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-REFERENCE TITLE: 2026-2027; health care.
-
-State of Arizona
-
-House of Representatives
-
-Fifty-seventh Legislature
-
-Second Regular Session
-
-2026
-
-HB 4145
-
-Introduced by
-
-Representatives
-  Livingston: Carbone, Carter N, Montenegro, Willoughby (with permission of
-  Committee on Rules)
-
-AN
-ACT
-
-Amending title 36, chapter 29, article 1,
-Arizona Revised Statutes, by adding sections 36-2903.18 and 36-2903.19;
-appropriating monies; relating to health care.
-
-(TEXT OF BILL BEGINS ON NEXT PAGE)
-
-Be it enacted by the Legislature of the State of Arizona:
-
-Section 1. Title 36, chapter 29, article 1,
-Arizona Revised Statutes, is amended by adding sections 36-2903.18 and 36-2903.19,
-to read:
-
-START_STATUTE36-2903.18. Data matching agreements; review of member eligibility
-information; quarterly eligibility redetermination; waiver requests
-
-A. The administration shall enter
-into a data matching agreement with the department of revenue
-to identify members who have lottery or gambling winnings of $3,000 or
-more. the administration shall review this information On at least a
-monthly basis. If a member fails to disclose winnings of $3,000 or
-more and is identified through the database match, the administration shall
-consider the member's failure to disclose the information a violation of the
-system's terms of eligibility.
-
-B. On at least a monthly basis, the
-administration shall:
-
-1. Receive and review death records
-information from the department of health services concerning members and shall
-adjust system eligibility accordingly.
-
-2. Review information concerning
-members that indicates a change in circumstances that may affect eligibility,
-including potential changes in residency as identified by out-of-state
-electronic benefit transfer card transactions.
-
-C. On a quarterly basis, the
-administration shall redetermine the eligibility of able-bodied
-adults who are eligible pursuant to section 36-2901, 36-2901.01 or
-36-2901.07 and who are not american indians or alaskan
-natives. For the purposes of the redetermination process, the
-administration shall receive and review information from both:
-
-1. the department of revenue
+ARIZONA HOUSE OF REPRESENTATIVES
+
+57th
+  Legislature, 2nd Regular Session
+
+Majority Research Staff
+
+HB
+4145: 2026-2027; health care.
+
+Sponsor:
+Representative Livingston, LD 28
+
+Committee
+on Appropriations
+
+Overview
+
+Contains provisions relating to
+health care needed to implement the FY 2027 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
+Department of Administration (ADOA)
+
+1.
+Requires
+ADOA to implement a 10% increase to medical premiums paid by active employees
+and retirees enrolled in the state employee health plan for Plan Year (PY)
+2027. (Sec. 6)
+
+2.
+States the
+Legislature intends that ADOA increase these premiums by an additional 5% in PY
+2028 and 5% in PY 2029.� (Sec. 6)
+
+Arizona
+Health Care Cost Containment System (AHCCCS) Member Eligibility
+
+3.
+Requires
+AHCCCS to enter into a data matching agreement with Department of Revenue (DOR)
+to identify members who have lottery or gambling winnings of $3,000 or more and
+directs AHCCCS to review this information at least once a month. (Sec. 1)
+
+4.
+Declares
+that a member who fails to disclose winnings of $3,000 or more and who is
+identified by AHCCCS through the database match is in violation of AHCCCS's
+terms of eligibility. (Sec. 1)
+
+5.
+Requires
+AHCCCS, at least once a month, to:
+
+a.
+receive and
+review death record information from the Department of Health Services
+concerning its members and to adjust system eligibility accordingly; and
+
+b.
+review
+information concerning members indicating a change in circumstances that may
+affect eligibility, including changes in residency as identified by
+out-of-state electronic benefit transfer card transactions. (Sec. 1)
+
+6.
+Directs
+AHCCCS, at least once a quarter, to:
+
+a.
+redetermine
+the eligibility of able-bodied adults who are eligible and not American Indians
+or Alaskan natives; and
+
+b.
+for the
+purposes of the redetermination process, receive and review information from:
+
+i.
+DOR that
+indicates a change in members' circumstances that may affect eligibility,
+including potential changes in income, wages or residency as identified by tax
+records; and
+
+ii.
+DES
 concerning members that indicates a change in circumstances that may affect
-eligibility for the system, including potential changes in income, wages or
-residency as identified by tax records.
