Report on the Joint Legislative Committee for the Arizona Health Care Cost Containment System

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1996
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FINAL
SUNSET REPORT
JOINT LEGISLATIVE COMMITTEE
FOR THE ARIZONA HEALTH CARE
COST CONTAINMENT SYSTEM
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TABLE OF CONTENTS
A. STATUTORY AUTHORITY
B. EXECUTIVE SUMMARY
C. COVER LETTER
D. PERFORMANCE AUDIT
E. SUMMARY OF ACTIVITIES
F. MEETING NOTICE
\J. MINUTES
H. ATTENDANCE LIST'
HEALTH COftfMITTEE OFREFERENCE
Date: October 23, 1996
--
Lou-Ann Preble
Sue Gerar Co-Chair I
Senate Health Committee ofReference &
House Health Committee ofReference
REPORT ON THE JOINT LEGISLATIVE COMMITTEE
FOR THE ARIZONA HEALTH CARE COST
CONTAINMENT SYSTEM
The Joint Legislative Committee for the Arizona Health Care Cost Containment
System be terminated and tile Joint Health Committee ofReference absorb its
junctions.
James Henderson
Janice Brewer
To: JOINT LEGISLATIVE AUDITCOMMITTEE
Patricia Noland, Co-Chair
Sue Grace, Co-Chair
Pursuant to Title 41, Chapter 27, Arizona Revised Statutes, the Committee ofReference, after
performing a sunset review and conducting a public hearing, recommends the following:
DaVid Petersen
Sandra Kennedy /~ o ·~i, r ',~ f:~
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COMMIITEE OF REFERENCE REPORT
ON THE
JOINT LEGISLATIVE COMMIITEE FOR
THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
I. BACKGROUND
Pursuant to section 41-1292, Arizona Revised Statutes, the Joint Legislative Audit
Committee (JLAC) assigned the sunset review of the Joint Legislative Oversight Committee for
the Arizona Health Care Cost Containment System to the Joint Legislative Health Committees of
Reference.
II. COMMIITEE SUNSET REVIEW PROCEDURE
The Committee of Reference held a public hearing on October 23, 1996, to consider the
sunset report and receive public testimony regarding the Joint Legislative Oversight Committee
for the Arizona Health Care Cost Containment System. The Committee heard testimony from
the Senate Research Analyst, who explained the charge of the Joint Legislative Oversight
Committee for the Arizona Health Care Cost Containment System and explained the ongoing
legislative programs that may require the Oversight Committee's review, She also noted that the
On:rsight Committee is required to meet four times a year, but has only met one or two times a
year.
~1inutt:s of tht: puhlic hearing held on October ::!3, 1996 are attached. (Attachment)
111 CO\1\lrIlTE RECOMMENDATIONS
The Committee of Reference recommends that the Joint Legislative Oversight Committee
for the: :\T1lOna Health Care Cost Containment System be terminated, and that the scope of the
Jomt 1e:~lsbti\·t: flcalth Committees of Reference he expanded to include questions concerning
:\IlCCCS
1\'. STAll'TORY REPORT PURSl'.·\:,\T 10 SECTION 41- I292, A.R.S.
hkotllicatiQn of the problem ('r the ~s:s:ds that the Agency is Intended to Address
The Joint Legislative Chcrslght Committee of the Arizona Health Care Cost
Containment System was established in 1984 to conduct negotiations with the federal
government relating to all agreements hetween the federal government and the state concerning
Title XIX programs in the State under Title XIX of the Social Security Act. The Committee
must also review and make recommendations concerning all proposals for additions or
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modifications to populations covered or ~ervices provided by the AHCCCS Administration or
any other state agency providing services to populations eligible under Title XIX ofthe Social
Security Act. The Committee is further required to monitor the implementation ofthese
additions or modifications. Additionally, the Committee is required to review the
implementation of the AHCCCS hospital payment methodology established pursuant to § 36­2903.01.
The Oversight Committee consists of five members of the senate appointed by the president of
the senate and five members of the house of representatives appointed by the speaker ofthe
house of representatives.
2. A Statement to the Extent Practicable in Ouantitative and Qualitative TermS. ofthe Objectives
of Such Agency and Its Anticipated Accomplishments
The objectives of the Joint Legislative Oversight Committee on the Arizona Health Care
Cost Containment System are to review and make recommendations concerning any additions or
modifications to populations covered or services provided by the Arizona Health Care Cost
Containment System Administration or any other state agency providing services to populations
eligible under Title XIX of the Social Security Act. The Oversight Committee also monitors the
implementation of these additions or modifications.
