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REFERENCE TITLE: health; budget reconciliation; 2018-2019 |
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State of Arizona Senate Fifty-third Legislature Second Regular Session 2018
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SB 1526 |
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Introduced by Senators Kavanagh: Yarbrough (with permission of Committee on Rules)
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AN ACT
Amending section 30‑654, Arizona Revised Statutes; repealing section 30‑658, Arizona Revised Statutes; Amending title 32, chapter 28, article 1, Arizona Revised Statutes, by adding section 32‑2805; repealing section 32‑2823, Arizona Revised Statutes; amending section 36‑414, Arizona Revised Statutes; amending title 36, chapter 29, article 1, Arizona Revised Statutes, by adding section 36-2905.03; repealing section 36‑2921, Arizona Revised Statutes; amending section 36‑2922, Arizona Revised Statutes; Appropriating monies; relating to health budget reconciliation.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 30-654, Arizona Revised Statutes, is amended to read:
30-654. Powers and duties of the department
A. The department may:
1. Accept grants or other contributions from the federal government or other sources, public or private, to be used by the department to carry out any of the purposes of this chapter.
2. Do all things necessary, within the limitations of this chapter, to carry out the powers and duties of the department.
3. Conduct an information program, including:
(a) Providing information on the control and regulation of sources of radiation and related health and safety matters, on request, to members of the legislature, the executive offices, state departments and agencies and county and municipal governments.
(b) Providing such published information, audiovisual presentations, exhibits and speakers on the control and regulation of sources of radiation and related health and safety matters to the state's educational system at all educational levels as may be arranged.
(c) Furnishing to citizen groups, on request, speakers and such audiovisual presentations or published materials on the control and regulation of sources of radiation and related health and safety matters as may be available.
(d) Conducting, sponsoring or cosponsoring and actively participating in the professional meetings, symposia, workshops, forums and other group informational activities concerned with the control and regulation of sources of radiation and related health and safety matters when representation from this state at such meetings is determined to be important by the department.
B. The department shall:
1. Regulate the use, storage and disposal of sources of radiation.
2. Establish procedures for purposes of selecting any proposed permanent disposal site located within this state for low‑level radioactive waste.
3. Coordinate with the department of transportation and the corporation commission in regulating the transportation of sources of radiation.
4. Assume primary responsibility for and provide necessary technical assistance to handle any incidents, accidents and emergencies involving radiation or sources of radiation occurring within this state.
5. Adopt rules deemed necessary to administer this chapter in accordance with title 41, chapter 6.
6. Adopt uniform radiation protection and radiation dose standards to be as nearly as possible in conformity with, and in no case inconsistent with, the standards contained in the regulations of the United States nuclear regulatory commission and the standards of the United States public health service. In the adoption of the standards, the department shall consider the total occupational radiation exposure of individuals, including that from sources that are not regulated by the department.
7. Adopt rules for personnel monitoring under the close supervision of technically competent people in order to determine compliance with safety rules adopted under this chapter.
8. Adopt a uniform system of labels, signs and symbols and the posting of the labels, signs and symbols to be affixed to radioactive products, especially those transferred from person to person.
9. By rule, require adequate training and experience of persons utilizing using sources of radiation with respect to the hazards of excessive exposure to radiation in order to protect health and safety.
10. Adopt standards for the storage of radioactive material and for security against unauthorized removal.
11. Adopt standards for the disposal of radioactive materials into the air, water and sewers and burial in the soil in accordance with 10 Code of Federal Regulations part 20.
12. Adopt rules that are applicable to the shipment of radioactive materials in conformity with and compatible with those established by the United States nuclear regulatory commission, the department of transportation, the United States treasury department of the treasury and the United States postal service.
13. In individual cases, impose additional requirements to protect health and safety or grant necessary exemptions that will not jeopardize health or safety, or both.
14. Make recommendations to the governor and furnish such technical advice as required on matters relating to the utilization and regulation of sources of radiation.