-
-2. the department of economic
-security concerning members that indicates a change in circumstances that may
-affect eligibility, including changes to unemployment benefits, employment
-status or wages.
-
-D. Unless required by federal law,
-the administration may not accept self-attestation of income, residency,
-age, household composition, caretaker or relative status or receipt of other
-health insurance coverage without independent verification before
-enrollment. The administration may not request authority to waive or
-decline to periodically check any available income-related data sources
-to verify eligibility.
-
-E. The administration may not accept
-eligibility determinations for the system from an exchange established pursuant
-to 42 United States code section 18041(c). The
-administration may accept assessments from an exchange established pursuant to
-42 United States code section 18041(c) but shall
-independently verify eligibility and make eligibility determinations.
-
-F. If the administration receives
-information concerning a member that indicates a change in the member's
-circumstances that may affect eligibility, the administration shall review the
-member's eligibility.
-
-G. The administration may execute a
-memorandum of understanding with any other department of this state for
-information required to be shared pursuant to this section. The
-administration may contract with one or more independent vendors to provide
-additional data or information that may indicate a change in circumstances and
-affect an individual's eligibility.
-
-H. On or before April 1, 2027, the
-administration shall submit to the centers for medicare and medicaid services
-any waiver requests necessary to implement this section. END_STATUTE
-
-START_STATUTE36-2903.19. Presumptive eligibility; limits; standards; notification;
-training
-
-A. The administration shall request
-approval from the centers for medicare and medicaid services for a section 1115
-waiver to allow the administration to eliminate mandatory hospital presumptive
-eligibility and restrict presumptive eligibility determinations to children and
-pregnant women eligibility groups. If approval for the section 1115
-waiver is denied, the administration shall resubmit a subsequent request for
-approval within twelve months after each denial.
-
-B. Unless required by federal law,
-the administration may not designate itself as a qualified health entity for
-the purpose of making presumptive eligibility determinations or for any purpose
-not expressly authorized by state law.
-
-C. When making presumptive
-eligibility determinations, a qualified hospital shall do all of the following:
-
-1. Notify the administration of each
-presumptive eligibility determination within five working days after the date
-the determination is made.
-
-2. Assist individuals who are
-determined presumptively eligible under the system with completing and
-submitting a full application for system eligibility.
-
-3. Notify each applicant in writing
-and on all relevant forms with plain language and large print that if the
-applicant does not file a full application for system eligibility with the
-administration before the last day of the following month, presumptive
-eligibility coverage will end on the last day of the following month.
-
-4. Notify each applicant that if the
-applicant files a full application for system eligibility with the
-administration before the last day of the following month, presumptive
-eligibility coverage will continue until an eligibility determination is made
-on the application that is filed.
-
-D. The administration shall apply the
-following standards to establish and ensure that accurate presumptive
-eligibility determinations are made by each qualified hospital:
-
-1. Whether the qualified hospital
-submitted to the administration the presumptive eligibility card within five
-working days after the determination date.
-
-2. Whether a full application for
-system eligibility was received by the administration before the expiration of
-the presumptive eligibility period.
-
-3. If a full application was received
-by the administration, whether the individual was found to be eligible under
-the system.
-
-E. If the administration determines
-that a qualified hospital fails to meet any of the standards established under
-subsection D of this section for any presumptive eligibility determination that
-the qualified hospital made, the administration shall notify the qualified
-hospital in writing within five days after the determination. The
-notice must include:
-
-1. For the first violation, both of
-the following:
-
-(a) A
+eligibility, including changes to unemployment benefits, status or wages. (Sec.
+1)
+
+7.
+Prohibits
+AHCCCS, unless required by federal law, from accepting self-attestation of
+income, residency, age, household composition, caretaker or relative status or
+receipt of other health insurance coverage without independent verification
+before enrollment.�� (Sec. 1)
+
+8.
+Bars AHCCCS
+from requesting the authority to waive or decline to periodically check any
+available income-related data sources to verify eligibility. (Sec. 1)
+
+9.
+Prohibits
+AHHCS from accepting eligibility determinations for the system from a
+federally-facilitated exchange established in accordance with federal law.
+(Sec. 1)
+
+10.
+Allows
+AHCCCS to accept assessments from a federally-facilitated exchange established
+in accordance with federal law. (Sec. 1)
+
+11.
+Requires
+AHCCCS to independently verify eligibility and make eligibility determinations
+from the assessments accepted from a federally-facilitated exchange. (Sec. 1)
+
+12.
