Reference Title: medical care; county residual responsibility

AN ACT
AMENDING TITLE 11, CHAPTER 2, ARTICLE 7, ARIZONA REVISED STATUTES, BY ADDING SECTION 11-290; AMENDING SECTION 11-291, ARIZONA REVISED STATUTES; REPEALING SECTION 11-297.01, ARIZONA REVISED STATUTES; AMENDING TITLE 11, CHAPTER 2, ARTICLE 7, ARIZONA REVISED STATUTES, BY ADDING A NEW SECTION 11-297.01; AMENDING TITLE 11, CHAPTER 2, ARTICLE 7, ARIZONA REVISED STATUTES, BY ADDING SECTIONS 11-297.02, 11-297.03, 11-297.04, 11-297.05 AND 11-297.06; AMENDING SECTIONS 33-931, 33-934, 33-936, 36-2903 AND 41-1837, ARIZONA REVISED STATUTES; RELATING TO MEDICAL CARE OF INDIGENTS.

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 11, chapter 2, article 7, Arizona Revised Statutes, is amended by adding section 11-290, to read:

11-290 . Definitions

IN THIS ARTICLE, UNLESS THE CONTEXT OTHERWISE REQUIRES:

1. "CLAIM" MEANS A BILL FOR PAYMENT SUBMITTED PURSUANT TO THE REQUIREMENTS OF THIS ARTICLE BY A HOSPITAL OR A HEALTH CARE PROVIDER FOR A HEALTH CARE EXPENDITURE FOR ONE PATIENT.

2. "ERROR-FREE CLAIM" MEANS A CLAIM THAT CAN BE PROCESSED WITHOUT OBTAINING ADDITIONAL INFORMATION FROM THE PROVIDER OF SERVICE OR FROM A THIRD PARTY.

Sec. 2. Section 11-291, Arizona Revised Statutes, is amended to read:

11-291 . Hospitalization and medical care of indigent sick

A. Except as provided in sections 11-293 and 36-183.01 and title 36, chapter 29, the board of supervisors has the sole and exclusive authority to provide for the hospitalization and medical care of the indigent sick in the county, including home health services, which are defined in section 36-151, paragraph 3, and which are provided in lieu of hospitalization, to indigent persons and, to the extent that such expenses are not covered by a third party payor, to indigent persons under the supervision of a county corrections agency. For the purposes of this subsection, "third party payor" does not include the Arizona health care cost containment system or the Arizona long-term care system and hospitalization and medical care does not include long-term care. For the purposes of this section, an indigent is a resident of the county who is otherwise eligible for county services and, except for emergency services provided to persons who are in fact eligible pursuant to section 36-2905.05, who meets one of the following requirements for citizenship or alien status:

1. Is a citizen of the United States.

2. Is a qualified alien who entered the United States on or before August 21, 1996 as prescribed in section 36-2903.03.

3. Is a qualified alien who entered the United States on or after August 22, 1996 and is a member of an exception group as prescribed in section 36-2903.03.

B. Counties shall not be required to provide services specified in title 36, chapter 29 to persons eligible for care under title 36, chapter 29 after the persons have been determined eligible pursuant to the eligibility process. Except as provided in sections 36-2908 and 36-2909, until the final eligibility determination has been made and all applicable notice provisions have been complied with, the county shall provide services for indigent persons who are in fact eligible for care as required by section 11-291.01. A county may condition the provision of nonemergency care to a person who is otherwise eligible for county services on the completion by the person, or by a representative of the person on his behalf, of an application for eligibility for the Arizona health care cost containment system or the Arizona long-term care system pursuant to title 36, chapter 29. Beginning October 1, 1985, a county shall determine whether a person is eligible or ineligible for care provided pursuant to section 11-291.01 no later than it determines whether a person is eligible or ineligible for care pursuant to title 36, chapter 29, article 1.

C. The board may employ physicians and other persons necessary to accomplish the purpose of this section.

D. In carrying out the powers and duties prescribed by section 11-251, paragraph 5 and subsection A of this section and for health care education purposes, the board may contract with any qualified person to provide all or a part of the services required. Such contracts may be for a term of not more than ten years.

E. The board may enter into contracts for the operation of a county health care system for a term of not more than five years pursuant to procedures adopted by the board. The procedures shall require the exercise of sound business judgment and efforts to obtain contracts that are the most advantageous to the county.

F. For a health care expenditure including hospitalization and medical care, nonhospital services or long-term care services pursuant to this article, a county board of supervisors may reimburse contracting and noncontracting providers the lesser of either billed charges or payment schedules adopted by the Arizona health care cost containment system administration pursuant to title 36, chapter 29. Unless a hospital or a health care provider verifies through the county that a person has been determined ineligible or was not, at the time services were rendered, eligible for services, the provider shall not do either of the following:

1. Charge, submit a claim to, demand payment or otherwise collect payment from a person who has been provided covered care or services pursuant to this article.

2. Refer or report a person to a collection agency or credit reporting agency for the failure of the person to pay charges for covered care or services provided pursuant to this article.

G. A hospital bill is considered received for purposes of this article upon initial receipt of the legible, error-free claim if the claim includes the following error-free documentation in legible form:

1. An admission face sheet.

2. An itemized statement.

3. An admission history and physical.

4. A discharge summary or an interim summary if the claim is split.

5. An emergency record, if an admission was through the emergency room.

6. Operative reports, if applicable.

7. A labor and delivery room report, if applicable.

H. F. The county is entitled to a lien for the charges for hospital or medical care and treatment of an injured person or the provision of long-term care services for which it is responsible pursuant to subsection A of this section or section 11-293, on any and all claims of liability or indemnity for damages accruing to the person to whom hospital or medical service is rendered, or to the legal representative of such person, on account of injuries giving rise to such claims and which necessitated such hospital or medical care and treatment. Recovery of charges pursuant to this subsection shall be in a manner as nearly as possible the same as the procedures prescribed in section 36-2915.

I. G. Except as provided in sections 36-2908 and 36-2909, the county shall reimburse an ambulance company for the transportation to a hospital of a person in a medical emergency situation if that person's medical care is a county responsibility pursuant to section 11-291.01 and subsection A of this section and if such transportation is requested by a health care professional licensed under the provisions of title 32, chapter 13, 15, 17 or 25, by a paramedic or emergency medical technician certified pursuant to title 36, chapter 21.1, or by a law enforcement officer or fire fighter. The county shall reimburse the ambulance company for services on a capped fee-for-service basis not to exceed the maximum amount determined by the administration pursuant to section 36-2904, subsection B.

H. A PERSON WHO RECEIVES SERVICES PURSUANT TO THIS ARTICLE TO THAT EXTENT ONLY SHALL ASSIGN TO THE COUNTY BY OPERATION OF LAW THAT PERSON'S RIGHTS TO ALL TYPES OF MEDICAL BENEFITS TO WHICH THE PERSON IS ENTITLED, INCLUDING FIRST PARTY MEDICAL BENEFITS UNDER AUTOMOBILE INSURANCE POLICIES. THE COUNTY HAS A RIGHT TO SUBROGATION AGAINST ANY OTHER PERSON OR FIRM TO ENFORCE THE ASSIGNMENT OF MEDICAL BENEFITS. THE REQUIREMENTS OF THIS SUBSECTION CONTROL OVER THE PROVISIONS OF ANY INSURANCE POLICY THAT PROVIDES BENEFITS TO AN ELIGIBLE PERSON IF THE POLICY IS INCONSISTENT WITH THIS SUBSECTION.

Sec. 3. Repeal

Section 11-297.01 , Arizona Revised Statutes, is repealed.

Sec. 4. Title 11, chapter 2, article 7, Arizona Revised Statutes, is amended by adding a new section 11-297.01, to read:

11-297.01 . Care at private hospital or university hospital; notification requirements

A. AN INDIGENT PATIENT WHO IS QUALIFIED FOR CARE PURSUANT TO THIS ARTICLE MAY BE PLACED IN A PRIVATE HOSPITAL OR A HOSPITAL THAT IS OPERATED BY A UNIVERSITY IF:

1. THE COUNTY DOES NOT MAINTAIN A COUNTY HOSPITAL.

2. THE COUNTY HOSPITAL IS TOO OVERCROWDED TO ACCOMMODATE THE PATIENT.

3. THE PATIENT REQUIRES A SERVICE PROVIDED BY A PRIVATE HOSPITAL OR A HOSPITAL THAT IS OPERATED BY A UNIVERSITY AND THAT SERVICE IS NOT PROVIDED BY THE COUNTY HOSPITAL.

