Proposed State Rules

AHCCCS proposed rules are published in the Arizona Administrative Register (A.A.R.) for public review. To compare the following Proposed Rule language to Final Rule, please see corresponding topic when finalized at: http://www.azahcccs.gov/reporting/state/unpublishedrules.aspx

Note: Information provided in PDF files.

Cost Sharing Part II 2014 Submit Comment on Proposed Rule


Thursday July 31, 2014
Arizona Laws 2013, First Special Session, Chapter 10 (House Bill 2010) specified changes to the AHCCCS Program which require, among other items, rule-making to establish cost sharing provisions consistent with federal law and the Federal regulations which became effective January 1, 2014, in 42 CFR part 447.50, et seq. In this rulemaking, the Agency revised the current cost sharing rules to delineate the mandatory copayment requirements for the new adult group described in R9-22-1427 (E) with income above106% of the federal poverty guidelines (FPL) subject to CMS approval. In addition, this rulemaking clarifies that members in the new adult group with incomes at or below 106% FPL are exempt from any copayments. These proposed rules also clarify existing language, update cross-references, and include various non substantive changes.

Section 36 of this Law provides a rulemaking exemption: For a period of one year from the effective date of the Act, the AHCCCS Administration is exempt from the Administrative Procedure Act’s rulemaking requirements for rules regarding cost sharing.

BH/ADHS Changes Submit Comment on Proposed Rule


Thursday July 24, 2014
HB 2634 (Law 2011, Chapter 96) requires the Arizona Department of Health Services (ADHS) to reduce monetary or regulatory costs on persons or individuals receiving behavioral health services, streamline the regulation process, and facilitate licensure of integrated health programs that provide both behavioral and physical health services. The Administration cross references ADHS rules and must update its rules to correctly reference changes made by ADHS. In addition, changes recommended during a 5 year review of these rules have also been made along with any technical changes required to make the rulemaking clear.

Hospital Assessment Amendment Comment period ended - see Final Rule


Thursday May 15, 2014
A.R.S. § 36-2901.08, enacted by 2013 law, authorizes the Administration to establish, administer and collect an assessment on hospital revenues, discharges or bed days for funding a portion of the nonfederal share of the costs incurred beginning January 1, 2014, associated with eligible persons added to the program by A.R.S. §§ 36-2901.01 and 36-2901.07. The Administration is proposing a new rule to update the figures to be used as of State Fiscal Year 2015 for the process for establishing, administering and collecting the assessment on hospitals, this new assessment pays for a full year for the expansion population.

Laws 2013, 1st Special Session, Chapter 10 added an exemption to the Administrative Procedure Act for purposes of the administration and implementation of the hospital assessment: A.R.S. § 41-1005 (A)(32) exempts the Administration from Title 41, Chapter 6 of the Arizona Revised Statutes (the Arizona Administrative Procedure Act) for purposes of implementing and establishing the hospital assessment; however, that provision requires the Administration to provide public notice and an opportunity for public comment at least thirty days before doing so. Laws 2013, 1st Special Session, Chapter 10 provides: Sec. 44. Intent; hospital assessment It is the intent of the legislature that: 1. The requirement that the hospital assessment established pursuant to section 36-2901.08, Arizona Revised Statutes, as added by this act, be subject to approval by the federal government does not adopt federal law by reference.

Essential Health Care Benefits (EHB) or (AHB) Comment period ended - see Final Rule


Friday March 7, 2014
The Administration must conduct a rule-making to implement the elements of Arizona Laws 2013, First Special Session, Chapter 10 (House Bill 2010), that relate to changes to covered services regarding well exams, and other cost-effective services. In addition to “clean up” of rules related to scope of services, such as updating cross-references and non-substantive changes to improve clarity. The provisions are necessary to comply with federal or state requirements.

DRG - Diagnostic Related Groups Comment period ended - see Final Rule


Friday March 7, 2014
Arizona Laws 2013, Chapter 202, section 3, amended A.R.S. 36-2903.01.G.12 to require the AHCCCS administration to "adopt a diagnosis-related group based hospital reimbursement methodology consistent with title XIX of the social security act for inpatient dates of service on and after October 1, 2014." The statutory and regulatory provisions of Medicaid (Title XIX of the Social Security Act) provide state’s significant flexibility with respect to hospital reimbursement methodologies; however, the Medicaid Act, at 42 U.S.C. 1396a(a)(30)(A), requires that the State must adopt payment methodologies "as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area."

