Page 3, line
12, after the period, insert "This financial limit does not
apply to a member who is eligible to receive and who has received the dental
services at an Indian health service or tribal facility."
Page 7,
between lines 22 and 23, insert:
"Sec. 6. Section
36-2939, Arizona Revised Statutes, is amended to read:
START_STATUTE36-2939. Long-term care
system services
A. The
following services shall be provided by the program contractors to members who are determined to need
institutional services pursuant to this article:
1. Nursing
facility services other than services in an institution for tuberculosis or
mental disease.
2. Notwithstanding
any other law, behavioral health services if these services are not duplicative
of long‑term care services provided as of January 30, 1993 under
this subsection and are authorized by the program contractor through the long‑term
care case management system. If the administration is the program
contractor, the administration may authorize these services.
3. Hospice
services. For the purposes of this paragraph, "hospice" means a
program of palliative and supportive care for terminally ill members and their
families or caregivers.
4. Case
management services as provided in section 36‑2938.
5. Health
and medical services as provided in section 36‑2907.
6. Dental
services in an annual amount of not more than one thousand dollars per member. This financial limit does not apply to a member who is eligible to
receive and who has received the dental services at an Indian health service or
tribal facility.
B. In
addition to the services prescribed in subsection A of this section, the department,
as a program contractor, shall provide the following services if appropriate to
members who have a developmental disability as defined in section 36‑551
and are determined to need institutional services pursuant to this article:
1. Intermediate
care facility services for a member who has a developmental disability as
defined in section 36‑551. For purposes of this article, a
facility shall meet all federally approved standards and may only include the
Arizona training program facilities, a state owned and operated service center,
state owned or operated community residential settings and private facilities
that contract with the department.
2. Home
and community based services that may be provided in a member's home, at an
alternative residential setting as prescribed in section 36‑591 or at
other behavioral health alternative residential facilities licensed by the
department of health services and approved by the director of the Arizona
health care cost containment system administration and that may include:
(a) Home
health, which means the provision of nursing services, home health aide services or medical
supplies, equipment and appliances, that are provided on a part‑time or
intermittent basis by a licensed home health agency within a member's residence
based on a physician's orders and in accordance with federal
law. Physical therapy, occupational therapy, or speech and audiology
services provided by a home health agency may be provided in accordance with
federal law. Home health agencies shall comply with federal bonding
requirements in a manner prescribed by the administration.
(b) Home
health aide, which means a service that provides intermittent health
maintenance, continued treatment or monitoring of a health condition and
supportive care for activities of daily living provided within a member's
residence.
(c) Homemaker,
which means a service that provides assistance in the performance of activities
related to household maintenance within a member's residence.
(d) Personal
care, which means a service that provides assistance to meet essential physical
needs within a member's residence.
(e) Day
care for persons with developmental disabilities, which means a service that
provides planned care supervision and activities, personal care, activities of
daily living skills training and habilitation services in a group setting
during a portion of a continuous
twenty‑four‑hour period.
(f) Habilitation,
which means the provision of physical therapy, occupational therapy, speech or
audiology services or training in independent living, special developmental
skills, sensory‑motor development, behavior intervention, and orientation
and mobility in accordance with federal law.
(g) Respite
care, which means a service that provides short‑term care and supervision
available on a twenty‑four‑hour
basis.
(h) Transportation,
which means a service that provides or assists in obtaining transportation for
the member.
(i) Other
services or licensed or certified settings approved by the director.
