Page 1, between lines 1 and 2, insert:
"Section 1. Section 9-499.15, Arizona Revised Statutes, is amended to read:
START_STATUTE9-499.15. Proposed municipal taxes and fees; notification required;
exception
A. A municipality may not levy or assess any new
taxes or fees or increase existing taxes or fees pursuant to statute on a
business without complying with this section.
B. A municipality that proposes to levy or assess a
tax or fee shall:
1. If the imposition of the proposed tax or fee is a
new charge, provide written notice of the proposed charge on the home page of
the municipality's website at least sixty days before the date the proposed new
tax or fee is approved or disapproved by the governing body of the
municipality.
2. If the municipality proposes to increase the rate
of an existing tax or fee on a business, provide written notice of the proposed
increase on the home page of the municipality's website at least sixty days
before the date the proposed new rate is approved or disapproved by the
governing body of the municipality.
C. A municipality shall demonstrate that the taxes
or fees are imposed pursuant to statute.
D. This section does not apply to any fee adopted
pursuant to section 9‑463.05.
E. In
addition to any other limitation that may be imposed by law, a municipality
shall not levy or impose an assessment, fee or tax on hospital revenues,
discharges, beds or services for the purpose of receiving services or payments
pursuant to title 36, chapter 29. END_STATUTE
Sec. 2. Section 36-427, Arizona Revised
Statutes, is amended to read:
START_STATUTE36-427. Suspension or revocation; intermediate sanctions
A. The director may, pursuant to title 41, chapter 6, article
10, may suspend or
revoke, in whole or in part, the license of any health care institution if its
owners, officers, agents or employees:
1. Violate this chapter or the rules of the
department adopted pursuant to this chapter.
2. Knowingly aid, permit or abet the commission of
any crime involving medical and health related services.
3. Have been, are or may continue to be in
substantial violation of the requirements for licensure of the institution, as
a result of which the health or safety of one or more patients or the general
public is in immediate danger.
4. Fail to
comply with section 36-2901.08.
B. If the licensee, the chief administrative officer
or any other person in charge of the institution refuses to permit the
department or its employees or agents the right to inspect its premises as
provided in section 36‑424, such action shall be deemed reasonable cause
to believe that a substantial violation under subsection A, paragraph 3 of this
section exists.
C. If the director reasonably believes that a
violation of subsection A, paragraph 3 of this section has occurred and that
life or safety of patients will be immediately affected, the director, upon on
written notice to the licensee, may order the immediate
restriction of admissions or readmissions, selected transfer of patients out of
the facility, reduction of capacity and termination of specific services,
procedures, practices or facilities.
D. The director may rescind, in whole or in part,
sanctions imposed pursuant to this section upon correction of the violation or
violations for which the sanctions were imposed. END_STATUTE
Sec. 3. Section 36-2901, Arizona Revised
Statutes, is amended to read:
START_STATUTE36-2901. Definitions
In this article, unless the context otherwise requires:
1. "Administration" means the Arizona health care cost containment system administration.
2. "Administrator" means the administrator
of the Arizona health care cost containment system.
3. "Contractor" means a person or entity
that has a prepaid capitated contract with the administration pursuant to
section 36‑2904 to provide health care to members under this article
either directly or through subcontracts with providers.
4. "Department" means the department of
economic security.
5. "Director" means the director of the Arizona health care cost containment system administration.
6. "Eligible person" means any person who
is:
(a) Any of the following:
(i) Defined as mandatorily or optionally eligible
pursuant to title XIX of the social security act as authorized by the state
plan.
(ii) Defined in title XIX of the social security act
as an eligible pregnant woman with a family income that does not exceed one
hundred fifty per cent of the federal poverty guidelines, as a child under the
age of six years and whose family income does not exceed one hundred thirty‑three
per cent of the federal poverty guidelines or as children who have not attained
nineteen years of age and whose family income does not exceed one hundred per
cent of the federal poverty guidelines.
(iii) Under twenty‑one years of age and who
was in the custody of the department of economic security pursuant to title 8,
chapter 5 or 10 when the person became eighteen years of age.
(iv) Defined as eligible pursuant to section 36‑2901.01.
(v) Defined as eligible pursuant to section 36‑2901.04.
(vi) Defined as eligible pursuant to
section 36-2901.07.
(b) A full‑time officer or employee of this
state or of a city, town or school district of this state or other person who
is eligible for hospitalization and medical care under title 38, chapter 4,
article 4.
(c) A full‑time officer or employee of any
county in this state or other persons authorized by the county to participate
in county medical care and hospitalization programs if the county in which such
officer or employee is employed has authorized participation in the system by resolution
of the county board of supervisors.
