ARIZONA
HOUSE OF REPRESENTATIVES
|
HB 2754: health; budget reconciliation; 2019-2020. |
||
|
PRIME SPONSOR: Representative Cobb, LD 5 BILL STATUS: Transmitted to Governor |
|
|
Contains budget reconciliation provisions
relating to health needed for implementing the FY 2020 budget.
History
The Arizona Legislature adopts a budget for each fiscal year (FY) that contains general appropriations. Article IV, Section 20, Part 2, Constitution of Arizona, requires the General Appropriations Act (feed bill) to contain only appropriations for the different state departments, state institutions, public schools and interest on public debt. Statutory changes necessary to reconcile the appropriations made in the feed bill and other changes are drafted into separate bills known as Budget Reconciliation Bills (BRBs). These BRBs are prepared according to subject area.
Provisions
Arizona Department of Health Services (DHS)
1. Allows DHS to use the Disease Control Research Fund for acquired immune deficiency syndrome (AIDS) reporting and surveillance. (Sec. 2)
2. Permits DHS to use an unlicensed behavioral health profession who is at least 18 years of age at a health care institution that provides outpatient behavioral health services pursuant to DHS rules. (Sec. 3)
3. Requires DHS to license secure behavioral health residential facilities (secure health facility) to provide secure 24-hour onsite supportive treatment and supervision by staff with behavioral health training for persons who:
a. Have been determined to be seriously mentally ill;
b. Are chronically resistant to treatment for a mental disorder; and
c. Are placed in the facility pursuant to a court order. (Sec. 4)
4. Allows a secure health facility to provide services only to persons placed in the facility pursuant to a court order and the facility may not provide services to any other person on their premises. (Sec. 4)
5. Provides that a secure health facility may not have more than 16 beds. (Sec. 4)
6. Defines secure as premises that limit a patient's egress in the least restrictive manner consistent with the patient's court-ordered treatment plan. (Sec. 4)
7. States that the court may order the patient to undergo outpatient or combined inpatient and outpatient treatment if the court determines that the patient has been determined to be seriously mentally ill and chronically resistant to treatment. (Sec. 5)
8. Allows the court to order that the patient be placed in a secure health facility licensed by DHS. (Sec. 5)
9. Requires individual programs of a community residential treatment system include a secure health facility program. (Sec. 6)
10. Specifies that the program must provide secure 24-hour on-site supportive treatment and supervision by staff with behavioral health training only to persons who have been determined to be seriously mentally ill and chronically resistant to treatment. (Sec. 6)
11. Provides that if the court finds that a patient meets the criteria for court-ordered treatment, the court may approve placement in a secure health facility, licensed by DHS and willing to accept the patient, if the patient has been determined to be seriously mentally ill and the court finds that the patient is chronically resistant to treatment. (Sec. 7)
12. Specifies that placement in a secure health facility for treatment is not considered inpatient treatment for an individual found by the court to be a danger to self or others, have a persistent or acute disability, or be found to have a grave disability. (Sec. 7)
13. Provides that a court may determine a person is chronically resistant to treatment if they meet outlined conditions. (Sec. 7)
14. Requires the court's finding be based on clear and convincing evidence that establishes all of the following:
a. The person received treatment in the preceding 24-hour months in other less-restrictive settings, including unsecured residential treatment settings with on-site 24-hour supportive treatment and supervision by staff with behavioral health training;
b. The treatment was unsuccessful or is not likely to be successful due to the person's expressed or demonstrated unwillingness to cooperate with treatment in other less-restrictive or unsecured residential treatment settings;
c. The person's nonadherence to or nonparticipation in treatment over the preceding 24-months resulted in one or more of the following:
i. Serious harm to self;
ii. Serious harm or threats of serious harm to others;
iii. Recurrent periods of homelessness resulting from the mental disorder;
iv. Recurrent serious medical problems due to poor self-care or failure to follow medical treatment recommendations; or
v. Recurrent arrests due to behavior resulting from the mental disorder; and
d. Any other evidence relevant to the person's willingness or ability to participate in and adhere to treatment or the person's need for treatment in a licensed secure residential setting to ensure the person's compliance with court-ordered treatment. (Sec. 7)
15. Provides that a person's placement in a licensed secure health facility for treatment must be part of the written treatment plan presented to and approved by the court. (Sec. 7)
16. Requires that the court confirm in the order that the person's placement in a licensed secure health facility is the least restrictive environment to ensure the person's compliance with the treatment plan. (Sec. 7)
17. Allows monies from the Health Research Account to be used for Alzheimer's disease research and other health research purposes. These monies may only be used to supplement and not supplant other monies appropriated by the legislature. (Sec. 8)
18. Allows the director of DHS to increase fees in FY 2020 for services provided by the Bureau of Radiation Control.
a. Provides that the legislature intends that the revenue generated by fees not exceed $1,900,000.