In addition, the choices reflected in this proposed rule were based other design considerations such as achieving budget neutrality (recognizing that funding is not unlimited the methodology was designed to be budget neutral compared to past aggregate reimbursement for these services) and adaptability (whether the methodology facilitates adapting to changes in utilization and future service models).

Nursing Facility Assessment Amendment 2 | Comment period ended - see Final Rule


Friday February 28, 2014
A.R.S. § 36-2999.52 authorizes the Administration to administer a provider assessment on health care items and services provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. The Administration is proposing an amendment to rule to revise the process for calculating the nursing facility assessment using Uniform Accounting Report data submitted to the Arizona Department of Health Services and amending the dollar amounts used to calculate the assessment. In addition, the proposed rules update terminology and clarify language in both the assessment and supplemental payment sections so that the methodology is more concise and understandable.

Hospital Assessment | Comment period ended - see Final Rule


Friday December 13, 2013
A.R.S. § 36-2901.01, adopted by Initiative Measure Proposition 204 in the 2000 general election, includes individuals with income up to 100% of the federal poverty level as part of the definition of persons eligible for health care coverage through AHCCCS. Due to the lack of available funding, effective July 8, 2011, the Administration closed the program to new enrollment for persons described by A.R.S. § 36-2901.01 who were not also described in the Arizona State Plan for Medicaid. Arizona Laws 2013, 1st Special Session, Chapter 10, Section 5, added A.R.S. § 36-2901.07, which expanded the definition of eligible persons to include individuals with income between 100% and 133% of the federal poverty level

A.R.S. § 36-2901.08, also enacted in the same section of the 2013 law, authorizes the Administration to establish, administer and collect an assessment on hospital revenues, discharges or bed days for funding a portion of the nonfederal share of the costs incurred beginning January 1, 2014, associated with eligible persons added to the program by A.R.S. §§ 36-2901.01 and 36-2901.07. The Administration is proposing a new rule to describe the process for establishing, administering and collecting the assessment on hospitals. A.R.S. § 41-1005 (A)(32) exempts the Administration from Title 41, Chapter 6 of the Arizona Revised Statutes (the Arizona Administrative Procedure Act) for purposes of implementing and establishing the hospital assessment; however, that provision requires the Administration to provide public notice and an opportunity for public comment at least thirty days before doing so.

Health Care Group Program | Comment period ended - see Final Rule


Friday November 22, 2013
Arizona Laws 2013, First Special Session, Chapter 10 (House Bill 2010), relates to the operation of the Arizona Health Care Cost Containment System. That act made changes to the program which requires rulemaking repealing the Health Care Group program.

This provision is necessary to comply with federal or state requirements that contain dates certain for compliance. The Health Care Group program will no longer have an appropriation as described under A.R.S. § 36-2912.01 and will cease to exist January 1, 2014. New enrollment into Health Care Group ceased August 1, 2013.

Cost Sharing | Comment period ended - see Final Rule


Friday November 22, 2013
Arizona Laws 2013, First Special Session, Chapter 10 (House Bill 2010) specified changes to the AHCCCS Program which require, among other items, rule-making to establish cost sharing provisions consistent with federal law. In this rulemaking, the Agency revised the current cost sharing rules to incorporate exemptions of certain populations from cost sharing requirements specified in final federal regulations which will become effective January 1, 2014. In addition, this rulemaking repeals cost sharing requirements which apply to AHCCCS Waiver populations which will no longer exist beginning January 1, 2014. To clarify cost sharing requirements generally, this rulemaking also includes revision of language, updates to various cross-references, and non substantive changes. In the future, the AHCCCS Administration intends to promulgate other cost sharing provisions in subsequent rulemakings

Section 36 of this Law provides a rulemaking exemption: For a period of one year from the effective date of the Act, the AHCCCS Administration is exempt from the Administrative Procedure Act’s rulemaking requirements for rules regarding cost sharing. However, a thirty day advance notice and public comment period are required.

Medicaid Eligibility Changes | Comment period ended - see Final Rule


Friday September 20, 2013
The Administration is promulgating rule amendments as result of the Affordable Care Act of 2010 and Arizona Laws 2013, First Special Session, Chapter 10 (House Bill 2010). Expansion of eligibility for: Children 6-18 to 133% of FPL, Former foster care children from ages 21 to 26, Childless adults up to 133% (including restoring Prop 204 populations – up to 100% - and adding 100-133% per ARS 36-2901.07); Income determinations based on “modified adjusted gross income”; Changes to processes for determining and redetermining eligibility including changes to accommodate on line applications and internet-based verification of income, citizenship and alien status, state residence, and other eligibility factors; and miscellaneous changes to clarify and conform to federal requirements. These proposed rules are to be effective January 1, 2014.

