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ARIZONA HOUSE OF REPRESENTATIVESFifty-sixth Legislature First Regular Session |
Senate: APPROP DP 6-4-0-0 | 3rd Read 28-8-0-0
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SB 1726: health care; 2023-2024. (Substituted for HB 2816)
Sponsor: Senator Kavanagh (with permission of committee on Rules), LD 3
Transmitted to the Governor
Overview
Contains provisions relating to health care needed to implement the FY 2024 budget.
History
The Arizona Legislature adopts a budget for each fiscal year (FY) that contains general appropriations. Article IV, Section 20, Part 2, Constitution of Arizona, requires the General Appropriations Act (feed bill) to contain only appropriations for the different state departments, state institutions, public schools and interest on public debt. Statutory changes necessary to reconcile the appropriations made in the feed bill and other changes are drafted into separate budget bills. These bills are prepared according to subject area.
Provisions
Arizona Board of Chiropractic Examiners
1. Requires Arizona licensed chiropractors to annually submit their renewal applications by the end of their birth month, rather than by January 1. (Sec. 1)
Children's Health Insurance Program (CHIP)
2. Raises, beginning October 1, 2023, the income eligibility for CHIP to 225% federal poverty level (FPL) subject to approval by the Centers for Medicare and Medicaid Services (CMS). (Sec. 2)
Arizona Department of Administration (ADOA) Session Law Provisions
3. Requires ADOA, for FY 2024, to administer the Interoperability Software Technology Solution Grant Program (Grant Program) to provide a single company that licenses an interoperability software technology solution to support acute care for rural hospitals, health care providers and trauma centers with resources to further treatment and coordination with a focus on reducing public and private health care costs and unnecessary transportation costs. (Sec. 3)
4. Prohibits the grant recipient from using a third-party vendor to comply with any Grant Program requirements. (Sec. 3)
5. Instructs ADOA to award the grant by December 1, 2023. (Sec. 3)
6. Directs AHCCCS to work with ADOA to supplement the grant monies by identifying and applying to receive federal matching monies. (Sec.3)
7. Requires the Grant Program to enable the implementation of a single licensed interoperability software technology solution that is shared by hospitals and health care providers to benefit patient's before and after a patient is discharged from the provider's care and accessible to current and future providers via a mobile, native smartphone application. (Sec. 3)
8. Requires the software to:
a) be made available to participating rural hospitals, health care providers and trauma centers;
b) enable a hospital's electronic medical records system to interface with interoperability technology and other electronic medical records systems; and
c) enable providers to promote mobile connectivity between hospital systems and facilitate increased communication between hospital staff and providers that use different or distinctive online and mobile platforms and information systems when treating acute patients. (Sec. 3)
9. Requires ADOA to award one grant for an interoperability software technology solution that, at a minimum:
a) complies with the Health Insurance Portability and Accountability Act (HIPAA) privacy standards;
b) captures and forwards clinical data, including laboratory results and images and provides synchronous patient clinical data to health care providers regardless of geographic location;
c) provides a synchronous data exchange that is not batched or delayed, at the point the clinical data is captures and available in the hospital's electronic record system;
d) is capable of providing proactive alerts to health care providers on their smartphones or smart devices;
e) allows both synchronous and asynchronous communication via a native smartphone application;
f) is mobile and can be used on multiple electronic devices;
g) has patient-centric communication and is tracked with date and time stamping;
h) is connected to the appropriate physician resources; and
i) provides data to update cost reports to enhance emergency triage and to treat and transport patients. (Sec. 3)
10. Requires the mobile technology to include, at a minimum, the industry standard built-in application for the two most popular operating systems and a built-in application available to all users. (Sec. 3)
11. Requires the grant recipient to demonstrate that its interoperability software technology solution meets all outlined requirements and proof of veteran employment at least 30 days before applying for the grant. (Sec. 3)
12. Instructs the grant recipient for FY 2024 to provide to ADOA a report that provides metrics and quantifies cost and time savings for using an interoperable software solution in health care that complies with HIPAA privacy standards. (Sec. 3)
13. Requires, by June 30, 2024, ADOA in coordination with AHCCCS to provide a report to the following entities on the allocation of grant funding and compiled analysis of the reports provided by the grant recipient:
a) President of the Senate;
b) Speaker of the House of Representatives;
c) Chairpersons of the Senate Health and Human Services and House Health & Human Services Committee;
d) Directors of the Joint Legislative Budget Committee (JLBC); and
e) Governor's Office of Strategic Planning and Budgeting (OSPB). (Sec. 3)