C. In
addition to services prescribed in subsection A of this section, home and
community based services may be provided in a member's home, in an adult foster
care home as prescribed in section 36‑401, in an assisted living home or
assisted living center as defined in section 36‑401 or in a level one or
level two behavioral health alternative residential facility approved by the
director by program contractors to all members who do not have a developmental
disability as defined in section 36‑551 and are determined to need
institutional services pursuant to this article. Members residing in
an assisted living center must be provided the choice of single
occupancy. The director may also approve other licensed residential
facilities as appropriate on a
case‑by‑case basis for traumatic brain injured members. Home and
community based services may include the following:
1. Home
health, which means the provision of nursing services, home health aide
services or medical supplies, equipment and appliances, that are provided on a
part‑time or intermittent basis by a licensed home health agency within a
member's residence based on a physician's orders and in accordance with federal
law. Physical therapy, occupational therapy, or speech and audiology
services provided by a home health agency may be provided in accordance with
federal law. Home health agencies shall comply with federal bonding
requirements in a manner prescribed by the administration.
2. Home
health aide, which means a service that provides intermittent health
maintenance, continued treatment or monitoring of a health condition and
supportive care for activities of daily living provided within a member's
residence.
3. Homemaker,
which means a service that provides assistance in the performance of activities
related to household maintenance within a member's residence.
4. Personal
care, which means a service that provides assistance to meet essential physical
needs within a member's residence.
5. Adult
day health, which means a service that provides planned care supervision and
activities, personal care, personal living skills training, meals and health
monitoring in a group setting during a portion of a continuous twenty‑four‑hour
period. Adult day health may also include preventive, therapeutic
and restorative health related services that do not include behavioral health
services.
6. Habilitation,
which means the provision of physical therapy, occupational therapy, speech or
audiology services or training in independent living, special developmental
skills, sensory‑motor development, behavior intervention, and orientation
and mobility in accordance with federal law.
7. Respite
care, which means a service that provides short‑term care and supervision
available on a twenty‑four‑hour
basis.
8. Transportation,
which means a service that provides or assists in obtaining transportation for
the member.
9. Home delivered meals, which means
a service that provides for a nutritious meal that contains at least one‑third
of the recommended dietary allowance for an individual and that is delivered to
the member's residence.
10. Other
services or licensed or certified settings approved by the director.
D. The
amount of money expended by program contractors on home and community based
services pursuant to subsection C of this section shall be limited by the
director in accordance with the federal monies made available to this state for
home and community based services pursuant to subsection C of this section.
The director shall establish methods for the allocation of monies for home and
community based services to program contractors and shall monitor expenditures
on home and community based services by program contractors.
E. Notwithstanding
subsections A, B, C and F of this section, no service may be provided that does
not qualify for federal monies available under title XIX of the social security
act or the section 1115 waiver.
F. In
addition to services provided pursuant to subsections A, B and C of this
section, the director may implement a demonstration project to provide home and
community based services to special populations, including persons with
disabilities who are eighteen years of age or younger, are medically fragile, reside at
home and would be eligible for supplemental security income for the aged, blind
or disabled or the state supplemental payment program, except for the amount of
their parent's income or resources. In implementing this project, the director
may provide for parental contributions for the care of their child.
G. Subject
to section 36‑562, the administration by rule shall prescribe a
deductible schedule for programs provided to members who are eligible pursuant
to subsection B of this section, except that the administration shall implement
a deductible based on family income. In determining deductible
amounts and whether a family is required to have deductibles, the department
shall use adjusted gross income. Families whose adjusted gross income is at
least four hundred
percent and less than or equal to five hundred percent of the federal poverty
guidelines shall have a deductible of two percent of adjusted gross income.
Families whose adjusted gross income is more than five hundred percent of
adjusted gross income shall have a deductible of four percent of adjusted gross
income. Only families whose children are under eighteen years of age
and who are members who are eligible pursuant to subsection B of this section
may be required to have a deductible for services. For the purposes
of this subsection, "deductible" means an amount a family, whose
children are under eighteen years of age and who are members who are eligible
pursuant to subsection B of this section, pays for services, other than
departmental case management and acute care services, before the department
will pay for services other than departmental case management and acute care
services."END_STATUTE
Renumber to conform
Amend title to conform
Bill
Number: S.B. 1527