15. Conduct or cause to be conducted off‑site radiological environmental monitoring of the air, water and soil surrounding any fixed nuclear facility, any uranium milling and tailing site and any uranium leaching operation, and maintain and report the data or results obtained by the monitoring as deemed appropriate by the department.
16. Develop and utilize information resources concerning radiation and radioactive sources.
17. Prescribe by rule a schedule of fees to be charged to categories of licensees and registrants of radiation sources, including academic, medical, industrial, waste, distribution and imaging categories. The fees shall cover a significant portion of the reasonable costs associated with processing the application for license or registration, renewal or amendment of the license or registration and the costs of inspecting the licensee or registrant activities and facilities, including the cost to the department of employing clerical help, consultants and persons possessing technical expertise and using analytical instrumentation and information processing systems.
18. Adopt rules establishing radiological standards, personnel standards and quality assurance programs to ensure the accuracy and safety of screening and diagnostic mammography.
C. All The department shall deposit, pursuant to sections 35‑146 and 35‑147, the first $300,000 in fees collected under each fiscal year pursuant to subsection B, paragraph 17 of this section shall be deposited, pursuant to sections 35‑146 and 35‑147, and section 32‑2805 in the state general fund. The department shall deposit, pursuant to sections 35‑146 and 35‑147, ninety percent of the remaining monies received from fees collected pursuant to subsection B, paragraph 17 of this section and section 32‑2805 in the health services licensing fund established by section 36-414 and ten percent of the remaining monies received from fees collected pursuant to subsection B, paragraph 17 of this section and section 32‑2805 in the state general fund.
Sec. 2. Repeal; transfer of monies
A. Section 30-658, Arizona Revised Statutes, is repealed.
B. All unexpended and unencumbered monies remaining in the radiation regulatory fee fund established by section 30-658, Arizona Revised Statutes, as repealed by subsection A of this section, are transferred to the health services licensing fund established by section 36-414, Arizona Revised Statutes, on the effective date of this section.
Sec. 3. Title 32, chapter 28, article 1, Arizona Revised Statutes, is amended by adding section 32-2805, to read:
32-2805. Fees; deposit
The department shall deposit all fees collected pursuant to this chapter as prescribed by section 30‑654, subsection C.
Sec. 4. Repeal; transfer of monies
A. Section 32-2823, Arizona Revised Statutes, is repealed.
B. All unexpended and unencumbered monies remaining in the state radiologic technologist certification fund established by section 32-2823, Arizona Revised Statutes, as repealed by subsection A of this section, are transferred to the health services licensing fund established by section 36-414, Arizona Revised Statutes, on the effective date of this section.
Sec. 5. Section 36-414, Arizona Revised Statutes, is amended to read:
36-414. Health services licensing fund; exemption
A. The health services licensing fund is established consisting of monies deposited pursuant to sections 30-654, 32‑2805, 36‑405, 36‑851.01, 36‑882, 36‑897.01 and 36‑1903. The department of health services shall administer the fund.
B. Monies in the fund are subject to legislative appropriation.
C. Monies in the fund are exempt from the provisions of section 35‑190 relating to lapsing of appropriations.
Sec. 6. Title 36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding section 36-2905.03, to read:
36-2905.03. Behavioral health inpatient facilities; lack of contract; reimbursement
If a behavioral health inpatient facility, as defined in rule by the director of the department of health services, and a contractor or regional behavioral health authority do not enter into a contract, the reimbursement level for behavioral health services provided on dates of admission on or after July 1, 2018 for that behavioral health inpatient facility is the capped fee‑for‑service schedule adopted by the administration, multiplied by ninety percent.
Sec. 7. Repeal
Section 36-2921, Arizona Revised Statutes, is repealed.
Sec. 8. Section 36-2922, Arizona Revised Statutes, is amended to read:
36-2922. Medical services stabilization fund; definition
A. Subject to the availability of monies as prescribed in section 36‑2921, the medical services stabilization fund is established. The administration shall administer the fund as directed by the joint legislative budget committee pursuant to subsection E of this section.
B. The fund shall be used only to offset increases in the cost of providing levels of services established pursuant to this article.