B. SUBJECT TO THE REIMBURSEMENT LEVEL LIMITATION PRESCRIBED IN SUBSECTION C OF THIS SECTION, THE COUNTY IS LIABLE ONLY FOR COSTS THAT ARE RELATED TO THE CARE AND TREATMENT OF EMERGENCY MEDICAL CONDITIONS FROM THE BEGINNING OF TREATMENT AND THAT ARE INCURRED BY A PRIVATE HOSPITAL, A HOSPITAL OPERATED BY A UNIVERSITY OR A HEALTH CARE PROVIDER LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 FOR A PATIENT WHO IS QUALIFIED FOR THIS CARE AND TREATMENT UNDER THIS ARTICLE ON COMPLIANCE WITH THIS ARTICLE. THE COUNTY IS NOT LIABLE FOR THE COST OF SERVICES EXCLUDED PURSUANT TO SECTION 11-291, SUBSECTION B.

C. NOTWITHSTANDING ANY OTHER LAW, FOR DATES OF SERVICE BEGINNING ON OCTOBER 1, 1999, THE COUNTY BOARD OF SUPERVISORS SHALL REIMBURSE HOSPITALS FOR INPATIENT HOSPITAL ADMISSIONS AND OUTPATIENT HOSPITAL SERVICES THAT ARE PROVIDED TO PERSONS WHO ARE ELIGIBLE AND ONLY TO THE EXTENT PROVIDED PURSUANT TO SECTIONS 11-291, 11-291.01, 11-293, 11-297 AND THIS SECTION ACCORDING TO THE FOLLOWING REQUIREMENTS:

1. THE COUNTY SHALL MULTIPLY COVERED CHARGES BY THE HOSPITAL-SPECIFIC COST-TO-CHARGE RATIO. THE COUNTY SHALL ADJUST THIS AMOUNT TO REFLECT ANY APPLICABLE DISCOUNTS OR PENALTIES PURSUANT TO PARAGRAPH 5 OF THIS SUBSECTION.

2. AN ENTITY APPROVED PURSUANT TO PARAGRAPH 4 OF THIS SUBSECTION SHALL COMPUTE HOSPITAL-SPECIFIC COST-TO-CHARGE RATIOS BASED ON EACH HOSPITAL'S FISCAL YEAR THAT ENDED DURING 1997 COMBINED INPATIENT AND OUTPATIENT COSTS AND CHARGES AS REPORTED BY EACH HOSPITAL AND FILED IN A FORMAT PRESCRIBED BY THE FEDERAL HEALTH CARE FINANCING ADMINISTRATION. IF A HOSPITAL'S COSTS AND CHARGES ARE NOT FILED IN A FORMAT PRESCRIBED BY THE FEDERAL HEALTH CARE FINANCING ADMINISTRATION, THE ENTITY MAY USE AUDITED FINANCIAL STATEMENTS FROM THE SAME TIME PERIOD TO COMPUTE THE HOSPITAL'S COST-TO-CHARGE RATIO. THE ENTITY SHALL EXCLUDE A HOSPITAL'S COSTS AND CHARGES RELATED TO LONG-TERM CARE, SKILLED NURSING, NURSING FACILITIES AND EMERGENCY TRANSPORTATION WHEN IT COMPUTES THIS RATIO.

3. AN ENTITY APPROVED PURSUANT TO PARAGRAPH 4 OF THIS SUBSECTION SHALL REVISE HOSPITAL-SPECIFIC COST-TO-CHARGE RATIOS. FOR PAYMENTS BEGINNING ON OCTOBER 1, 2000 THROUGH SEPTEMBER 30, 2001, THE APPROVED ENTITY SHALL COMPUTE THE HOSPITAL-SPECIFIC COST-TO-CHARGE RATIOS USING EACH HOSPITAL'S FISCAL YEAR THAT ENDED DURING 1998 COMBINED INPATIENT AND OUTPATIENT COSTS AND CHARGES REPORTED BY EACH HOSPITAL AND FILED IN A FORMAT PRESCRIBED BY THE FEDERAL HEALTH CARE FINANCING ADMINISTRATION. IF A HOSPITAL'S COSTS AND CHARGES ARE NOT FILED IN A FORMAT PRESCRIBED BY THE FEDERAL HEALTH CARE FINANCING ADMINISTRATION THE ENTITY MAY USE AUDITED FINANCIAL STATEMENTS FROM THE SAME TIME PERIOD TO COMPUTE THE HOSPITAL'S COST-TO-CHARGE RATIO. THE ENTITY SHALL EXCLUDE A HOSPITAL'S COSTS AND CHARGES RELATED TO LONG-TERM CARE, SKILLED NURSING, NURSING FACILITIES AND EMERGENCY TRANSPORTATION WHEN IT COMPUTES THE RATIO. ENTITIES SHALL CONTINUE TO ADJUST RATES AND MAKE PAYMENTS IN THIS MANNER IN SUBSEQUENT YEARS.

4. AN ENTITY APPROVED JOINTLY BY AN ASSOCIATION REPRESENTING COUNTY SUPERVISORS AND AN ASSOCIATION REPRESENTING HOSPITALS IN THIS STATE OR THEIR RESPECTIVE SUCCESSOR ORGANIZATIONS SHALL COMPUTE COST-TO-CHARGE RATIOS AS PROVIDED IN PARAGRAPHS 2 AND 3 OF THIS SUBSECTION. THE ASSOCIATION REPRESENTING HOSPITALS IN THIS STATE SHALL COLLECT INPATIENT AND OUTPATIENT COSTS AND CHARGES AS REPORTED BY EACH HOSPITAL AND FILED IN A FORMAT PRESCRIBED BY THE FEDERAL HEALTH CARE FINANCING ADMINISTRATION. THE ASSOCIATION REPRESENTING HOSPITALS IN THIS STATE MUST PROVIDE HOSPITAL COST AND CHARGE INFORMATION TO THE ENTITY APPROVED TO COMPUTE RATES BY JUNE 1 OF EACH YEAR. THE ENTITY APPROVED TO COMPUTE RATES SHALL BE PAID BY THE COUNTIES JOINTLY BASED ON POPULATION UNLESS AN ALTERNATIVE PAYMENT FORMULA IS AGREED TO BY ALL COUNTY BOARDS OF SUPERVISORS. IF THE ASSOCIATION REPRESENTING HOSPITALS FAILS TO PROVIDE THE DATA REQUIRED BY THIS SECTION BY JUNE 1 OF EACH YEAR, THE ASSOCIATION REPRESENTING HOSPITALS SHALL PROVIDE PAYMENT TO THE APPROVED ENTITY FOR THE COMPUTATION OF RATES FOR THAT YEAR. IN ANY YEAR, IF COST-TO-CHARGE RATIOS OR REVISED COST-TO-CHARGE RATIOS ARE UNAVAILABLE ON OCTOBER 1 OF THAT YEAR, THE COUNTY MAY CONTINUE TO REIMBURSE HOSPITALS BASED ON THE COUNTY REIMBURSEMENT RATES OR COST-TO-CHARGE RATIOS THAT WERE IN EFFECT BEFORE OCTOBER 1 OF THAT YEAR UNTIL REVISED RATIOS ARE AVAILABLE. IN ANY YEAR, IF THE ASSOCIATION REPRESENTING HOSPITALS DOES NOT PROVIDE THE ENTITY APPROVED TO COMPUTE COST-TO-CHARGE RATIOS WITH HOSPITAL COST-TO-CHARGE INFORMATION, A COUNTY MAY COMPUTE THESE RATIOS PURSUANT TO PARAGRAPH 3 OF THIS SUBSECTION AND USE THOSE RATIOS TO REIMBURSE HOSPITALS. IF AN APPROVED ENTITY DOES NOT COMPUTE COST-TO-CHARGE RATIOS, A COUNTY MAY REIMBURSE HOSPITALS BASED ON COST-TO-CHARGE RATIOS PROVIDED BY A HOSPITAL IF THE HOSPITAL COMPUTES THESE RATIOS PURSUANT TO PARAGRAPH 3 OF THIS SUBSECTION.

