Assigned to HEALTH & APPROP                                                                            AS PASSED BY THE SENATE

ARIZONA STATE SENATE

Forty-seventh Legislature, Second Regular Session

AMENDED

FACT SHEET FOR S.B. 1085

AHCCCS; chiropractic services.

Purpose

            Creates a pilot program in the Arizona Health Care Cost Containment System (AHCCCS) to provide chiropractic services to 300 adult members who meet specified requirements, conditions the program on federal funding and a waiver and outlines program requirements.  Requires AHCCCS to evaluate and report on the cost effectiveness of the program.

Background

            According to the National Center for Complementary and Alternative Medicine, a center under the National Institutes of Health, chiropractic health care focuses on the relationship between the body’s structure and its function.  Conditions commonly treated by chiropractors include back pain, neck pain, headaches and sports injuries.  Chiropractors evaluate each individual patient, and then develop a treatment plan based on that patient’s specific needs.  Treatment plans can contain any number of treatments, including spine adjustments sometimes known as manipulations.  Patients may receive one or more adjustments over the course of their treatment based on their specific condition.

            AHCCCS clients under the age of 21 are provided chiropractic care under the Early and Periodic Screening Diagnosis and Treatment Program (EPSDT).  EPSDT is the Medicaid program’s comprehensive child health care program and federal law requires medically necessary services to be provided to individuals under the age of 21, even if those services are not offered to the rest of the Medicaid population.  Under current statute, adult AHCCCS clients are not offered coverage for chiropractic care. 

            AHCCCS allows members to choose a primary care provider who can be either a nurse practitioner, a physician assistant or a physician who is a family practitioner, general practitioner, pediatrician, general internist, obstetrician or gynecologist.  The agency’s rules and contracts permit primary care providers to refer members to other types of practitioners to receive services covered by AHCCCS.  Under S.B. 1085, adult AHCCCS members may be referred by a primary care provider to a chiropractor.

            According to the Kaiser Commission on Medicaid and the Uninsured, as of 2004, a total of 23 states included chiropractic coverage for their adult Medicaid recipients.  Twelve of the 23 states limited their coverage to 12 or more visits per year.  In FY 2002-2003, a total of 18 states eliminated adult chiropractic care completely from their Medicaid programs as part of budget reductions. 

            Federal law requires that medical services provided to one qualified individual must not be less in amount, duration or scope than the medical assistance given to any other qualified individual.  S.B. 1085 requires the AHCCCS Administration to obtain a waiver of this requirement for enactment of the pilot program.

            The Joint Legislative Budget Committee staff completed a fiscal note on a prior version of the bill that estimated the cost to the state General Fund to be between $800,000 and $6 million in FY 2006-2007 and between $1.7 million and $12.5 million in FY 2007-2008.  Subsequent amendments made changes to the bill that affected the fiscal impact.  The fiscal impact of the bill as amended is undetermined, but is likely less than the fiscal note estimate.

Provisions

1. Establishes, beginning October 1, 2007, the chiropractic care pilot program within AHCCCS.

2. Requires the AHCCCS Administration to enroll 300 members who have previously received treatment for neck and back pain and to adopt by rule additional requirements for program participants.

3. Allows program participants to receive chiropractic coverage for at least 12 visits per year effective October 1, 2007.

4. Requires the AHCCCS Administration to conduct an evaluation of the pilot program on or before September 1, 2010, and to submit a report of its evaluation findings to the Governor, the Speaker of the House of Representatives and the President of the Senate with copies to the Secretary of State and the Director of the Arizona State Library, Archives and Public Records.

5. Requires the evaluation report to contain:

a) the number of program participants.

b) the average number of treatments and the average claim cost of care for each program participant in the fiscal year before enrolling in the pilot program.

c) the average number of treatments and the average claim cost of care for each program participant in the fiscal year after enrolling in the pilot program.

d) an analysis of the cost effectiveness of the services.

6. Requires the AHCCCS Administration to apply to the Centers for Medicare and Medicaid Services for a waiver of the federal requirements that all individuals enrolled in Medicaid receive the same services; conditions the program on a waiver of the requirements.

7. Becomes effective on the general effective date, except as otherwise noted, and subject to the provisions of the conditional enactment.

Amendments Adopted by Health Committee

· Limits covered chiropractic services to those that are required to be covered by health care services organizations; subjects coverage to referral by a primary care provider.

Amendments Adopted by Appropriations Committee

· Adds a delayed effective date of October 1, 2007.

Amendments Adopted by Committee of the Whole

· Makes the chiropractic services added by the bill a pilot program subject to specified conditions and requires an evaluation of the pilot program.

Senate Action

HEALTH        1/16/06     DPA     5-1-1

APPROP         2/14/06     DPA     6-3-2

3^rd Read           3/8/06                    20-10-0

Prepared by Senate Research

March 13, 2006

BKL/AH/jas