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ARIZONA STATE SENATE
Fifty-Fifth Legislature, First Regular Session
AMENDED
health care; 2022-2023.
Purpose
Makes statutory and session law changes relating to health care necessary to implement the FY 2023 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. 1730 contains the budget reconciliation provisions for changes relating to health care.
Provisions
Behavioral Health Care Provider Loan Repayment Program (Program)
1. Establishes the Program within the Department of Health Services (DHS) to pay off portions of educational loans taken out by behavioral health care providers who serve in behavioral health facilities, the Arizona State Hospital (ASH), behavioral health residential facilities or secure behavioral health residential facilities, including:
a) behavioral health technicians;
b) behavioral health nurse practitioners;
c) psychiatric nurse practitioners;
d) practical nurses;
e) physicians;
f) psychiatrists; and
g) psychologists.
2. Requires DHS to prescribe Program application and eligibility requirements.
3. Requires an applicant to meet at least the following requirements to be eligible for participation in the Program:
a) have completed the final year of an accredited course of study or program in a health profession or have an active health profession license;
b) demonstrate current employment providing direct patient care with a public or nonprofit entity located and providing services in a behavioral health hospital, behavioral health residential facility or secure residential behavioral health residential facility;
c) demonstrate that the current employer is contracted with the Arizona Health Care Cost Containment System (AHCCCS) to provide services; and
d) not be participating in any other established loan repayment program.
4. Requires physician applicants to have completed a professional residency or certification program in behavioral health care.
5. Requires a behavioral health care provider who participates in the Program to initially contract with DHS to provide behavioral health services for at least two years.
6. Directs DHS, in making recommendations for the Program, to give priority to applicants who intend to practice in ASH, a behavioral health residential facility or a secure behavioral health residential facility in Arizona.
7. Specifies that all repayment contract obligations are subject to the availability of monies and legislative appropriation.
8. Allows DHS to cancel or suspend a loan repayment contract based on unavailability of monies for the Program.
9. Holds DHS harmless from liability for any claims, actual damage or consequential damages arising out of the cancellation or suspension of a contract.
10. Specifies that DHS is not prevented from encumbering an amount that is sufficient to ensure payment of each behavioral care provider loan for services rendered during a contract period.
11. Requires DHS to issue Program monies to pay behavioral health care provider loans, according to the following schedule:
a) up to $50,000 for the first two years of service; and
b) up to $25,000 for subsequent years.
12. Limits Program payments to the principal, interest and related expenses of educational loans, not exceeding a provider's total student loan indebtedness.
13. Specifies that a Program participant who breaches the loan repayment contract is liable for liquidated damages in an amount equal to the amount that would be owed for default, as determined and authorized by DHS.
14. Allows DHS to:
a) waive the liquidated damages if it is determined that death or permanent physical disability of a participant accounted for the failure to fulfill the contract; and
b) prescribe additional conditions for loan repayment contract default, cancellation, waiver or suspension.
15. Permits DHS to retain legal counsel and commence actions necessary to collect loan payments and charges if there is a default or breach of a contract.
16. Allows DHS to use monies to develop programs, such as resident-to-service loan repayment and employer recruitment assistance, to increase participation in the Program and to use private donations, grants and federal monies to implement, support, promote or maintain the Program.
Arizona Long-Term Care System (ALTCS)
17. Outlines the following FY 2023 county contributions for ALTCS:
|
County |
Contribution Amount |
|
Apache |
$860,500 |
|
Cochise |
$6,320,300 |
|
Coconino |
$2,583,200 |
|
Gila |
$2,855,600 |
|
Graham |
$1,258,800 |
|
La Paz |
$653,700 |
|
Maricopa |
$229,265,800 |
|
Mohave |
$10,473,800 |
|
Navajo |
$3,561,400 |
|
Pima |
$54,350,500 |
|
Pinal |
$17,427,100 |
|
Santa Cruz |
$2,775,000 |
|
Yavapai |
$9,429,000 |
|
Yuma |
$10,883,000 |
18. 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 2023.
19. Specifies that the counties' share of the state's contribution must comply with any federal maintenance effort requirements.