(d) An employee of a business within this state.
(e) A dependent of an officer or employee who is
participating in the system.
(f) Not enrolled in the Arizona long‑term care
system pursuant to article 2 of this chapter.
(g) Defined as eligible pursuant to section
1902(a)(10)(A)(ii)(XV) and (XVI) of title XIX of the social security act and
who meets the income requirements of section 36‑2929.
7. "Graduate medical education" means a
program, including an approved fellowship, that prepares a physician for the
independent practice of medicine by providing didactic and clinical education
in a medical discipline to a medical student who has completed a recognized
undergraduate medical education program.
8. "Malice" means evil intent and
outrageous, oppressive or intolerable conduct that creates a substantial risk
of tremendous harm to others.
9. "Member" means an eligible person who
enrolls in the system.
10. "Modified
adjusted gross income" has the same meaning prescribed in 42 United States
Code section 1396a(e)(14).
10. 11. "Noncontracting
provider" means a person who provides health care to members pursuant to
this article but not pursuant to a subcontract with a contractor.
11. 12. "Physician"
means a person licensed pursuant to title 32, chapter 13 or 17.
12. 13. "Prepaid
capitated" means a mode of payment by which a health care contractor
directly delivers health care services for the duration of a contract to a
maximum specified number of members based on a fixed rate per member
notwithstanding:
(a) The actual number of members who receive care
from the contractor.
(b) The amount of health care services provided to
any member.
13. 14. "Primary
care physician" means a physician who is a family practitioner, general
practitioner, pediatrician, general internist, or obstetrician or gynecologist.
14. 15. "Primary
care practitioner" means a nurse practitioner certified pursuant to title
32, chapter 15 or a physician assistant certified pursuant to title 32, chapter
25. This paragraph does not expand the scope of practice for nurse
practitioners as defined pursuant to title 32, chapter 15, or for physician
assistants as defined pursuant to title 32, chapter 25.
15. 16. "Section
1115 waiver" means the research and demonstration waiver granted by the
United States department of health and human services.
16. 17. "Special
health care district" means a special health care district organized
pursuant to title 48, chapter 31.
17. 18. "State
plan" has the same meaning prescribed in section 36‑2931.
18. 19. "System"
means the Arizona health care cost containment system established by this
article. END_STATUTE
Sec. 4. Title 36, chapter 29, article 1, Arizona
Revised Statutes, is amended by adding sections 36-2901.07, 36-2901.08 and
36-2901.09, to read:
START_STATUTE36-2901.07. Definition of eligible person; conditional eligibility
A. Beginning
January 1, 2014, for the purposes of section 36-2901, "eligible
person" includes a person who is eligible pursuant to 42 United States
Code section 1396a(a)(10)(a)(i)(VIII) and whose household's modified adjusted gross income
is more than one hundred per cent but equal to or less than one hundred
thirty-three per cent of the federal poverty guidelines.
B. The
administration shall discontinue eligibility for a person who is eligible
pursuant to subsection A of this section if the federal medical assistance
percentage established pursuant to 42 United States Code section 1396d(y) or 1396d(z) is
less than eighty per cent.
C. The
administration shall discontinue eligibility for persons who are eligible
pursuant to subsection a of this section if the maximum amount that can be assessed
under section 36-2901.08 without causing a reduction in federal financial
participation, in combination with the monies specified in section 36-2901.09
and any other monies appropriated for the costs of this section and section
36-2901.01, is insufficient to cover those costs. END_STATUTE
START_STATUTE36-2901.08. Hospital assessment
A. The
director shall establish, administer and collect an assessment on hospital
revenues or bed days for the purpose of funding the nonfederal share of the
costs that are incurred beginning January 1, 2014 of eligibility for persons
who are defined as eligible pursuant to sections 36-2901.01 and 36-2901.07.
B. The
director shall adopt rules regarding the method for determining the assessment,
the amount or rate of the assessment, and modifications or exemptions from the
assessment. The assessment is subject to approval by the federal government to
ensure that the assessment is not established or administered in a manner that
causes a reduction in federal financial participation.
C. The
director may establish modifications or exemptions to the
assessment. In determining the modifications or exemptions, the
director may consider factors including the size of the hospital, the specialty
services available to patients and the geographic location of the hospital.
D. Before
implementing the assessment, and annually thereafter if the methodology is
modified, the director shall present the methodology to the joint legislative
budget committee for review.
E. The
administration shall not collect an assessment for costs associated with
service after the effective date of any reduction of the federal medical
assistance percentage established by 42 United States Code section 1396d(y) or 1396d(z) to
less than eighty per cent.
