 |
ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
AMENDED
AHCCCS services; diabetes management
Purpose
Requires the Arizona Health Care Cost Containment System (AHCCCS) to annually cover up to 10 program hours of outpatient diabetes self-management training (DSMT) for certain AHCCCS members under specified circumstances.
Background
AHCCCS was originally established by the
Legislature, in 1981, as Arizona’s Medicaid Program to provide health insurance
coverage for certain low-income individuals and families. AHCCCS uses federal,
state and county funds to provide healthcare coverage to Arizona's acute and
long-term care Medicaid populations. Statute requires AHCCCS contractors to
provide specified medically-necessary health and medical services, with certain
limitations and exclusions, to AHCCCS members including: 1) inpatient hospital
services that are ordinarily furnished by a hospital for the care and treatment
of inpatients and that are provided under the direction of a physician or a
primary care practitioner; 2) outpatient health services that are ordinarily
provided in hospitals, clinics, offices and other healthcare facilities by
licensed healthcare providers;
3) laboratory and X-ray services ordered by a physician or a primary care
practitioner;
4) medications that are ordered on prescription by a physician or a licensed
dentist; 5) medical supplies, durable medical equipment, insulin pumps and
prosthetic devices ordered by a physician or a primary care practitioner; 6)
health screenings and diagnostic services; 7) podiatry services and orthotics;
8) hospice; 9) ambulance and non-ambulance transportation; 10) nonexperimental
transplants; and 11) emergency dental care and extractions in an annual amount
of $1,000 per AHCCCS member (A.R.S. §§ 36-2904
and 36-2907).
DSMT educates individuals about diabetes management and includes training regarding healthy eating, remaining active, monitoring blood sugar and reducing risks. According to the American Diabetes Association, DSMT seeks to facilitate the knowledge, skills and abilities necessary for optimal diabetes self-care and incorporates the needs, goals and life experiences of individuals with diabetes. The overall objective of DSMT is to support informed decision making, self-care behaviors, problem-solving and active collaboration with healthcare teams to improve clinical outcomes, health status and quality of life in a cost-effective manner. Currently, Medicare Part B covers 10 hours of initial outpatient DSMT for individuals who have been diagnosed with diabetes, if the individual has a written order from the individual's doctor or another qualified practitioner.
According to AHCCCS, there is an anticipated $1,168,000 fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires AHCCCS to annually cover up to 10 program hours of out-patient DSMT that is prescribed by a primary care practitioner, if:
a) an AHCCCS member is initially diagnosed with diabetes;
b) a change occurs in an AHCCCS member's diabetes diagnosis, medical condition or treatment regimen; or
c) an AHCCCS member who is diagnosed with diabetes is not meeting appropriate clinical outcomes.
2. Prohibits Hospital Assessment Fund monies from being used to provide DSMT services.
3. Makes technical and conforming changes.
4. Becomes effective on the general effective date.
Amendments Adopted by Committees
1. Requires AHCCCS to annually cover up to 10 hours of DSMT that is prescribed by a primary care practitioner if the member is initially diagnosed with diabetes or a member is not meeting appropriate clinical outcomes.
2. Prohibits Hospital Assessment Fund monies from being used to provide DSMT services.
Senate Action
HHS 2/20/19 DPA 8-0-0
APPROP 2/26/19 DPA 9-0-0
Prepared by Senate Research
February 27, 2019
CRS/AG/kja