 |
ARIZONA STATE SENATE
Fifty-Fifth Legislature, Second Regular Session
AHCCCS services; diabetes management
Purpose
Requires the Arizona Health Care Cost Containment System (AHCCCS) to cover the costs of up to 10 annual program hours of diabetes self-management training (DSMT) services if prescribed by a primary care physician.
Background
AHCCCS contracts with health professionals to provide
medically necessary health and medical services to eligible members. Currently,
AHCCCS contractors are required to provide:
1) inpatient hospital services; 2) outpatient health services; 3) laboratory
and X-ray services;
4) prescription medications; 5) medical supplies, durable medical equipment,
insulin pumps and prosthetic devices; 6) treatment of medical conditions of the
eye; 7) early and periodic health screening and diagnostic services; 8) family
planning services; 9) podiatry services;
10) nonexperimental transplants; 11) emergency dental care; 12) ambulance and
nonambulance transportation; 13) hospice care; and 14) orthotics (A.R.S.
§ 36-2907).
DSMT services are educational and training services provided to an individual with diabetes by a certified provider in an outpatient setting if the physician who is managing the individual’s diabetic condition certifies that such services are needed under a comprehensive care plan to ensure therapy compliance or to provide the individual with necessary skills and knowledge to participate in the management of the individual’s condition (42 C.F.R. § 1395x).
The Hospital Assessment
Fund consists of monies collected from an assessment of hospital
revenues, discharges or bed days for the purpose of supplementing AHCCCS funding
from the Proposition 204 Protection Account and Arizona Tobacco Litigation Settlement
Fund (A.R.S.
§ 36-2901.09).
If there is an additional cost associated with covering DSMT services, there may be an impact to the state General Fund.
Provisions
1. Requires AHCCCS to cover the costs of up to 10 program hours annually of DSMT services for members initially diagnosed with diabetes, if prescribed by a primary care physician.
2. Extends AHCCCS coverage of DSMT services to members previously diagnosed with diabetes if:
a) a change occurs in the member's diagnosis, medical condition or treatment regimen; or
b) the member is not meeting appropriate clinical outcomes.
3. Prohibits monies from the Hospital Assessment Fund from being used to provide DSMT services.
4. Makes technical and conforming changes.
5. Becomes effective on the general effective date.
House Action
HHS 1/31/22 DP 7-2-0-0
APPROP 2/2/22 DP 13-0-0-0
3rd Read 2/24/22 49-10-1
Prepared by Senate Research
March 7, 2022
MM/CC/sr