Prior Quarter Eligibility | Comment period ended - see Final Rule


Mon May 6, 2013
42 CFR 435.914 requires the Administration to provide Prior Quarter (PQ) eligibility. A.R.S. § 36-2903 (A) provides reimbursement responsibility for care provided during an eligibility period. Currently, the Administration is waived from providing PQ eligibility. The waiver expires December 31, 2013. The Administration will need to implement prior quarter eligibility requirements effective January 1, 2014.

Nursing Facility Assessment Amendment | Comment period ended - see Final Rule


Fri April 26, 2013
A.R.S. § 36-2999.52 authorizes the Administration to administer a provider assessment on health care items and services provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. The Administration is proposing an amendment to rule to describe the process for estimating and distributing supplemental payments to contractors for enhanced payments to eligible nursing facilities based on bed days paid for through managed care. The rule amendments also describe the process for calculating and distributing the enhanced payments to eligible nursing facilities by the Administration for bed days paid by the Administration. In addition, the rules clarify general requirements applicable to nursing facilities in order for them to qualify for the supplemental payments.

Children's Rehabilitative Services (CRS) | Comment period ended - see Final Rule


Fri April 19, 2013
The CRS program was administered by the Arizona Department of Health Services (ADHS) until SB1619 Arizona Laws 2011 Regular Session was enacted directing the Administration to administer the CRS program. SB1619 specified that the existing CRS program rules adopted by ADHS were left in effect "until superceded by rules adopted by [AHCCCS]." The Legislature enacted this change as part of a larger initiative by ADHS and AHCCCS to better integrate conditions provided to medically eligible with CRS related conditions while at the same time streamlining the administration of the program. Therefore, AHCCCS finalized rules to transition the ADHS requirements under AHCCCS as published in the Arizona Administrative Register August 24, 2012 and Arizona Laws 2011, Regular Session, Ch. 31, § 34, exempted AHCCCS from the requirements of A.R.S. Title 41, Ch.6., these rules were promulgated under exemption repealed, then repromulgated. SB1528 Laws 2012, Chapter 299, Section 7 repealed the rule-making exemption authority and Section 8 stipulated that rules adopted through the previous year’s authority would expire December 31, 2013, absent specific statutory authority for those rules.

Hospital Rates and NonER transport copay | Comment period ended - see Final Rule


Fri April 12, 2013
After an evaluation of the Agency’s overall statutory authority regarding rates and copayments, AHCCCS has determined to repromulgate these rules specifying specific statutory authority to continue measures it previously enacted consistent with Laws 2012 Chapter 299 Section 8. The intent of the rulemakings has not changed as what was described in the rulemakings posted.


Benefit Limits Repromulgation | Comment period ended - see Final Rule


Tue March 19, 2013
After an evaluation of the Agency’s overall statutory authority regarding covered services, rates, and eligibility, AHCCCS has determined that it will re-promulgate certain rules implementing “program changes” made pursuant to Laws 2011, Chapter 31, Section 34 by identifying the specific statutory authority for the rules to ensure that the rules continue beyond December 31, 2013 in accordance with Laws 2012, Chapter 299, Section 8.

Therefore, to ensure continuity of the rules previously adopted under Section 34, the AHCCCS Administration is re-promulgating the same rules which became effective October 1, 2011. No changes have been proposed to the language of the rules.


340B Pharmacy Pricing Rerun | Comment period ended - see Final Rule


Fri January 24, 2013
Due to recent legislative direction within Laws 2012, Chapter 299, Section 7 of the bill repealed the rule-making authority and Section 8 stipulated that rules adopted through the previous year’s authority would expire December 31, 2013 without specific statutory authority.

After an evaluation of our overall statutory authority regarding covered services, rates and eligibility, AHCCCS has determined that it requires statutory changes to continue measures it enacted under the Chapter 299 authority that prohibits AHCCCS from continuing after December 31, 2013 any “program changes” made pursuant to Section 34 of Senate Bill 1619. Therefore, the Administration is re-promulgating rules in regard to the 340B program.

The Veterans Health Care Act of 1992 established the 340B program in section 340B of the Public Health Service Act (PHS Act). The 340B program requires drug manufacturers participating in Medicaid to provide discounted covered outpatient drugs to certain eligible health care entities, known as covered entities. Covered entities include disproportionate share hospitals, family planning clinics, and federally qualified health centers, among others as described under 42 U.S.C. §256b(a)(4). As of October 2010, approximately 15,000 covered-entity locations were enrolled in the 340B program.