20. Requires the AHCCCS Director to 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 (JLBC).
21. 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 (HURF), 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.
County Acute Care
22. Outlines the following FY 2023 county acute care contributions:
|
County |
Contribution Amount |
|
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 |
$16,887,200 |
|
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 |
23. Requires the State Treasurer, if a county does not provide funding as specified, 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 HURF, an amount necessary to fulfill that county’s requirement.
24. Requires payments equal to 1/12th 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.
25. Requires the State Treasurer to deposit the amounts paid and withheld into the AHCCCS Fund and the ALTCS Fund.
26. 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:
a) reduce the 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.
27. Declares the Legislature's intent 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.
Disproportionate Share Hospital (DSH) Payments
28. Establishes the FY 2023 DSH payments as follows:
a) $113,818,500 for a qualifying nonstate-operated public hospital, of which $4,202,300 is distributed to the Maricopa County Special Health Care District (District) and the remaining federal portion is deposited in the state General Fund (state GF);
b) $28,474,900 for ASH, of which the federal portion is deposited in the state GF; and
c) $884,800 for private qualifying DSHs, which are hospitals that meet the mandatory definition of qualifying DSHs as defined by the Social Security Act or DSHs that are located in Yuma County and contain at least 300 beds.
29. Outlines the following requirements once AHCCCS files a claim with the federal government and receives federal financial participation based on the amount certified by the District:
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 the District and deposit the balance of the federal financial participation in 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 in the state GF; or
c) if the certification is for an amount greater than $113,818,500, AHCCCS must distribute $4,202,300 to the District and deposit $74,696,800 of the federal financial participation in the state GF.
30. Allows AHCCCS to make additional DSH payments to the District.
31. 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 deposit the entire amount of federal financial participation in 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.
32. Stipulates that, after DSH payment distributions are made, the allocation of DSH payments designated to political subdivisions, tribal governments and universities must be provided in the following order of priority, for FY 2021, FY 2022 and FY 2023, to qualifying private hospitals located:
a) in a county with a population of fewer than 400,000 persons;
b) in a county with a population of at least 400,000 but fewer than 900,000 persons; and
c) in a county with a population of at least 900,000 persons.
33. Requires the District, by May 1, 2023, and ASH, by March 31, 2023, to each provide a CPE form for qualifying DSH expenditures to AHCCCS.
34. Continues to require AHCCCS to assist the District and ASH in determining the amount of qualifying DSH expenditures and maintains reporting requirements and distribution procedures of received federal matching funds in FY 2023.
AHCCCS
35. Requires AHCCCS to provide medically necessary chiropractic services performed by a licensed chiropractor and ordered by a primary care physician or practitioner, subject to approval by the U.S. Centers for Medicare and Medicaid Services (CMS) and rules adopted by AHCCCS.
36. Allows a primary care physician or practitioner to:
a) order up to 20 medically necessary chiropractic visits annually; and
b) authorize additional chiropractic services in that same year if medically necessary.
37. Requires AHCCCS to:
a) prescribe provider qualifications for chiropractic services;
b) report on chiropractic service utilization and any identified cost savings;
c) submit the report, by January 21, 2027, on its findings to the Governor, President of the Senate and Speaker of the House of Representatives; and
d) provide a copy of the report to the Secretary of State (SOS).
38. Repeals AHCCCS chiropractic reporting requirements on June 30, 2027.
39. Prohibits monies from the Hospital Assessment Fund from being used to provide chiropractic services.
40. Continues to require AHCCCS to transfer to the counties any excess monies necessary to comply with the Patient Protection and Affordable Care Act, regarding the counties' proportional share of the state's contribution.
41. Declares the Legislature's intent that it is the intent of the Legislature for FY 2023 that AHCCCS implement a Medicaid program within the available appropriation.
42. Continues to allow AHCCCS to extend risk contingency rate settings for all managed care organizations (MCOs) and funding for all MCO administrative funding levels imposed for the contract year beginning October 1, 2010, and ending September 30, 2011.
43. Exempts AHCCCS from statutory rulemaking requirements for one year for purposes of implementing the Health Care Investment Fund assessment.