5. THE COUNTY SHALL APPLY THE FOLLOWING PROMPT PAYMENT DISCOUNT AND SLOW PAY PENALTY SCHEDULES:

(a) FOR DATES OF SERVICE BEGINNING ON OCTOBER 1, 1999 THROUGH SEPTEMBER 30, 2000:

(i) IF THE COUNTY PAYS THE HOSPITAL'S BILL WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY EIGHTY-EIGHT PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(ii) IF THE COUNTY PAYS THE HOSPITAL'S BILL MORE THAN THIRTY DAYS BUT WITHIN SIXTY DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(iii) IF THE COUNTY PAYS THE HOSPITAL'S BILL SIXTY OR MORE DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION PLUS A FEE OF ONE PER CENT FOR EACH THIRTY DAY PERIOD OR PORTION OF EACH THIRTY DAY PERIOD FOLLOWING THE SIXTIETH DAY OF RECEIPT OF THE BILL UNTIL THE DATE OF PAYMENT.

(b) FOR DATES OF SERVICE BEGINNING ON OCTOBER 1, 2000 THROUGH SEPTEMBER 30, 2001:

(i) IF THE COUNTY PAYS THE HOSPITAL'S BILL WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY NINETY-ONE PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(ii) IF THE COUNTY PAYS THE HOSPITAL'S BILL MORE THAN THIRTY DAYS BUT WITHIN SIXTY DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(iii) IF THE COUNTY PAYS THE HOSPITAL'S BILL SIXTY OR MORE DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION PLUS A FEE OF ONE PER CENT FOR EACH THIRTY DAY PERIOD OR PORTION OF EACH THIRTY DAY PERIOD FOLLOWING THE SIXTIETH DAY OF RECEIPT OF THE BILL UNTIL THE DATE OF PAYMENT.

(c) FOR DATES OF SERVICE BEGINNING ON OCTOBER 1, 2001 THROUGH SEPTEMBER 30, 2002:

(i) IF THE COUNTY PAYS THE HOSPITAL'S BILL WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY NINETY-FOUR PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(ii) IF THE COUNTY PAYS THE HOSPITAL'S BILL MORE THAN THIRTY DAYS BUT WITHIN SIXTY DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(iii) IF THE COUNTY PAYS THE HOSPITAL'S BILL SIXTY OR MORE DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION PLUS A FEE OF ONE PER CENT FOR EACH THIRTY DAY PERIOD OR PORTION OF EACH THIRTY DAY PERIOD FOLLOWING THE SIXTIETH DAY OF RECEIPT OF THE BILL UNTIL THE DATE OF PAYMENT.

(d) FOR DATES OF SERVICE BEGINNING ON OCTOBER 1, 2002 THROUGH SEPTEMBER 30, 2003:

(i) IF THE COUNTY PAYS THE HOSPITAL'S BILL WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY NINETY-SEVEN PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(ii) IF THE COUNTY PAYS THE HOSPITAL'S BILL MORE THAN THIRTY DAYS BUT WITHIN SIXTY DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(iii) IF THE COUNTY PAYS THE HOSPITAL'S BILL SIXTY OR MORE DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION PLUS A FEE OF ONE PER CENT FOR EACH THIRTY DAY PERIOD OR PORTION OF EACH THIRTY DAY PERIOD FOLLOWING THE SIXTIETH DAY OF RECEIPT OF THE BILL UNTIL THE DATE OF PAYMENT.

(e) FOR DATES OF SERVICE BEGINNING ON OCTOBER 1, 2003 THROUGH SEPTEMBER 30, 2004:

(i) IF THE COUNTY PAYS THE HOSPITAL'S BILL WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY NINETY-EIGHT PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(ii) IF THE COUNTY PAYS THE HOSPITAL'S BILL MORE THAN THIRTY DAYS BUT WITHIN SIXTY DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(iii) IF THE COUNTY PAYS THE HOSPITAL'S BILL SIXTY OR MORE DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION PLUS A FEE OF ONE PER CENT FOR EACH THIRTY DAY PERIOD OR PORTION OF EACH THIRTY DAY PERIOD FOLLOWING THE SIXTIETH DAY OF RECEIPT OF THE BILL UNTIL THE DATE OF PAYMENT.

(f) SUBDIVISION (e) OF THIS PARAGRAPH APPLIES FOR DATES OF SERVICE BEGINNING ON OR AFTER OCTOBER 1, 2004, EXCEPT THAT IF THE DISCOUNT RELATED TO PROMPT PAYMENT OF CLAIMS USED BY THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION FOR PAYMENT OF SERVICES PROVIDED TO PERSONS WHO ARE DEFINED AS ELIGIBLE PURSUANT TO SECTION 36-2901, PARAGRAPH 4, SUBDIVISION (a), (c), (h) OR (j) OR SECTION 36-2905.03 IS SET AT ONE PER CENT OR LESS, ONE OF THE FOLLOWING APPLIES:

(i) IF THE COUNTY PAYS THE HOSPITAL'S BILL WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY NINETY-NINE PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(ii) IF THE COUNTY PAYS THE HOSPITAL'S BILL MORE THAN THIRTY DAYS BUT WITHIN SIXTY DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION.

(iii) IF THE COUNTY PAYS THE HOSPITAL'S BILL SIXTY OR MORE DAYS AFTER THE DATE THE COUNTY RECEIVES THE BILL, THE COUNTY SHALL PAY ONE HUNDRED PER CENT OF THE CHARGES COMPUTED PURSUANT TO PARAGRAPH 1 OF THIS SUBSECTION PLUS A FEE OF ONE PER CENT FOR EACH THIRTY DAY PERIOD OR PORTION OF A THIRTY DAY PERIOD AFTER THE SIXTIETH DAY AFTER THE COUNTY RECEIVES THE BILL UNTIL THE DATE OF PAYMENT.

D. FOR THE PURPOSES OF THIS SECTION, A HOSPITAL BILL IS CONSIDERED RECEIVED ON RECEIPT OF THE LEGIBLE, ERROR FREE CLAIM BY THE COUNTY AS PROVIDED IN SECTION 11-297.02, SUBSECTION B.

E. THE ONE PER CENT FEE FOR EACH THIRTY DAY PERIOD PROVIDED IN SUBSECTION C, PARAGRAPH 5 OF THIS SECTION ACCRUES FOR NOT MORE THAN THREE HUNDRED SIXTY DAYS AFTER THE CLAIMS RESOLUTION PROCESS IS COMPLETED PURSUANT TO SECTION 11-297.03.

F. HOSPITAL BILLS THAT THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION PAYS OR THAT THE ADMINISTRATION IS CONSIDERING PAYING PURSUANT TO A SUPPLEMENTAL APPROPRIATION MADE IN 1997 ARE EXEMPT FROM THE MONTHLY FEE PROVISIONS PRESCRIBED IN SUBSECTION C, PARAGRAPH 5 OF THIS SECTION.

G. TO BE ENTITLED TO RECOVER FOR HOSPITALIZATION AND MEDICAL CARE PURSUANT TO THIS ARTICLE, A PRIVATE HOSPITAL OR A HOSPITAL THAT IS OPERATED BY A UNIVERSITY SHALL DO EITHER OF THE FOLLOWING:

1. GIVE THE RESPONSIBLE COUNTY NOTICE WITHIN TWELVE HOURS AFTER THE PATIENT ARRIVES FOR TREATMENT OF AN EMERGENCY CONDITION.