b. Requires DHS to deposit monies received from any fees in the Health Services Licensing Fund.
c. Exempts DHS from rule making requirements until July 1, 2020 for the purpose of increasing fees. (Sec. 17)
Arizona Health Care Cost Containment System (AHCCCS)
19. Requires AHCCCS to submit a report to JLBC by January 2 of each year on the availability of inpatient psychiatric treatment for adults, children and adolescents who receive services from the Regional Behavioral Health Authorities. The report must include all of the following:
a. The total number of inpatient psychiatric treatment beds available and the occupancy rate for those beds;
b. Expenditures on inpatient psychiatric treatment;
c. The total number of individuals in this state who are sent out of state for inpatient psychiatric treatment; and
d. The prevalence of psychiatric boarding or holding psychiatric patients in emergency rooms for at least 24 hours before transferring the patients to a psychiatric facility. (Sec. 9)
20. Requires that the report provide information separately for adults who are at least 21 years of age and for children and adolescents who are 20 years of age or younger. (Sec. 9)
21. Provides that if the director of AHCCCS determines that federal and state monies appropriated for the Children's Health Insurance Program are insufficient, AHCCCS may stop processing all new applications. (Sec. 10)
22. Requires AHCCCS to transfer to the counties any portion necessary to comply with the Patient Protection and Affordable Care Act regarding the counties' proportional share of this state's contribution. (Sec. 13)
23. Continues the risk contingency rate setting for all managed care organizations that was imposed in 2010 for the contract year beginning October 1, 2019 and ending September 20, 2020. (Sec. 16)
24. States the legislature intends that for FY 2020, that AHCCCS implement a program with the available appropriation. (Sec. 19)
25. Requires AHCCCS and DHS to annually submit a joint report on hospital charge master transparency to the governor, the legislature, and a copy to the secretary of state by January 2 of each year. The report must do all the following:
a. Summarize the current charge master reporting process and hospital billed charges compared to costs;
b. Provide examples of how charge masters or hospital prices are reported and used in other states; and
c. Include recommendations to improve this state's use of hospital charge information, including reporting and oversight charges. (Sec. 9)
Counties
26. Sets the annual county Arizona Long Term Care System (ALTCS) contributions for FY 2020 at $290,276,100.
a. Outlines each counties contribution.
b. Requires the state treasurer to recover the cost of any funding that was not provided.
c. Requires the state treasurer to deposit monies received in the ALTCS fund. (Sec. 11)
27. Requires the counties' share of the state's contributions to comply with federal maintenance of effort requirements. (Sec. 11)
28. Sets the county acute care contributions at $46,161,700 and states it is the intent of the legislature that the Maricopa County contribution be reduced in each subsequent year according to the changes in the GDP price deflator.
a. Outlines each county's contribution.
b. Requires the state treasurer to recover the cost of any funding that was not provided by a county from other funds owed to that county, excluding Highway User Revenue Fund.
c. Specifies payment processes and requirements. (Sec. 14)
29. Continues to exclude the Proposition 204 administration costs from the county expenditure limitations. (Sec. 15)
Hospital Disproportionate Share (DSH) Payments
30. Sets the annual DSH payment amount for the Maricopa County Special Health Care District (District) at $113,818,500.
a. Requires the District to provide a certified public expense form for the amount of qualifying DSH expenditures made to AHCCCS by May 1, 2020 for all state plan years as required by the AHCCCS Section 1115 waiver.
b. States that if the certification is equal to or less than $113,818,500 and AHCCCS determines the amount is correct they must:
i. Notify the governor and the legislature; and
ii. Distribute $4,202,300 to the District and deposit the balance in the state GF.
c. Provides that if the certification is less than $113,818,500 and AHCCCS determines the amount is not correct they must:
i. Notify the governor and the legislature; and
ii. Deposit the total amount into the state GF.
d. Stipulates that if the certification is greater than $113,818,500, AHCCCS must distribute $4,202,300 to the District and deposit $75,493,400 in the state GF.
e. Permits AHCCCS to make additional DSH payments to the District pursuant to statute. (Sec. 12)
31. Allots $28,474,900 of the DSH payments to the Arizona State Hospital (ASH) in FY 2020.
a. Requires ASH to provide a certified public expense form for the amount of qualifying DSH expenditures to AHCCCS by March 31, 2020;
b. Requires AHCCCS to assist ASH in determining the amount of qualifying DSH expenditures.
c. Requires AHCCCS to deposit the entire amount in the state GF.
