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SB1630 - 572R - H Ver
House Engrossed
Senate Bill
home;
community-based services; mental illness
(now:� enhanced
residential treatment; SMI)
State of Arizona
Senate
Fifty-seventh Legislature
Second Regular Session
2026
SENATE BILL 1630
AN
ACT
Amending section 36-401, Arizona
Revised Statutes; Amending title 36, chapter 4, ARTICLE 2, Arizona Revised
Statutes, by adding section 36-425.10; amending SECTION 36-2935,
Arizona Revised Statutes; Amending title 36, chapter 29, Arizona Revised
Statutes, by adding article 3.1; relating to serious mental illness.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Section 36-401, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-401.
Definitions; adult foster care
A. In this chapter, unless the context otherwise requires:
1. "Accredited health care institution"
means a health care institution, other than a hospital, that is currently
accredited by a nationally recognized accreditation organization.
2. "Accredited hospital" means a hospital
that is currently accredited by a nationally recognized organization on
hospital accreditation.
3. "Adult behavioral health therapeutic
home" means a residence for individuals who are at least eighteen years of
age, have behavioral health issues and need behavioral health services that
does all of the following for those individuals:
(a) Provides room and board.
(b) Assists in acquiring daily living skills.
(c) Coordinates transportation to scheduled
appointments.
(d) Monitors behaviors.
(e) Assists in the self-administration of
medication.
(f) Provides feedback to case managers related to
behavior.
4. "Adult day health care facility" means
a facility that provides adult day health services during a portion of a
continuous twenty-four-hour period for compensation on a regular
basis for five or more adults who are not related to the proprietor.
5. "Adult day health services" means a
program that provides planned care supervision and activities, personal care,
personal living skills training, meals and health monitoring in a group setting
during a portion of a continuous twenty-four-hour
period. Adult day health services may also include preventive,
therapeutic and restorative health-related services that do not include
behavioral health services.
6. "Adult foster care home" means a
residential setting that provides room and board and adult foster care services
for at least one and not more than four adults who are participants in the
Arizona long-term care system pursuant to chapter 29, article 2 of this
title or contracts for services with the United States department of veterans
affairs and in which the sponsor or the manager resides with the residents and
integrates the residents who are receiving adult foster care into that person's
family.
7. "Adult foster care services" means
supervision, assistance with eating, bathing, toileting, dressing, self-medication
and other routines of daily living or services authorized by rules adopted
pursuant to section 36-405 and section 36-2939, subsection C.
8. "Assisted living center" means an
assisted living facility that provides resident rooms or residential units to
eleven or more residents.
9. "Assisted living facility" means a
residential care institution, including an adult foster care home, that
provides or contracts to provide supervisory care services, personal care
services or directed care services on a continuous basis.
10. "Assisted living home" means an
assisted living facility that provides resident rooms to ten or fewer
residents.
11. "Behavioral health services" means
services that pertain to mental health and substance use disorders and that are
either:
(a) Performed by or under the supervision of a
professional who is licensed pursuant to title 32 and whose scope of practice
allows the professional to provide these services.
(b) Performed on behalf of patients by behavioral
health staff as prescribed by rule.
12. "Construction" means building,
erecting, fabricating or installing a health care institution.
13. "Continuous" means available at all
times without cessation, break or interruption.
14. "Controlling person" means a person
who:
(a) Through ownership, has the power to vote at
least ten percent of the outstanding voting securities.
(b) If the applicant or licensee is a partnership,
is the general partner or a limited partner who holds at least ten percent of
the voting rights of the partnership.
(c) If the applicant or licensee is a corporation,
an association or a limited liability company, is the president, the chief
executive officer, the incorporator or any person who owns or controls at least
ten percent of the voting securities. For the purposes of this subdivision,
corporation does not include nonprofit corporations.
(d) Holds a beneficial interest in ten percent or
more of the liabilities of the applicant or the licensee.
15. "Department" means the department of
health services.