2. DEMONSTRATE THAT THE PATIENT OR A PERSON WHO ACTS ON BEHALF OF THE PATIENT SUBMITTED EVIDENCE OF INSURANCE COVERAGE TO THE HOSPITAL THAT WAS LATER DETERMINED TO BE INVALID FOR THE CARE AND TREATMENT OF THE EMERGENCY MEDICAL CONDITIONS IF BOTH OF THE FOLLOWING ARE TRUE:

(a) THE HOSPITAL DOCUMENTS IN THE PATIENT'S RECORD THAT EVIDENCE OF THE INSURANCE WAS SUBMITTED.

(b) IF THE HOSPITAL SUBSEQUENTLY RECEIVES INFORMATION FROM AN INSURER THAT THE INSURANCE OF A PATIENT FOR WHOM THE HOSPITAL IS PROVIDING MEDICAL SERVICES OR HOSPITALIZATION FOR AN EMERGENCY CONDITION IS NOT AVAILABLE OR DOES NOT PROVIDE COVERAGE FOR THE SERVICES RENDERED, THE HOSPITAL NOTIFIES THE RESPONSIBLE COUNTY WITHIN THIRTY DAYS AFTER IT RECEIVES THIS INFORMATION.

H. IF A HOSPITAL FAILS TO GIVE NOTICE WITHIN THE PERIOD PRESCRIBED IN SUBSECTION G OF THIS SECTION, THE HOSPITAL IS ENTITLED TO PAYMENT FROM THE RESPONSIBLE COUNTY FOR TREATMENT THAT IS RENDERED TO THE PATIENT FROM THE TIME NOTICE IS ACTUALLY GIVEN TO THE COUNTY UNTIL THE TIME THE PATIENT IS DISCHARGED FROM THE HOSPITAL OR THE PATIENT IS DETERMINED TO BE ELIGIBLE FOR SERVICES PURSUANT TO TITLE 36, CHAPTER 29, ARTICLE 1.

I. FOR THE PURPOSES OF THIS SECTION, NOTICE SHALL BE MADE AT A LOCATION DESIGNATED BY THE COUNTY BOARD OF SUPERVISORS. THE BOARD SHALL DESIGNATE WHETHER THE NOTICE MUST BE WRITTEN OR ORAL. A HOSPITAL OR HEALTH CARE PROVIDER MAY RECEIVE INFORMATION CONCERNING ACTION TAKEN BY THE BOARD PURSUANT TO THIS ARTICLE REGARDING NOTICE BY FILING A REQUEST WITH THE CLERK OF THE COUNTY BOARD OF SUPERVISORS. THE NOTICE MUST COMPLY WITH THE FOLLOWING REQUIREMENTS FOR CURRENT INFORMATION REGARDING THE PATIENT PROVIDED BY THE PATIENT OR A PERSON WHO PROVIDES INFORMATION ON THE PATIENT'S BEHALF:

1. THE NAME, LOCATION OF RESIDENCE, MAILING ADDRESS, SOCIAL SECURITY NUMBER, IF AVAILABLE, AND TELEPHONE NUMBER, IF AVAILABLE.

2. IF THE PATIENT IS A CHILD, THE PARENT'S OR RESPONSIBLE ADULT'S NAME, THE LOCATION OF RESIDENCE, MAILING ADDRESS, SOCIAL SECURITY NUMBER, IF AVAILABLE, AND TELEPHONE NUMBER, IF AVAILABLE.

3. THE PATIENT'S DATE OF BIRTH, IF AVAILABLE.

4. THE PATIENT'S GENDER.

5. THE DATE AND TIME OF ARRIVAL FOR TREATMENT OF EMERGENCY CONDITION.

6. IF AVAILABLE, A DESCRIPTION OF THE INITIAL PROBLEM THAT REQUIRED MEDICAL CARE.

7. THE NAME AND ADDRESS OF THE FACILITY WHERE MEDICAL TREATMENT WAS OR IS BEING RENDERED.

8. IF KNOWN, ANY THIRD PARTY LIABILITY INFORMATION.

9. THE NAME AND TELEPHONE NUMBER OF THE PERSON WHO PROVIDED THE INFORMATION TO THE HOSPITAL OR A RESPONSIBLE PARTY CONTACT, IF AVAILABLE.

10. THE DATE AND TIME THE COUNTY NOTIFICATION WAS SENT.

J. IF A PATIENT LACKS THE CAPACITY TO PROVIDE INFORMATION AND NO RESPONSIBLE PERSON OR OTHER SOURCE OF INFORMATION IS AVAILABLE FOR THAT PATIENT, THE HOSPITAL IS NOT REQUIRED TO PROVIDE INFORMATION REQUIRED PURSUANT TO SUBSECTION I, PARAGRAPHS 1, 2, 3, 8 AND 9 IF THE HOSPITAL USES A TERM TO ANONYMOUSLY DESIGNATE THE PATIENT. THE HOSPITAL SHALL NOTIFY THE COUNTY AS PRESCRIBED IN THIS SECTION IF THE HOSPITAL LEARNS OF IDENTIFYING INFORMATION FOR A PATIENT AS DESCRIBED IN THIS SUBSECTION BEFORE IT DISCHARGES THE PATIENT.

K. A PRIVATE HOSPITAL OR A HOSPITAL OPERATED BY A UNIVERSITY MAY SUBMIT, AND A COUNTY BOARD OF SUPERVISORS OR ITS DESIGNEE MAY APPROVE, A NOTIFICATION FORM OR NOTIFICATION PROCEDURE IF IT RESULTS IN TIMELY NOTIFICATION OF SUFFICIENT INFORMATION THAT IS NECESSARY FOR THE COUNTY TO PERFORM ITS ELIGIBILITY FUNCTIONS AND PROCESS CLAIMS. THE COUNTY BOARD OF SUPERVISORS OR THE BOARD'S DESIGNEE MAY WAIVE NOTIFICATION REQUIREMENTS FOR PATIENTS WHO A HOSPITAL CLASSIFIES AS EMERGENCY TREAT AND RELEASE PATIENTS.

Sec. 5. Title 11, chapter 2, article 7, Arizona Revised Statutes, is amended by adding sections 11-297.02, 11-297.03, 11-297.04, 11-297.05 and 11-297.06, to read:

11-297.02 . Claims against county for medical care; liability

A. NOTWITHSTANDING ANY LAW TO THE CONTRARY, A COUNTY IS NOT LIABLE FOR A CLAIM FOR HOSPITALIZATION AND MEDICAL CARE MADE PURSUANT TO THIS ARTICLE FROM A HOSPITAL OR HEALTH CARE PROVIDER IF THE CLAIM DOES NOT COMPLY WITH THE REQUIREMENTS OF THIS ARTICLE.

B. A HOSPITAL BILL IS CONSIDERED RECEIVED FOR PURPOSES OF THIS ARTICLE ON INITIAL RECEIPT OF THE LEGIBLE, ERROR-FREE CLAIM IF THE CLAIM INCLUDES THE FOLLOWING ERROR-FREE DOCUMENTATION IN LEGIBLE FORM:

1. AN ADMISSION FACE SHEET OR REGISTRATION RECORD.

2. AN ITEMIZED STATEMENT.

3. AN ADMISSION HISTORY AND PHYSICAL.

4. A DISCHARGE SUMMARY, IF APPLICABLE.

5. IF AN ADMISSION WAS THROUGH THE EMERGENCY ROOM, AN EMERGENCY RECORD.

6. OPERATIVE REPORTS, IF APPLICABLE.

7. LABOR AND DELIVERY ROOM REPORT, IF APPLICABLE.

C. UNDER CONDITIONS ESTABLISHED BY THE BOARD OF SUPERVISORS, THE BOARD MAY WAIVE DOCUMENTS REQUIRED PURSUANT TO SUBSECTION B OF THIS SECTION FOR PATIENTS WHO A HOSPITAL CLASSIFIES AS EMERGENCY TREAT AND RELEASE PATIENTS IF THE COUNTY CONTINUES TO RECEIVE SUFFICIENT DOCUMENTATION TO JUSTIFY PAYING OR DENYING A CLAIM.