The Health Resources and Services Administration (HRSA) administers the 340B program. In 2000, HRSA issued guidance directing covered entities to refer to State Medicaid agencies’ policies for applicable billing policies in regards to 340B claims. The Centers for Medicare and Medicaid Services (CMS), which administers the Medicaid program, does not require State Medicaid agencies to set 340B policies.


Nursing Facility (NF) Assessment | Comment period ended - see Final Rule


Fri September 7, 2012
A.R.S. § 36-2999.52 authorizes the Administration to administer a provider assessment on health care items and services provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. The Administration is proposing rule to delineate the method for imposing the assessment, the criteria for qualifying for supplemental payments, and the method for determining the amount of supplemental payments.


Ambulance Rates | Comment period ended - see Final Rule


Tues August 21, 2012
The recently enacted Health Budget Reconciliation Bill, Senate Bill 1528 (Arizona Laws 2012, Chapter 299), amended ARS 36-2239 such that reimbursement of ambulances is no longer tied to rates established by the Arizona Department of Health Services (section 3). However, for the contract year beginning October 1, 2012, the bill requires that AHCCCS reimburse ambulance services at 68.59% of the rates established by ADHS (section 18). The bill also exempted rules regarding revisions to ambulance reimbursement from the rule-making requirements of ARS Title 41 (section 25). The bill becomes effective August 2, 2012.

As part of this rule-making, AHCCCS intends to describe the reimbursement methodology that the program will employ as of the effective date of the Health BRB.

Agency with Choice (aka Community First Choice (CFC)) | Comment period ended - see Final Rule


Thur August 2, 2012
The AHCCCS Administration is proposing rulemaking that provides elderly and disabled AHCCCS long-term care beneficiaries (AHCCCS beneficiary) flexibility and control with respect to the way in which attendant services and supports are provided in their homes or other community based settings. Attendant care services consist of nonprofessional assistance with activities of daily living and other services such as housekeeping. AHCCCS currently has a rule regarding this topic, Self-Directed Attendant Care (AAC R9-28-508), which was adopted as a final rule in 2011. Since that time, Congress adopted section 1915(k) of the Social Security Act, the Community First Choice (CFC) state plan option. AHCCCS plans to elect the “Agency with Choice” CFC state plan option. Both, Agency with Choice and Self-Directed Attendant Care are member-directed service models. The models are not a service, but rather a manner in which services are delivered. By way of example of the differences, under Self- Directed Attendant Care, the AHCCCS beneficiary or their legal guardian serves as the legal employer of the paid caregiver. Under Agency with Choice, the agency serves as the legal employer of the paid caregiver while AHCCCS beneficiaries or their individual representatives assume some of the employer-based responsibilities.

Children's Rehabilitative Services (CRS) | Comment period ended - see Final Rule


Thur June 28, 2012
With the recent change in Arizona Law, AHCCCS now has direct legal responsibility for the CRS program. As part of that legislative act, the existing CRS program rules adopted by ADHS were left in effect "until superceded by rules adopted by [AHCCCS]." The legislature enacted this change as part of a larger initiative by ADHS and AHCCCS to better integrate the care provided to children eligible for Medicaid and CRS related services while at the same time streamlining the administration of the program. Therefore, AHCCCS is proposing rule to transition the ADHS requirements under AHCCCS.

KidsCare II Program New Applications | Comment period ended - see Final Rule


Thur June 21, 2012
The AHCCCS Administration had offered every child on the waiting list the opportunity to enroll in KidsCare under AAC R9-31-401. Based on the response from those households and consistent with the Special Terms & Conditions of the Arizona Demonstration Project approved by the federal government, the AHCCCS Administration has determined that funding is sufficient to reopen KidsCare based on new applications for children in households with income at or under 175% of the federal poverty level. This rule expands R9-31-401 to permit new applications and describes how those applications will be received and processed.

Hospital Rates | Comment period ended - See Final Rule


Thur June 14, 2012
The purpose of this rule-making is to maintain reimbursement reductions for inpatient and outpatient hospital services covered through the AHCCCS program that were instituted last contract year (October 1, 2011 through September 30, 2012) and to eliminate adjustments to those rates based on inflation.