14. Specifies that monies appropriated for the purposes of the Grant Program in the FY 2024 General Appropriations Act do not affect the monies appropriated in FY 2023 for interoperability software technology solutions or any grant awarded to or contract with a grant recipient. (Sec. 3)
15. Repeals the FY 2024 Grant Program requirements by July 1, 2024. (Sec. 3)
Arizona Health Care Cost Containment System (AHCCCS) Session Law Provisions
16. Requires AHCCCS for FY 2024-2026, subject to any required CMS approval, to provide pilot coverage of rapid whole genome sequencing as a separately payable service for members who are under one years old, have a complex or acute illness of unknown etiology and is receiving inpatient hospital services in an intensive care unit or a high acuity pediatric care unit. (Sec. 9)
17. Specifies that rapid whole genome sequencing may be subject to applicable evidence-based medical necessity criteria. (Sec. 9)
18. Requires genetic data generated as a result of performing covered rapid whole genome sequencing to:
a) have a primary use of assisting the ordering health care professional and treating care team to diagnose and treat the patient; and
b) be protected health information subject to the applicable requirements as set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act and their attendant regulations, including HIPAA Privacy Standards. (Sec. 9)
19. Directs AHCCCS to:
a) submit any new waiver application, amendment to an existing waiver or Medicaid state plan amendment necessary for CMS approval of rapid whole genome sequencing coverage; and
b) adopt any rules or take administrative actions to implement rapid whole genome sequencing coverage. (Sec. 9)
20. Requires by December 31, 2024, for FY 2024, AHCCCS to transfer to the counties any portion necessary to comply with the Patient Protection and Affordable Care Act regarding the counties' proportional share of this state's contribution. (Sec. 12)
21. Allows, for the contract year beginning October 1, 2023, and ending September 30, 2024, AHCCCS to continue the risk contingency rate settings for all managed care organizations (MCO) and funding for all MCO administrative funding levels that were imposed for the contract year beginning October 1, 2010 and ending September 30, 2011. (Sec. 16)
22. Continues to state that it is the intent of the Legislature for FY 2024 that AHCCCS implement a program within its available appropriation. (Sec. 17)
Collaborative Care Uptake Fund Session Law Provisions
23. Establishes the Collaborative Care Uptake Fund (Fund) within DHS consisting of monies appropriated by the Legislature that are continuously appropriated. (Sec. 4)
24. Prohibits DHS from using more than three percent of the Fund monies for Fund administration. (Sec. 4)
25. Requires DHS to use Fund monies to award grants to primary care physicians who are in a medical practice with not more than 50 employees to meet the initial costs of establishing and delivering behavioral health integration services through the Collaborative Care Model (Model) and for technical assistance grants. (Sec. 4)
26. Allows a primary care physician who receives a grant to use the monies for:
a) hiring staff;
b) identifying and formalizing contractual relationships with other health care practitioners;
c) purchasing or upgrading software and other resources needed to appropriately provide behavioral health integration services through the Model, including resources needed to establish a patient registry and implement measurement-based care; and
d) any other purpose DHS prescribes as necessary to support the Model. (Sec. 4)
27. Specifies that contractual relationships include health care practitioners who will function as psychiatric consultants and behavioral health care managers in providing behavioral health integration services through the Model. (Sec. 4)
28. Directs DHS to solicit proposals from and enter into grant agreements for FY 2024 with eligible collaborative care technical assistance center applicants to provide technical assistance to primary care physicians on providing behavioral health integration services through the Model. (Sec. 4)
29. Requires each collaborative care technical assistance center applicant to provide in the grant application information on how the collaborative care technical assistance center will meet the prescribed assistance requirements in order to be eligible for a grant. (Sec. 4)
30. Instructs collaborative care technical assistance centers that receive a grant to provide technical assistance to primary care physicians with:
a) developing financial models and budgets for program launch and sustainability based on practice size;
b) developing staffing models for essential staff roles, including care managers and consulting psychiatrists;
c) providing information technology expertise to assist with building the Model requirements into electronic health records, including assistance with care manager tools, patient registry, ongoing patient monitoring and patient records;
d) providing training support for all key staff and operational consultation to develop practice workflows;
e) establishing methods to ensure the sharing of best practices and operational knowledge among primary care physicians who provide behavioral health integration services through the Model; and
f) for any other purposes DHS prescribes as necessary to support the Model. (Sec. 4)
County Session Law Provisions
31.