F. The
administration shall deposit the revenues collected pursuant to this section in
the hospital assessment fund established by section 36‑2901.09.
G. A
hospital shall not pass the cost of the assessment on to patients or
third-party payors that are liable to pay for care on a patient's behalf. As
part of its financial statement submissions pursuant to section 36-125.04, a
hospital shall submit to the department of health services an attestation that
it has not passed on the cost of the assessment to patients or third‑party
payors.
H. If a
hospital does not comply with this section as prescribed by the director, the
director may suspend or revoke the hospital's Arizona health care cost
containment system provider agreement registration. If the hospital does not
comply within one hundred eighty days after the director suspends or revokes
the hospital's provider agreement, the director shall notify the director of
the department of health services, who shall suspend or revoke the hospital's
license pursuant to section 36-427. END_STATUTE
START_STATUTE36-2901.09. Hospital assessment fund
A. The hospital
assessment fund is established consisting of monies collected pursuant to
section 36-2901.08. The director shall administer the fund.
B. The
director shall use fund monies only as necessary to supplement monies in the
proposition 204 protection account established by section 36‑778 and the Arizona tobacco litigation settlement fund established by section 36-2901.02.
C. Monies in
the fund:
1. Do not
revert to the state general fund.
2. Are
exempt from the provisions of section 35-190 relating to lapsing of
appropriations.
3. Are
continuously appropriated." END_STATUTE
Renumber to conform
Page 16, between lines 8 and 9,
insert:
"Sec. 7. Section
41-1005, Arizona Revised Statutes, is amended to read:
START_STATUTE41-1005. Exemptions
A. This chapter does not apply to any:
1. Rule that relates to the use of public works,
including streets and highways, under the jurisdiction of an agency if the
effect of the order is indicated to the public by means of signs or signals.
2. Order of the Arizona game and fish commission
that opens, closes or alters seasons or establishes bag or possession limits
for wildlife.
3. Rule relating to section 28‑641 or to any
rule regulating motor vehicle operation that relates to speed, parking,
standing, stopping or passing enacted pursuant to title 28, chapter 3.
4. Rule concerning only the internal management of
an agency that does not directly and substantially affect the procedural or substantive
rights or duties of any segment of the public.
5. Rule that only establishes specific prices to be
charged for particular goods or services sold by an agency.
6. Rule concerning only the physical servicing,
maintenance or care of agency owned or operated facilities or property.
7. Rule or substantive policy statement concerning
inmates or committed youths of a correctional or detention facility in secure
custody or patients admitted to a hospital, if made by the state department of
corrections, the department of juvenile corrections, the board of executive
clemency or the department of health services or a facility or hospital under
the jurisdiction of the state department of corrections, the department of
juvenile corrections or the department of health services.
8. Form whose contents or substantive requirements
are prescribed by rule or statute, and instructions for the execution or use of
the form.
9. Capped fee‑for‑service schedule
adopted by the Arizona health care cost containment system administration
pursuant to title 36, chapter 29.
10. Fees prescribed
by section 6‑125.
11. Order of the
director of water resources adopting or modifying a management plan pursuant to
title 45, chapter 2, article 9.
12. Fees established under section 3‑1086.
13. Fee‑for‑service schedule adopted by
the department of economic security pursuant to section 8‑512.
14. Fees established under sections 41‑2144
and 41‑2189.
15. Rule or other matter relating to agency
contracts.
16. Fees established under section 32‑2067 or
32‑2132.
17. Rules made pursuant to section 5‑111,
subsection A.
18. Rules made by the Arizona state parks board
concerning the operation of the Tonto natural bridge state park, the facilities
located in the Tonto natural bridge state park and the entrance fees to the
Tonto natural bridge state park.
19. Fees or charges established under section 41‑511.05.
20. Emergency medical services protocols except as
provided in section 36‑2205, subsection B.
21. Fee schedules established pursuant to section 36‑3409.
22. Procedures of the state transportation board as
prescribed in section 28‑7048.
23. Rules made by the state department of
corrections.
24. Fees prescribed pursuant to section 32‑1527.
25. Rules made by the department of economic
security pursuant to section 46‑805.
26. Schedule of fees prescribed by section 23‑908.
27. Procedure that is established pursuant to title
23, chapter 6, article 5 or
6.
28. Rules, administrative policies, procedures and
guidelines adopted for any purpose by the Arizona commerce authority pursuant
to chapter 10 of this title if the authority provides, as appropriate under the
circumstances, for notice of an opportunity for comment on the proposed rules,
administrative policies, procedures and guidelines.