16. "Directed care services" means
programs and services, including supervisory and personal care services, that
are provided to persons who are incapable of recognizing danger, summoning
assistance, expressing need or making basic care decisions.
17. "Direction" means authoritative policy
or procedural guidance to accomplish a function or activity.
18. "Director" means the director of the
department.
19. "Direct owner" means a person that has
an ownership or control interest in a health care institution totaling fifty-one
percent or more.
20. "Enhanced residential
treatment facility" means a residential care institution that is licensed
to provide programs and services, including behavioral health services,
structured support services AND health-related services, to residents who
are seriously mentally ill as defined in section 36-550.
20.
21.
"Facilities"
means buildings that are used by a health care institution for providing any of
the types of services as defined in this chapter.
21.
22.
"Freestanding
urgent care center":
(a) Means an outpatient treatment center that,
regardless of its posted or advertised name, meets any of the following
requirements:
(i) Is open twenty-four hours a day, excluding
at its option weekends or certain holidays, but is not licensed as a hospital.
(ii) Claims to provide unscheduled medical services
that are not otherwise routinely available in primary care physician offices.
(iii) By its posted or advertised name, gives the
impression to the public that it provides medical care for urgent, immediate or
emergency conditions.
(iv) Routinely provides ongoing unscheduled medical
services for more than eight consecutive hours for an individual patient.
(b) Does not include the following:
(i) A medical facility that is licensed under a
hospital's license and that uses the hospital's medical provider number.
(ii) A qualifying community health center pursuant
to section 36-2907.06.
(iii) Any other health care institution licensed
pursuant to this chapter.
(iv) A physician's office that offers extended hours
or same-day appointments to existing and new patients and that does not
meet the requirements of subdivision (a), item (i), (iii) or (iv) of this
paragraph.
22.
23.
"Governing
authority" means the individual, agency, partners, group or corporation,
whether appointed, elected or otherwise designated, in which the ultimate
responsibility and authority for the conduct of the health care institution are
vested.
23.
24.
"Health
care institution" means every place, institution, building or agency,
whether organized for profit or not, that provides facilities with medical
services, nursing services, behavioral health services, health screening services,
other health-related services, supervisory care services, personal care
services or directed care services and includes home health agencies as defined
in section 36-151, outdoor behavioral health care programs and hospice
service agencies.
24.
25.
"Health-related
services" means services, other than medical, that pertain to general
supervision, protective, preventive and personal care services, supervisory
care services or directed care services.
25.
26.
"Health
screening services" means the acquisition, analysis and delivery of health-related
data of individuals to aid in determining the need for medical services.
26.
27.
"Hospice"
means a hospice service agency or the provision of hospice services in an
inpatient facility.
27.
28.
"Hospice
service" means a program of palliative and supportive care for terminally
ill persons and their families or caregivers.
28.
29.
"Hospice
service agency" means an agency or organization, or a subdivision of that
agency or organization, that provides hospice services at the place of
residence of its clients.
29.
30.
"Indirect
owner":
(a) Means a person that has an ownership or control
interest in a direct owner totaling fifty-one percent or more.
(b) Includes an ownership or control interest in an
indirect owner totaling fifty-one percent or more and a combination of direct
ownership and indirect ownership or control interests totaling fifty-one
percent or more in the health care institution.
30.
31.
"Inpatient
beds" or "resident beds" means accommodations with supporting
services, such as food, laundry and housekeeping, for patients or residents who
generally stay in excess of twenty-four hours.
31.
32.
"Intermediate
care facility for individuals with intellectual disabilities" has the same
meaning prescribed in section 36-551.
32.
33.
"Licensed
capacity" means the total number of persons for whom the health care
institution is authorized by the department to provide services as required
pursuant to this chapter if the person is expected to stay in the health care
institution for more than twenty-four hours.� For a hospital, licensed
capacity means only those beds specified on the hospital license.
33.
34.
"Medical
services" means the services that pertain to medical care and that are
performed at the direction of a physician on behalf of patients by physicians,
dentists, nurses and other professional and technical personnel.
34.
35.