Sets the annual county Arizona Long Term
Care System (ALTCS) contributions for FY 2024 at $366,205,400 and:
a) outlines each county's contribution;
b) requires the State Treasurer to recover the cost of any funding that was not provided; and
c) requires the State Treasurer to deposit monies received into the ALTCS fund. (Sec. 10)
32. Requires the counties' share of the state's contribution to comply with federal maintenance of effort requirements. (Sec. 10)
33. Sets the FY2024 county acute care contributions at $43,733,700 and:
a) outlines each county's contribution;
b) outlines payment processes and requirements;
c) requires the State Treasurer to recover the cost of any funding that was not provided by a county from other funds owed to that county, excluding the Highway User Revenue Fund; and
d) states that the Legislature intends that the Maricopa County contribution be reduced in each subsequent year according to changes in the GDP price deflator. (Sec. 13)
34. Continues to exclude the Proposition 204 administration costs from the county expenditure limitations. (Sec. 14)
Disproportionate Share Hospital (DSH) Payments Session Law Provisions
35. Sets the annual DSH payment allotment for the Maricopa County Special Health Care District (District) at $113,818,500 for FY 2024 and:
a) requires the District to provide a certified public expense form for the amount of qualifying DSH expenditures made to AHCCCS by May 1, 2024, for all state plan years as required by the AHCCCS state plan;
b) states that if the certification is equal to or less than $113,818,500 and AHCCCS determines the revised amount is correct, AHCCCS must:
i. notify the Governor and the Legislature; and
ii. distribute $4,202,300 to the District and deposit the balance in the state GF.
c) states that if the certification is less than $113,818,500 and AHCCCS determines the revised amount is not correct, AHCCCS must:
i. notify the Governor and the Legislature; and
ii. deposit the total amount in the state GF.
d) provides that if the certification is greater than $113,818,500, AHCCCS must:
i. distribute $4,202,300 to the District; and
ii. $71,248,000 of the federal financial participation in the state GF; and
e) allows AHCCCS to make additional DSH payments to the District pursuant to statute. (Sec. 11)
36. Sets the annual DSH payment allotment to the Arizona State Hospital (ASH) at $28,474,900 for FY 2024 and:
a) requires ASH to provide a certified public expense form for the amount of qualifying DSH expenditures made to AHCCCS by March 31, 2024;
b) directs AHCCCS to:
i. assist ASH in determining the amount of qualifying DSH expenditures; and
ii. deposit the entire amount of federal financial participation in the state GF;
c) states that if the certification is less than $28,474,900, AHCCCS must:
i. notify the Governor and the Legislature; and
ii. deposit the entire amount of federal financial participation in the state GF; and
d) requires the certified public expense form to contain the total amount of qualifying DSH expenditures and the amount limited by federal law. (Sec. 11)
37. Establishes the annual DSH payment allotment for private qualifying DSH hospitals at $884,800 for FY 2024, consistent with the appropriation and the terms of the State plan and:
a) limits payments to hospitals that either:
i. meet the mandatory definition of DSH qualifying hospital under Section 1923 of the Social Security Act; or
ii. are located in Yuma County and contain at least 300 beds. (Sec. 11)
38. Outlines the order of priority for DSH payment allotments for private qualifying hospitals once the preceding DSH distributions are made. (Sec. 11)
Dementia Services Program Session Law Provisions
39. Designates DHS as the lead state agency to address Alzheimer's disease and related forms of dementia. (Sec. 5)
40. Requires the DHS Director to establish a Dementia Services Program (Program) within DHS to do all of the following:
a) facilitate coordination and support of policies and programs in the Legislature and executive branch, including agencies of the executive branch that relate to Alzheimer's disease and related forms of dementia;
b) facilitate the coordination, review, publication and implementation of and updates to the Alzheimer's disease state plan;
