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REFERENCE TITLE: AHCCCS; SCHIP; pregnant women |
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State of Arizona House of Representatives Fiftieth Legislature Second Regular Session 2012
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HB 2453 |
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Introduced by Representatives Alston, Gonzales, Hobbs, Pancrazi, Patterson: Campbell, McCune Davis, Tovar
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AN ACT
Amending sections 36-2981 and 36-2985, Arizona Revised Statutes; relating to the children's health insurance program.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 36-2981, Arizona Revised Statutes, is amended to read:
36-2981. Definitions
In this article, unless the context otherwise requires:
1. "Administration" means the Arizona health care cost containment system administration.
2. "Contractor" means a health plan that contracts with the administration for the provision of hospitalization and medical care to members according to the provisions of this article or a qualifying plan.
3. "Director" means the director of the administration.
4. "Federal poverty level" means the federal poverty level guidelines published annually by the United States department of health and human services.
5. "Health plan" means an entity that contracts with the administration for services provided pursuant to article 1 of this chapter.
6. "Member" means a person who is eligible for and enrolled in the program, who is under nineteen years of age and whose gross household income is at or below two hundred per cent of the federal poverty guidelines and who meets either of the following requirements:
(a) Beginning on November 1, 1998 through September 30, 1999, has income at or below one hundred fifty per cent of the federal poverty level.
(b) Beginning on October 1, 1999 and for each fiscal year thereafter, has income at or below two hundred per cent of the federal poverty level.
(a) Is under nineteen years of age.
(b) Subject to legislative appropriation, is a pregnant woman for purposes of prenatal care.
7. "Noncontracting provider" means an entity that provides hospital or medical care but does not have a contract or subcontract with the administration.
8. "Physician" means a person licensed pursuant to title 32, chapter 13 or 17.
9. "Prepaid capitated" means a method of payment by which a contractor delivers health care services for the duration of a contract to a specified number of members based on a fixed rate per member, per month without regard to the number of members who receive care or the amount of health care services provided to a member.
10. "Primary care physician" means a physician who is a family practitioner, general practitioner, pediatrician, general internist, obstetrician or gynecologist.
11. "Primary care practitioner" means a nurse practitioner who is certified pursuant to title 32, chapter 15 or a physician assistant who is licensed pursuant to title 32, chapter 25 and who is acting within the respective scope of practice of those chapters.
12. "Program" means the children's health insurance program.
13. "Qualifying plan" means a contractor that contracts with the state pursuant to section 38‑651 to provide health and accident insurance for state employees and that provides services to members pursuant to section 36‑2989, subsection A.
14. "Special health care district" means a special health care district organized pursuant to title 48, chapter 31.
15. "Tribal facility" means a facility that is operated by an Indian tribe and that is authorized to provide services pursuant to Public Law 93‑638, as amended.
Sec. 2. Section 36-2985, Arizona Revised Statutes, is amended to read:
36-2985. Enrollment cap; program termination; spending limitation; exception
A. If the director determines that monies may be insufficient for the program, the director shall immediately notify the governor, the president of the senate and the speaker of the house of representatives. After consulting with the governor, the administration shall stop processing new applications for the program until the administration is able to verify that funding is sufficient to begin processing applications and the governor agrees that the administration may begin processing applications.
B. If the federal government eliminates federal funding for the program or significantly reduces the federal funding below the estimated federal expenditures, the administration shall immediately stop processing all applications and shall provide at least thirty days' advance notice to contractors and members that the program will terminate.
C. The total amount of state monies that may be spent in any fiscal year by the administration for health care provided under this article shall not exceed the amount appropriated or authorized by section 35‑173.
D. This article does not impose a duty on an officer, agent or employee of this state to discharge a responsibility or to create any right in a person or group if the discharge or right would require an expenditure of state monies in excess of the expenditure authorized by legislative appropriation for that specific purpose.
E. Notwithstanding any cap in enrollment imposed or authorized pursuant to this section, the administration shall enroll pregnant women who meet the requirement of section 36-2981, paragraph 6, subdivision (b).