Official Summary Text
SB1630 - 572R - Senate Fact Sheet
Assigned to
HHS
& ATT����������������������������������������������������������������������������������� AS
PASSED BY COMMITTEE
ARIZONA STATE SENATE
Fifty-Seventh
Legislature, Second Regular Session
REVISED
AMENDED
FACT SHEET FOR
s.b. 1630
home;
community-based services; mental illness
Purpose
Establishes the Home
and Community-Based Services (HCBS) for Adults who are Seriously Mentally Ill
(SMI) Program (HCBS for SMI Program) in the Arizona Health Care Cost
Containment System (AHCCCS) to provide, with federal approval, a dedicated HCBS
benefit for adults who are determined to be SMI. Outlines HCBS for SMI Program
coverage, eligibility, capacity and reporting requirements.
Background
AHCCCS serves as
Arizona's Medicaid agency, which offers qualifying Arizona residents access to
healthcare programs. AHCCCS contracts with health professionals to provide
medically necessary health and medical services to eligible members.
Additionally, AHCCCS must contract for a coordinated
system of behavioral health services for persons who are SMI, including
screening and intake, case management, treatment planning family involvement
and a continuum of care. (A.R.S. ��
36-2901
and
36-3407
).
The Arizona Long
Term Care System (ALTCS) is the management and delivery system of
hospitalization, medical care, institutional services and home and
community-based services to members through AHCCCS program contractors and
providers, together with federal participation under Title XIX of the Social
Security Act. As an ALTCS program contractor, the Department of Economic
Security must provide additional services, if appropriate, to members who have
a developmental disability and are determined to need institutional services.
These services include HCBS that may be provided in a member's home, at an
alternative residential setting or at other licensed behavioral health
alternative residential facilities approved by the Director of AHCCCS. HCBS may
include in-home health and support services, therapies, personal and homemaker
services, respite care, transportation and other approved community-based
services. (
A.R.S.
� 36-2939
).
Seriously
mentally ill
means persons who, as a result of a mental disorder, exhibit
emotional or behavioral functioning that is so impaired as to interfere
substantially with their capacity to remain in the community without supportive
treatment or services of a long-term or indefinite duration. In these persons
mental disability is severe and persistent, resulting in a long-term limitation
of their functional capacities for primary activities of daily living such as
interpersonal relationships, homemaking, self-care, employment and recreation (
A.R.S. � 36-550
)
The Joint
Legislative Budget Committee (JLBC) fiscal note estimates that S.B. 1630 would
increase AHCCCS state General Fund (state GF) costs by $5,500,000 annually and Total
Funds costs by $15,300,000 once the HCBS for SMI Program is fully implemented,
if enrollment remains capped at 250 members. If the enrollment cap is expanded
to the maximum 1,000 members, annual state GF costs may increase to $22,200,000
and Total Funds costs to $61,300,000 (
JLBC
fiscal note
).
Provisions
Program
Establishment
1.
Establishes the HCBS for SMI Program in AHCCCS and directs AHCCCS to
develop and request authority from the Centers for U.S. Medicare and Medicaid
Services (CMS) to implement a dedicated HCBS benefit for adults determined to
be SMI.
2.
Requires AHCCCS, through the submission of the first annual report, to convene
a stakeholder workgroup that includes representatives from behavioral health
providers, counties, tribal nations, community organizations and family
members, caregivers and guardians of SMI individuals to advise on HCBS for SMI Program
design and implementation.
3.
Requires stakeholder input to specifically address the needs of
individuals who require complex medication management, enhanced monitoring and
structured community-based supports, including assisted living-type models, to
promote medication continuity and safety.
4.
Requires AHCCCS to request approval from CMS for the HCBS for SMI Program
by July 1, 2027.
5.
Requires AHCCCS to begin implementing the HCBS for SMI Program within
one year after approval.
6.
Requires AHCCCS, until the HCBS for SMI Program is implemented, to provide
semiannual implementation updates to the President of the Senate, the Speaker
of the House of Representatives and the Chairpersons of the Health and Human
Services Committees, or their successor committees.