C. Notwithstanding chapter 6, article 8 of this title, the fund may also be used to offset increases in the cost of providing levels of services established pursuant to this article to persons eligible for those services pursuant to section 36‑2901, paragraph 6, subdivision (a) if the increase results from a decrease in federal funding for levels of service including a decrease in the federal match rate for levels of service provided to persons eligible pursuant to section 36‑2901, paragraph 6, subdivision (a).
D. If, during a fiscal year, the administration determines that the amount the legislature appropriated for that fiscal year for services provided to persons who are determined to be eligible for services pursuant to section 36‑2901, paragraph 6, subdivision (a) is insufficient to pay for unanticipated increases in the cost of providing those services, the administration shall provide written notice of the deficiency to the chairperson of the joint legislative budget committee and the director of the governor's office of strategic planning and budgeting with evidence supporting the determination of deficiency.
E. On receiving notice under subsection D of this section, the chairperson of the joint legislative budget committee shall call a public committee meeting to review the evidence of the deficiency presented by the administration. After reviewing the evidence, the committee may recommend to the administration to withdraw an amount from the fund that is equal to the deficiency to pay the increases in the cost of providing levels of service.
F. For the purposes of this section, "levels of service" means the provider payment methodology, eligibility criteria and covered services established pursuant to this article and in effect on July 1, 1993.
Sec. 9. ALTCS; county contributions; fiscal year 2018-2019
A. Notwithstanding section 11-292, Arizona Revised Statutes, county contributions for the Arizona long-term care system for fiscal year 2018‑2019 are as follows:
1. Apache $ 644,500
2. Cochise $ 5,288,900
3. Coconino $ 1,935,200
4. Gila $ 2,239,000
5. Graham $ 1,578,400
6. Greenlee $ 49,000
7. La Paz $ 599,500
8. Maricopa $170,486,100
9. Mohave $ 8,479,400
10. Navajo $ 2,668,000
11. Pima $ 41,749,300
12. Pinal $ 13,853,200
13. Santa Cruz $ 2,084,400
14. Yavapai $ 8,334,500
15. Yuma $ 8,565,400
B. If the overall cost for the Arizona long-term care system exceeds the amount specified in the general appropriations act for fiscal year 2018‑2019, the state treasurer shall collect from the counties the difference between the amount specified in subsection A of this section and the counties' share of the state's actual contribution. The counties' share of the state's contribution shall comply with any federal maintenance of effort requirements. The director of the Arizona health care cost containment system administration shall notify the state treasurer of the counties' share of the state's contribution and report the amount to the director of the joint legislative budget committee. The state treasurer shall withhold from any other monies payable to a county from whatever state funding source is available an amount necessary to fulfill that county's requirement specified in this subsection. The state treasurer may not withhold distributions from the Arizona highway user revenue fund pursuant to title 28, chapter 18, article 2, Arizona Revised Statutes. The state treasurer shall deposit the amounts withheld pursuant to this subsection and amounts paid pursuant to subsection A of this section in the long-term care system fund established by section 36-2913, Arizona Revised Statutes.
Sec. 10. Competency restoration treatment; city, town and county reimbursement; fiscal year 2018‑2019; deposit; tax distribution withholding
A. Notwithstanding section 13-4512, Arizona Revised Statutes, if this state pays the costs of a defendant's inpatient, in custody competency restoration treatment pursuant to section 13-4512, Arizona Revised Statutes, the city, town or county shall reimburse the department of health services for one hundred percent of these costs for fiscal year 2018‑2019.
B. The department of health services shall deposit, pursuant to sections 35-146 and 35-147, Arizona Revised Statutes, the reimbursements under subsection A of this section in the Arizona state hospital fund established by section 36-545.08, Arizona Revised Statutes.
C. Each city, town and county shall reimburse these costs as specified in subsection A of this section within thirty days after a request by the department of health services. If the city, town or county does not make the reimbursement, the superintendent of the Arizona state hospital shall notify the state treasurer of the amount owed and the treasurer shall withhold the amount, including any additional interest as provided in section 42-1123, Arizona Revised Statutes, from any transaction privilege tax distributions to the city, town or county. The treasurer shall deposit, pursuant to sections 35-146 and 35-147, Arizona Revised Statutes, the withholdings in the Arizona state hospital fund established by section 36‑545.08, Arizona Revised Statutes.