3. Identification of Any Other Agencies Having Similar. Conflicting or Duplicating Objectives
The Joint Legislative Health Committees of Reference, created by section 41-2954,
Arizona Revised Statutes. are also involved in overseeing health-related issues, and therefore, it
was recommended that they assume the responsibilities of the Oversight Committee should it be
terminated.
4. Assessment of the Conseguences of Eliminating the Agency or of Consolidating it with
Another Agency
The Joint Legislative Oversight Committee has been active in overseeing AHCCCS and
issues related to it. However, the Joint Legislative Health Committees of Reference are capable
of assuming the Oversight Committee's functions and maintaining effective oversight of the
AHCCCS.
V. ATTACHMENTS
A. Statutory Authority
B . Exccutive Summary
C. Covcr Letter
D. Performance Audit
E. Summary of Activities
F. Mceting Notice
G. Minutes
H. Attendance List
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STATUTORYAUTHORITY
(Section A)
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41-1292. Joint legislative committee for the Arizona health care cost containment system
A. The joint legislative committee for the Arizona health care cost containment system is established.
B. The committee shall be comprised of five members of the senate appointed by the president of the senate
and five members of the house of representatives appointed by the speaker of the house of representatives. No more
than three members appointed from the house of representatives and no more than three members appointed from the
senate may be members of the same political party.
C. The committee may use the expertise and services of legislative staff and, as necessary, may employ and
contract for the advice and services of experts in the fields as well as other necessary professional and clerical services.
D. The committee shall be convened at least four times each year.
E. The committee, in conjunction with the Arizona health care cost containment system administration, shall
conduct negotiations with the federal government relating to all agreements between the federal government and the state
concerning title XIX programs in this state under title XIX of the social security act (P.L. 89-97; 79 Stat. 344, 42 United
States Gode section 1396, and sections 1396a through 1396u).
F. The committee shall review and make recommendations concerning all proposals for additions or
modifications to popUlations covered or services provided by the Arizona health care cost containment system
administration or any other state agency providing services to populations eligible under title XIX of the social security act
(P.L. 89-97; 79 Stat. 344,42 United States Code section 1396, and sections 1396a through 1396u). The committee shall
also monitor the implementation of these additions or modifications, inclUding the review of the preadmission screening
instrument, the eligibility and enrollment system and the service delivery system.
G. The committee shall review the implementation of the Arizona health care cost containment system hospital
payment methodology established pursuant to section 36-2903.01. Before the implementation of changes in payment
made to a hospital within the first thirty days after receipt of a bill as authorized by law beginning March 1, 1996, the
committee shall review and approve those rate changes in order to ensure the state's continued compliance with federal
laws regarding reasonable and adequate rates that meet the costs incurred by efficiently and economically operated
hospitals in this state.
H. The committee has the powers conferred by law on legislative committees including the authority to issue
subpoenas.
41-2997.14. Joint legislative committee for the Arizona health care cost containment system: termination July 1
A The Joint legislative committee for the Arizona health care cost containment
system terminates on July 1, 1997.
B Section 41-1292 is repealed on January 1, 1998.
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EXECUTIVE SUMMARY
The Joint Legislative Oversight Committee for the Arizona Health Care Cost Containment
System is comprised of 5 members of the Senate and 5 members ofthe House of
Representatives.
Pursuant to § 41-1292, Arizona Revised Statutes, the Committee is required to conduct
negotiations with the federal government relating to all agreements between the federal
government and the State concerning Title XIX programs in the State under Title XIX of the
Social Security Act. The Committee must also review and make recommendations concerning
all proposals for additions or modifications to populations covered or services provided by the
AHCCCS Administration or any other state agency providing services to populations eligible
under Title XIX of the Social Security Act. The Committee is further required to monitor the
implementation of these additions or modifications. Additionally, the Committee is required to
review the implementation of the AHCCCS hospital payment methodology established pursuant
to § 36-2903.01.
l-he Committee's responsibilities were increased during the Forty-second Legislature, Second
Regular Session, (Laws 1996, Chapter 288) to include the review of the implementation and
adoption of rules for the Inpatient Hospital Reimbursement Pilot Program. Other areas where the
Committee could playa role include (1) reviewing the per diem hospital reimbursement rates
methodology established by the Administration in conjunction with the Arizona Hospital Trade
Association and prepaid capitated providers who contract with AHCCCS; (2) ensuring that the
quick pay discount is appropriately phased out; and (3) reviewing the Administration's
calculation of Disproportionate Share payments methodology.