Covered
Services
7.
Requires AHCCCS, subject to the approval of CMS, to provide HCBS that are
comparable to those authorized for ALTCS, with appropriate modifications for
behavioral health needs.
8.
Requires
the HCBS to include:
a)
attendant care and personal care;
b)
habilitation with behavior management;
c)
adult day health care with a behavioral health care focus;
d)
supervised community living services, including assisted living-type
supports;
e)
respite care;
f)
home-delivered meals;
g)
nursing, home health and medication administration services; and
h)
nonemergency
transportation.
9.
Requires AHCCCS to establish service descriptions and scope and staffing
standards through rule or policy.
10.
Allows HCBS to be delivered
in any residential setting authorized under state law when an individual is
subject to a valid court order, guardianship or involuntary treatment if:
a)
Medicaid reimbursement is limited to covered HCBS and does not include
room, board, supervision for custody or enforcement of court orders; and
b)
the
individual is afforded periodic review and planning for transition to a less
restrictive setting when clinically appropriate.
11.
Allows
AHCCCS to add, modify or combine services consistent with federal approval and
legislative intent.
Eligibility
12.
Requires an individual, to
be eligible for the HCBS for SMI Program, to:
a)
have been determined to be SMI;
b)
meet the SMI long-term level of care adopted by AHCCCS;
c)
require HCBS to avoid placement in a behavioral health residential
facility (BHRF) or psychiatric institution; and
d)
meet
the outlined financial eligibility requirements.
13.
Deems
an individual who meets the AHCCCS SMI long-term level of care financially
eligible for the HCBS for SMI Program if the individual's income does not
exceed 300 percent of the federal supplemental security income benefit rate.
14.
Allows
an individual whose income exceeds the outlined standard to establish a
qualified income trust to achieve eligibility.
15.
Specifies
that resource and spousal impoverishment standards are the same as required for
enrollees of the ALTCS HCBS Program.
16.
Requires AHCCCS to adopt an
SMI long-term level of care specific to individuals who are SMI that is based
on behavioral, functional and safety criteria, which may include:
a)
current or recent court-ordered treatment;
b)
legal guardianship due to psychiatric incapacity;
c)
recent discharge from a jail or prison, the Arizona State Hospital (ASH)
or a BHRF;
d)
impaired judgement, disorganization or inability to perform activities
of daily living due to psychiatric symptoms;
e)
documented safety risks, including elopement, fire or water misuse,
aggression, delusional behavior or exploitation risk;
f)
homelessness or imminent risk of homelessness;
g)
high-intensity or complex psychotropic medication regimens requiring
enhanced monitoring to ensure adherence and to identify potential adverse
effects; and
h)
clinical
needs that necessitate structured community-based supports, including assisted
living-type supports, to maintain continuity of medication therapy, such as those
at elevated risk of relapse, decompensation or hospitalization related to
medication nonadherence.
17.
Prohibits
the adopted SMI long-term level of care from requiring a nursing facility level
of care, physical disability or impairment criteria or using a preadmission
screening tool.
18.
Allows
AHCCCS to refine the assessment criteria and processes through rule or policy,
consistent with legislative intent, including adjustment to assessment tools,
thresholds or processes.
Program
Capacity
19.
Limits
enrollment in the HCBS for SMI Program to 250 members statewide, including
temporary emergency placements, subject to CMS approval.
20.
Allows
AHCCCS to increase enrollment above 250 members if data reported in the annual
report demonstrates reduced utilization of high-cost services or cost avoidance
in state-funded systems, subject to review JLBC review.
21.
Prohibits
enrollment in the HCBS for SMI Program from exceeding 1,000 members unless
authorized by the Legislature.
22.