D. Notwithstanding any other law, a county may meet any statutory funding requirements of this section from any source of county revenue designated by the county, including funds of any countywide special taxing district of which the board of supervisors serves as the board of directors.
E. County contributions made pursuant to this section are excluded from the county expenditure limitations.
Sec. 11. AHCCCS; disproportionate share payments
A. Disproportionate share payments for fiscal year 2018-2019 made pursuant to section 36-2903.01, subsection O, Arizona Revised Statutes, include:
1. $113,818,500 for a qualifying nonstate operated public hospital. The Maricopa county special health care district shall provide a certified public expense form for the amount of qualifying disproportionate share hospital expenditures made on behalf of this state to the Arizona health care cost containment system administration on or before May 1, 2019 for all state plan years as required by the Arizona health care cost containment system section 1115 waiver standard terms and conditions. The administration shall assist the district in determining the amount of qualifying disproportionate share hospital expenditures. Once the administration files a claim with the federal government and receives federal financial participation based on the amount certified by the Maricopa county special health care district, if the certification is equal to or less than $113,818,500 and the administration determines that the revised amount is correct pursuant to the methodology used by the administration pursuant to section 36-2903.01, Arizona Revised Statutes, the administration shall notify the governor, the president of the senate and the speaker of the house of representatives, shall distribute $4,202,300 to the Maricopa county special health care district and shall deposit the balance of the federal financial participation in the state general fund. If the certification provided is for an amount less than $113,818,500 and the administration determines that the revised amount is not correct pursuant to the methodology used by the administration pursuant to section 36-2903.01, Arizona Revised Statutes, the administration shall notify the governor, the president of the senate and the speaker of the house of representatives and shall deposit the total amount of the federal financial participation in the state general fund. If the certification provided is for an amount greater than $113,818,500, the administration shall distribute $4,202,300 to the Maricopa county special health care district and shall deposit $75,254,400 of the federal financial participation in the state general fund. The administration may make additional disproportionate share hospital payments to the Maricopa county special health care district pursuant to section 36‑2903.01, subsection P, Arizona Revised Statutes, and subsection B of this section.
2. $28,474,900 for the Arizona state hospital. The Arizona state hospital shall provide a certified public expense form for the amount of qualifying disproportionate share hospital expenditures made on behalf of this state to the administration on or before March 31, 2019. The administration shall assist the Arizona state hospital in determining the amount of qualifying disproportionate share hospital expenditures. Once the administration files a claim with the federal government and receives federal financial participation based on the amount certified by the Arizona state hospital, the administration shall distribute the entire amount of federal financial participation to the state general fund. If the certification provided is for an amount less than $28,474,900, the administration shall notify the governor, the president of the senate and the speaker of the house of representatives and shall distribute the entire amount of federal financial participation to the state general fund. The certified public expense form provided by the Arizona state hospital shall contain both the total amount of qualifying disproportionate share hospital expenditures and the amount limited by section 1923(g) of the social security act.
3. $884,800 for private qualifying disproportionate share hospitals. The Arizona health care cost containment system administration shall make payments to hospitals consistent with this appropriation and the terms of the section 1115 waiver, but payments are limited to those hospitals that either:
(a) Meet the mandatory definition of disproportionate share qualifying hospitals under section 1923 of the social security act.
(b) Are located in Yuma county and contain at least three hundred beds.
B. After the distributions made pursuant to subsection A of this section, the allocations of disproportionate share hospital payments made pursuant to section 36‑2903.01, subsection P, Arizona Revised Statutes, shall be made available first to qualifying private hospitals located outside of the Phoenix metropolitan statistical area and the Tucson metropolitan statistical area before being made available to qualifying hospitals within the Phoenix metropolitan statistical area and the Tucson metropolitan statistical area.