c) facilitate and support coordination of outreach programs and services between state agencies, local public health departments, tribal nations, educational institutions and community groups to foster public awareness and education regarding Alzheimer's disease and related forms of dementia;
d) facilitate the coordination of services and activities between groups that are interested in dementia research, programs and services, including Area Agencies on Aging, service providers, advocacy groups, legal services, emergency personnel, law enforcement, local public health departments, tribal nations, state colleges and universities;
e) apply for federal funding and grants related to public health services for and early detection and risk reduction of Alzheimer's disease and related forms of dementia; and
f) incorporate early detection and risk reduction strategies into existing DHS-led public health programs. (Sec. 5)
41. Allows the Program to use community partners, state agencies and local governments for assistance. (Sec. 5)
Alzheimer's Disease State Plan Session Law Provisions
42. Tasks DHS with developing an Alzheimer's disease state plan that:
a) assesses the current and future impact of Alzheimer's disease and related forms of dementia in Arizona;
b) assesses the existing state services and resources that address the needs of persons who have Alzheimer's disease or a related form of dementia and their family caregivers;
c) assesses the needs of persons of all cultural backgrounds who have Alzheimer's disease or a related form of dementia and how their lives are affected by the disease, including from younger-onset, through mid-stage, to late-stage;
d) assesses Arizona's capacity and capability to provide effective detection and diagnosis of cognitive impairments and dementia;
e) identify gaps in the provision of public services and private services for persons who have Alzheimer's disease or a related form of dementia; and
f) provides a strategic plan, including recommendations, for state action that does all of the following:
i. increases access to care, support and treatment for persons who have Alzheimer's disease or a related form of dementia;
ii. improves the quality of care for persons who have Alzheimer's disease or a related form of dementia; and
iii. ensure a coordinated statewide response to Alzheimer's disease and related forms of dementia;
iv. advance risk reduction, early detection and diagnosis of Alzheimer's disease and related form of dementia; and
g) is published on DHS's public website. (Sec. 5)
43. Requires DHS, by July 1, 2024 and June 30, 2026, to review the Alzheimer's disease state plan and submit an updated state plan to the Governor, Legislature and submit a copy to the Secretary of State (SOS). (Sec. 5)
44. Instructs DHS to collaborate with individuals who have Alzheimer's disease or a related form of dementia, those who directly care for them and public, private and nonprofit organizations focused on Alzheimer's care services, research, advocacy, health care and caregiver support when reviewing and updating the Alzheimer's disease state plan. (Sec. 5)
45. Repeals the requirements for the Dementia Services Program and Alzheimer's State Plan on July 1, 2026. (Sec. 5)
Dementia Awareness Report Session Law Provisions
46. Requires DHS to distribute monies appropriated in FY 2024 to implement a public education campaign to increase awareness of Alzheimer's disease and related forms of dementia in rural and underserved urban areas in Arizona to a nonprofit organization that:
a) demonstrates expertise in memory loss, dementia and Alzheimer's disease;
b) provides care and support for those affected by Alzheimer's disease and related forms of dementia;
c) demonstrates experience in marketing and public awareness campaigns; and
d) hosts a toll-free hotline 24 hours a day, seven days a week, with interpreter services if needed, that is staffed by master's-level consultants to provide education on the signs and symptoms of Alzheimer's disease and related forms of dementia, decision-making support, dementia crisis assistance, treatment options and referrals to local community resources. (Sec. 8)
47. Directs DHS, by June 30, 2026, to submit a report to the Governor, Legislature and a copy to the SOS on the impact of the public education campaign. (Sec. 8)
Psilocybin Research Grants Session Law Provisions