340B FQHC Pharmacy Definition | Comment period ended - see Final Rule


Thur June 7, 2012
The AHCCCS Administration recently promulgated a rule which describes the reimbursement methodology applicable to FQHCs and FQHC Look Alikes and their contacted pharmacies for drugs that are subject to 340 B pricing. This rule became effective February 1, 2012. In response to questions regarding the scope of this rule, the AHCCCS Administration found that further clarification was needed to define an FQHC and FQHC Look-Alike pharmacy. Additionally, the proposed rule clarifies that contracted pharmacies shall not submit claims for drugs dispensed under an agreement with a 340 B entity as part of the 340 B drug pricing program the 340B drug discount federal law imposes on drug manufacturers.

Medicare Cost Sharing (MCS) | Comment period ended - see Final Rule


Thur June 7, 2012
The AHCCCS Administration is initiating this rulemaking for purposes of amending its existing rules that define the scope of benefits for persons eligible for both Medicaid and Medicare. In general, the Medicare program has primary responsibility for the cost of care for these individuals, and Medicaid (that is, AHCCCS) is responsible for paying for the cost of Medicare Part B premiums, and/or Medicare coinsurance, copayments, and deductibles depending on the extent of the individual’s entitlement under the Medicaid program to “Medicare Cost Sharing”.

AHCCCS has implemented several significant statutory and regulatory changes to benefits, such as limitations of Inpatient hospital days for adults. With respect to persons eligible for Medicare Cost Sharing, AHCCCS is responsible in many instances for the cost of services that have been excluded or limited by AHCCCS but are still covered by Medicare. In light of the recent changes in AHCCCS benefits, there is a heightened need to ensure that the Medicare Cost Sharing rules clearly identify the rights of persons eligible for MCS and the extent of AHCCCS’ responsibility for payment for services. In addition, the Administration intends to update Medicare Cost-Sharing regulations with any necessary technical changes to ensure clarity and conciseness of the rule.

Inpatient Burn Unit Exception | Comment period ended - see Final Rule


Thur May 17, 2012
The Governor's Medicaid Reform Plan, as announced on March 15, 2011, includes proposals to reduce nonfederal expenditures for the AHCCCS program by approximately $500 million during state fiscal year 2012. To achieve some of these reductions, the AHCCCS Administration promulgated limitations to covered inpatient days for adults and within these limitations there were exceptions, such as hospitalizations due to severe burns. This rulemaking was effective October 1, 2011. Based on comments obtained from the Center of Medicare and Medicaid Services during the State Plan approval process, the Administration is proposing a clarification to the description of the exception of hospitalizations due to severe burns.

Burn center verification, a joint program of the American Burn Association and the American College of Surgeons, is designed to ensure provision of optimal care to burn patients from the time of injury through rehabilitation. In order to receive this distinction of high quality patient care, the provider participates in a rigorous review process, including an in depth site visit followed by a written report. It is likely that burn victims requiring in excess of 25 days of inpatient treatment would be transferred to an ACS verified burn center.

Trauma and ED Funds | Comment period ended - see Final Rule


Thur May 17, 2012
AHCCCS anticipates conducting exempt rule making to modify the methodology for determining uncompensated costs associated with trauma and emergency services to comply with the terms and conditions for claiming federal matching funds for supplemental payments to hospitals for the unrecovered cost of providing trauma and emergency services. Following stakeholder input, the proposed exempt rules also establish a new allocation of the federally matched tribal gaming funds between hospitals providing trauma services and urban and rural hospitals providing emergency services.

Proposition 202 established A.R.S. 36-2903.07 which appropriates tribal gaming funds for the purpose of making supplemental payments to Arizona hospitals for the cost of unrecovered trauma and emergency services. Historically these funds have provided approximately $20 million with 90% of the funds paid to 6 trauma facilities and the remaining 10% spread among dozens of hospitals for uncovered emergency department costs. To date, federal matching funds through the Medicaid program have not been available for these supplemental payments for trauma and emergency services because the proposed payments are intended to cover costs for care unassociated with Medicaid eligible persons. In general, under 42 U.S.C. § 1396b, federal financial participation in the State’s expenditure for medical coverage under Title XIX of the Social Security Act (Medicaid) is limited to expenditures for services covered under 42 U.S.C. § 1396d for persons eligible under 42 U.S.C. § 1396a. However, the Secretary of the United States Department of Health and Human Services (who oversees the federal Medicaid program) has the authority under 42 U.S.C. § 1315 to allow the state to claim federal financial participation for expenditures not explicitly listed in the Medicaid Act so long as the expenditure, “in the judgment of the Secretary, is likely to assist in promoting the objectives of title XIX.” On April 6, the Secretary, under the authority of 42 U.S.C. § 1315, approved an amendment to the Arizona Demonstration Project that permits Arizona to claim federal financial participation for supplemental payments to hospitals for the unrecovered cost of trauma and emergency services. See the Arizona Section 1115 Demonstration Project Waiver page.