D. EXCEPT AS PROVIDED IN SECTIONS 36-2908 AND 36-2909, THE COUNTY SHALL REIMBURSE AN AMBULANCE COMPANY FOR THE TRANSPORTATION TO A HOSPITAL OF A PERSON IN A MEDICAL EMERGENCY SITUATION IF THAT PERSON'S MEDICAL CARE IS A COUNTY RESPONSIBILITY PURSUANT TO SECTION 11-291, SUBSECTION A AND SECTION 11-291.01, AND IF THE TRANSPORTATION IS REQUESTED BY A HEALTH CARE PROFESSIONAL LICENSED UNDER TITLE 32, CHAPTER 13, 15, 17 OR 25, BY A PARAMEDIC OR EMERGENCY MEDICAL TECHNICIAN CERTIFIED PURSUANT TO TITLE 36, CHAPTER 21.1 OR BY A LAW ENFORCEMENT OFFICER OR FIRE FIGHTER. THE COUNTY SHALL REIMBURSE THE AMBULANCE COMPANY FOR SERVICES ON A CAPPED FEE-FOR-SERVICE BASIS THAT DOES NOT EXCEED THE MAXIMUM AMOUNT DETERMINED BY THE ADMINISTRATION PURSUANT TO SECTION 36-2904, SUBSECTION B.

E. COUNTIES SHALL NOT PAY A CLAIM FOR HOSPITALIZATION AND MEDICAL CARE IF THE CLAIM IS INITIALLY SUBMITTED MORE THAN SIX MONTHS AFTER THE DATE THE PATIENT IS DISCHARGED OR IS SUBMITTED AS AN ERROR FREE CLAIM MORE THAN NINE MONTHS FROM THAT DATE. IF A HOSPITAL OR HEALTH CARE PROVIDER HAS RECEIVED EVIDENCE OF INSURANCE COVERAGE AND HAS SUBMITTED A CLAIM TO THE INSURER, THE COUNTY SHALL NOT PAY A CLAIM THAT IS SUBMITTED MORE THAN SIX MONTHS AFTER THE DATE THAT THE PATIENT IS DISCHARGED OR TWO MONTHS AFTER THE DATE THE COUNTY IS PROVIDED WITH NOTICE PURSUANT TO SECTION 11-297.01, SUBSECTION G, PARAGRAPH 2, SUBDIVISION (b) , WHICHEVER IS LATER.

F. COUNTIES MAY REVIEW CLAIMS THAT ARE RECEIVED IN A TIMELY MANNER PURSUANT TO THE FOLLOWING CRITERIA:

1. PERSONAL CARE ITEMS SUPPLIED BY A HOSPITAL, INCLUDING THE FOLLOWING, ARE NOT COVERED:

(a) PATIENT CARE KITS.

(b) TOOTHBRUSHES.

(c) TOOTHPASTE.

(d) PETROLEUM JELLY.

(e) DEODORANT.

(f) ANTISEPTIC SOAP.

(g) RAZORS.

(h) DISPOSABLE RAZORS.

(i) SHAVING CREAM.

(j) SLIPPERS.

(k) MOUTHWASH.

(l) SHAMPOO.

(m) POWDER.

(n) LOTION.

(o) COMBS.

(p) PATIENT GOWNS.

2. THE FOLLOWING MEDICALLY NECESSARY AND USED HOSPITAL SUPPLIES AND EQUIPMENT ARE COVERED INCLUDING:

(a) ARM BOARDS.

(b) DIAPERS.

(c) UNDERPADS.

(d) SPECIAL MATTRESSES AND SPECIAL BEDS.

(e) GLOVES.

(f) WRIST RESTRAINTS.

(g) LIMB HOLDERS.

(h) DISPOSABLE ITEMS THAT ARE USED INSTEAD OF DURABLE ITEMS.

(i) UNIVERSAL PRECAUTION.

(j) STAT CHARGES.

(k) PORTABLE CHARGES.

3. THE HOSPITAL CLAIMS REVIEW SHALL DETERMINE WHETHER SERVICES RENDERED WERE:

(a) CONSISTENT WITH THE SERVICES REIMBURSABLE PURSUANT TO SECTIONS 11-291, 11-291.01, 11-297 AND 11-297.01.

(b) MEDICALLY NECESSARY.

(c) PROVIDED IN THE MOST APPROPRIATE, MOST COST-EFFECTIVE AND LEAST RESTRICTIVE SETTING.

G. FOR A HEALTH CARE EXPENDITURE INCLUDING MEDICAL CARE, NONHOSPITAL SERVICES OR LONG-TERM CARE SERVICES PURSUANT TO THIS ARTICLE, A COUNTY BOARD OF SUPERVISORS MAY REIMBURSE CONTRACTING AND NONCONTRACTING PROVIDERS THE LESSER OF THE BILLED CHARGES OR THE AMOUNT DETERMINED PURSUANT TO THE MOST RECENT CAPPED FEE PRICE SCHEDULE PROVIDED BY THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION. THE COUNTY SHALL APPLY ANY APPLICABLE DISCOUNTS RELATED TO PROMPT PAYMENT PRESCRIBED PURSUANT TO SECTION 11-297.01, SUBSECTION C, PARAGRAPH 5. UNLESS A HOSPITAL OR HEALTH CARE PROVIDER VERIFIES THROUGH THE COUNTY THAT A PERSON HAS BEEN DETERMINED INELIGIBLE OR, AT THE TIME SERVICES WERE RENDERED, WAS NOT ELIGIBLE FOR SERVICES, THE PROVIDER SHALL NOT DO EITHER OF THE FOLLOWING:

1. CHARGE, SUBMIT A CLAIM TO, DEMAND PAYMENT FROM OR OTHERWISE COLLECT PAYMENT FROM A PERSON WHO HAS BEEN PROVIDED COVERED CARE OR SERVICES PURSUANT TO THIS ARTICLE.

2. REFER OR REPORT A PERSON TO A COLLECTION AGENCY OR CREDIT REPORTING AGENCY FOR THAT PERSON'S FAILURE TO PAY CHARGES FOR COVERED CARE OR SERVICES PROVIDED PURSUANT TO THIS ARTICLE.

11-297.03 . Claims resolution process

A. PURSUANT TO THE REQUIREMENTS OF THIS SECTION, A COUNTY BOARD OF SUPERVISORS OR ITS DESIGNEE SHALL ESTABLISH A CLAIMS RESOLUTION PROCESS FOR USE BY HOSPITALS AND HEALTH CARE PROVIDERS THAT RECEIVE A DENIAL FROM A COUNTY OF ALL OR ANY PORTION OF A CLAIM SUBMITTED PURSUANT TO THIS ARTICLE. A HOSPITAL OR HEALTH CARE PROVIDER SHALL USE A CLAIMS RESOLUTION PROCESS ESTABLISHED PURSUANT TO THIS SECTION AS A CONDITION OF SEEKING ANY OTHER RELIEF. A CLAIMS RESOLUTION PROCESS ESTABLISHED PURSUANT TO THIS SECTION REQUIRES A MUTUAL OBLIGATION OF A COUNTY AND HOSPITAL OR HEALTH CARE PROVIDER TO MAKE AVAILABLE DOCUMENTS OR INFORMATION AND A GOOD FAITH EFFORT TO RESOLVE THE DISPUTED CLAIM THROUGH THE CLAIMS RESOLUTION PROCESS.

B. A HOSPITAL OR A HEALTH CARE PROVIDER MAY DISPUTE A CLAIM OR ANY PORTION OF A CLAIM THAT A COUNTY DENIES BY TRANSMITTING A LETTER OF DISPUTE AND REQUEST FOR CLAIM RESOLUTION TO THE COUNTY WITHIN NINETY DAYS AFTER THE COUNTY DENIES THE CLAIM.