44. Requires AHCCCS to provide notice and an opportunity for public comment at least 30 days prior to establishing or implementing the administration of the hospital assessment.
45. Expands AHCCCS eligibility to include women who are less than one year postpartum with a family income that does not exceed 150 percent of the federal poverty level.
46. Expands the definition of an AHCCCS-contracted primary care practitioner to include certified nurse midwives.
47. Conditions enactment of the AHCCCS expansion to include women who are less than one year postpartum on AHCCCS receiving authorization, by July 1, 2023, from CMS to either redetermine the eligibility of members who are less than one year postpartum and are under 133 percent of the federal poverty level or use another methodology that enables AHCCCS to provide coverage within the existing appropriation.
48. Requires the Director of AHCCCS, by July 1, 2023, to notify the Director of Legislative Council in writing whether the condition was met and on which date it was met.
Arizona Health Innovation Trust Fund (Fund)
49. Establishes the Fund, administered by the State Treasurer as a trustee, as a permanent endowment fund consisting of:
a) legislative appropriations;
b) earnings from the Fund; and
c) gifts or grants donated to the Fund.
50. Specifies that Fund monies are continuously appropriated and exempt from lapsing.
51. Requires the State Treasurer to accept, separately account for and hold in trust any Fund monies deposited in the State Treasury.
52. Prohibits Fund monies from being commingled with any other monies in the State Treasury for non-investment purposes.
53. Requires the State Treasurer to invest and divest any Fund monies deposited into the State Treasury and requires monies earned from interest and investment income to be credited to the Fund.
54. Requires the State Treasurer to annually allocate four percent of the monies in the Fund to an entity that:
a) is a qualified 501(c)(3) charitable organization;
b) provides entrepreneurial education, mentoring and support to persons in the health innovation and health care delivery sectors in Arizona;
c) provides workforce development programs designed to support the talent requirements of employers in health innovation and health care delivery in Arizona;
d) provides programs that support development and commercialization of health innovation by businesses that are based in Arizona and employ fewer than 100 employees; and
e) has entered into an endowment agreement with the State Treasurer that meets prescribed requirements.
55. Requires an endowment agreement to include:
a) investment procedures and maturity timelines;
b) entity reporting requirements, including use of Fund distributions; and
c) other requirements established by the State Treasurer.
56. Requires the selected entity, by December 31 of each year, to submit an annual report as prescribed by the State Treasurer, to the:
a) Governor;
b) President of the Senate;
c) Speaker of the House of Representatives;
d) State Treasurer; and
e) SOS.
Health Care Interoperability Grant Program (Program)
57. Requires the Arizona Department of Administration (ADOA) to administer the Program, which provides an interoperability software technology solution to support rural hospitals, health care providers and urban trauma centers for the purpose of reducing public and private health care costs and unnecessary transportation costs.
58. Requires ADOA to award the first grant by December 31, 2022.
59. Requires AHCCCS to work with ADOA to supplement the grant monies by identifying and applying to receive federal matching monies.
60. Requires the Program to enable the implementation of an interoperability software technology solution that is shared by hospitals and health care providers to benefit patients before and after a patient is discharged from the provider's care.
61. Requires the software to be made available to rural hospitals, health care providers and urban trauma centers that want to participate by:
a) enabling a hospital's electronic medical records system to interface with other electronic medical records systems;
b) promoting connectivity between hospital systems; and
c) facilitating increased communication between hospital staff and providers that use different or distinctive online platforms and information systems when treating patients.
62. Requires ADOA to award grants for an interoperability software technology solution that, at a minimum:
a) complies with the Health Information Portability and Accountability Act;
b) captures and forwards clinical data that includes laboratory results and images and provides synchronous patient clinical data to health care providers regardless of location;
c) provides a synchronous data exchange that is not batched or delayed at the point the clinical data is captured and available in the hospital's electronic record system;
d) is capable of providing proactive alerts to health care providers;
e) allows both synchronous and asynchronous communication;
f) has a patient-centric communication and is tracked with a date and time stamp;
g) is connected to the appropriate physician resources; and
h) provides data to update cost reports to enhance emergency triage and to treat and transport patients.
