
				Division shall maintain rate schedules for providers of community developmental
				disability services at the central office of the Division for reference use
				during customary business hours.