29. Rules made by a marketing commission or
marketing committee pursuant to section 3‑414.
30. Administration of public assistance program
monies authorized for liabilities that are incurred for disasters declared
pursuant to sections 26‑303 and 35‑192.
31. User charges, tolls, fares, rents, advertising
and sponsorship charges, services charges or similar charges established
pursuant to section 28‑7705.
32. Administration
and implementation of the hospital assessment pursuant to section 36-2901.08, except
that the Arizona health care cost containment system administration must
provide notice and an opportunity for public comment at least thirty days
before establishing or implementing the administration of the assessment.
B. Notwithstanding subsection A, paragraph 22 of
this section, at such time as the federal highway administration authorizes the
privatization of rest areas, the state transportation board shall make rules
governing the lease or license by the department of transportation to a private
entity for the purposes of privatization of a rest area.
C. Coincident with the making of a final rule
pursuant to an exemption from the applicability of this chapter under this
section, another statute or session law, the agency shall file a copy of the
rule with the secretary of state for publication pursuant to section 41‑1012
and provide a copy to the council.
D. Unless otherwise required by law, articles 2, 3,
4 and 5 of this chapter do not apply to the Arizona board of regents and the
institutions under its jurisdiction, except that the Arizona board of regents
shall make policies or rules for the board and the institutions under its
jurisdiction that provide, as appropriate under the circumstances, for notice
of and opportunity for comment on the policies or rules proposed.
E. Unless otherwise required by law, articles 2, 3,
4 and 5 of this chapter do not apply to the Arizona state schools for the deaf
and the blind, except that the board of directors of all the state schools for
the deaf and the blind shall adopt policies for the board and the schools under
its jurisdiction that provide, as appropriate under the circumstances, for
notice of and opportunity for comment on the policies proposed for adoption.
F. Unless otherwise required by law, articles 2, 3,
4 and 5 of this chapter do not apply to the state board of education, except
that the state board of education shall adopt policies or rules for the board
and the institutions under its jurisdiction that provide, as appropriate under
the circumstances, for notice of and opportunity for comment on the policies or
rules proposed for adoption. In order to implement or change any rule, the
state board of education shall provide at least two opportunities for public
comment." END_STATUTE
Renumber to conform
Page 23, strike lines 7 through 41
Renumber to conform
Page 26, between lines 39 and 40, insert:
"Sec. 28. Arizona health care cost containment system; hospital work groups
The Arizona health care cost containment system administration
shall establish work groups to study and provide input on the development of
the hospital assessment established pursuant to this act. The work groups
shall include, at a minimum, representatives from the urban, rural and critical
access hospital communities.
Sec. 29. Arizona health care cost containment system; cost sharing;
exemption from rule making
A. The Arizona health care cost containment system
administration shall pursue cost sharing requirements for members to the
maximum extent allowed under federal law.
B. For the purposes of implementing cost sharing
pursuant to subsection A of this section, the Arizona health care cost
containment system administration is exempt from the rule making requirements
of title 41, chapter 6, Arizona Revised Statutes, for one year after the
effective date of this act.
Sec. 30. Hospital transparency; report
On or before January 1, 2014, 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, 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 provide a summary of the current charge master
reporting process, a summary of hospital billed charges compared to costs and
examples of how charge masters or hospital prices are reported and used in
other states. The report shall include recommendations to improve the state's
use of hospital charge master information, including reporting and oversight
changes.
Sec. 31. Arizona health care cost containment system; member notice
As part of the information provided at the time of enrollment
to new members who are eligible pursuant to section 36-2901.01, Arizona Revised
Statutes, and section 36-2901.07, Arizona Revised Statutes, as added by this
act, the Arizona health care cost containment system administration shall
provide notice that the member's enrollment in the Arizona health care cost
containment system may be dependent on the availability of federal financial
participation for the program.
Sec. 32. Medicaid federal circuit breaker study committee;
membership; duties; delayed repeal
A. The medicaid federal circuit breaker study
committee is established consisting of the following members:
1. Three members of the senate who are appointed by
the president of the senate, not more than two of whom are members of the same
political party. At least one member must be from a county other
than Maricopa county.
2. Three members of the house of representatives who
are appointed by the speaker of the house of representatives, not more than two
of whom are members of the same political party. At least one member must be
from a county other than Maricopa county.
3. The director of the governor's office of
strategic planning and budgeting, or the director's designee.
4. The director of the Arizona health care cost
containment system administration, or the director's designee.
5. Two representatives of Arizona hospitals, one
whom is from an urban area and one of whom is from a rural area. The governor
shall appoint these members.
6. Two representatives of the health insurance
industry. The governor shall appoint these members.