Requires AHCCCS, when
capacity is limited, to assign available slots based on the following:
a)
individuals under court-ordered treatment;
b)
individuals with legal guardianship due to psychiatric incapacity;
c)
individuals discharged from a jail or prison, ASH or a BHRF;
d)
individuals who are homeless or at imminent risk of homelessness;
e)
individuals with repeated crisis episodes, psychiatric hospitalizations
or public safety involvement;
f)
individuals presenting significant safety risks due to psychiatric
symptoms; and
g)
individuals
with high-intensity or complex psychotropic medication regimens requiring
enhanced monitoring to ensure adherence and identify potential adverse effects.
23.
Allows
a court to recommend participation in the HCBS for SMI Program.
24.
Prohibits
a court from compelling AHCCCS to exceed the HCBS for SMI Program enrollment
cap.
25.
Allows
AHCCCS to reserve a portion of available capacity for emergency or priority
placements.
Provider
Requirements
26.
Requires
providers to document behavioral interventions, crisis supports and staffing
adjustments before initiating discharge.
27.
Requires
a provider that receives reimbursement under the HCBS for SMI Program to
implement eviction-prevention protocols and obtain regional behavioral health
authority approval before issuing nonemergency notices to vacate.
28.
Allows
AHCCCS to adopt enhanced reimbursement rates for high-acuity SMI individuals
who are receiving HCBS.
29.
Specifies that the provider
requirements do not:
a)
limit AHCCCS's authority to ensure the health and safety of participants;
or
b)
require
a provider to continue services when immediate and documented risks to health
or safety cannot be mitigated through reasonable clinical interventions.
Miscellaneous
30.
Requires AHCCCS, beginning
one year after implementation of the HCBS for SMI Program and each year
thereafter, to submit a report to the Governor, the President of the Senate and
the Speaker of the House of Representatives that includes:
a)
the number of enrolled members and the number of individuals who are on
the waitlist;
b)
the percentage of members who are under court-ordered treatment,
guardianship or criminal justice supervision;
c)
housing stability outcomes for members;
d)
member utilization statistics, as outlined;
e)
provider denials and discharges and the reasons for the denials and
discharges of members; and
f)
the
fiscal impact and estimated cost of avoidance related to the HCBS for SMI
Program.
31.
Requires
AHCCCS to seek and maintain any necessary federal approvals to operate the HCBS
for SMI Program through approved Medicaid state plan authorities, waivers or demonstration
authorities.
32.
Requires
AHCCCS, if CMS denies or does not approve a request necessary to implement the
HCBS for SMI Program, to continue to pursue approval to the extent allowed by
federal law through modifications, resubmissions or alternative federal
authority.
33.
Requires
AHCCCS to report the status of approval efforts in the semiannual
implementation updates.
34.
Allows
AHCCCS to adopt rules to implement the HCBS for SMI Program.
35.
Specifies
that statutory authorization for the HCBS for SMI Program does not expand or
modify standards for involuntary treatment.
36.
Defines
home and
community-based services
to:
a)
mean services authorized under one or more Medicaid state plan
authorities, waivers or demonstration authorities that support individuals in
the community as an alternative to institutionalization; and
b)
include
services that provide assistance with activities of daily living, medication
administration, supervision and structured supports comparable to assisted
living models.
37.
Defines
terms.
38.
Becomes
effective on the general effective date.
Amendments Adopted by the
Health and Human Services Committee
1.
Requires the stakeholder workgroup to be convened through the submission
of the first annual report.
2.
Narrows eligibility for the HCBS for SMI Program to individuals
requiring an SMI long-term level of care, rather than any SMI level of care.
3.
Requires implementation updates to be made semiannually, rather than
quarterly.
4.
Reduces the enrollment limit of the HCBS for SMI Program from 500 to 250
members but allows the limit to increase to up to 1,000 members if outlined
conditions apply.
5.
Removes the requirement that AHCCCS assign available slots in an order
of priority when availability in the HCBS for SMI Program is limited.
6.
Modifies the annual report to require reporting on member utilization of
emergency departments, evaluation agencies and screening agencies, rather than
crisis services and jail.