"Modification"
means the substantial improvement, enlargement, reduction or alteration of or
other change in a health care institution.
35.
36.
"Nonproprietary
institution" means any health care institution that is organized and
operated exclusively for charitable purposes, no part of the net earnings of
which inures to the benefit of any private shareholder or individual, or that
is operated by the state or any political subdivision of the state.
36.
37.
"Nursing
care institution" means a health care institution that provides inpatient
beds or resident beds and nursing services to persons who need continuous
nursing services but who do not require hospital care or direct daily care from
a physician.
37.
38.
"Nursing
services" means those services that pertain to the curative, restorative
and preventive aspects of nursing care and that are performed at the direction
of a physician by or under the supervision of a registered nurse licensed in
this state.
38.
39.
"Nursing-supported
group home" means a health care institution that is a community
residential setting as defined in section 36-551 for not more than six
persons with developmental disabilities, that is operated by a service provider
under contract with the department of economic security and that provides room
and board, daily habilitation and continuous nursing support and intervention.
39.
40.
"Organized
medical staff" means a formal organization of physicians, and dentists if
appropriate, with the delegated authority and responsibility to maintain proper
standards of medical care and to plan for continued betterment of that care.
40.
41.
"Outdoor
behavioral health care program" means an agency that provides behavioral
health services in an outdoor environment as an alternative to behavioral
health services that are provided in a health care institution with facilities.
Outdoor behavioral health care programs do not include:
(a) Programs, facilities or activities that are
operated by a government entity or that are licensed by the department as a
child care program pursuant to chapter 7.1 of this title.
(b) Outdoor activities for youth that are designated
to be primarily recreational and that are organized by church groups, scouting
organizations or similar groups.
(c) Outdoor youth programs that are licensed by the
department of economic security.
41.
42.
"Personal
care services" means assistance with activities of daily living that can
be performed by persons without professional skills or professional training
and includes the coordination or provision of intermittent nursing services and
the administration of medications and treatments by a nurse who is licensed
pursuant to title 32, chapter 15 or as otherwise provided by law.
42.
43.
"Physician"
means any person who is licensed pursuant to title 32, chapter 13 or 17.
43.
44.
"Recidivism
reduction services" means services that are delivered by an adult
residential care institution to its residents to encourage lawful behavior and
to discourage or prevent residents who are suspected of, charged with or convicted
of one or more criminal offenses, or whose mental health and substance use can
be reasonably expected to place them at risk for the future threat of
prosecution, diversion or incarceration, from engaging in future unlawful
behavior.
44.
45.
"Recidivism
reduction staff" means a person who provides recidivism reduction
services.
45.
46.
"Residential
care institution" means a health care institution other than a hospital or
a nursing care institution that provides resident beds or residential units,
supervisory care services, personal care services, behavioral health services,
directed care services or health-related services for persons who do not
need continuous nursing services.
46.
47.
"Residential
unit" means a private apartment, unless otherwise requested by a resident,
that includes a living and sleeping space, kitchen area, private bathroom and
storage area.
47.
48.
"Respite
care services" means services that are provided by a licensed health care
institution to persons who are otherwise cared for in foster homes and in
private homes to provide an interval of rest or relief of not more than thirty
days to operators of foster homes or to family members.
49. "Structured support
services" includes services that are available for up to twenty-four-hours
per day and case management, crisis intervention, social skills training and
budgeting assistance.
48.
50.
"Substantial
compliance" means that the nature or number of violations revealed by any
type of inspection or investigation of a health care institution does not pose
a direct risk to the life, health or safety of patients or residents.
49.
51.
"Supervision"
means directly overseeing and inspecting the act of accomplishing a function or
activity.
50.
52.
"Supervisory
care services" means general supervision, including daily awareness of
resident functioning and continuing needs, the ability to intervene in a crisis
and assistance in self-administering prescribed medications.
51.
53.
"Temporary
license" means a license that is issued by the department to operate a
class or subclass of a health care institution at a specific location and that
is valid until an initial licensing inspection.