Sec. 12. AHCCCS transfer; counties; federal monies
On or before December 31, 2019, notwithstanding any other law, for fiscal year 2018‑2019 the Arizona health care cost containment system administration shall transfer to the counties the portion, if any, as may be necessary to comply with section 10201(c)(6) of the patient protection and affordable care act (P.L. 111‑148), regarding the counties' proportional share of this state's contribution.
Sec. 13. County acute care contribution; fiscal year 2018‑2019
A. Notwithstanding section 11-292, Arizona Revised Statutes, for fiscal year 2018-2019 for the provision of hospitalization and medical care, the counties shall contribute the following amounts:
1. Apache $ 268,800
2. Cochise $ 2,214,800
3. Coconino $ 742,900
4. Gila $ 1,413,200
5. Graham $ 536,200
6. Greenlee $ 190,700
7. La Paz $ 212,100
8. Maricopa $18,482,600
9. Mohave $ 1,237,700
10. Navajo $ 310,800
11. Pima $14,951,800
12. Pinal $ 2,715,600
13. Santa Cruz $ 482,800
14. Yavapai $ 1,427,800
15. Yuma $ 1,325,100
B. If a county does not provide funding as specified in subsection A of this section, the state treasurer shall subtract the amount owed by the county to the Arizona health care cost containment system fund and the long‑term care system fund established by section 36-2913, Arizona Revised Statutes, from any payments required to be made by the state treasurer to that county pursuant to section 42-5029, subsection D, paragraph 2, Arizona Revised Statutes, plus interest on that amount pursuant to section 44-1201, Arizona Revised Statutes, retroactive to the first day the funding was due. If the monies the state treasurer withholds are insufficient to meet that county's funding requirements as specified in subsection A of this section, the state treasurer shall withhold from any other monies payable to that county from whatever state funding source is available an amount necessary to fulfill that county's requirement. The state treasurer may not withhold distributions from the Arizona highway user revenue fund pursuant to title 28, chapter 18, article 2, Arizona Revised Statutes.
C. Payment of an amount equal to one-twelfth of the total amount determined pursuant to subsection A of this section shall be made to the state treasurer on or before the fifth day of each month. On request from the director of the Arizona health care cost containment system administration, the state treasurer shall require that up to three months' payments be made in advance, if necessary.
D. The state treasurer shall deposit the amounts paid pursuant to subsection C of this section and amounts withheld pursuant to subsection B of this section in the Arizona health care cost containment system fund and the long-term care system fund established by section 36-2913, Arizona Revised Statutes.
E. If payments made pursuant to subsection C of this section exceed the amount required to meet the costs incurred by the Arizona health care cost containment system for the hospitalization and medical care of those persons defined as an eligible person pursuant to section 36-2901, paragraph 6, subdivisions (a), (b) and (c), Arizona Revised Statutes, the director of the Arizona health care cost containment system administration may instruct the state treasurer either to reduce remaining payments to be paid pursuant to this section by a specified amount or to provide to the counties specified amounts from the Arizona health care cost containment system fund and the long-term care system fund established by section 36‑2913, Arizona Revised Statutes.
F. It is the intent of the legislature that the Maricopa county contribution pursuant to subsection A of this section be reduced in each subsequent year according to the changes in the GDP price deflator. For the purposes of this subsection, "GDP price deflator" has the same meaning prescribed in section 41-563, Arizona Revised Statutes.
Sec. 14. Proposition 204 administration; exclusion; county expenditure limitations
County contributions for the administrative costs of implementing sections 36-2901.01 and 36-2901.04, Arizona Revised Statutes, that are made pursuant to section 11-292, subsection O, Arizona Revised Statutes, are excluded from the county expenditure limitations.
Sec. 15. AHCCCS; risk contingency rate setting
Notwithstanding any other law, for the contract year beginning October 1, 2018 and ending September 30, 2019, the Arizona health care cost containment system administration may continue the risk contingency rate setting for all managed care organizations and the funding for all managed care organizations administrative funding levels that were imposed for the contract year beginning October 1, 2010 and ending September 30, 2011.