7.
Requires AHCCCS to continue pursuing approval if CMS denies or does not
approve implementation of the HCBS for SMI Program and report the status of the
efforts in the semiannual implementation updates.
8.
Allows, rather than requires, AHCCCS to adopt rules to implement the
HCBS for SMI Program.
9.
Makes conforming changes.
Amendments Adopted by the
Appropriations, Transportation & Technology Committee
1.
Requires the stakeholder workgroup to be convened through the submission
of the first annual report.
2.
Narrows eligibility for the HCBS for SMI Program to individuals
requiring an SMI long-term level of care, rather than any SMI level of care.
3.
Requires implementation updates to be made semiannually, rather than
quarterly.
4.
Reduces the enrollment limit of the HCBS for SMI Program from 500 to 250
members but allows the limit to increase to up to 1,000 members if outlined
conditions apply.
5.
Removes the requirement that AHCCCS assign available slots in an order
of priority when availability in the HCBS for SMI Program is limited.
6.
Requires the annual report to include reporting on member utilization of
emergency departments, evaluation agencies and screening agencies, in addition
to utilization of crisis services and jails.
7.
Requires AHCCCS to continue pursuing approval if CMS denies or does not
approve implementation of the HCBS for SMI Program and report the status of the
efforts in the semiannual implementation updates.
8.
Allows, rather than requires, AHCCCS to adopt rules to implement the
HCBS for SMI Program.
9.
Makes conforming changes.
Revisions
�
Updates the fiscal impact statement.
Senate Action
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Prepared by Senate Research
April 2, 2026
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Current Bill Text
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SB1630 - 572R - S Ver
Senate Engrossed
home; community-based
services; mental illness
State of Arizona
Senate
Fifty-seventh Legislature
Second Regular Session
2026
SENATE BILL 1630
AN
ACT
Amending title 36, chapter 29, Arizona Revised
Statutes, by adding article 3.1; relating to the Arizona health care cost
containment system.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 29, Arizona
Revised Statutes, is amended by adding article 3.1, to read:
ARTICLE
3.1. HOME AND COMMUNITY-BASED SERVICES
FOR
PERSONS WITH SERIOUS MENTAL ILLNESS
START_STATUTE
36-2979.
Definitions
In this article, unless the context otherwise
requires:
1. "Administration" means
the Arizona health care cost containment system administration.
2. "Behavioral health
residential facility" means a health care institution that is licensed
pursuant to this title to provide level I or II behavioral health residential
services.
3. "High-acuity seriously
mentally ill individual" means a person who meets a serious mental illness
long-term level of care and one or more priority criteria
listed in section 36-2979.04, subsection B.
4. "Home and community-based
services":
(
a
) means
services authorized under one or more medicaid state plan authorities, waivers
or demonstration authorities, including those authorized under 42 United States
Code section 1315 or 1396
n,
that support individuals in
the community as an alternative to institutionalization.
(
b
) includes
services that provide assistance with activities of daily living, medication
administration, supervision and structured supports comparable to assisted
living models.
5. "Member" means a person
who is enrolled in the program.
6. "Program" means the home
and community-based service program for adults who are seriously mentally
ill.
7. "Qualified income trust"
means a trust as described in 42 United States Code section 1396
p
(
d
)(4)(B).
8. "Seriously mentally ill"
has the meaning prescribed in section 36-550.
9. "Serious mental illness
long-term level of care" means the behavioral health
institutional level of care adopted by the administration pursuant to section
36-2979.02.
END_STATUTE
START_STATUTE
36-2979.01.
Home and community-based service program for adults who are
seriously mentally ill; request for federal approval; stakeholder workgroup;
semiannual implementation updates
A. The home and community-based
service program for adults who are seriously mentally ill is established.� The
administration shall develop and request authority from the centers for
medicare and medicaid services to implement a dedicated home and community-based
services benefit for adults who are determined to be seriously mentally ill.
B.