The Joint Legislative Oversight Committee for the Arizona Health Care Cost Containment
System is required by statute to meet at least four times each year.
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~~ri;:oltu ;§httr 7[cgtslaturr
17Ll olll rst lll:tsl!ilt~tolt
~ll~orllix, .Ari~ol1a 83007
July 11, 1996
Senator Ann Day
Representative Sue Gerard
Arizona State Capitol
1700 West Washington
Phoenix, AZ 85007
Dear Senator Day and Representative Sue Gerard:
The sunset review process prescribed in Title 41, Chapter 27, Arizona Revised Statutes,
provides a system for the Legislature to evaluate the need to continue the existence of state agencies.
Under the sunset review process, an agency is reviewed by a legislative committee of reference.
Upon completion ofthe sunset review, the committee of reference recommends to continue, revise,
consolidate or terminate the agency.
The Joint Legislative Audit Committee (JLAC) has assigned the sunset review of Joint
Legislative Committee for the Arizona Health Care Cost Containment System (AHCCCS) to the
committee of reference comprised of members of the Senate Health Committee and the House of
Representatives Health Committee.
ARS section 41-2954 requires the committee of reference to consider certain factors in
deciding whether to recommend continuance or termination of an agency. Please provide your
response to those factors as provided below:
The objective and purpose in establishing the Committee
2 The effectiveness with which the Committee has met its objective and purpose and the
efficiency with which it has operated
3 The extent to which the Committee has operated within the public interest.
4 The extent to which rules adopted by the Committee are consistent with the legislative
mandate
5 The extent to which the Committee has encouraged input from the public before adopting
its rules and the extent to which it has informed the public as to its actions and their expected impact
on the public
9. The extent to which changes are necessary in the laws of the Committee to adequately
comply with the factors listed in this subsection.
10. The extent to which the termination ofthe Committee would significantly harm the public
health, safety or welfare.
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Representative Sue Gerard
Co-Chair, Health Committee ofReference
12. The extent to which the Committee has used private contractors in the performances of
its duties and how effective use of private contractors could be accomplished.
Thank you for your cooperation Please contact Senate or House health research staff if you
have any questions
8. The extent to which the Committee has addressed deficiencies in its enabling statutes
which prevent it from fulfilling their statutory mandate.
Senator Ann Day
Representative Sue Gerard
July 11, 1996
Page 2
6. The extent to which the Committee has been able to investigate and resolve complaints
that are within its jurisdiction.
7. The extent to which the Attorney General or any other applicable agency of state
government has the authority to prosecute actions under the enabling legislation.
11. The extent to which the level ofregulation exercised by the Committee is appropriate and
whether less or more stringent levels of regulation would be appropriate.
Sincerely,
In addition to responding to the factors in ARS section 41-2954, please provide the committee
of reference with copies of minutes from your meetings during fiscal year(s) 1995 through 1996, and
an annual report, and respond to the attached questionnaire by August 30, 1996 so that we may
proceed with the sunset review and schedule the required public hearing.
AD/SG/cmh
cc. Senator Kennedy
Senator Pena
Senator Huppenthal
Senator Ann Day
Co-Chair, Health Committ of Reference
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Senator Ann Day
Representative Sue Gerard
July 11, 1996
Page 3
Senator Springer
Senator Brewer
Senator Henderson
Senator Petersen
Representative Garcia
Representative Horton
Representative Preble
Representative Weiers
Representative Aldridge
Representative Foster
Lisa Block, House Staff
Kitty Boots, Senate Staff
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THE JOINT LEGISLATIVE COMMITTEE FOR
THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
I. PURPOSE
II. EFFECTIVENESS AND EFFICIENCY OF COMMITTEE
III. PUBLIC INTEREST SERVED
IV. COMMIITEE RULES
V. PUBLIC INPUT AND PARTICIPATION IN THE RULE MAKING PROCESS
VI. INVESTIGATION AND RESOLUTION OF COMPLAINTS
VII. PROSECUTION AND IMMUNITY
VIII. DEFICIENCIES IN ENABLING STATUTE
IX. NECESSARY CHANGES IN CURRENT STATUTES
X. TERMINATION OF THE COMMIITEE AND THE RAMIFICATIONS
XI. LEVEL OF COMMIITEE REGULATION
XII THE LISE OF PRIVATE CONTRACTORS
XIII. O~GOI!'iG PROJECTS
I. PURPOSE
The Committee was created by the Thirty-sixth Legislature, Second Regular Session,
1984 (A.R.S. §41-1292). The Committee's purpose is explained in the statute as follows:
A. Committee Charge (§ 41-1292 )
1. Conduct negotiations with the federal government relating to all agreements between
the federal government and the state concerning Title XIX programs in this state under
Title XIX of the Social Security Act.