+Requires
+AHCCCS to review a member�s eligibility if it receives information concerning
+that member indicating a change in circumstances that may affect eligibility.
+(Sec. 1)
+
+13.
+Allows
+AHCCCS to enter a memorandum of understanding with any other department of this
+state to obtain the required information. (Sec. 1)
+
+14.
+Authorizes
+AHCCCS to contract with one or more independent vendors to provide additional
+data or information that may indicate a change in an individual's circumstances
+and eligibility. (Sec. 1)
+
+15.
+Requires
+AHCCCS to submit any waiver requests necessary to implement this act's
+requirements to the Centers for Medicare and Medicaid Services (CMS) on or
+before April 1, 2027. (Sec. 1)
+
+Presumptive Eligibility
+Determinations
+
+16.  Requires AHCCCS to request
+approval from CMS for a section 1115 wavier to allow the agency to eliminate
+mandatory hospital presumptive eligibility and restrict presumptive eligibility
+determinations to only children and pregnant women eligibility groups.���������
+(Sec. 1)
+
+17.
+Declares
+that if the section 1115 waiver request for restricting presumptive eligibility
+is denied by CMS, AHCCCS is required to resubmit a subsequent request within 12
+months of each denial. (Sec. 1)
+
+18.
+Prohibits
+AHCCCS, unless required by federal law, from designating itself as a qualified
+health entity for the purpose of making presumptive eligibility determinations
+or for any other purpose not expressly authorized by statute. (Sec. 1)
+
+19.
+Requires a
+qualified hospital making presumptive eligibility determinations to:
+
+a.
+notify
+AHCCCS of each presumptive eligibility determination within five working days
+of the determination being made;
+
+b.
+assist
+individuals determined to be presumptively eligible by the qualified hospital
+with completing and submitting a full application for AHCCCS eligibility;
+
+c.
+notify each
+applicant in writing and on all relevant forms that if the applicant does not
+file a full application before the last day of the following month, presumptive
+eligibility coverage will end on the last day of the following month; and
+
+d.
+notify each
+applicant that if they file a full application for AHCCCS eligibility before
+the last day of the following month coverage will continue until an eligibility
+determination is made on the filed application. (Sec. 1)
+
+20.
+Outlines
+standards AHCCCS must establish and apply in order to ensure that accurate
+presumptive eligibility determinations are made by each qualified hospital.
+(Sec. 1)
+
+21.
+Requires
+AHCCCS to notify a qualified hospital that fails to meet the established
+standards for any presumptive eligibility determinations within five days after
+the determination:
+
+a.
+for the
+first violation:
+
+i.
+a
 description of the standard that was not met and an explanation of why it was
-not met.
-
-(b) Confirmation
-that a second finding will require that all applicable hospital staff
-participate in mandatory training by the administration on hospital presumptive
-eligibility rules.
-
-2. For the second violation, all of
-the following:
-
-(a) A
+not met; and
+
+ii.
+confirmation
+that a second finding will require all applicable hospital staff to participate
+in mandatory training by AHCCCS on hospital presumptive eligibility rules.
+
+b.
+for the
+second violation;
+
+i.
+a
 description of the standard that was not met and an explanation of why it was
-not met.
-
-(b) Confirmation
-that all applicable hospital staff will be required to participate in mandatory
-training by the administration on hospital presumptive eligibility rules,
-including the date, time and location of the training as determined by the
-administration.
-
-(c) A
-description of available appeals procedures by which a qualified hospital may
-dispute the finding and remove the finding from the qualified hospital's record
-by providing clear and convincing evidence that the standard was met.
-
-(d) Confirmation
-that if the qualified hospital subsequently fails to meet any standard for
-presumptive eligibility for any determination, the qualified hospital will no
-longer be qualified to make presumptive eligibility determinations under the
-system.
-
-3. For the third violation, all of
-the following:
-
-(a) A
+not met; and
+
+ii.
+confirmation
+that all applicable hospital staff are required to participate in mandatory
+training by AHCCCS on hospital presumptive eligibility rules and the date, time
+and location of the training as determined by AHCCCS;
+
+iii.
+a
+description of available appellate procedures by which a qualified hospital may
+dispute the finding and remove it from the hospital's record by providing clear
+and convincing evidence the standards were met; and
+
+iv.
