AHCCCS; eligibility;
programs
DPA |
Committee on Health |
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DPA |
Committee on Approp |
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DP |
Caucus and COW |
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X |
As Transmitted To The Governor |
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Beginning September 30, 2001, HB 2585 removes the demonstration project status of the Arizona Health Care Cost Containment System (AHCCCS) Premium Sharing health care benefits program and continues the project as a permanent and statewide program. The bill increases Premium Sharing eligibility requirements from 0-200% of Federal Poverty Level (FPL) to 0-250% of FPL. The adjusted eligibility considers the participants who will be covered under the Proposition 204 initiative and expands eligibility for new populations from 200 to 250% FPL. The bill appropriates $5 million in FY 2001-2002 and $20 million on July 1, 2002 using tobacco tax and designated monies collected pursuant to the master tobacco settlement.
Two additional programs are funded in HB 2585. An appropriation of $1,591,000 from the state general fund in FY 2001-2002 and FY 2002-2003 will be used for the Ticket To Work program This program expands Medicaid coverage to allow workers with disabilities to buy into the program. Critical access hospitals in rural areas will receive an appropriation of $800,000 from the state general fund in FY 2001-2002 and FY 2002-2003.
HB 2585 adjusts the reimbursement and pay rate structure for community developmental disability service providers and subcontracted providers. The bill transfers the medical services stabilization fund to the medically needy account after December 31, 2003.
The Premium Sharing Program was established as a three year pilot program in 1997 (Laws 1997, Chapter 186, Section 3, as amended by Laws 1997, second special session, Chapter 1, Section 1). The program enables families who do not meet AHCCCS requirements but who have an income of less than 200% of the federal poverty level, to obtain low cost health care. Participants pay a monthly premium based on a percentage of gross monthly income and copayments for services. The program currently operates in Maricopa, Pima, Pinal and Cochise counties.
Enrollment for services as of February 1, 2001 includes 7,342 members, 182 who have chronic illnesses such as hemophilia or Hodgkins disease. The current enrollment in the demonstration project is Cochise County 11.5%, Maricopa County 47.1%, Pima County 33.4% and Pinal County 7.8%. Premium Sharing has been funded with $20 million annually from the medically needy fund.
Ticket to Work
In December 1999, a federal law entitled The Ticket to Work and Work Incentives Improvement Act (TWWIIA) was passed. The act expands a state’s options and funding for the Medicaid buy-in for workers with disabilities. The act permits states to expand limits on resources and income. The act also provides the opportunity for employed individuals with medically determinable impairments to buy into Medicaid even though they may no longer be eligible for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) disability benefits. With the Medicaid buy-in, states are authorized to require individuals to pay premiums based on an income sliding scale.
Critical Access Hospitals
In 1997, the Balanced Budget Act was passed creating the Medicare Rural Hospital Flexibility Program. The Medicare Critical Access Hospital Program is a component of this program designed to allow rural hospitals to scale back the services they provide while continuing to maintain their Medicare certification and receive sufficient Medicare reimbursement. These hospitals qualify for cost-based reimbursement from Medicaid agencies (AHCCCS) that is more favorable than a typical Medicare payment.
In order for a hospital to qualify to become a CAH, it must be all of the following:
1. Have an acute care bed limit of 15 beds.
2. Have an additional swing bed limit of 10 beds.
3. Have an average length of stay less than or equal to 96 hours
4. Provide 24-hour emergency care.
5. Participate in a network including a tertiary facility and EMS organization.
6. Participate in Medicare reimbursement program.
7. Located more than 35 miles from another hospital or 15 miles from another hospital in mountainous areas.
The Rural Health Office at the University of Arizona reports that seven hospitals may be eligible for CAH designation. These hospitals include Carondelet Holy Cross Hospital, Northern Cochise Community Hospital, Page Hospital, Sage Memorial Hospital, Southeast Arizona Medical Center, White Mountain Communities Hospital and Community General Hospital.
Premium Sharing
· Amends statute to allow the Department of Economic Security (DES) greater flexibility in establishing its provider pay rate structure and hospital reimbursement rates for community developmental disability (DD) service providers and subcontracted providers.
· Adds new statutory language requiring DES to contract with an independent consulting firm for that annual study of the adequacy and appropriateness of Title 19 reimbursement rates to service providers for the DD programs of both the Arizona Long Term Care System (ALTCS) and the state-only program.
· Adds new statutory language requiring AHCCCS to contract for a similar study of Title 19 reimbursement rates to service providers for the elderly and physically disabled program of ALTCS.
· Adds new statutory language requiring the Department of Health Services (DHS) to contract for a similar study of Title 19 reimbursement rates to service providers of behavioral health services. DHS must include the results of that study in its yearly capitalization request to AHCCCS.
· Amends the AHCCCS section of the General Appropriations Act (GAA) to add footnote language exempting AHCCCS from rule-making requirements for the purposes of implementing the finger-imaging enrollment program and requiring instead that hearings be held to give the public the opportunity to comment on the proposed rules.
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Amends the GAA to strike footnote language in the
AHCCCS budget stating that it is the Legislature’s intent that (1) AHCCCS
allocate funds for the Long Term Care program as a flat percentage increase
across the total dollar value of all contracts in eligible categories and that
(2) monies for the adjustment effective October 1, 2001 be allocated only to
providers with contracts for eligible services in effect as of October 1, 2001.
Footnote language is added stating the Legislature’s intent that the pay
adjustments be directed toward raising rates paid to providers receiving less
than other providers providing similar services.
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Amends the pay adjustments section of the GAA to
require that the community treatment provider rates increases for DES, DHS, DJC
and the Superior Court be equal to an
average of 5%. Footnote language in
that section is also amended to state the Legislature’s intent that provider
rate adjustments be directed towards raising rates paid to providers receiving
less than others providing similar services, and its intent that the Aging and
Community Services, Long Term Care and Developmental Disabilities cost centers
in DES use the adjustment to reduce the number of different contract rates
employed for each service type.
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Amends the pay
adjustments section of the GAA to set new dates for implementation of the first
5% provider rate adjustment on July 1, 2002.
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Transfers the medical services stabilization fund to
the medically needy account after December 31, 2003.
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45th Legislature
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First Regular Session 5 May
15, 2001
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