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ARIZONA HOUSE OF REPRESENTATIVESFifty-seventh Legislature First Regular Session |
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HB 2945: developmental disabilities; appropriations; waivers
Sponsor: Representative Livingston (with permission of committee on Rules), LD 28
Committee on Appropriations
Overview
An emergency measure that appropriates a total of $109,200,300 from various sources and $403,000,000 in developmental disabilities (DD) Medicaid expenditure authority in FY 2025 to the Arizona Department of Economic Security (DES) for DD Medicaid Program expenses. Appropriates $13,100,000 from the Prescription Drug Rebate Fund in FY 2025 to DES for Cost-Effectiveness Study – Client Services. Outlines requirements relating to waiver amendment requests, capitation rates and reporting requirements for the use of federal funds.
History
AHCCCS
Laws 1981, Fourth Special Session, Chapter 1, effective 1982, established AHCCCS to administer Arizona's Medicaid program. It is a federal health care program jointly funded by the federal and state government that oversees contracted health plans for the delivery of health care services to individuals and families who qualify for Medicaid and other medical assistance programs. AHCCCS statutory authority is outlined in Arizona Revised Statutes Title 36, Chapter 29 (AHCCCS Administration) and Chapter 34 (Behavioral Health Services).
AHCCCS operates under an integrated managed care model, through a Research and Demonstration 1115 Waiver. The 1115 Waiver refers to Section 1115 of the Social Security Act (SSA). The 1115 Waiver grants the U.S. Secretary of Health and Human Services the authority to approve experimental, pilot or demonstration projects that promote the objectives of the Medicaid program. States must comply with Title XIX (Medicaid) and Title XXI (Children's Health Insurance Program) of the SSA. AHCCCS has been exempt from specific provisions of the SSA, pursuant to an 1115 Research and Demonstration Waiver.
AHCCCS Parent as Paid Caregivers 1115 Waiver Amendment Request
During the federal COVID-19 Public Health Emergency, AHCCCS received temporary authority from the Centers for Medicare and Medicaid Services (CMS) to allow parents of minor children with disabilities to be paid caregivers. The temporary authority ensured children received services during the Public Health Emergency and continued when direct care workers became ill or left the workforce. AHCCCS sent an 1115 Waiver amendment to CMS requesting to make this authority permanent on September 27, 2023 (1115 Waiver Amendment Request).
AHCCCS received approval from CMS to permanently allow parents of minor children to get paid to provide attendant care and habilitation when it meets an extraordinary care definition. Extraordinary care is described as: 1) care for the Medicaid member that exceeds the range of activities a parent would ordinarily perform in the household on the member’s behalf if they did not have a disability or chronic illness; and 2) care which is necessary to assist the Medicaid member’s health and welfare to avoid institutionalization.
DES and AHCCCS work collaboratively to implement the Parents as Paid Caregivers (PPCG) Program (AHCCCS/DES PPCG letter).
Cost-Effectiveness Study – Client Services
The FY 2025 Enacted Budget included $8,420,000 for Cost-Effectiveness Study (CES) – Client Services. Of that amount, $7,200,000 came from the state General Fund and $1,220,000 from the Special Administration Fund. The DD program's Federal Waiver requires a client's home and community-based services to be at or below the cost of an institutional setting to ensure home and community-based services are cost-neutral for the federal government. The CES – Client Services line-item funds the costs of clients above the CES rate of an institutional setting, allowing them to remain in a home and community-based setting.
Federal Grants-In-Aid Reporting Requirements
The Director of the Governor's Office of Strategic Planning and Budgeting (OSPB) is required to report to the Legislature each regular session findings and recommendations relating to federal grants-in-aid. The report on federal grants-in-aid is required to specify findings and recommendations on: 1) the total amount received by state agencies during the prior fiscal year; 2) the total amount available to state agencies during the prior fiscal year; 3) the adequacy of grant-in-aid programs in this state; 4) the federal grant-in-aid programs this state does not participate in; 5) legislation necessary for the activation of federal programs the state does not participate in; 6) legislation necessary for the improved operation of federal-in-grant programs in progress in this state; and 7) the advisability of accepting new grant-in-aid programs or discontinuing existing programs (A.R.S. § 41-723).
Provisions
Division of Developmental Disabilities
1. Appropriates the following amounts in FY 2025 to DES for DD Medicaid Program expenses:
a) $10,000,000 from the Arizona Competes Fund;
b) $38,000,000 from the Housing Trust Fund;
c) $61,200,300 from the Prescription Drug Rebate Fund; and
d) $403,000,000 in DD Medicaid expenditure authority. (Sec. 4)
2. Appropriates $13,100,000 from the Prescription Drug Rebate Fund in FY 2025 to DES for DD CES - Client Services. (Sec. 4)
Waivers
3. Requires capitation rate adjustments for the following fiscal year for DES for persons with developmental disabilities and AHCCCS to be specified in the General Appropriations Act. (Sec. 1)
4. Prohibits AHCCCS from submitting to CMS or its successor agency any new, renewal or termination request for any waiver or waiver amendments without first obtaining legislative approval in the form of an authorizing statute. (Sec. 2)
5. Directs DES and AHCCCS to implement the weekly cap of 40 hours of care services per child for the PPCG Program by July 1, 2025. (Sec. 2)
6. Requires AHCCCS to submit a waiver amendment request to CMS to lower the PPCG Program weekly care services cap to 20 hours per child. (Sec. 2)
7. Clarifies that the waiver amendment request does not limit the total direct care services hours available to an eligible member. (Sec. 2)
Federal Monies Reporting Requirements
8. Requires the Director of OSPB annually on September 1 or with the submission of agency budget requests to report to the staff of the Joint Legislative Budget Committee (JLBC):
a) a report on the use of federal monies by any state agency that receives or expects to receive federal monies or administers a program supported by federal monies; and
b) if any state agency received notice of a reduction in federal monies from a specific grant of 50% or more from the previous fiscal year and the plan to either reduce or eliminate the services provided through the grant or to continue services without increases to any state resources. (Sec. 3)
9. Directs the report on the use of federal monies by a state agency to:
a) delineate the federal monies received for the prior fiscal year;
b) delineate the federal monies to be used by the agency for the current and upcoming fiscal year, including any programs supported by federal monies in which a loss of those monies may impact the continuity or delivery of services;
c) identify the date, if known, when federal monies are set to expire;
d) identify any obligations, agreements or memoranda of understanding that may be impacted by federal or state decisions regarding federal receipts, including state matching requirements; and
e) calculate the percentage of federal monies from the total monies available for the state agency for the fiscal year. (Sec. 3)
10. Exempts universities under the jurisdiction of the Arizona Board of Regents from the usage of federal monies reporting requirements for state agencies. (Sec. 3)
11. Requires universities to submit an audited schedule of federal award spending for the prior fiscal year to JLBC staff. (Sec. 3)
12. Eliminates reporting requirements for the Director of OSBP relating to:
a) the total amount of federal grants-in-aid received by state agencies during the prior fiscal year;
b) the total amount of federal grants-in-aid available to state agencies during the prior fiscal year and the reasons for any differences between the amount of money available to the amount accepted by state agencies; and
c) the adequacy of grant-in-aid programs in this state. (Sec. 3)
Miscellaneous
13. Contains an emergency clause. (Sec. 5)
14. Defines terms. (Sec. 2)
15. Makes technical and conforming changes. (Sec. 1, 3)
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19. HB 2945
20. Initials JB/AG Page 0 Appropriations
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