+confirmation
+that if the qualified hospital subsequently fails to meet any of the standards
+for presumptive eligibility the hospital will no longer be qualified to make
+presumptive eligibility determinations under AHCCCS.
+
+c.
+For the
+third violation:
+
+i.
+a
 description of the standard that was not met and an explanation of why it was
-not met.
-
-(b) A
-description of available appeals procedures by which a qualified hospital may
-dispute the finding and remove the finding from the qualified hospital's record
-by providing clear and convincing evidence that the standard was met.
-
-(c) Confirmation
-that, effective immediately, the qualified hospital is no longer qualified to
-make presumptive eligibility determinations under the system. END_STATUTE
-
-Sec. 2. ALTCS; county
-contributions; fiscal year 2026-2027
-
-A. Notwithstanding section
-11-292, Arizona Revised Statutes, county contributions for the Arizona
-long-term care system for fiscal year 2026-2027 are as follows:
-
-1. Apache���������������������������������� $  792,400
-
-2. Cochise��������������������������������� $ 8,055,900
-
-3. Coconino�������������������������������� $ 2,378,900
-
-4. Gila������������������������������������ $ 3,365,400
-
-5. Graham���������������������������������� $ 2,320,400
-
-6. Greenlee�������������������������������� $  138,200
-
-7. La Paz���������������������������������� $  756,100
-
-8. Maricopa�������������������������������� $298,895,000
-
-9. Mohave���������������������������������� $ 12,022,500
-
-10. Navajo��������������������������������� $ 3,279,800
-
-11. Pima����������������������������������� $ 68,282,000
-
-12. Pinal���������������������������������� $ 19,662,800
-
-13. Santa Cruz����������������������������� $ 3,204,100
-
-14. Yavapai�������������������������������� $ 8,793,400
-
-15. Yuma����������������������������������� $ 13,867,000
-
-B. If the overall cost for
-the Arizona long-term care system exceeds the amount specified in the general
-appropriations act for fiscal year 2026-2027, the state treasurer shall
-collect from the counties the difference between the amount specified in
-subsection A of this section and the counties' share of the state's actual
-contribution. The counties' share of the state's contribution must
-comply with any federal maintenance of effort requirements. The
-director of the Arizona health care cost containment system administration
-shall 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. The state treasurer shall withhold from any other
-monies payable to a county from whatever state funding source is available an
-amount necessary to fulfill that county's requirement specified in this
-subsection. The state treasurer may not withhold distributions from
-the Arizona highway user revenue fund pursuant to title 28, chapter 18, article
-2, Arizona Revised Statutes.� The state treasurer shall deposit the amounts
-withheld pursuant to this subsection and amounts paid pursuant to subsection A
-of this section in the long-term care system fund established by section 36-2913,
-Arizona Revised Statutes.
-
-Sec. 3. AHCCCS; disproportionate share payments; fiscal year
-2026-2027
-
-A. Disproportionate
-share payments for fiscal year 2026-2027 made pursuant to section
-36-2903.01, subsection O, Arizona Revised Statutes, include:
-
-1. $28,474,900 for the
-Arizona state hospital. The Arizona state hospital shall provide a
-certified public expense form for the amount of qualifying disproportionate
-share hospital expenditures made on behalf of this state to the Arizona health
-care cost containment system administration on or before March 31,
-2027. The administration shall assist the Arizona state hospital in
-determining the amount of qualifying disproportionate share hospital
-expenditures. Once the administration files a claim with the federal
-government and receives federal financial participation based on the amount
-certified by the Arizona state hospital, the administration shall deposit the
-entire amount of federal financial participation in the state general
-fund. If the certification provided is for an amount less than
-$28,474,900, the administration shall notify the governor, the president of the
-senate and the speaker of the house of representatives and shall deposit the
-entire amount of federal financial participation in the state general
-fund. The certified public expense form provided by the Arizona
-state hospital must contain both the total amount of qualifying
-disproportionate share hospital expenditures and the amount limited by section
-1923(g) of the social security act.
-
-2. $884,800 for private
-qualifying disproportionate share hospitals.� The Arizona health care cost
-containment system administration shall make payments to hospitals consistent
-with this appropriation and the terms of the state plan, but payments are
-limited to those hospitals that either:
-
-(a) Meet
-the mandatory definition of disproportionate share qualifying hospitals under
-section 1923 of the social security act.
-
-(b) Are
-located in Yuma county and contain at least three hundred beds.