48. Requires the DHS Director to provide from appropriated monies, competitive research grants for whole mushroom psilocybin phase one, phase two and phase three clinical trials that are capable of being approved by the U.S. Food and Drug Administration to evaluate the effects of whole mushroom psilocybin on treating any of the following:
a) post-traumatic stress disorder;
b) symptoms associated with long COVID-19;
c) depression;
d) anxiety disorders;
e) symptoms associated with end-of-life distress;
f) obsessive compulsive disorder;
g) substance abuse and addiction disorders;
h) eating disorders;
i) chronic pain;
j) inflammatory disorders;
k) autoimmune disorders;
l) seizure disorders; and
m) other degenerative disorders. (Sec. 6)
49. Requires DHS to announce the opening of the application process at least 30 days before applications are available and allow at least 30 days for applicants to complete their submission. (Sec. 6)
50. Requires funded psilocybin clinical trials to prioritize:
a) using whole mushroom psilocybin cultivated under a schedule I license issued by the U.S. Drug Enforcement Administration; and
b) using veterans, first responders, frontline health care workers and persons from underserved communities as the research subjects. (Sec. 6)
51. Requires psilocybin research grants to be awarded no later than February 1 each year. (Sec. 6)
52. Asserts that a person who receives a grant for a whole mushroom psilocybin clinical trial and any of their employees working on the clinical trial are not to be charged with or prosecuted for psilocybin possession when the person is working on the clinical trial. (Sec. 6)
53. Establishes the 4-member Psilocybin Research Advisory Council (Advisory Council) and outlines membership. (Sec. 6)
54. Authorizes the DHS Director to appoint Advisory Council members and serve as Chairperson of the Advisory Council. (Sec. 6)
55. Requires the Advisory Council to:
a) establish criteria for the clinical trials that qualify to receive research grants;
b) oversee the application process and review applications for the clinical trial research grants to assist the DHS Director in selecting the most credible clinical trials to award the research grants; and
c) ensure that all Advisory Council meetings are open to the public and allow for public testimony. (sec. 6)
56. Specifies that Advisory Council members are eligible to receive reimbursement of expenses. (Sec. 6)
57. Requires the Advisory Council, annually on June 1, to make recommendations to the Governor, Legislature and DHS on psychedelic-assisted therapy based on current and federal state research policy. (Sec. 6)
58. Repeals the Psilocybin Competitive Research Grant requirements by July 1, 2026. (Sec. 6)
Student Registered Nurse Anesthetist Clinical Rotation Program (Program)
Session Law Provisions
59. Establishes the Program within the Arizona State Board of Nursing (Board) for FY 2024 to expand the capacity of preceptor training programs at health care institutions for nurse anesthetist students. (Sec. 7)
60. Requires the Board to develop a grant program for FY 2024 to distribute Program monies to licensed health care institutions to expand or develop clinical training placements for nurse anesthetist students, with preference given to the expansion or development of clinical rotations in obstetrics, pediatrics and cardiovascular care. (Sec. 7)
61. Specifies that awarded grant monies are intended to supplement and not supplant existing training program expenses covered by the health care institution grantee. (Sec. 7)
62. Instructs the Board to establish an application process for the grant program. (Sec. 7)
63. Requires the Board to consider the following factors when determining grant awards:
a) the geographic and population distribution;
b) the number of nurse anesthetist students expected to be trained and retained; and
c) the cost of the proposal for the number of nurse anesthetist students expected to participate and be retained compared to other proposals. (Sec. 7)
Miscellaneous Session law Provisions
64. Exempts county expenditures for restoration to competency treatment from the county expenditure limitation. (Sec. 15)
65. Defines terms. (Sec. 4, 6 and 7)
66.
Makes technical and
conforming changes. (Sec. 1, 2)
67.
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70. SB 1726
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