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ARIZONA HOUSE OF REPRESENTATIVESFifty-seventh Legislature First Regular Session |
Senate: HHS DP 7-0-0-0 | APPROP DP 8-0-2-0 | 3rd Read 24-3-3-0 |
SB 1347: AHCCCS; comprehensive dental care
S/E: AHCCCS; noncontracting providers; reimbursement; prohibitions
Sponsor: Senator Shope, LD 16
Committee on Health & Human Services
Summary of the Strike-Everything Amendment to SB 1347
Overview
Requires a contractor to reimburse a noncontracting provider for laboratory services rendered to a member of the Arizona Health Care Cost Containment System (AHCCCS) who is enrolled with the contractor if the member was referred by a contracted provider.
History
Established in 1981, AHCCCS is Arizona's Medicaid program that oversees contracted health plans for the delivery of health care to individuals and families who qualify for Medicaid and other medical assistance programs. Through contracted health plans across the state, AHCCCS delivers health care to qualifying individuals including low-income adults, their children or people with certain disabilities.
A contractor is a person or entity that has a prepaid capitated contract with AHCCCS to provide health care to eligible members or persons either directly or through subcontracts with providers. A noncontracting provider is a person who provides health care to AHCCCS members but not pursuant to a subcontract with a contractor (A.R.S. § 36-2901).
Subject to exclusions and limitations outlined in statute, contractors must provide the following medically necessary health and medical services: 1) inpatient hospital services; 2) outpatient health services; 3) laboratory and X-ray services ordered by a physician or a primary care practitioner; 4) medications that are ordered on prescription by a physician or a dentist; 5) medical supplies, durable medical equipment, insulin pumps and prosthetic devices ordered by a physician or a primary care practitioner; 6) treatment of medical conditions of the eye for persons over 21 years of age; 7) early and periodic health screening and diagnostic service; 8) family planning services; 9) podiatry services; 10) nonexperimental transplants; 11) dental services; 12) ambulance and nonambulance transportation; 13) hospice care; 14) orthotics; 15) medically necessary chiropractic services; and 16) diabetes outpatient self-management training services for up to 10 program hours annually (A.R.S. § 36-2907).
Provisions
1. Requires a contractor to reimburse a noncontracting provider for laboratory services rendered to an AHCCCS member who is enrolled with the contractor if the member was referred by a contracted provider. (Sec. 1)
2. Prohibits a contractor from requiring prior authorization for diagnostic services. (Sec. 1)
3. Prohibits a contractor from taking or threatening to take retaliatory action against a contracted provider for referring an AHCCCS member to a noncontracted provider. (Sec. 1)
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7. SB 1347
8. Initials AG/BG Page 0 Health & Human Services
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