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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
health; budget reconciliation; 2019-2020
Purpose
Makes statutory and session law changes relating to health necessary to implement the FY 2020 state budget.
Background
The Arizona Constitution prohibits substantive law from being included in the general appropriations, capital outlay appropriations and supplemental appropriations bills. However, it is often necessary to make statutory and session law changes to effectuate the budget. Thus, separate bills called budget reconciliation bills (BRBs) are introduced to enact these provisions. Because BRBs contain substantive law changes, the Arizona Constitution provides that they become effective on the general effective date, unless an emergency clause is enacted.
S.B. 1553 contains the budget reconciliation provisions for changes relating to health.
Provisions
1. Authorizes the Department of Health Services (DHS) to use monies from the Disease Control Research Fund for Acquired Immune Deficiency Syndrome reporting and surveillance.
2. Makes permanent the authority of DHS to use monies in the Health Research Account of the Tobacco Tax and Health Care Fund for Alzheimer's disease research and other health research purposes.
3. Directs DHS to allow a person who is employed at a healthcare institution that provides behavioral health services, who is not a licensed behavioral health profession and who is at least 18 years old to provide outpatient behavioral health and other related healthcare services.
4. Continues to allow the Director of DHS to increase fees in FY 2020 for services provided by the Bureau of Radiation Control (BRC) and continues to exempt DHS from rulemaking requirements for this purpose until July 1, 2020.
5. States that it is the intent of the Legislature that revenues generated by fees collected for BRC services do not exceed $1,900,000.
6. Directs DHS to deposit fees collected for BRC services into the Health Services Licensing Fund.
7. Continues to allow monies in the Health Services Lottery Monies Fund to be used for purposes specified in the FY 2020 General Appropriations Act.
Behavioral Health Residential Facilities (BHRFs)
8. Requires DHS to license secure BHRFs to provide secure 24-hour on-site supportive treatment and supervision by staff with behavioral health training for individuals who:
a) have been determined to be seriously mentally ill (SMI);
b) are chronically resistant to treatment for a mental disorder; and
c) are placed in the BHRF pursuant to a court order.
9. Requires that each community residential treatment system include a secure BHRF program that provides secure 24-hour on-site supportive treatment and supervision by staff with behavioral health training only to individuals who meet the prescribed criteria.
10. Limits a secure BHRF to 16 beds.
11. Specifies that a secure BHRF may only provide services to individuals placed in the BHRF pursuant to a court order and prohibits the provision of services to any other individuals on the BHRF's premises.
12. Allows the court to approve and order placement in a licensed secure BHRF if the patient has met prescribed criteria for court-ordered treatment, been determined to be SMI and the court finds that the patient is chronically resistant to treatment.
13. Authorizes a court to determine that a person is chronically resistant to treatment if the court finds that within 24 months before the issuance of a court order, excluding any time that the person was hospitalized or incarcerated, the person demonstrated a persistent or recurrent unwillingness or inability to participate in or adhere to treatment for a mental disorder despite having treatment offered, prescribed, recommended or ordered to improve the person's condition, prevent a relapse or prevent harmful deterioration of the person's condition.
14. Requires the court's determination that a person is chronically resistant to treatment to be based on clear and convincing evidence that establishes:
a) the person received treatment in the preceding 24 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, and the treatment:
i. was unsuccessful; or
ii. is unlikely to be successful due to the person's expressed or demonstrated unwillingness to cooperate with treatment in less-restrictive or unsecured residential treatment settings;
b) the person's nonadherence to or nonparticipation in treatment over the preceding 24 months resulted in:
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
c) 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 BHRF setting to ensure compliance with court-ordered treatment.
15. Requires that a person's placement in a licensed secure BHRF for treatment be part of the written treatment plan as presented to and approved by the court.
16. Directs the court to confirm in the court order that the person's placement in a licensed secure BHRF is the least restrictive environment to ensure compliance with the person's treatment plan.
17. Specifies that placement in a secure BHRF for treatment is not considered a period of inpatient treatment.
18. Defines secure as it relates to BHRFs.
Arizona Health Care Cost Containment System (AHCCCS)
19. Continues to allow AHCCCS to continue risk contingency rate settings for all managed care organizations (MCOs) and funding for all MCO administrative funding levels imposed in contract year 2010 for the contract year beginning October 1, 2019, and ending September 30, 2020.