d. Provides that if the certification is less than $28,474,900, AHCCCS must:
i. Notify the governor and the legislature;
ii. Distribute the entire amount in the state GF; and
iii. States that the certified public expense form must contain the total amount of qualifying DSH expenditures and the amount limited by federal law. (Sec. 12)
32. Provides $884,800 for private qualifying DSH hospitals consistent with the appropriation and the terms of the Section 1115 waiver, however payments are limited to those hospitals that either:
a. Meet the mandatory definition of DSH qualifying hospital under Section 1923 of the Social Security Act; or
b. Are located in Yuma county and contain at least 300 beds. (Sec. 12)
33. States that once the DSH distributions are made, further distributions must be made available first to qualifying private hospitals located outside the Phoenix and Tucson metropolitan statistical areas before being made available to qualifying hospitals within the Phoenix and Tucson metropolitan statistical areas. (Sec. 12)
Family Caregiver Grant Program (Grant Program)
34. Establishes the Grant Program beginning January 1, 2020 for individuals who have qualifying expenses during a calendar year due to caring for and supporting a qualifying family member in the individual's home. (Sec. 12)
35. Instructs that to apply for the Grant Program:
a. An individual must submit an application to DES on a prescribed form;
b. An individual must be a resident of Arizona;
c. The individual's Arizona gross income in the taxable year, together with any Arizona gross income of each qualifying family member, may not exceed:
i. $75,000 in the case of a single person or a married person filing separately; or
ii. $150,000 for a married couple filing a joint return;
d. The individual must incur qualifying expenses during the calendar year in which the individual applies for the grant for the care of one or more qualifying family members; and
e. The individual must submit, with the claim for the grant, the qualifying family member's name and relationship to the individual. (Sec. 12)
36. Specifies that the amount of the grant is equal to 50% of the qualifying expenses incurred during the calendar year in which the individual applies for the Grant Program, but not more than $1,000 for each qualifying family member. (Sec. 12)
37. Stipulates that an individual who receives a grant is not eligible to apply for a grant again for three consecutive calendar years. (Sec. 12)
38. Requires DES to certify applications for the Grant Program on a first-come, first-served basis. (Sec. 12)
39. Prohibits DES from awarding grants that exceed in the aggregate $500,000 for any calendar year. (Sec. 12)
40. Directs DES to include questions in the application to help DES determine if the grants provided delayed or prevented a qualifying family member from entering a long-term care facility or assisted living facility in the calendar year of application or future calendar years. (Sec. 12)
41. Allows DES to use the Advisory Council on Aging to provide input on approval of applications for grants and whether an expense is a qualifying expense or other issues relating to the Grant Program as determined by DES. (Sec. 12)
Family Caregiver Grant Fund (Fund)
42. Establishes the Fund, requires the director of DES administer the Fund and the Fund must consist of grants, gifts, donations and legislative appropriations. Monies in the fund are continuously appropriated. (Sec. 12)
43. Provides that monies in the Fund may be spent only for grants provided to individuals who are caring for and supporting a qualifying family member in the individuals home. (Sec. 12)
44. Specifies expenditures from the Fund from the previous calendar year:
a. Must be reported to the legislature in DES' annual report; and
b. Must include aggregated data summarizing the qualifying expenses that were approved for:
i. Grants;
ii. The types of individual's that qualified for the grants; and
iii. Information about the ability for qualified family members to delay entering a long-term care facility or assisted living facility. (Sec. 12)
45. Requires the state treasurer to invest and divest monies in the Fund and monies earned from investment to be credited to the Fund. (Sec. 12)
46. Allows interest or other income derived from the fund to be used only for the Grant Program. (Sec. 12)
47. Prohibits the use of interest or other income derived from the Fund from being used to supplant other appropriations. (Sec.12)
48. Repeals the Grant Program and Fund on July 1, 2023. (Sec. 13)
49. Defines department, director, qualifying expenses and qualifying family member. (Sec. 1)
Miscellaneous
50. Provides that if a defendant if unable to pay all or part of the costs of inpatient competency restoration treatment the city, town or county must pay the costs of treatment. (Sec. 1)
51. Continues to allow counties to use any revenue source to pay restoration to competency costs. Exempts these payment from the county expenditure limitations. (Sec. 1 and 19)
52. Allows monies in the Seriously Mentally Ill Housing Trust Fund to be used for rental assistance in addition to housing projects. (Sec. 11)
53. Requires AHCCCS to submit a report on the number of individuals who benefitted from rental assistance. (Sec. 11)
54. Allows monies in the Health Services Lottery Monies Fund to be used for the purposes specified in the general appropriations act. (Sec. 18)
55. Requires AHCCCS, by January 31, 2022 to issue a report to the governor, the legislature, and a copy to the secretary of state, that measures the outcomes over a 12-month period of persons who have been determined to be SMI and who reside in secure behavioral health residential facilities. Outlines items to be included in the report and allows AHCCCS to contract with a third-party entity to collect the data and compile the report. (Sec. 23)
---------- DOCUMENT FOOTER ---------
Fifty-fourth Legislature HB 2754
First Regular Session Version 4: Transmitted
---------- DOCUMENT FOOTER ---------