Contracts and RFP | Comment period ended - see Final Rule


Thur Apr 26, 2012
A.R.S. § 36-2906 authorizes the Administration to adopt rules for the RFP process and the award of contracts. The Administration is proposing a clearer application of timeframes required for contract or proposal protests. In addition, the use of the term “procurement file” instead of “contract record” and also clarifying sanctions are monetary based rather than by percentage.

SDAC - Insulin Provision | Comment period ended - see Final Rule


Thu April 18, 2012
A.R.S. § 36-2951 authorizes the Administration to provide requirements for Self-Directed Attendant Care (SDAC) services. The Administration is proposing a revision to the rule language describing the administration of insulin. An Attendant Care Worker may provide insulin and is not limited to only providing the insulin when using a sliding scale.

KidsCare II Program | Comment period ended - See Final Rule


Tue March 20, 2012
AHCCCS anticipates conducting exempt rule making to establish the standards, methods, and procedures for making a defined number of children on the KidsCare waiting list eligible using SNCP funds.

Final rulemaking is contingent upon CMS approval of a waiver and availability of political subdivision funding. In the event CMS does not approve the AHCCCS proposal then a Notice of Terminated Rulemaking will be filed.

340B Pricing for FQHC Pharmacy Reimbursement (2nd Notice) | Comment period ended - See Final Rule


Wed Nov 30, 2011
To address the inability of AHCCCS to claim the Medicaid drug rebate for these drugs and the disparity between actual acquisition cost of drugs in the 340 pricing program dispensed by FQHC and FQHC Look-Alike pharmacies and the current AHCCCS reimbursement rate for those drugs, the AHCCCS Administration is proposing a rule to require a reimbursement methodology specific to 340B drugs dispensed by FQHC and FQHC Look-Alike Pharmacies. In addition, the rule specifies the reimbursement methodology applicable to drugs dispensed by 340B covered entities that are not eligible for purchase under the 340B pricing program and also describes the reimbursement to pharmacies that contract with 340B covered entities to dispense drugs as part of that program. By implementing this methodology, the potential for duplicate discounts will be eliminated, 340B covered entities and pharmacies that contract with them will receive reasonable compensation taking into consideration their reduced acquisition cost, and AHCCCS will not carry the cost of the 340B drug discount federal law imposes on drug manufacturers.

Non-ER Transportation Copay | Comment period ended - see Final Rule.

 

Fri Nov 18, 2011
The AHCCCS Administration has received a waiver from the Centers of Medicare and Medicaid Services allowing the Administration to impose copayments for taxi transportation. The copayment will be in the amount of $2 for each one-way trip for a member who resides in Maricopa or Pima County. This copayment will be charged to AHCCCS members who are adults that fall under the category "AHCCCS Care".

Expansion Population (aka "Childless Adults" or "AHCCCS Care") Amended | Comment period ended - see Final Rule.


Wed Nov 02, 2011
The Administration is amending this rule to conform to the recently approved Demonstration Project under section 1115 of the Social Security Act with respect to medical coverage for the Medicaid expansion population sometimes referred to as "Childless Adults" or "AHCCCS Care."

340B Pricing for FQHC Pharmacy reimbursement | Comment period ended - See Final Rule


Fri Sep 23, 2011
The AHCCCS Administration is proposing a rule to require a specific reimbursement methodology for drugs subject to the 340B pricing program dispensed by Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes and their contracted pharmacies. Unlike other drugs paid for by AHCCCS and its Medicaid Managed Care Contractors, the State is not entitled, under 42 USC 1396r-8, to rebates from drug manufacturers for drugs purchased under the 340B pricing program. Instead drug manufacturers are required under federal law to provided deep discounted to entities that participate in the 340B program including FQHCs and FQHC Look-Alikes. This rule is intended to provide reasonable compensation to FQHCs and FQHC Look-Alikes for the cost of dispensing the drug while requiring the FQHC and FQHC Look-Alikes to pass some of the ingredient cost savings of the 340B program on to AHCCCS when those drugs are dispensed to AHCCCS eligible members.

Respite Service Limits | Comment period ended - see Final Rule.