52.
54.
"Unscheduled
medical services" means medically necessary periodic health care services
that are unanticipated or cannot reasonably be anticipated and that require
medical evaluation or treatment before the next business day.
B. If there are fewer than four Arizona long-term
care system participants receiving adult foster care in an adult foster care
home, nonparticipating adults may receive other types of services that are
authorized by law to be provided in the adult foster care home as long as the
number of adults served, including the Arizona long-term care system
participants, does not exceed four.
C. Nursing care services may be provided by the
adult foster care licensee if the licensee is a nurse who is licensed pursuant
to title 32, chapter 15 and the services are limited to those allowed pursuant
to law. The licensee shall keep a record of nursing services rendered.
END_STATUTE
Sec. 2. Title
36, chapter 4, article 2, Arizona Revised Statutes, is amended by adding
section 36-425.10, to read:
START_STATUTE
36-425.10.
Enhanced residential treatment facilities; licensure; rules
The department
shall license enhanced residential treatment facilities consistent with this
chapter. The department shall adopt rules for enhanced residential treatment
facilities, including licensure standards, staffing requirements and physical
plant standards
.
An enhanced residential treatment facility may provide PROGRAMS AND
services, through a combination of facility-based or coordinated
community-based services, to residents who are seriously mentally ill as
defined in section 36-550.
END_STATUTE
Sec. 3. Section 36-2935, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-2935.
Estate recovery program; liens
A. The director shall adopt rules in accordance with
state and federal law to allow the administration to file a claim against a
member's estate to recover paid assistance. The administration is
also entitled to a lien on a member's property to recover paid assistance the
member receives.
B. A member's personal representative must notify
the administration of the member's estate or property within three months after
the member's death if the member was at least fifty-five years of age and the
administration has not already filed a statement of claim in the estate
proceedings.
C. As nearly as is possible, the administration
shall recover charges pursuant to the procedures prescribed in sections 36-2915
and 36-2916. If both the administration and a county have
valid liens for paid assistance provided to the same member, or if both the
administration and a special health care district have valid claims for paid
assistance provided to the same member, the value of the property shall be
divided between the administration, the special health care district and the
county pro rata according to the amounts of their respective liens.
D. The administration shall impose liens in a manner
consistent with federal law.
E. This section also applies to
:
1.
Persons who are eligible
pursuant to section 36-2901, paragraph 6, subdivision (a) and who receive
medical assistance under article 1 of this chapter.
2. Persons who are eligible for the
seriously mentally ill enhanced residential treatment pilot program pursuant to
article 3.1 of this chapter.
END_STATUTE
Sec. 4. Title
36, chapter 29, Arizona Revised Statutes, is amended by adding article 3.1, to
read:
ARTICLE 3.1.
SERIOUSLY MENTALLY
ILL
ENHANCED RESIDENTIAL TREATMENT
PILOT PROGRAM
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. "Applicant" means a
person who applies for enrollment in the pilot program.
3. "Behavioral health
services" has the same meaning prescribed in section 36-401.
4. "Contractor" means an
entity that has entered into an agreement with the administration to provide
acute care and behavioral health services to seriously mentally ill individuals
pursuant to article 1 of this chapter and chapter 34, article 1 of this title.
5. "Eligible individual"
means a person who meets the eligibility criteria prescribed in section 36-2979.02.
6. "Enhanced residential
treatment facility" has the same meaning prescribed in section 36-401.
7. "Enhanced residential
treatment services" means services authorized under federal medicaid
authority pursuant to section 36-2979.09 that support individuals in an
enhanced residential treatment facility and that include continuous
supervision, structured support services, medication administration and
monitoring, treatment planning and coordination and personal care services necessary
for health and safety.
8. "Member" means
an eligible individual who is enrolled in the
pilot
program.
9. "
Pilot program"
means the seriously mentally ill
enhanced residential
treatment pilot program established by section 36-2979.01.
10. "Seriously mentally
ill"
or "SMI" has the
same meaning prescribed in section 36-550.