-
-B. After the distributions made pursuant to subsection A of
-this section, the allocations of disproportionate share hospital payments made
-pursuant to section 36-2903.01,
-subsection P, Arizona Revised Statutes, shall be made available in the
-following order to qualifying private hospitals that are:
-
-1. Located in a county with
-a population of less than four hundred thousand persons.
-
-2. Located in a county with
-a population of at least four hundred thousand persons but less than nine
-hundred thousand persons.
-
-3. Located in a county with
-a population of at least nine hundred thousand persons.
-
-Sec. 4. AHCCCS transfer; counties; federal monies; fiscal year
-2026-2027
-
-On or
-before December 31, 2027, notwithstanding any other law, for fiscal year 2026-2027,
-the Arizona health care cost containment system administration shall transfer
-to the counties the portion, if any, as may be necessary to comply with section
-10201(c)(6) of the patient protection and affordable care act (P.L. 111-148),
-regarding the counties' proportional share of this state's contribution.
-
-Sec. 5. County acute care
-contributions; fiscal year 2026-2027; intent
-
-A. Notwithstanding section
-11-292, Arizona Revised Statutes, for fiscal year 2026-2027 for the provision
-of hospitalization and medical care, the counties shall contribute the
-following amounts:
-
-1. Apache ��������������������������������� $  268,800
-
-2. Cochise��������������������������������� $ 2,214,800
-
-3. Coconino�������������������������������� $  742,900
-
-4. Gila������������������������������������ $ 1,413,200
-
-5. Graham���������������������������������� $  536,200
-
-6. Greenlee�������������������������������� $  190,700
-
-7. La Paz���������������������������������� $  212,100
-
-8. Maricopa�������������������������������� $14,417,300
-
-9. Mohave���������������������������������� $ 1,237,700
-
-10. Navajo��������������������������������� $  310,800
-
-11. Pima����������������������������������� $14,951,800
-
-12. Pinal���������������������������������� $ 2,715,600
-
-13. Santa Cruz����������������������������� $  482,800
-
-14. Yavapai�������������������������������� $ 1,427,800
-
-15. Yuma����������������������������������� $ 1,325,100
-
-B. If a county does not
-provide funding as specified in subsection A of this section, the state
-treasurer shall subtract the amount owed by the county to the Arizona health
-care cost containment system fund and the long-term care system fund
-established by section 36-2913, Arizona Revised Statutes, from any payments
-required to be made by the state treasurer to that county pursuant to section
-42-5029, subsection D, paragraph 2, Arizona Revised Statutes, plus interest on
-that amount pursuant to section 44-1201, Arizona Revised Statutes, retroactive
-to the first day the funding was due. If the monies the state
-treasurer withholds are insufficient to meet that county's funding requirements
-as specified in subsection A of this section, the state treasurer shall
-withhold from any other monies payable to that county from whatever state
-funding source is available an amount necessary to fulfill that county's
-requirement. The state treasurer may not withhold distributions from
-the Arizona highway user revenue fund pursuant to title 28, chapter 18, article
-2, Arizona Revised Statutes.
-
-C. Payment of an amount
-equal to one-twelfth of the total amount determined pursuant to subsection A of
-this section shall be made to the state treasurer on or before the fifth day of
-each month. On request from the director of the Arizona health care
-cost containment system administration, the state treasurer shall require that
-up to three months' payments be made in advance, if necessary.
-
-D. The state treasurer
-shall deposit the amounts paid pursuant to subsection C of this section and
-amounts withheld pursuant to subsection B of this section in the Arizona health
-care cost containment system fund and the long-term care system fund
-established by section 36-2913, Arizona Revised Statutes.
-
-E. If payments made
-pursuant to subsection C of this section exceed the amount required to meet the
-costs incurred by the Arizona health care cost containment system for the
-hospitalization and medical care of those persons defined as an eligible person
-pursuant to section 36-2901, paragraph 6, subdivisions (a), (b) and (c),
-Arizona Revised Statutes, the director of the Arizona health care cost
-containment system administration may instruct the state treasurer either to
-reduce remaining payments to be paid pursuant to this section by a specified
-amount or to provide to the counties specified amounts from the Arizona health
-care cost containment system fund and the long-term care system fund
-established by section 36-2913, Arizona Revised Statutes.