63. Requires each grant recipient to demonstrate proof of veteran employment.
64. Requires each grant recipient, for each year of the Program, to provide a report to ADOA that provides metrics and quantifies cost and time savings for using an interoperable software solution in health care.
65. Requires ADOA, in coordination with AHCCCS, to provide a report on the allocation of grant funding and a compiled analysis of the reports provided by grant recipients, by July 1 of each fiscal year, to the:
a) President of the Senate;
b) Speaker of the House of Representatives;
c) Chairpersons of the Legislative Health and Human Services Standing Committees;
d) Director of the JLBC; and
e) Director of the Governor's Office of Strategic Planning and Budgeting (OSPB).
66. Defines rural as a county with a population of fewer than 900,000 persons.
67. Defines veteran employment as a business organization that employs an individual or has a company officer who served and was honorably discharged or released from service in the armed forces.
68. Repeals the Program on July 1, 2026.
Accelerated Nursing Program Grants
69. Requires DHS, of the monies appropriated in FY 2023 for accelerated nursing programs, to distribute:
a) $6,000,000 to a private university with a health sciences campus in Phoenix that offers a 12-month accelerated nursing program, with monies to be used for capital costs associated with adding a new cohort of accelerated nursing students; and
b) $44,000,000 to public and private universities and community colleges that offer accelerated nursing programs for the purpose of expanding program capacity, with priority given to institutions that offer 12-month accelerated nursing programs, though any program that is up to 18 months in length is still eligible.
70. Requires each university that receives grant monies to demonstrate that each of the following occurs:
a) at least 80 percent of the monies received are used for the costs of providing scholarships, with no more than 20 percent of monies used for administrative expenses;
b) no grant monies are used for capital expansion costs;
c) students receiving scholarships are enrolled in an accelerated nursing program that takes no more than 18-months to complete;
d) students receiving scholarships are required to enter into a four-year nursing contract in this state after completing an accelerated degree;
e) each contract with a student-nurse stipulates that, if a student does not successfully complete the accelerated program in good academic standing or does not fulfill the service requirement, the student must reimburse the university for all scholarship costs;
f) any scholarship reimbursements received by the university will be used to provide scholarship awards to accelerated nursing students enrolled in newly accelerated nursing program seats;
g) scholarships awarded to accelerated nursing students are provided after all other financial gifts, aid or grants and do not exceed the actual cost of tuition and fees; and
h) monies received to provide scholarships do not supplant other institutional financial aid sources.
71. Requires, by September 1 of each year, each university that receives accelerated nursing program grant monies to report to DHS:
a) the number of students who have received a scholarship;
b) the number of nurses who are currently completing the four-year service commitment; and
c) the number of students who have reimbursed the university.
72. Requires DHS, by October 1 of each year, to compile information received from each university and transmit a report to the JLBC and OSPB that includes the total finding distributions by each university.
73. Repeals accelerated nursing program grants on January 1, 2031.
Miscellaneous
74. Accelerates, from July 1, 2023, to January 1, 2023, the transfer of the Psychiatric Security Review Board from DHS to the Superior Court.
75. Continues to exclude county contributions for Proposition 204 administrative costs from county expenditure limitations.
76. Continues to exclude county contributions related to the costs of inpatient, in-custody competency restoration treatment from county expenditure limitations.
77. Continues to allow monies in the Health Services Lottery Monies Fund to be used for purposes specified in the FY 2023 General Appropriations Act.
78. Exempts the DHS from statutory rulemaking requirements for FY 2023 for the purpose of addressing air ambulance service medical staffing.
79. Makes technical and conforming changes.
80. Becomes effective on the general effective date.
Amendment Adopted by the Committee of the Whole
1. Clarifies that any accelerated nursing program that is up to 18 months in length is eligible to receive accelerated nurse program funding.
2. Exempts DHS from statutory rulemaking requirements for FY 2023 for the purpose of addressing air ambulance service medical staffing.
Senate Action
APPROP 6/22/22 DP 4-3-3
Prepared by Senate Research
June 22, 2022
MM/sr