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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.

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 Restoration |  Comment 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 Out |  Comment 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
    3480 East Route 66
    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