Thur Jul 21, 2011
The AHCCCS Administration is proposing an approximate 15 percent reduction in the annual limit for respite hours. Respite services are provided to members receiving Behavioral Health services in an Acute care setting and to members in the ALTCS program. The respites services are not delineated under the State Plan, however, they are a covered service under the 1115 Waiver.

Federal Emergency Service (FES) Program Inpatient Limits | Comment period ended - see Final Rule.


Thur Aug 04, 2011
The Administration initially proposed a revision to rule R9-22-210 to exclude the use of CPT code 99281 for facility services provided in an emergency department. As a result of feedback from the Center for Medicare and Medicaid Services (CMS), the Administration will not proceed with exclusion of CPT code 99281. Therefore, the Administration has limited the rulemaking to the change provided under R9-22-217 which cross references the promulgated Inpatient Limit rule R9-22-204 effective October 1, 2011.

CMP – Civil Monetary Penalties | Comment period ended - see Final Rule.


Mon Jul 11, 2011
The Administration has initiated the following rulemaking regarding Civil Monetary Penalties as result of a 5-year-rule-review approved by the Governor’s Regulatory Review Council on December 2, 2008.

Adult Inpatient Limitations with Member Billing | Comment period ended - see Final Rule.


Thur Jun 23, 2011
The Governor's Medicaid Reform Plan, as announced on March 15, 2011, includes proposals to reduce nonfederal expenditures for the AHCCCS program by approximately $500 million during state fiscal year 2012. To achieve some of these reductions, the AHCCCS Administration is proposing limitations to covered inpatient days for adults. In addition, this rule-making proposes changes to current rules regarding limitations on providers charging members for services.

Outlier Reimbursement | Comment period ended - see Final Rule.


Thur May 26, 2011
The purpose of the proposed rule making is to implement changes to the methodology for qualifying and paying claims for inpatient hospital services with extraordinary operating costs per day, commonly referred to as “outlier” claims. Specifically, the agency proposes to increase the thresholds used to qualify claims by 5% and to reduce the cost-to-charge ratios used to qualify and pay outliers by 5% plus by a like percentage of any increase in a hospital’s charge master as filed with the Arizona Department of Health Services. In addition, the rule making clarifies that all inpatient services provided by out of state hospitals are not paid using the tiered per diem methodology, but are paid by multiplying billed charges by a cost-to-charge ratio. As such, there is no outlier methodology for payments to out of state hospitals.

Expansion Population Freeze (aka Childless Adult or AHCCCS Care) | Amended - See amended Proposed Rule

Fri Apr 29, 2011
The AHCCCS Administration is initiating this proposed exempt rule-making to comply with the legislative requirement that the Administration adopt rules regarding eligibility necessary to implement a program within available appropriations. Specifically, the Administration is proposing to establish through rule 1) closing all new eligibility beginning July 1 for persons in AHCCCS Care not designated as eligible in the Arizona State Plan under Title XIX of the Social Security Act 2) flexibility and a methodology for the Director to: delay closure of the AHCCCS Care program, re-open the AHCCCS Care program, or terminate coverage for some or all persons in the AHCCSC Care Program. These changes will be predicated on the most current information and estimates of available resources to support the Medicaid program. The proposed rule also sets forth the means by which changes in eligibility and their effective dates will be communicated to the public. Approval of this methodology by the Center for Medicare and Medicaid Services is required. See the links below for additional information:

Transplant RestorationComment period ended - See final rule

Thur Apr 7, 2011
Governor Brewer’s Medicaid Reform Plan restores the transplants AHCCCS previously covered for adult members age 21 and older effective April 1, 2011. See the links below for additional information:

Lifting PA requirement | Comment period ended - See final rule

Mon Mar 21, 2011
The proposed rules will eliminate the requirement for obtaining PA for services such as, but not limited to: dialysis shunt placement, apnea management and training for premature babies up to one year of life, certain eye surgeries, and hospitalizations for labor and delivery not exceeding specific time parameters. In addition, technical changes and striking of redundant rules will be made.

MED Phase OutComment period ended - See final rule

Mon Mar 21, 2011
The AHCCCS Administration is initiating this proposed exempt rule-making to comply with the requirement that the Administration adopt rules regarding eligibility necessary to implement a program within available appropriations. Specifically, the Administration is proposing to phase out eligibility for Medical Expense Deduction (MED) coverage. The Administration intends to stop all new approvals for persons under the MED program with eligibility effective dates on or after May 1, 2011. Because any single period of eligibility is limited to the remainder of the month in which eligibility is determined plus five additional months under A.R.S. § 2901.04(F), no one will remain eligible for the MED program after September 30, 2011. The AHCCCS Administration does not intend to establish a waiting list for persons who would be eligible for MED but for this rule.