C. NOTWITHSTANDING ANY LAWS OR REQUIREMENTS RELATING TO CONFIDENTIALITY OR PRIVILEGE THAT DO NOT RELATE TO ATTORNEY-CLIENT PRIVILEGE, NOT LESS THAN NINETY DAYS OR MORE THAN ONE HUNDRED EIGHTY DAYS AFTER THE COUNTY RECEIVES THE LETTER OF DISPUTE PURSUANT TO SUBSECTION B OF THIS SECTION, THE COUNTY AND THE HOSPITAL OR HEALTH CARE PROVIDER SHALL MAKE AVAILABLE RELEVANT DOCUMENTS AND ATTEMPT TO RESOLVE THE DISPUTE. WITHIN SIXTY DAYS OF A WRITTEN REQUEST MADE WITHIN THAT PERIOD, THE COUNTY, HOSPITAL OR HEALTH CARE PROVIDER SHALL MAKE AVAILABLE RELEVANT DOCUMENTS AND INFORMATION CONCERNING A DISPUTED CLAIM.

D. WITHIN FORTY-FIVE DAYS AFTER THE PERIOD PROVIDED FOR THE EXCHANGE OF DOCUMENTS AND DISPUTE RESOLUTION PURSUANT TO SUBSECTION C OF THIS SECTION, THE COUNTY SHALL PROVIDE THE HOSPITAL OR HEALTH CARE PROVIDER WRITTEN NOTICE OF ITS DECISION WITH REGARD TO EACH CLAIM THAT IS SUBJECT TO THE CLAIMS RESOLUTION PROCESS. IF THE COUNTY AGREES TO ISSUE A PAYMENT, THE COUNTY SHALL REMIT PAYMENT WITHIN FORTY-FIVE DAYS AFTER IT ISSUES THIS WRITTEN NOTICE.

E. NOTWITHSTANDING SUBSECTION C OR D OF THIS SECTION, IF AFTER ALL RELEVANT DOCUMENTS ARE MADE AVAILABLE AND THE PARTIES AGREE IN WRITING THAT THE DISPUTE CANNOT BE RESOLVED THROUGH THE CLAIMS RESOLUTION PROCESS, THE COUNTY SHALL ISSUE A WRITTEN NOTICE OF ITS DECISION PURSUANT TO SUBSECTION D OF THIS SECTION WITHIN FORTY-FIVE DAYS AFTER THE PARTIES MAKE THIS AGREEMENT.

F. THE CLAIMS RESOLUTION PROCESS BEGINS WHEN THE COUNTY RECEIVES THE LETTER OF DISPUTE AND ENDS WHEN THE COUNTY PROVIDES NOTICE PURSUANT TO SUBSECTION D, E OR H OF THIS SECTION. DURING THE CLAIMS RESOLUTION PROCESS, A CLAIM IS NOT SUBJECT TO A PAYMENT PENALTY PURSUANT TO SECTION 11-297.01 AND INTEREST SHALL NOT ACCRUE PURSUANT TO SECTION 44-1201.

G. THE CLAIMS RESOLUTION PROCESS IS NOT SUBJECT TO REVIEW PURSUANT TO TITLE 12, CHAPTER 7, ARTICLE 6.

H. NOTWITHSTANDING SUBSECTION A OF THIS SECTION, A COUNTY BOARD OF SUPERVISORS OR ITS DESIGNEE AND A HOSPITAL OR HEALTH CARE PROVIDER MAY ESTABLISH AN ALTERNATIVE CLAIMS RESOLUTION PROCESS IF THE PROCESS ESTABLISHES A RESOLUTION COMPLETION DATE.

11-297.04 . Binding arbitration; county option

A. AS THE EXCLUSIVE REMEDY FOR RESOLVING CLAIMS OF HOSPITALS AND HEALTH CARE PROVIDERS AT OR LESS THAN THE AMOUNT ESTABLISHED IN SUBSECTION B OF THIS SECTION, A COUNTY BOARD OF SUPERVISORS MAY ADOPT A SYSTEM OF BINDING ARBITRATION AS PROVIDED IN THIS SECTION.

B. A DISPUTED CLAIM OF NOT MORE THAN FOUR THOUSAND FIVE HUNDRED DOLLARS AFTER DEDUCTING ANY PAYMENTS COMPUTED AT FULL BILL CHARGES IS SUBJECT TO BINDING ARBITRATION. THE PARTIES MAY AGREE TO RESOLVE CLAIMS OF MORE THAN THIS AMOUNT BY BINDING ARBITRATION.

C. A COUNTY BOARD OF SUPERVISORS THAT ADOPTS BINDING ARBITRATION SHALL ESTABLISH A ROSTER OF AVAILABLE ARBITRATORS. THE ROSTER SHALL CONTAIN THE NAMES OF AVAILABLE ARBITRATORS THAT ARE ACCEPTABLE TO BOTH THE COUNTY AND AN ASSOCIATION REPRESENTING HOSPITALS IN THIS STATE. THE ENTITIES SHALL NOT UNREASONABLY WITHHOLD AGREEMENT OF PROPOSED ARBITRATORS.

D. WITHIN NINETY DAYS AFTER RECEIVING NOTICE OF THE COUNTY'S DECISION PURSUANT TO SECTION 11-297.03, SUBSECTION D, E OR H, A HOSPITAL OR HEALTH CARE PROVIDER MAY FILE WITH THE COUNTY A NOTICE OF INTENT TO SEEK BINDING ARBITRATION.

E. WITHIN THIRTY DAYS AFTER THE COUNTY RECEIVES THE NOTICE PURSUANT TO SUBSECTION D OF THIS SECTION, THE COUNTY AND THE HOSPITAL OR HEALTH CARE PROVIDER SHALL AGREE ON AN ARBITRATOR. IF THE PARTIES CANNOT AGREE, EACH PARTY SHALL DESIGNATE AN ARBITRATOR FROM THE ROSTER AND THESE TWO ARBITRATORS SHALL DESIGNATE A THIRD ARBITRATOR, WHO SHALL CONDUCT THE HEARING NOT MORE THAN ONE HUNDRED TWENTY DAYS AFTER THAT ARBITRATOR IS SELECTED.

F. THE COUNTY AND THE HOSPITAL OR THE HEALTH CARE PROVIDER SHALL SEEK ANY DEPOSITIONS PURSUANT TO SECTION 12-1507, SUBSECTION B WITHIN FORTY DAYS AFTER THE ARBITRATOR IS SELECTED. THE ARBITRATOR SHALL DIRECT THAT THE PARTIES PRODUCE DOCUMENTS AND OTHER INFORMATION AND IDENTIFY WITNESSES WITHIN FORTY DAYS AFTER THE ARBITRATOR IS SELECTED OR WITHIN A SHORTER TIME PRESCRIBED BY THE ARBITRATOR. THE PARTIES SHALL EXCHANGE ALL BOOKS, RECORDS, DOCUMENTS AND OTHER EVIDENCE AND ALL WITNESS LISTS NOT LESS THAN FIVE DAYS BEFORE THE HEARING DATE.

G. UNLESS OTHERWISE PROVIDED IN THIS SECTION, THE PROCEDURES FOR THE CONDUCT OF A HEARING, AWARD, CONFIRMATION OF AWARD, FEES AND EXPENSES OF ARBITRATION AND OPPOSITION TO AN AWARD SHALL BE AS PROVIDED IN TITLE 12, CHAPTER 9, ARTICLE 1. IN THE ABSENCE OF A GOVERNING STATUTE, THE RULES OF THE AMERICAN ARBITRATION ASSOCIATION FOR COMMERCIAL ARBITRATION THEN IN EFFECT SERVE AS A GUIDELINE ON PROCEDURAL ISSUES.

H. AN ARBITRATOR DESIGNATED PURSUANT TO THIS SECTION AND THE PARTIES TO THE ARBITRATION SHALL MAINTAIN THE CONFIDENTIALITY OF PATIENT MEDICAL RECORDS.

11-297.05 . Stays of arbitration; declaratory judgments

ANY PARTY TO AN ARBITRATION CONDUCTED PURSUANT TO SECTION 11-297.04 MAY REQUEST THE ARBITRATOR FOR A TEMPORARY STAY OF THE ARBITRATION TO ALLOW THE PARTY OR PARTIES TO SEEK A DECLARATORY JUDGMENT PURSUANT TO SECTION 12-1831 ON THE GROUNDS THAT A DECLARATORY JUDGMENT IS NECESSARY TO DETERMINE A QUESTION OF LAW ARISING FROM THE RIGHTS AND OBLIGATIONS ESTABLISHED BY THIS ARTICLE AND THAT THE ISSUE OF LAW ON WHICH JUDGMENT IS SOUGHT IS OF A RECURRING NATURE.

