ARIZONA STATE SENATE
Phoenix, Arizona
children’s health insurance;
covered services
Purpose
Makes several programmatic changes to the children’s health insurance program (CHIP) relating to covered benefits, information and outreach activities, hardship exemptions and eligibility waiting periods.
Background
In 1998 the Legislature established CHIP to provide health care coverage to children under age 19 from families with income at or below 200 percent federal poverty level ($34,100 for a family of four). As of May 1, 2001, 112,660 children have been approved for health care coverage due to the outreach activities of the Arizona Health Care Cost Containment System (AHCCCS) administration and other organizations; 50,596 have been enrolled in CHIP and 62,064 have been approved for Medicaid.
A.R.S. §36-2989 limits behavioral health services under CHIP during each 12-month period to 30 days of inpatient services and 30 outpatient visits. This statute also limits eye care to one eye examination and one set of prescription lenses per year, and limits medically necessary transportation to emergency conditions only. S.B. 1087 eliminates the limitations on behavioral health services and specifies these services are limited to the same extent that behavioral health services are limited under the least restrictive state employee health care services organization (HCSO) plan. In addition, this legislation removes the limits on eye care, and includes nonemergency transportation as a covered services. If a state employee HCSO plan does not limit behavioral health services, S.B. 1087 will have the affect of eliminating the burden of the AHCCCS health plans and regional behavioral health authorities from administering two different systems of benefits.
According to AHCCCS, from October 1, 1999 to September 30, 2000, 57 children exceeded the behavioral health services limits under CHIP. These children continued to receive services through the non-title XIX program (general fund revenue) at a cost of $339,000. Under the provisions of this bill, the state’s share of this cost would have been 25 percent or $84,000. In addition, the state share of the cost associated with the removal of the limit on eye care and the addition of nonemergency transportation is $37,300 in FY 2001-2002 and $40,200 in FY 2002-2003.
Currently, on request, AHCCCS provides CHIP applications and information to schools. However, A.R.S. § 36-2988 prohibits the administration and contractors from contracting with school districts to perform outreach and information activities relating to CHIP. According to a survey conducted by the AHCCCS administration, 40 states currently involve schools in outreach, information and application activities relating to CHIP. Also, according to a recent study presented to Congress regarding CHIP, the U.S. General Accounting Office stated, “blanketing school-aged children and their families with program information through local school districts is another outreach technique that some states are finding particularly effective.”
In addition, this legislation includes provisions similar to S.B. 1074 (children’s health insurance; requirements; study) and S.B. 1075 (children’s health insurance; hardship exceptions).
Provisions
1. Eliminates, as of October 1, 2001, the limitation on behavioral health services and specifies these services are covered to the same extent behavioral health services are covered under the least restrictive HCSO plan for state employees.
2. Eliminates, as of October 1, 2001, the limitation on eye care coverage and expands, as of October 1, 2001, covered benefits to include nonemergency transportation.
3. Eliminates the requirement that CHIP enrollees age 18 and older receive behavioral health services through the health plans.
4. Authorizes school districts to perform outreach and information activities related to CHIP, providing such activities do not reduce or interfere with classroom instruction time.
5. Requires the Director of AHCCCS to adopt rules for hardship exemptions to the disenrollment requirements for members who are not able to pay the premium.
6. Reduces, from six months to three months, the eligibility waiting period for children who voluntarily drop their health care coverage.
7. Allows the AHCCCS administration to waive the three month waiting period for children who are chronically ill. Defines “chronically ill”.
8. Requires, beginning January 1, 2002, AHCCCS to provide the chronically ill conditions and number of children under each condition in the annual report.
9. Makes a conforming change.
10. Provides for a general effective date except as noted.
Amendments Adopted by Committee
Maintains the prohibition of the AHCCCS administration and contractors from contracting with school districts to perform outreach and information activities relating to CHIP.
Amendments Adopted by Committee of the Whole
1. Prohibits school districts conducting CHIP outreach activities from interfering with or reducing classroom instruction time.
2. Eliminates the requirement that CHIP enrollees age 18 and older receive behavioral health services through the health plans.
Amendments Adopted by the House of Representatives
1. Requires the Director of AHCCCS to adopt rules for hardship exemptions.
2. Reduces the eligibility waiting period for children who voluntarily lose coverage from six months to three months and allow AHCCCS to waive the waiting period if the child is chronically ill.
3. Maintains the limitation on behavioral health services and specifies these services are covered to the same extent behavioral health services are covered under the least restrictive HCSO plan for state employees.
Senate Action House Action
HEA 1/23/01 DPA 7-0-1-0 HEA 3/19/01 DP 8-0-0-2
3rd Rd 2/19/01 DPA 27-1-2-0 FII 4/6/01 DP 5-1-0-4
FINAL 5/2/01 25-3-2 APP 4/25/01 DPA/SE 10-4-0-2
3rd Rd 5/1/01 46-10-4
Signed by Governor 5/7/01
Chapter 360
Prepared by Senate Staff
May 21, 2001