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ARIZONA STATE SENATE
Fifty-Fifth Legislature, First Regular Session
rate structure; hospital services; prisoners
Purpose
Allows the Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) to establish an alternative reimbursement rate for inpatient and outpatient hospital services that are provided in a fully locked unit setting that does not exceed 120 percent of the current Medicare rate.
Background
If
a prisoner in a secure care facility requires health care services that ADCRR,
the facility or a private prison provider contracted by ADCRR cannot provide,
ADCRR must pay approved claims from a facility or provider that provides these
services. For inpatient and outpatient hospital services, ADCRR must reimburse
at a level that does not exceed the Arizona Health Care Cost Containment System
(AHCCCS) reimbursement methodology. For health and medical services, ADCRR must
reimburse at a level that does not exceed the AHCCCS-adopted capped
fee-for-service schedule that is in effect at the time the services are
delivered (A.R.S.
§ 41-1608).
AHCCCS is Arizona's
Medicaid program that provides health care services to qualifying Arizona
individuals and families. AHCCCS pays hospitals for inpatient and outpatient
services to AHCCCS members and reimburses inpatient hospital services using a
diagnosis-related
group-based hospital payment methodology. For outpatient hospital services, AHCCCS reimburses
claims based on the capped fee-for-service schedule or the statewide
cost-to-charge ratio. AHCCCS may make additional adjustments to the inpatient
or outpatient hospital rates based on statutorily outlined factors (A.R.S.
§ 36-2903.01).
Medicare fee schedules are defined by the U.S. Centers for Medicare and Medicaid Services (CMS). CMS administers the federal Medicare Program and the Medicare fee schedule determines the maximum amount Medicare will reimburse for medical services. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services and durable medical equipment, prosthetics, orthotics and supplies (CMS).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Allows ADCRR to establish an alternative reimbursement rate for inpatient and outpatient hospital services that are provided in a fully locked unit setting.
2. Caps the alternative reimbursement rate at 120 percent of the current Medicare rate.
3. Defines a fully locked unit setting as a ward or a wing in which treatment and services are provided and that is secured in a manner that prevents patients from leaving the ward or wing at will.
4. Specifies that a fully locked unit setting does not include a ward or wing that is locked only for the purpose of preventing unauthorized entry and allows a patient to exit the ward or wing at will.
5. Makes conforming changes.
6. Becomes effective on the general effective date.
Prepared by Senate Research
February 12, 2021
LMM/DH/kja