11. "SMI enhanced level of
care" means the functional and behavioral level of care criteria adopted
by the administration pursuant to section 36-2979.02.
12. "Structured support
services" has the same meaning prescribed in section 36-401.
END_STATUTE
START_STATUTE
36-2979.01.
Seriously mentally ill enhanced residential treatment pilot
program; stakeholder work group; semiannual implementation updates; enrollment
cap; federal approval
A. Subject to the approval of the
centers for medicare and medicaid services, available appropriations and the
enrollment cap prescribed in subsection F of this section, the seriously
mentally ill enhanced residential treatment pilot program is established for
three years from the date that the centers for medicare and medicaid services
approve the pilot program consistent with this article.� The pilot program
operates through and is administered by contractors pursuant to their
agreements with the administration under chapter 34, article 1 of this title.�
The administration shall seek any necessary federal authority to implement the
pilot program, including authority under 42 United States code section 1315 or
other applicable federal authority, and shall request approval not later than
July 1, 2027. The administration shall begin enrolling eligible
individuals not later than one year after receiving federal approval, subject
to the available appropriations.
B. The administration shall incorporate the
requirements of this article into contractor agreements executed pursuant to
sections 36-3410 and 36-3412 and shall require contractors to
fulfill the obligations of this article as part of their contractual duties.
C.
Through the
submission of the first annual report required by section 36-2979.08, the
administration shall convene a stakeholder
work group
that includes
individuals who are seriously mentally ill
and behavioral health providers, family members, caregivers and guardians of
individuals who are seriously mentally ill, counties, tribal nations and
community organizations to advise on
pilot program design
and implementation. Stakeholder input shall specifically address the
needs of individuals who require complex medication management, enhanced
monitoring and structured
support services to promote
medication continuity and safety.
D. Until the
pilot
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.
E. The administration may implement
this article through policy, contract requirements and other administrative
mechanisms authorized under sections 36-2903, 36-2904 and 36-3412.
F. Subject to the approval of the
centers for medicare and medicaid services and to available appropriations, the
administration shall implement the pilot program for up to sixty members
statewide.� The administration may increase the enrollment cap above sixty
members during the pilot program if the administration demonstrates, through
data reported pursuant to section 36-2979.08, reduced utilization of high-cost
services or cost avoidance in state-funded systems that demonstrates that
the pilot program appropriation could sustain members beyond the enrollment
cap, subject to available appropriations and review by the joint legislative
budget committee.
G. A court may recommend
participation in the pilot program but may not compel the administration to
exceed the enrollment cap specified in subsection F of this section.
END_STATUTE
START_STATUTE
36-2979.02.
Eligibility; financial eligibility; SMI enhanced level of care;
criteria
A.
Subject to
the approval of the centers for medicare and medicaid services, available
monies and the enrollment cap prescribed in section 36-2979.01,
subsection F, to be eligible for the
pilot program, an
individual must meet all of the following
criteria:
1. Be eighteen years of age or older.
2. Be a resident of this state.
3. have been determined to be
seriously mentally ill.
4. meet the
SMI
enhanced level of care adopted by the administration pursuant to subsection
E of this section
, as determined pursuant to
section 36-2979.03.
5. meet the financial eligibility
requirements pursuant to subsection b of this section
, as
determined by the administration.
B.
The
administration shall determine financial eligibility for the pilot program and
may not delegate that function to a contractor.� An individual is financially
eligible for the
pilot program if the individual's income
does not exceed three hundred percent of the federal supplemental security
income benefit rate
and the individual meets the resource
requirement for long-term care programs, as prescribed by 42 United
States Code section 1396
p
.
C. An individual whose income exceeds
this standard may establish a qualified trust to achieve
financial
eligibility
, pursuant to section 36-2934.01 and
section 1917(
d
)(4)(A), (b) and (c) of the social security
act.
For the purposes of this article, the
following sections of article 2 of this chapter apply to applicants and members
in the same manner that the sections apply to applicants and members in the
Arizona long-term care system:
1. Section 36-2934.02 relating
to financial instruments.