-
-F. The legislature intends
-that the Maricopa county contribution pursuant to subsection A of this section
-be reduced in each subsequent year according to the changes in the GDP price
-deflator.� For the purposes of this subsection, "GDP price deflator"
-has the same meaning prescribed in section 41-563, Arizona Revised Statutes.
-
-Sec. 6. Department of
-administration; state employee health insurance; premiums; intent
-
-A. Notwithstanding sections
-38-651, 38-651.01 and 38-654, Arizona Revised Statutes, for
-the health insurance benefit plan year 2027 the department of administration
-shall implement a ten percent increase to the health insurance premium
-contributions paid by full-time officers and employees of this state and
-by former employees who worked for this state and who opt on retirement to
-enroll or continue enrollment in the group health and accident coverage for
-active employees working for this state.
-
-B. The legislature intends
-that for the health insurance benefit plan years 2028 and 2029 the department
-of administration implement in each plan year a five percent increase to the
-health insurance premium contributions paid by full-time officers and
-employees of this state and by former employees who worked for this state and
-who opt on retirement to enroll or continue enrollment in the group health and
-accident coverage for active employees working for this state.
-
-Sec. 7. AHCCCS; mental health medication utilization; report;
-definition
-
-A. Not
-later than January 31, 2027, the Arizona health care cost containment system
-administration shall prepare and issue a report to the governor, the
-chairpersons of the house of representatives and senate health and human
-services committees, or their successor committees, the director of the joint
-legislative budget committee and the director of the governor's office of
-strategic planning and budgeting that includes information about the costs and
-aggregate spending on and aggregate utilization of mental health medications
-during contract year 2024-2025.� The administration shall provide a copy
-of the report to the secretary of state.
-
-B. The report required by
-subsection A of this section shall include the annual aggregate gross amount
-spent for each mental health medication class and the annual aggregate net
-amount spent by this state for each mental health medication class after
-rebates without disclosing any information about manufacturer-negotiated
-supplemental rebate agreements for any specific drug. The report
-shall also include the average annual cost by class for generic and nongeneric
-mental health medications. Without disclosing any information about
-manufacturer-negotiated supplemental rebate agreements that could
-compromise the competitive or proprietary nature of these agreements, for
-antipsychotic and antidepressant medications, the report shall include the
-total number of prior authorizations submitted for nonpreferred antipsychotic
-and nonpreferred antidepressant medications, the percentage of prior
-authorization approvals and denials, the generic antipsychotic and generic
-antidepressant medication utilization percentages and the total amount of
-antipsychotic and antidepressant medication claims.
-
-C. For purposes of this
-section, "mental health medication" means the following medications:
-
-1. Antipsychotics.
-
-2. Antidepressants.
-
-3. Anxiolytics.
-
-4. Stimulants.
-
-5. Sedative hypnotics.
-
-Sec. 8. Proposition 204
-administration; exclusion; county expenditure limitations
-
-County contributions for the
-administrative costs of implementing sections 36-2901.01 and 36-2901.04,
-Arizona Revised Statutes, that are made pursuant to section 11-292, subsection
-O, Arizona Revised Statutes, are excluded from the county expenditure limitations.
-
-Sec. 9. Competency
-restoration; exclusion; county expenditure limitations
-
-County contributions made pursuant to
-section 13-4512, Arizona Revised Statutes, are excluded from the county
-expenditure limitations.
-
-Sec. 10. AHCCCS; risk
-contingency rate setting
-
-Notwithstanding any other law, for the
-contract year beginning October 1, 2026 and ending September 30, 2027, the
-Arizona health care cost containment system administration may continue the
-risk contingency rate setting for all managed care organizations and the
-funding for all managed care organizations administrative funding levels that
-were imposed for the contract year beginning October 1, 2010 and ending
-September 30, 2011.
-
-Sec. 11. Legislative
-intent; implementation of program
-
-The legislature intends that for
-fiscal year 2026-2027 the Arizona health care cost containment system
-administration implement a program within the available appropriation.
-
-Sec. 12. Effective date
-
-Sections 36-2903.18 and 36-2903.19,
-Arizona Revised Statutes, as added by this act, are effective from and after
-December 31, 2026.
+not met; and
+
+ii.
+a
+description of available appellate procedures by which a qualified hospital may
+dispute the finding and remove it from the hospital's record by providing clear
+and convincing evidence the standards were met; and
+
+iii.
+confirmation
+that, effective immediate, the hospital is no longer qualified to make
+presumptive eligibility determinations under AHCCCS. (Sec. 1)
+
+22.