Through the
submission of the first annual report, the administration shall convene a
stakeholder workgroup that includes representatives from behavioral health
providers, family members, caregivers and guardians of individuals who are
seriously mentally ill, counties, tribal nations and community organizations to
advise on program design and implementation. Stakeholder input shall
specifically address the needs of individuals who require complex medication
management, enhanced monitoring and structured community-based supports,
including assisted living-type models, to promote medication continuity
and safety.
C. The administration shall request
approval from the centers for medicare and medicaid services for the program
not later than July 1, 2027 and shall begin implementing the program not later
than one year after the approval by the centers for medicare and medicaid
services.
D. Until the program is implemented,
the administration shall provide
semiannual implementation
updates to the president of the senate, the speaker of the house of
representatives and the chairpersons of the senate and house of representatives
health and human services committees, or their successor committees.
END_STATUTE
START_STATUTE
36-2979.02.
Eligibility; financial eligibility; serious mental illness
long-term level of care; criteria
A. To be eligible for the program, an
individual must meet all of the following:
1. have been determined to be
seriously mentally ill.
2. meet the serious mental illness
long-term level of care adopted by the administration pursuant to
subsection C of this section.
3. require home and community-based
services in order to avoid placement in a behavioral health residential
facility or psychiatric institution.
4. meet the financial eligibility
requirements pursuant to subsection b of this section.
B. An individual who meets the
Serious mental illness
long-term level of care adopted by
the administration pursuant to subsection C of this section is financially
eligible for the program if the individual's income does not exceed three
hundred percent of the federal supplemental security income benefit rate. An
individual whose income exceeds this standard may establish a qualified income
trust to achieve eligibility. Resource and spousal impoverishment
standards shall be the same as required pursuant to article 2 of this chapter
for enrollees in the Arizona long-term care system home and community-based
services.
C. The administration shall adopt a
serious mental illness
long-term level of care
specific to individuals who are seriously mentally ill that is based on
behavioral, functional and safety criteria, which may include any of the
following:
1. Current or recent court-ordered
treatment.
2. Legal guardianship due to
psychiatric incapacity.
3. Recent discharge from a jail or
prison, the state hospital or a behavioral health residential facility.
4. Repeated psychiatric
hospitalizations or crisis episodes.
5. Impaired judgment, disorganization
or inability to perform activities of daily living due to psychiatric symptoms.
6. Documented safety risks, including
elopement, fire or water misuse, aggression, delusional behavior or
exploitation risk.
7. Homelessness or imminent risk of
homelessness.
8. High-intensity or complex
psychotropic medication regimens requiring enhanced monitoring to ensure
adherence and to identify potential adverse effects.
9. Clinical needs that necessitate
structured community-based supports, including assisted living-type
supports, to maintain continuity of medication therapy, such as those at
elevated risk of relapse, decompensation or hospitalization related to
medication nonadherence.
D. The Serious mental illness
long-term level of care adopted pursuant to subsection C of this
section may not require a nursing facility level of care or physical disability
or physical impairment criteria and may not use a preadmission screening tool.
E. The administration may refine the
assessment criteria and processes through rule or policy, consistent with
legislative intent, including adjustment to assessment tools, thresholds or
processes.
END_STATUTE
START_STATUTE
36-2979.03.
Covered services; modification
A. Subject to the approval of the
centers for medicare and medicaid services, the administration shall provide
home and community-based services that are comparable to those authorized
under article 2 of this chapter, with modifications appropriate for behavioral
health needs.� The home and community-based services shall include:
1. Attendant care and personal care.
2. Habilitation with behavior
management.
3. Adult day health care with a
behavioral health focus.
4. Supervised community living
services, including assisted living-type supports.
5. Respite care.
6. Home-delivered meals.
7. Nursing, home health and
medication administration services.
8. Nonemergency transportation.
B. The administration shall establish
service descriptions and scope and staffing standards through rule or policy.