Sec. 16. AHCCCS; social security administration; medicare liability waiver; report of credits
The Arizona health care cost containment system may participate in any special disability workload section 1115 demonstration waiver offered by the centers for medicare and medicaid services. Any credits provided by the section 1115 demonstration waiver process are to be used in the fiscal year when those credits are made available to fund the state share of any medical assistance expenditures that qualify for federal financial participation under the medicaid program. The Arizona health care cost containment system administration shall report the receipt of any credits to the director of the joint legislative budget committee on or before December 31, 2018 and June 30, 2019.
Sec. 17. Hospital charge master transparency; joint report
On or before January 2, 2019, 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, the 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 this state's use of hospital charge master information, including reporting and oversight changes.
Sec. 18. Inpatient psychiatric treatment; report
A. On or before January 2, 2019, the director of the Arizona health care cost containment system administration shall submit a report to the director of the joint legislative budget committee on the availability of inpatient psychiatric treatment both for adults and for children and adolescents who receive services from the regional behavioral health authorities. The report shall include all of the following information:
1. The total number of inpatient psychiatric treatment beds available and the occupancy rate for those beds.
2. Expenditures on inpatient psychiatric treatment.
3. The total number of individuals in this state who are sent out of state for inpatient psychiatric care.
4. The prevalence of psychiatric boarding or the holding of psychiatric patients in emergency rooms for at least twenty‑four hours before transferring the patients to a psychiatric facility.
B. The report shall provide the information specified in subsection A of this section separately for adults who are at least twenty‑two years of age and for children and adolescents who are twenty‑one years of age or younger.
Sec. 19. Department of health services; fees; increase; intent; rulemaking exemption
A. Notwithstanding any other law, the director of the department of health services may increase fees in fiscal year 2018‑2019 for services provided by the bureau of radiation control in fiscal year 2018‑2019.
B. It is the intent of the legislature that the revenue generated by the fees collected pursuant to subsection A of this section not exceed $561,000.
C. The department of health services shall deposit monies received from any fees increased pursuant to subsection A of this section in the health services licensing fund established by section 36‑414, Arizona Revised Statutes, as amended by this act.
D. The department of health services is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, until July 1, 2019 for the purpose of increasing fees pursuant to this section.
Sec. 20. Department of health services; disease control research fund; AIDS reporting and surveillance
Notwithstanding section 36‑273, Arizona Revised Statutes, the department of health services may use the amount appropriated to the department in fiscal year 2018‑2019 from the disease control research fund established by section 36‑274, Arizona Revised Statutes, for AIDS reporting and surveillance.
Sec. 21. Health services lottery monies fund; use; fiscal year 2018-2019
Notwithstanding sections 5‑572 and 36‑108.01, Arizona Revised Statutes, monies in the health services lottery monies fund established by section 36‑108.01, Arizona Revised Statutes, may be used for the purposes specified in the fiscal year 2018‑2019 general appropriations act.
Sec. 22. Department of health services; health research account; Alzheimer's disease research
Notwithstanding section 36‑773, Arizona Revised Statutes, the department of health services may use the amount appropriated to the department in fiscal year 2018‑2019 from the health research account established by section 36‑773, Arizona Revised Statutes, for Alzheimer's disease research.
Sec. 23. AHCCCS; department of health services; opioid epidemic monies; joint report
On or before January 1, 2019, the Arizona health care cost containment system and the department of health services shall jointly report to the joint legislative budget committee how grant monies for states to address the opioid epidemic included in the Consolidated Appropriations Act, 2018 (P.L. 115‑141) will supplement the monies appropriated to the Arizona health care cost containment system administration pursuant to Laws 2018, first special session, chapter 1.
Sec. 24. Intent; implementation of program
It is the intent of the legislature that for fiscal year 2018‑2019 the Arizona health care cost containment system administration implement a program within the available appropriation.
Sec. 25. Retroactivity
Section 36-2905.03, Arizona Revised Statutes, as added by this act, applies retroactively to from and after June 30, 2018.