11-297.06 . Statute of limitation; time frames

A. NOTWITHSTANDING ANY OTHER LAW, A HOSPITAL OR HEALTH CARE PROVIDER THAT IS NOT REQUIRED TO USE BINDING ARBITRATION PURSUANT TO SECTION 11-297.04 TO RESOLVE A DISPUTED CLAIM SHALL FILE AN ACTION IN COURT NOT LESS THAN NINETY DAYS AFTER IT RECEIVES WRITTEN NOTICE PURSUANT TO SECTION 11-297.03, SUBSECTION D, E OR H.

B. NOTWITHSTANDING ANY OTHER LAW, FOR SERVICES BEGINNING ON OCTOBER 1, 1999, A HOSPITAL AND HEALTH CARE PROVIDER SHALL SEEK REIMBURSEMENT OF CLAIMS ONLY PURSUANT TO THIS ARTICLE.

Sec. 6. Section 33-931, Arizona Revised Statutes, is amended to read:

33-931 . Lien of health care provider on damages recovered by person receiving services; hospital priority

A. Every individual, partnership, firm, association, corporation or institution or any governmental unit maintaining and operating A HEALTH CARE INSTITUTION or providing health care services in this state, which has been duly licensed by this state or any political subdivision or private entity with ambulances operated, licensed , or registered pursuant to title 36, chapter 21.1, is entitled to a lien for the customary charges for care and treatment or transportation of an injured person, upon any and ON all claims of liability or indemnity except health insurance for damages accruing to the person to whom the services are rendered, or to the THAT PERSON'S legal representative of such person , on account of THE injuries giving THAT GAVE rise to such THE claims and which necessitated such THAT REQUIRED THE services.

B. IF A COUNTY MAINTAINS, OPERATES OR PROVIDES HEALTH CARE SERVICES, IT IS ENTITLED TO AN ASSIGNMENT BY OPERATION OF LAW FOR CUSTOMARY CHARGES FOR CARE AND TREATMENT OR TRANSPORTATION OF AN INJURED PERSON ON ANY CLAIMS OF LIABILITY OR INDEMNITY, EXCEPT HEALTH INSURANCE, FOR DAMAGES ACCRUING TO THE PERSON TO WHOM THE SERVICES ARE RENDERED, OR TO THAT PERSON'S LEGAL REPRESENTATIVE, ON ACCOUNT OF INJURIES THAT GAVE RISE TO THE CLAIMS AND THAT REQUIRED THE SERVICES.

B. C. The lien entitlements authorized by subsection A AND THE ASSIGNMENT AUTHORIZED BY SUBSECTION B are applicable to all customary charges by hospitals or ambulances of political subdivisions , but ARE restricted to customary charges in excess of two hundred fifty dollars by all other providers and privately owned ambulance companies excluding interest and service charges. Liens perfected pursuant to this article by a hospital have priority for payment over all other liens authorized by this article.

Sec. 7. Section 33-934, Arizona Revised Statutes, is amended to read:

33-934 . Release of claim by injured person ineffective as to lienholder; action to enforce lien

No A release of claims upon ON which a lien OR ASSIGNMENT is given by section 33-931 , or of any judgment thereon, shall be ON THAT CLAIM IS NOT valid or effectual as against the lien OR ASSIGNMENT unless the lienholder OR ASSIGNEE joins therein IN THE RELEASE or executes a release of the lien , and the claimant or assignee of the lien may, OR ASSIGNMENT. If any amount has been or is to be collected by the injured person or his THAT PERSON'S legal representative from or on account of the person, firm or corporation liable for damages by reason of a judgment, settlement or compromise, THE CLAIMANT OR ASSIGNEE OF THE LIEN OR ASSIGNMENT MAY enforce the lien OR ASSIGNMENT by action against the person, firm or corporation liable for damages. Such THIS action shall be commenced and tried in the county in which the lien OR ASSIGNMENT is filed, unless ordered by the court to be removed to another county for cause. If the claimant prevails in such action, the court may allow reasonable attorney's ATTORNEY fees and disbursements. Such THE action shall be commenced within two years after the entry of the judgment or the making of the settlement or compromise.

Sec. 8. Section 33-936, Arizona Revised Statutes, is amended to read:

33-936 . Release of hospital lien; liability

When IF any lien OR ASSIGNMENT established by the provisions of this article has been satisfied, the lienholder shall, within thirty days after satisfaction , THE LIENHOLDER OR ASSIGNEE SHALL issue a release of the lien OR ASSIGNMENT to the person against whom the lien OR ASSIGNMENT was claimed. Such THE release shall be a document in a form as specified in section 11-480. Failure A LIENHOLDER OR ASSIGNEE THAT FAILS to grant such a release shall IS subject the lienholder to liability in the amount of one thousand HUNDRED dollars and also to liability for actual damages.

Sec. 9. Section 36-2903, Arizona Revised Statutes, is amended to read:

36-2903 . Arizona health care cost containment system; administrator; powers and duties of director and administrator; exemption from attorney general representation

A. There is established The Arizona health care cost containment system . The system shall consist IS ESTABLISHED CONSISTING of contracts with providers for the provision of hospitalization and medical care coverage to members. Except as specifically required by federal law and by section 36-2909, the system is only responsible for providing care on or after the date that the person has been determined eligible for the system, and is only responsible for reimbursing the cost of care rendered on or after the date that the person was determined eligible for the system.

B. The director shall take all steps necessary to implement the system on October 1, 1982. No hospitalization and medical care services may be provided pursuant to this article prior to October 1, 1982.

C. An agreement may be entered into with an independent contractor, subject to title 41, chapter 23, to serve as the statewide administrator of the system. The administrator has full operational responsibility, subject to supervision by the director, for the system which may include any or all of the following:

1. Development of county-by-county implementation and operation plans for the system which include reasonable access to hospitalization and medical care services for members.

2. Contract administration, certification and oversight of providers.

3. Provision of technical assistance services to providers and potential providers.

4. Development of a complete system of accounts and controls for the system including provisions designed to ensure that covered health and medical services provided through the system are not used unnecessarily or unreasonably including but not limited to inpatient mental health services provided in a hospital. Prior to the development of a system of accounts and controls and periodically thereafter, the administrator shall compare the scope, utilization rates, utilization control methods and unit prices of major health and medical services provided in this state in comparison with other states' health care services to identify any unnecessary or unreasonable utilization within the system. The administrator shall periodically assess the cost effectiveness and health implications of alternate approaches to the provision of covered health and medical services through the system in order to reduce unnecessary or unreasonable utilization.

5. Establishment of peer review and utilization review functions for all providers.

6. Assistance in the formation of medical care consortiums to provide covered health and medical services under the system for a county.

7. Development and management of a provider payment system.

8. Establishment and management of a comprehensive system for assuring the quality of care delivered by the system.

9. Establishment and management of a system to prevent fraud by members, eligible persons and providers of the system.

10. Coordination of benefits provided under this article to any member. The administrator may require that providers and nonproviders are responsible for the coordination of benefits for services provided under this article. Requirements for coordination of benefits by nonproviders under this section shall be limited to coordination with standard health insurance and disability insurance policies and similar programs for health coverage.

11. Development of a health education and information program.

12. Development and management of a participant enrollment system.

13. Establishment and maintenance of a claims resolution procedure to ensure that ninety per cent of the clean claims shall be paid within thirty days of receipt and ninety-nine per cent of the remaining clean claims shall be paid within ninety days of receipt. For the purpose of this paragraph, "clean claims" has the same meaning as prescribed in section 36-2904, subsection H.

14. Establishment of standards for the coordination of medical care and patient transfers pursuant to section 36-2909, subsection D.

15. Establishment of a system to implement medical child support requirements, as required by federal law. The administration may enter into an intergovernmental agreement with the department of economic security to implement the provisions of this paragraph.