2. Section 36-2935 relating to
estate recovery and liens.
D. To the extent that any provision
of article 2 of this chapter as incorporated by reference in subsection C of
this section references the Arizona long-term care system, that reference
shall be construed to apply to the pilot program established by this article.
E. The administration shall adopt
SMI enhanced level of care specific to individuals who are seriously
mentally ill
. The criteria shall be based on
behavioral, functional and safety criteria
and may not
require physical disability or physical impairment criteria.� The criteria 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, aggression, delusional behavior
, fire or water
misuse 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
support services to maintain continuity of
medication therapy, such as those at elevated risk of relapse, decompensation
or hospitalization related to medication nonadherence.
F. The administration may
modify the eligibility processes through policy, consistent with
this article, subject to any necessary approval by the centers for
medicare and medicaid services and available appropriations.
END_STATUTE
START_STATUTE
36-2979.03.
Enrollment in pilot program; application; delegation of clinical
eligibility; waitlist management
A. An individual who seeks to enroll
in the pilot program shall apply through the individual's
contractor. After determining the individual meets the SMI enhanced
level of care criteria, the contractor shall forward the application to the
administration for financial eligibility determination pursuant to section 36-2979.02,
subsection B.� If the individual is not yet enrolled with a contractor, the
individual may apply through the administration.
B. Subject to the approval of the
centers for medicare and medicaid services, available appropriations and the
enrollment cap prescribed in section 36-2979.01, subsection F, the
administration may delegate to contractors the authority to determine whether
an applicant meets the SMI enhanced level of care criteria adopted by the
administration pursuant to section 36-2979.02, subsection E and to manage pilot
program waitlists, enrollment decisions and capacity prioritization for
individuals who have been determined financially eligible by the
administration.
C. The administration or a contractor
exercising delegated authority under this section shall:
1. Apply the eligibility criteria
adopted by the administration pursuant to section 36-2979.02.
2. Implement and maintain one or more
waitlists, the total of which may not exceed one hundred applicants, for
applicants for whom eligibility has been determined.
3. If the waitlist reaches one
hundred applicants, implement an interest list for additional applicants and
employ phased enrollment or other utilization controls as necessary to ensure
that the enrollment cap prescribed in section 36-2979.01, subsection F is not
exceeded.
4. Assign available pilot program
capacity by applying the priority factors prescribed in subsection D of this
section.
5. Report enrollment data to the
administration in the form and frequency required by the administration by
policy.
D. If the number of financially and
clinically eligible individuals exceeds available pilot program capacity, the
contractor shall assign available slots based on the highest clinical acuity
and functional impairment defined by a methodology that takes into account the
following priority factors:
1. Individuals under court-ordered
treatment.
2. Individuals with legal
guardianship due to psychiatric incapacity.
3. Individuals recently discharged
from 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.
E. The administration shall retain
authority to review and reverse contractor clinical eligibility and enrollment
determinations and to audit contractor compliance with eligibility and
enrollment requirements.
F. The administration may reserve a
portion of available enrollment capacity for emergency or priority placements.
END_STATUTE
START_STATUTE
36-2979.04.
Covered services
A. Subject to the approval of the
centers for medicare and medicaid services, available appropriations and the
enrollment cap prescribed in section 36-2979.01, subsection F, each contractor
shall provide enrolled members with the following services:
1. All services that the contractor
is required to provide to seriously mentally ill individuals under the
contractor's agreement with the administration pursuant to sections 36-3407
and 36-3410, including behavioral health services, physical health
services, crisis services, case management and peer support services.
2. Enhanced residential treatment
services.
B. The contractor shall conduct, at
minimum, an annual review of the ongoing medical necessity of services for each
member and shall engage with the member to plan for transition to a less
restrictive setting when clinically appropriate.
C. The administration may add, modify
or combine services consistent with federal approval and legislative intent,
subject to the approval of monies.
END_STATUTE
START_STATUTE
36-2979.05.