C. Home and community-based
services may be delivered in any residential setting authorized under state law
when an individual is subject to a valid court order, guardianship or
involuntary treatment authority pursuant to this title, if:
1. Medicaid reimbursement under this
article is limited to covered home and community-based services and does
not include room, board, supervision for custody or enforcement of court
orders.
2. The individual is afforded
periodic review and planning for transition to a less restrictive setting when
clinically appropriate.
D. The administration may add, modify
or combine services consistent with federal approval and legislative intent.
END_STATUTE
START_STATUTE
36-2979.04.
Program capacity; enrollment factors; emergency placements
A. Subject to the approval of the
centers for medicare and medicaid services,
the
administration shall implement the program for up to two hundred fifty members
statewide, including temporary emergency placements.�
The
administration may increase enrollment above two hundred fifty members if the
administration demonstrates, through data reported pursuant to section 36-2979.06,
reduced utilization of high-cost services or cost avoidance in state-funded
systems, subject to review by the joint legislative budget
committee. Enrollment may not exceed one thousand members unless
authorized by the legislature.
B. When capacity is limited, the
administration shall assign available slots based on the following:
1. Individuals under court-ordered
treatment.
2. Individuals with legal
guardianship due to psychiatric incapacity.
3. Individuals discharged from a jail
or prison, the state hospital or a behavioral health residential facility.
4. Individuals who are homeless or at
imminent risk of homelessness.
5. Individuals with repeated crisis
episodes, psychiatric hospitalizations or public safety involvement.
6. Individuals presenting significant
safety risks due to psychiatric symptoms.
7. Individuals with high-intensity
or complex psychotropic medication regimens requiring enhanced monitoring to
ensure adherence and to identify potential adverse effects.
C. A court may recommend
participation in the program but may not compel the administration to exceed
the enrollment cap.
D. The administration may reserve a
portion of available capacity for emergency or priority placements.
END_STATUTE
START_STATUTE
36-2979.05.
Provider requirements; enhanced reimbursement rates
A. Providers
shall document behavioral interventions, crisis supports and staffing
adjustments before initiating discharge.
B. A
provider that receives reimbursement under the program shall implement eviction-prevention
protocols and obtain regional behavioral health authority approval before
issuing nonemergency notices to vacate.
C. The administration may adopt
enhanced reimbursement rates for high-acuity seriously mentally ill
individuals who are receiving home and community-based services.
D. This section does not limit the
administration's authority to ensure the health and safety of participants.
E. This section does not require a
provider to continue services when immediate and documented risks to health or
safety cannot be mitigated through reasonable clinical interventions.
END_STATUTE
START_STATUTE
36-2979.06.
Annual report
Beginning one
year after program implementation and each year thereafter, the administration
shall submit a report to the Governor, the President of the Senate and the
Speaker of the House of Representatives that includes:
1. The number of enrolled members and
the number of individuals who are on the waitlist.
2. The percentage of members who are
under court-ordered treatment, guardianship or criminal justice
supervision.
3. Housing stability outcomes for
members.
4. Hospitalization, crisis service
, jail
, emergency department, evaluation agency
and screening agency utilization of members.
5. Provider denials and discharges
and the reasons for the denials and discharges of members.
6. The fiscal impact of and estimated
cost avoidance related to the program.
END_STATUTE
START_STATUTE
36-2979.07.
Authority to seek and maintain federal approval; rules
A
. The
administration shall seek and maintain any necessary federal approvals and may
operate the program pursuant to one or more approved medicaid state plan
authorities, waivers or demonstration authorities, including those authorized
under 42 United States Code section 1315 or 1396
n
.
B. If the centers for medicare and
medicaid services denies or does not approve a request necessary to implement
this article, the administration, to the extent allowed by federal law, shall
continue to pursue approval through modifications, resubmissions or alternative
federal authority and shall report the status of these efforts in the
semiannual implementation updates required pursuant to section 36-2979.01.
c. The administration
may adopt rules to implement this article.
d. This article does not expand or
modify standards for involuntary treatment under this title.
END_STATUTE