7. One physician who is licensed pursuant to title
32, chapter 13 or 17, Arizona Revised Statutes. The governor shall appoint
this member.
8. One nurse who is licensed pursuant to title 32,
chapter 15, Arizona Revised Statutes. The governor shall appoint this member.
9. One representative of the business community.
The governor shall appoint this member.
B. The committee shall evaluate the potential impact
on the Arizona health care cost containment system of a decrease in federal
funding and shall research the following impacts of decreased federal medicaid
funding:
1. Options for transitioning members to
cost-effective private health insurance coverage.
2. The impact on the state general fund.
3. The impact on health care delivery in this state,
including on the following:
(a) Hospitals.
(b) Health insurance companies.
(c) Health care providers.
C. On or before October 1, 2014, the committee shall
submit to the governor, the president of the senate and the speaker of the
house of representatives a report of its findings and recommendations to
address each of the impacts described in subsection B of this section. The
committee shall provide a copy of its report to the secretary of state.
D. This section is repealed from and after December
31, 2014.
Sec. 33. Exemption from rule making
For the purposes of implementing the provisions of this act,
the department of health services is exempt from the rule making requirements
of title 41, chapter 6, Arizona Revised Statutes, for one year after the
effective date of this act.
Sec. 34. Intent; hospital assessment
It is the intent of the legislature that:
1. The requirement that the hospital assessment
established pursuant to section 36-2901.08, Arizona Revised Statutes, as added
by this act, be subject to approval by the federal government does not adopt
federal law by reference.
2. The requirement that the director of the Arizona
health care cost containment system administration establish a hospital
assessment pursuant to section 36-2901.08, Arizona Revised Statutes, as added
by this act, does not delegate legislative taxing authority to the
administration, and the director must impose the assessment in accordance with
clear guidance as provided in this act."
Renumber to conform
Page 27, after line 9, insert:
"Sec. 38. AHCCCS; department of health services; expenditure
authority; fiscal year 2013-2014
A. In addition to any other appropriations made in
fiscal year 2013‑2014 to the Arizona health care cost containment system,
sufficient monies from expenditure authority are appropriated to the Arizona
health care cost containment system for the purposes of implementing section
36-2901.01, Arizona Revised Statutes, and section 36-2901.07, Arizona Revised
Statutes, as added by this act.
B. In addition to any other appropriations made in
fiscal year 2013‑2014 to the department of health services, sufficient
monies from expenditure authority are appropriated to the department of health
services for the purposes of implementing section 36-2901.01, Arizona Revised
Statutes, and section 36-2901.07, Arizona Revised Statutes, as added by this
act.
Sec. 39. Effective date
Section 9-499.15, Arizona Revised Statutes, as amended by this
act, is effective from and after December 31, 2013.
Sec. 40. Conditional repeals
A. Sections 36-2901.07 and 36-2901.08, Arizona
Revised Statutes, as added by this act, are repealed:
1. From and after the date the federal medical
assistance percentage pursuant to 42 United States Code section 1396d(y) or
1396d(z) is less than eighty per cent.
2. If the patient protection and affordable care act
established pursuant to Public Law 111-148, as amended by the health care and
education reconciliation act of 2010 pursuant to Public Law 111-152, is repealed.
3. If the maximum amount that can be assessed under
section 36‑2901.08, Arizona Revised Statutes, as added by this act,
without causing a reduction in federal financial participation, in combination
with the monies specified in section 36-2901.09, Arizona Revised Statutes, as
added by this act, and any other monies appropriated for the costs of section
36-2901.01, Arizona Revised Statutes, and section 36-2901.07, Arizona Revised
Statutes, as added by this act, is insufficient to cover those costs.
B. The Arizona health care cost containment system
administration shall notify the director of the Arizona legislative council in
writing of the effective date if:
1. The federal medical assistance percentage under
42 United States Code section 1396d(y) or 1396d(z) is less than eighty per
cent.
2. The patient protection and affordable care act
established pursuant to Public Law 111-148, as amended by the health care and
education reconciliation act of 2010 pursuant to Public Law 111-152, is
repealed.
3. If the maximum
amount that can be assessed under section 36‑2901.08, Arizona Revised
Statutes, as added by this act, without causing a reduction in federal
financial participation, in combination with the monies specified in section
36-2901.09, Arizona Revised Statutes, as added by this act, and any other
monies appropriated for the costs of section 36-2901.01, Arizona Revised
Statutes, and section 36-2901.07, Arizona Revised Statutes, as added by this
act, is insufficient to cover those costs."
Amend title to conform
Bill
Number: S.B. 1492