Service plan; assessment
A.
The
contractor shall develop and maintain a written service plan for each member.
The service plan must:
1. Be based on a comprehensive
assessment of the member's behavioral health, functional and safety needs.
2. Identify the specific services and
support to be provided and the settings in which the services and support will
be provided.
3. Include goals for recovery,
stability and, if appropriate, transition to less restrictive settings.
4. Be updated at least annually or
more frequently if the member's needs change.
B. The member and, if applicable, the
member's guardian or authorized representative shall participate in the
development and revision of the service plan.
END_STATUTE
START_STATUTE
36-2979.06.
Enhanced residential treatment services; provider requirements;
transition and discharge planning protocols; reimbursement
A. Providers of enhanced residential
treatment services shall document behavioral interventions, crisis support and
staffing adjustments before initiating the discharge of any member.
B. A provider of enhanced residential
treatment services shall implement transition and discharge planning protocols
and shall obtain approval from the contractor before issuing to a member a
nonemergency notice to vacate.
C. The administration may adopt
enhanced reimbursement rates for enhanced residential treatment services
provided to members under this article. The administration shall
incorporate reimbursement rates and methodologies into contractor agreements
pursuant to section 36-3412.
D. This section does not:
1. limit the administration's
authority to ensure the health and safety of members.
2. Require a provider to continue
services when immediate and documented risks to health or safety cannot be
mitigated through reasonable clinical interventions.
3. Require a contractor to continue
paying for services that are not medically necessary.
END_STATUTE
START_STATUTE
36-2979.07.
Grievance and appeal process
A. A member or applicant aggrieved by
an action of the administration or a contractor relating to eligibility,
enrollment or services under this article has the right to file a grievance or
appeal pursuant to section 36-3413 and, if applicable, to a hearing
pursuant to rules adopted pursuant to section 36-2903.01, subsection B.
B. The contractor's grievance and
appeal process required under section 36-3413 applies to matters arising
under this article, including denials, reductions or terminations of enhanced
residential treatment services and contractor clinical eligibility
determinations.
C. Appeals of financial eligibility
determinations made by the administration pursuant to section 36-2979.02,
subsection B shall be heard pursuant to rules adopted pursuant to section 36-2903.01,
subsection B.
END_STATUTE
START_STATUTE
36-2979.08.
Annual report
Beginning one year after
pilot
program implementation and each year thereafter
for the
duration of the pilot program, 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 members and the
number of individuals who are on the waitlist
and the
number of individuals who are on the interest list for services and who have
not yet been enrolled, if applicable.
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
pilot program.
7. The number of members who are
served in enhanced residential treatment facilities.
END_STATUTE
START_STATUTE
36-2979.09.
Authority to seek and maintain federal approval
A
. The
administration shall seek and maintain any necessary federal approvals and may
operate the
pilot 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
other applicable federal authority.
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.
The administration shall obtain legislative approval for modifications or
resubmissions that are inconsistent with this article.
c. On federal approval and subject to
available appropriations, the administration may implement this article through
policy and contract requirements pursuant to sections 36-2903, 36-2904
and 36-3412.
d. This article does not expand or
modify standards for involuntary treatment under this title.
END_STATUTE
START_STATUTE
36-2979.10.
Service plan; assessment
A. Services provided under this
article shall supplement but not replace any other benefits or services for
which a member is otherwise eligible.
B. The administration shall
coordinate benefits with other payors, including medicare and private
insurance, to the extent required by federal law.
C. A member in the pilot program may
not also be enrolled in the Arizona long-term care system pursuant to
article 2 of this chapter.
END_STATUTE
Sec. 5.
Delayed repeal; condition; notice
A. The seriously mentally
ill enhanced residential treatment pilot program established by title 36,
chapter 29, article 3.1, Arizona Revised Statutes, as added by this act, is
repealed three years after the date that the centers for medicare and medicaid
services approve the pilot program.
B. The Arizona health care
cost containment system administration shall notify the director of the Arizona
legislative council in writing of this date.