20. Continues to require AHCCCS, for FY 2020, to transfer to the counties by December 31, 2019, any portion necessary to comply with the Patient Protection and Affordable Care Act regarding the counties’ proportional share of the state’s contribution.
21. Eliminates the requirement that AHCCCS immediately stop processing KidsCare applications if the state's federal assistance percentage is less than 100 percent, and instead permits the Director of AHCCCS to stop processing KidsCare applications upon a determination that federal and state appropriations for KidsCare are insufficient.
22. Makes permanent the requirement that the AHCCCS and DHS submit an annual joint report on hospital charge master transparency, by January 2 of each year, that:
a) summarizes the current charge master reporting process and hospital billed charges compared to costs;
b) provides examples of how charge masters or hospital prices are reported and used in other states; and
c) includes recommendations to improve Arizona's use of hospital charge master information, including reporting and oversight changes.
23. Requires that the report be submitted to the Governor and the presiding officer in each chamber of the Legislature and that a copy be provided to Secretary of State.
24. Makes permanent the requirement that AHCCCS submit an annual report to the Director of the Joint Legislative Budget Committee (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 that includes:
a) the total number of inpatient psychiatric treatment beds available and the occupancy rate;
b) expenditures on inpatient psychiatric treatment;
c) the total number of individuals in Arizona 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 prior to transferring the patients to a psychiatric facility.
25. Specifies that the report must provide the prescribed information separately for adults who are at least 21 years old and for children and adolescents who are 21 years old or younger.
26. Outlines the following FY 2020 county contributions for the Acute Long-Term Care System (ALTCS), totaling $290,276,100:
|
County |
Contribution |
|
Apache |
$720,200 |
|
Cochise |
$5,176,200 |
|
Coconino |
$2,162,200 |
|
Gila |
$2,418,200 |
|
Graham |
$1,684,400 |
|
Greenlee |
$8,200 |
|
La Paz |
$822,000 |
|
Maricopa |
$185,791,300 |
|
Mohave |
$9,232,700 |
|
Navajo |
$2,981,000 |
|
Pima |
$45,157,400 |
|
Pinal |
$13,755,300 |
|
Santa Cruz |
$2,266,800 |
|
Yavapai |
$8,543,800 |
|
Yuma |
$9,556,400 |
27. Directs the State Treasurer to collect from the counties the difference between the total contribution and the counties' share of the state's actual contribution, if the overall cost for ALTCS exceeds the amount specified in the General Appropriations Act for FY 2020.
28. Specifies that the counties' share of the state's contribution must comply with any federal maintenance effort requirements.
29. Requires the Director of AHCCCS to notify the State Treasurer of the counties' share of the state's contribution and report the amount to the Director of the JLBC.
30. Directs the State Treasurer to:
a) withhold from any other monies payable to a county from any available state funding source, excluding the Arizona Highway User Revenue Fund, an amount necessary to fulfill that county's contribution requirement; and
b) deposit the withheld amounts and amounts paid by counties into the ALTCS Fund.
31. Outlines the following FY 2020 county Acute Care contributions:
|
County |
Contribution |
|
Apache |
$268,800 |
|
Cochise |
$2,214,800 |
|
Coconino |
$742,900 |
|
Gila |
$1,413,200 |
|
Graham |
$536,200 |
|
Greenlee |
$190,700 |
|
La Paz |
$212,100 |
|
Maricopa |
$18,131,400 |
|
Mohave |
$1,237,700 |
|
Navajo |
$310,800 |
|
Pima |
$14,951,800 |
|
Pinal |
$2,715,600 |
|
Santa Cruz |
$482,800 |
|
Yavapai |
$1,427,800 |
|
Yuma |
$1,325,100 |
32. Requires the State Treasurer, if a county does not provide the aforementioned funding, to:
a) subtract the amount owed by the county from any payments required to be made by the State Treasurer to the county plus interest on that amount, retroactive to the first day the funding was due; and
b) if the amount withheld is insufficient to meet that county’s funding requirement, withhold from any other monies payable to that county from any available state funding source, excluding the Arizona Highway User Revenue Fund, an amount necessary to fulfill that county’s requirement.