+Contains an
+effective date of January 1, 2027. (Sec. 12)�
+
+County Session Law Provisions
+
+23.
+Sets the
+annual county Arizona Long Term Care System (ALTCS) contributions for FY 2027
+at $445,813,900 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.
+2)�������
+
+24.
+Requires the
+counties' share of the state's contribution to comply with federal maintenance
+of effort requirements. (Sec. 2)������
+
+25.
+Sets the FY
+2027 county acute care contributions at $42,447,600 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. 5)
+
+26.
+Continues to
+exclude Proposition 204 administration costs from county expenditure
+limitations. (Sec. 8)
+
+27.
+Continues to
+exempt county expenditures on Restoration to Competency treatment at ASH from
+county expenditure limitations. (Sec. 9)
+
+Disproportionate Share Hospital
+(DSH) Payment Session Law Provisions
+
+28.
+Sets the
+annual DSH payment allotment to the Arizona State Hospital (ASH) at $28,474,900
+for FY 2026 and:
+
+a.
+requires ASH
+to provide a certified public expense form for qualifying DSH expenditures made
+to AHCCCS by March 31, 2026;
+
+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 the Social Security Act. (Sec. 3)
+
+29.
+Establishes
+the annual DSH payment allotment for private qualifying DSH hospitals at
+$884,800 for FY 2026, consistent with the appropriation and the terms of the
+State plan and limits payments to hospitals that either:
+
+a.
+meet the
+mandatory definition of DSH qualifying hospital under Section 1923 of the
+Social Security Act; or
+
+b.
+are located
+in Yuma County and contain at least 300 beds. (Sec. 3)
+
+30.
+Outlines the
+order of priority for DSH payment allotments for private qualifying hospitals
+once the preceding DSH distributions are made. (Sec. 3)
+
+31.
+Requires, by
+December 31, 2027, for FY 2027, 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 the state's contribution. (Sec.
+4)
+
+AHCCCS Mental Health Medication
+Utilization Report
+
+32.
+Requires
+AHCCCS to report by January 31, 2027, on aggregate spending and aggregate
+utilization of mental health medications, including antipsychotics and
+antidepressants, during the contract year 2024-2025. (Sec. 7)
+
+33.
+Requires the
+AHCCCS report on the costs and utilization of mental health medications to
+include the:
+
+a.
+aggregate
+gross amount spent for each mental health medication class;
+
+b.
+annual
+aggregate net amount spent for each mental health medication class after
+rebates, without disclosing any information about manufacturer-negotiated
+supplemental rebate agreements for any specific drug; and
+
+c.
+average
+annual cost by class for generic and nongeneric mental health medications.
+(Sec. 7)
+
+34.
+Requires
+AHCCCS to submit the mental health medication utilization report to the:
+
+a.
+Governor;
+
+b.
+chairpersons
+of the Health and Human Services Committees of the Senate and House of
+Representatives, or their successor committees;
+
+c.
+Director of
+Joint Legislative Budget Committee;
+
+d.
+Director of
+the Office of Strategic Planning & Budgeting; and
+
+e.
+Secretary of
+State. (Sec. 7)
+
+35.
+Requires the
+AHCCCS report on the costs and utilization of mental health medications, for
+antipsychotic and antidepressant medications, without disclosing any
+information about manufacturer-negotiated supplemental rebate agreements that
+could compromise the competitive or proprietary nature of the agreements, to
+include the:
+
+a.
+total number
+of prior authorizations submitted for nonpreferred antipsychotic and
+antidepressant medications;
+
+b.
+percentage
+of prior authorization approvals and denials;
+
+c.
+generic
+antipsychotic and antidepressant medication utilization percentages; and
+
+d.
+total amount
+of antipsychotic and antidepressant medication claims. (Sec. 7)
+
+36.
+Defines mental
+health medication. (Sec. 7)
+
+Miscellaneous
+
+37.
+Allows, for
+the contract year beginning October 1, 2026, and ending September 30, 2027,
+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. 10)
+
+38.
+Continues to
+state that it is the intent of the Legislature for FY 2027 that AHCCCS
+implement a program within its available appropriation. (Sec. 11)
+
+---------- DOCUMENT FOOTER ---------
+
+Initials AG���������������� HB
+4145
+
+4/27/2026������� Page
+0 Appropriations
+
+---------- DOCUMENT FOOTER ---------