D. If an agreement is not entered into with an independent contractor to serve as statewide administrator of the system pursuant to subsection C of this section, the director shall ensure that the operational responsibilities set forth in subsection C of this section are fulfilled by the administration and other contractors as necessary.

E. If the director determines that the administrator will fulfill some but not all of the responsibilities set forth in subsection C of this section, the director shall ensure that the remaining responsibilities are fulfilled by the administration and other contractors as necessary.

F. The administrator or any direct or indirect subsidiary of the administrator is not eligible to serve as a provider.

G. Except for reinsurance obtained by providers, the administrator shall coordinate benefits provided under this article to any eligible person who is covered by workers' compensation, disability insurance, a hospital and medical service corporation, a health care services organization, an accountable health plan or any other health or medical or disability insurance plan including coverage made available to persons defined as eligible by section 36-2901, paragraph 4, subdivisions (d), (e), (f) and (g), or who receives payments for accident-related injuries, so that any costs for hospitalization and medical care paid by the system are recovered from any other available third party payors. The administrator may require that providers and nonproviders are responsible for the coordination of benefits for services provided under this article. Requirements for coordination of benefits by nonproviders under this section shall be limited to coordination with standard health insurance and disability insurance policies and similar programs for health coverage. The system shall act as a payor of last resort for persons defined as eligible pursuant to section 36-2901, paragraph 4, subdivision (a), (c) or (h). The system shall also act as payor of last resort for persons defined as eligible pursuant to section 36-2901, paragraph 4, subdivision (b) or section 36-2974 unless specifically prohibited by federal law. The director may require eligible persons to assign to the system AND A COUNTY rights to all types of medical benefits to which the person is entitled, including but not limited to first party medical benefits under automobile insurance policies BASED ON THE ORDER OF PRIORITIES ESTABLISHED PURSUANT TO SECTION 36-2915 . The state has a right to subrogation against any other person or firm to enforce the assignment of medical benefits. The provisions of this subsection are controlling over the provisions of any insurance policy which provides benefits to an eligible person if the policy is inconsistent with the provisions of this subsection.

H. Notwithstanding subsection F of this section, the administrator may subcontract distinct administrative functions to one or more persons who may be providers within the system.

I. The director shall require as a condition of a contract with any provider that all records relating to contract compliance are available for inspection by the administrator and the director subject to subsection J of this section and that such records be maintained by the provider for five years. The director shall also require that such records be made available by a provider on request of the secretary of the United States department of health and human services, or its successor agency.

J. Subject to existing law relating to privilege and protection, the director shall prescribe by rule the types of information that are confidential and circumstances under which such information may be used or released, including requirements for physician-patient confidentiality. Notwithstanding any other provision of law, such rules shall be designed to provide for the exchange of necessary information among the counties, the administration and the department of economic security for the purposes of eligibility determination under this article. Notwithstanding any law to the contrary, a member's medical record shall be released without the member's consent in situations or suspected cases of fraud or abuse relating to the system to an officer of the state's certified Arizona health care cost containment system fraud control unit who has submitted a written request for the medical record.

K. The director shall prescribe rules which specify methods for:

1. The transition of patients between system providers and nonproviders.

2. The transfer of members and persons who have been determined eligible from hospitals which do not have contracts to care for such persons.

L. The director shall adopt rules that set forth procedures and standards for use by the system in requesting county long-term care for members or persons determined eligible.

M. To the extent that services are furnished pursuant to this article, and unless otherwise required pursuant to this chapter, a provider is not subject to the provisions of title 20.

N. As a condition of the contract with any provider, the director shall require such contract terms as are necessary in the judgment of the director to ensure adequate performance and compliance with all applicable federal laws by the provider of the provisions of each contract executed pursuant to this article. Contract provisions required by the director shall include, but are not limited to, the maintenance of deposits, performance bonds, financial reserves or other financial security. The director may waive requirements for the posting of bonds or security for providers which have posted other security, equal to or greater than that required by the system, with a state agency for the performance of health service contracts if funds would be available from such security for the system upon default by the provider. The director may also adopt rules which provide for the withholding or forfeiture of payments to be made to a provider by the system for the failure of the provider to comply with a provision of the provider's contract with the system or with the provisions of adopted rules. The director may also require contract terms allowing the administration to operate a provider directly under circumstances specified in the contract. The administration shall operate the provider only as long as it is necessary to assure delivery of uninterrupted care to members enrolled with the provider and accomplish the orderly transition of those members to other system providers, or until the provider reorganizes or otherwise corrects the contract performance failure. The administration shall not operate a provider unless, prior to that action, the administration delivers notice to the provider and provides an opportunity for a hearing in accordance with procedures established by the director. Notwithstanding the provisions of a contract, if the administration finds that the public health, safety or welfare requires emergency action, it may operate as the provider on notice to the provider and pending an administrative hearing which it shall promptly institute.

O. The administration for the sole purpose of matters concerning and directly related to the Arizona health care cost containment system and the Arizona long-term care system is exempt from section 41-192.

P. Notwithstanding subsection G of this section, beginning on July 1, 1991 and in accordance with section 4402 of the omnibus budget reconciliation act of 1990, if the administration determines that according to federal guidelines it is more cost effective for a person defined as eligible under section 36-2901, paragraph 4, subdivision (b) to be enrolled in a group health insurance plan in which the person is entitled to be enrolled, the administration may pay all of that person's premiums, deductibles, coinsurance and other cost sharing obligations for services covered under section 36-2907. The person shall apply for enrollment in the group health insurance plan as a condition of eligibility under section 36-2901, paragraph 4, subdivision (b).

Q. The total amount of state monies that may be spent in any fiscal year by the administration for health care shall not exceed the amount appropriated or authorized by section 35-173 for all health care purposes. This article does not impose a duty on an officer, agent or employee of this state to discharge a responsibility or to create any right in a person or group if the discharge or right would require an expenditure of state monies in excess of the expenditure authorized by legislative appropriation for that specific purpose.

Sec. 10. Section 41-1837, Arizona Revised Statutes, is amended to read:

41-1837 . Financial responsibility for emergency medical services rendered to indigents

A. When IF an indigent emergency medical patient is received by an emergency receiving facility from an ambulance with necessary medical equipment and supplies to provide emergency medical services AND which is licensed pursuant to title 36, chapter 21.1, the county shall be IS liable pursuant to section 11-297.01 11-297.02 to the ambulance service for the cost of transporting the patient and to the facility for the reasonable costs of all medical services rendered to such indigent THE PATIENT by the facility until such THE patient is transferred by the county to the county hospital, or some other facility designated by the county.

B. This section does not apply to air ambulances, including ambulance helicopters, operated by the department. There shall be no charge made to the patient for any emergency medical care provided by department personnel.

Sec. 11. Joint legislative committee on county medical care residual responsibility

A. The joint legislative committee on county medical care residual responsibility is established consisting of the following members:

1. The chairman of the house of representatives health committee, who shall cochair the committee.

2. The chairman of the senate health committee, who shall cochair the committee.

3. Three members from the house of representatives appointed by the speaker of the house of representatives, not more than two of whom represent the same political party.

4. Three members from the senate appointed by the president of the senate, not more than two of whom represent the same political party.

B. The task force shall:

1. Examine the procedures used to determine eligibility of county residents for residual responsibility, including the medically needy, medically indigent program.

2. Examine alternative means of reimbursing hospitals and providers that make claims pursuant to title 11, chapter 2, article 7, Arizona Revised Statutes.

3. Examine the manner in which the procedures related to claims from hospitals and health care providers pursuant to title 11, chapter 2, article 7, Arizona Revised Statutes, can be improved.

4. Submit a written report of its findings and recommendations to the governor, the president of the senate and the speaker of the house of representatives on or before November 15, 1999. The committee shall provide a copy of the report to the secretary of state and the director of the department of library, archives and public records.

Sec. 12. Delayed repeal

Section 11 of this act, relating to the joint legislative committee on county medical care residual responsibility, is repealed from and after December 31, 1999.

APPROVED BY THE GOVERNOR MAY 18, 1999.

FILED IN THE OFFICE OF THE SECRETARY OF STATE MAY 18, 1999.