33. Requires payment equal to one-twelfth of the total amount for county Acute Care contributions to be made to the State Treasurer by the fifth day of each month and requires the State Treasurer, on request from the Director of AHCCCS, to require that up to three months payment be made in advance, if necessary.
34. Requires the State Treasurer to deposit the amounts paid or withheld into the AHCCCS Fund and the ALTCS Fund.
35. Allows the Director of AHCCCS, if payments made exceed the amount required to meet the costs incurred by AHCCCS for the hospitalization and medical care of eligible persons, to instruct the State Treasurer to do either of the following:
a) reduce remaining payments to be paid by a specified amount; or
b) provide to the counties specified amounts from the AHCCCS Fund and the ALTCS Fund.
36. States that it is the intent of the Legislature that the Maricopa County Acute Care contribution be reduced in each subsequent year according to the changes in the Gross Domestic Product price deflator.
37. States it is the intent of the Legislature for FY 2020 that AHCCCS implement a Medicaid program within the available appropriation.
Disproportionate Share Hospital (DSH) Payments
38. Establishes the FY 2020 DSH payments as follows:
a) $113,818,500 for a qualifying non-state-operated public hospital, of which $4,202,300 is distributed to the Maricopa County Special Health Care District (MIHS), and the remaining federal portion is distributed to the state GF;
b) $28,474,900 for the Arizona State Hospital (ASH), of which the federal portion is distributed into the state GF; and
c) $884,800 for private qualifying DHS hospitals, which are hospitals that meet the mandatory definition of qualifying DSHs, as defined by the Social Security Act, or hospitals that are located in Yuma and contain at least 300 beds.
39. Outlines the following requirements once AHCCCS files a claim with the federal government and receives federal financial participation based on the amount certified by MIHS:
a) if the certification is equal to or less than $113,818,500 and AHCCCS determines that the revised amount is correct, AHCCCS must notify the Governor, the President of the Senate and the Speaker of the House of Representatives, and distribute $4,202,300 to MIHS and deposit the balance of the federal financial participation into the state GF;
b) if the certification is for an amount less than $113,818,500 and AHCCCS determines that the revised amount is incorrect, AHCCCS must notify the Governor, the President of the Senate and the Speaker of the House of Representatives and must deposit the total amount of the federal financial participation into the state GF; or
c) if the certification is for an amount greater than $113,818,500, AHCCCS must distribute $4,202,300 to MIHS and $75,254,400 of the federal financial participation to the state GF.
40. Allows AHCCCS to make additional DSH payments to MIHS.
41. Outlines the following requirements once AHCCCS files a claim with the federal government and receives federal financial participation based on the amount certified by ASH:
a) if the certification is for an amount less than $28,474,900, AHCCCS must notify the Governor, the President of the Senate and the Speaker of the House of Representatives and must distribute the entire amount of federal financial participation to the state GF; and
b) requires the certified public expense (CPE) form to contain both the total amount of qualifying DSH expenditures and the amount limited by the Social Security Act.
42. Stipulates that, after DSH payment distributions are made, the allocation of DSH payments designated by political subdivisions, tribal governments and universities must be made available first to qualifying private hospitals located outside the Phoenix Metropolitan Statistical Area and the Tucson Metropolitan Statistical Area before being made available to qualifying hospitals within those areas.
43. Requires MIHS and ASH to each provide a CPE form for the amount of qualifying DSH expenditures to AHCCCS by May 1, 2020, for MIHS, and March 31, 2020, for ASH.
44. Continues to require AHCCCS to assist MIHS and ASH in determining the amount of qualifying expenditures and maintains reporting requirements and distribution procedures of received federal matching funds in FY 2020.
Miscellaneous
45. Makes permanent the requirement that a city, town or county, rather than the state, pay for the costs of inpatient, in-custody competency restoration treatment at the Arizona State Hospital for defendants who are unable to pay all or a portion of the cost of treatment.
46. Continues to exclude county contributions for Proposition 204 administrative costs from county expenditure limitations.
47. Makes technical and conforming changes.
48. Becomes effective on the general effective date.
Prepared by Senate Research
May 22, 2019
CS/kja