Note: Information provided in PDF files.
Hospital Assessment Amendment 2015
Friday March 13, 2015
A.R.S. § 36-2901.08 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. It is the agency’s objective to assess only so
much as is necessary to meet the estimated costs associated with the projected populations referenced in the statute. As such, it
is necessary for the Administration to adjust the assessment from time to time as the Administration obtains new information to
update estimations of the number of eligible persons and projections of the costs anticipated to provide coverage for those persons.
The Administration is proposing a new rule to update the figures to be used as of April 1, 2015 for collecting the assessment on hospitals.
Incontinence Brief Coverage
Thursday March 12, 2015
This rulemaking is required as a result of the May 2014 Ninth Circuit Court of Appeals Decision
in Alvarez et al v Betlach. Litigation challenging AHCCCS coverage of incontinence briefs for
members in the ALTCS Program was filed in federal court in 2009 by the Arizona Center for
Disability Law. The lawsuit sought to compel AHCCCS to provide incontinence briefs and supplies to
members in the Arizona Long Term Care Program who were age 21 years and older and who were incontinent
as a result of their disabilities in order to prevent skin breakdown. The current rule applicable to
this population limits coverage of incontinence briefs for members age 21 and older to circumstances
when medically necessary to treat a medical condition, such as an infection, but not for preventive
purposes. The Ninth Circuit Court of Appeals determined that AHCCCS is required to provide coverage of
incontinence briefs prescribed for members in the Arizona Long Term Care Program who are 21 years of
age and older when medically necessary to prevent skin breakdown and infection.
BH Inpatient Payment Responsibility
Comment Period Closed
Friday November 11, 2014
The Administration is proposing a rulemaking to clarify an issue that has been identified
through the administrative hearing process regarding contractor responsibility for covering
inpatient hospital services when both medical and behavioral health services are provided
during the same hospital stay. The proposed rule will clarify the reimbursement methodology.
The Administration is proposing to clarify through rule, its existing policy that the RBHA is
responsible for all inpatient hospital services if the principle diagnosis on the hospital
claim is a behavioral health diagnosis. Those claims will be paid in accordance with a per
diem fee schedule developed by ADHS and approved by AHCCCS. Hospital claims that do not have a
behavioral health diagnosis as the principle diagnosis will be paid by the acute care contractor
using the DRG payment methodology. This proposed amendment will benefit hospitals by clarifying
to whom claims should be submitted and the amount of reimbursement that the hospital can expect.
The Administration intends to initiate and implement this clarification as soon as possible to
reduce billing disputes between hospitals and health plans and to reduce unnecessary
administrative hearings arising from those disputes.
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