Outpatient Rebase | Comment period ended - See final rule

Wed Feb 2, 2011
The current rule requires that the fee schedule and the state-wide cost-to-charge ratio be “rebased” using more current Medicare cost data every five years as described in A.A.C. R9-22-712.40. In the five years since the original adoption of the current rule, AHCCCS has also identified the need to consider a number of refinements to the existing methodology to ensure proper cost containment and provide more equitable compensation among hospitals. Some of the issues that have been identified include, but are not limited to, adjustments to the peer group modifiers that are currently fixed in rule and their application to certain charges, adjustment or elimination of separate payment for outpatient observation, grouping charges by dates of service as well as by procedure type, clarification of settings that qualify for payment as outpatient hospital settings.

Preadmission Screening (PAS) Tool rulemaking | Comment period ended - See final rule

Mon Aug 23, 2011
The AHCCCS Administration has reviewed the validity of the PAS tools used to evaluate an individual’s medical and functional eligibility for the ALTCS Program. In order to qualify for the ALTCS Program, individuals must require an institutional level of care. The PAS tools are intended to reflect the current consensus of the medical community and experts in developmental disability on best practices for reliably assessing the need for institutional care. As the opinion of those experts advance, the PAS tools should be updated to reflect the new consensus. A decision was made last year to update and revise the PAS tool used for children with developmental disabilities under age 6. The new tool has been developed and piloted and is now being finalized. The developmental evaluation in the tool has been expanded and updated. Developmental items on the tool are based on questions from several standardized, up to date and commonly accepted assessment tools. The tool has been piloted in-house and the analysis for a new scoring methodology has been completed. Because the current rules very specifically describe the elements and scoring routine of the current PAS tools, it is necessary to update the rules.

SDAC – Self Directed Attendant Care | Comment period ended - See final rule

Tues Nov 25, 2008
The legislature in SB 1329 created A.R.S. § 36-2951 to provide requirements for self-directed attendant care (SDAC) services. The Administration is proposing rule language to describe the requirements a person must follow in order to provide or receive SDAC services.

Adult Benefit Redesign | Comment period ended - See final rule

Thur May 13, 2010
The AHCCCS Administration is proposing rule changes to delineate the service limitations/ exclusions as described in HB2010, Forty-ninth Legislature Seventh Special Session of 2010. The AHCCCS Administration is exempt from the rule making requirements of Title 41, Chapter 6, A.R.S., as described in HB2010, Forty-ninth Legislature Seventh Special Session of 2010, Section 34.

Costsharing/Copayments | Comment period ended - See final rule

Thur Nov 12, 2009
The DRA created section 1916A of Title XIX (42 U.S.C. 1396o-1) which permits states to impose higher than nominal copayments on certain populations with incomes over 100% of the Federal Poverty Level (FPL). The AHCCCS Administration plans to move forward using this authority to change the copayment requirements for those members under the Transitional Medical Assistance (TMA) program with income over 100% of the FPL and any other changes required to conform to 1916A of Title XIX.

Kids Care Premium Increase | Comment period ended - See final rule

Mon Mar 09, 2009
As described in SB1004, Forty-ninth Legislature First Special Session of 2009, the monthly premiums must be charged up to the maximum amount allowed by federal law to all populations of eligible persons who may be charged. The Administration is proposing changes in premiums to Kids Care eligible children and Kids Care eligible parents. The rules contained in this package are exempt from review by the Governor’s Regulatory Review Council and the Attorney General under Laws 2009, Ch.4, § 11 until May 1, 2010.

AHCCCS Public Hearing Locations

  • AHCCCS Administration
    701 East Jefferson, Gold Room
    Phoenix, AZ 85034
  • Arizona Long Term Care System
    1010 North Finance Center Drive, Suite 201
    Tucson, AZ 85701
  • Arizona Long Term Care System
    2717 N. 4th St. STE 130
    Flagstaff, AZ 86004

Contact

Comments on proposed AHCCCS rules may be submitted in the following ways:

  • Mail:
    Office of Administrative Legal Services (OALS)
    701 East Jefferson Street, Mail Drop 6200
    Phoenix, Arizona 85034
  • Phone: (602) 417-4232
  • FAX: (602) 253-9115
  • E-mail: AHCCCSRules@azahcccs.gov