2. Review and make recommendations concerning all proposals for additions or
modifications to populations covered or services provided by the Arizona Health Care
Cost Containment System Administration or any other state agency providing services
to populations eligible under Title XIX of the Social Security Act.
3. Monitor the implementation of these additions or modifications, including the review of
the pre-admission screening instrument, the eligibility and enrollment system and the
service delivery system.
4. Review the implementation of the Arizona Health Care Cost Containment System
hospital payment methodology. The Committee must also review and approve all
hospital rate changes before implementation of changes in hospital payments, as
authorized by law beginning March 1. 1996.
II. EFFECTIVENESS AND EFFICIENCY OF COMMITTEE
A. Committee Meetings & Actions Taken (See Minutes)
The Committee has been achieving its objectives of conducting negotiations with
AHCCCS and the federal government relating to Title XIX programs in the state. The
Committee has also been actively involved in reviewing and making recommendations for
additions or modifications to AHCCCS populations served under Title XIX. Additionally, over
the la<;t six years the Committee has convened to discuss and review a variety of related issues,
including the following:
I. Payor-of-last reson lawsuit for state-funded groups on reservations.
., On-reservation demonstratlon project regarding the coordination of tribal, state, and
federal services and resources
3. Continuation of the Committee
4. Implementation of Adult Title XIX Mental Health Services
5. Implementation of Arnold v Sam criteria.
6. Consultation with the Governor's staff regarding program implementation delays for
mental health services for ALTCS members 6S years and over.
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7. County responsibility for providing mental health care services for the ALTCS
population.
8. County eligibility determinations
9. Defining "emergency services" for the fee-for-service program.
10. Collection of$5 co-payments for state-only members' office visits.
11. Third Party Recovery. .
12. The Department of Health Services request for proposal process for general mental
health and substance abuse for Title XIX coverage.
13. The regional behavioral health authority bidding process and financial solvency.
14. Capitation rates for children.
15. ComCare crisis intervention system.
16. Southern Arizona Mental Health Care Privatization
17. Child Protective Services and Behavioral Health Services
III. PUBLIC INTEREST SERVED
A. Who is Served?
The Committee has made a concerted effort to involve the public in discussions
related to the AHCCCS and the programs and services it provides. This public input has enabled
changes to be implemented and new programs, such as The Supportive Residential Living
Centers pilot program, to be created. As a result. the Committee's oversight and inquiries have
furthered the interests of both the AHCCCS population and the general public.
IV. COMMITTEE RULES
N/A
\'. Pl1BLlC I~PllT AND PARTICIPATION IN THE RULE MAKING PROCESS
A. Public Input
The Committee meetings are open to the public, enabling the public to address its
concerns to the Committee and the agencies that are responsible for enacting the Legislature's
mandates,
VI. I~\'ESTIGATION AND RESOLVTION OF COMPLAINTS
The purpose of the Committee is to hold the relevant agencies accountable for
their actions and inactions. Although its role is not to conduct its own investigations into
constituent complaints. the Committee has addressed several concerns generated from
constituents. including such issues as child capitation rates. agency administrative expenses, and
lack of adequate services.
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VII. PROSECUTION AND IMMUNITY
The Committee has the powers conferred by law on legislative committees, including the
authority to issue subpoenas. .
VIII. DEFICIENCIES IN ENABLING STATUTE
See IX
IX. NECESSARY CHANGES IN CURRENT STATUTES
A. Changes
1. The Committee is required to meet four times a year. Over the last six years, the
Committee has only met one or two times each year. Thus, it may be advisable to
decrease the number of annual meetings from four to two or, in the alternative,
change "shall" to "may" and leave it up to the chairmen to decide how often the
Committee should meet.
2. Change the Committee's charge to reflect changes that have already been
implemented, such as the review of the new hospital payment methodology.
(See S8 1283, 1996; Chapter 288)
X. TERMINATION OF THE COMMITTEE AND THE RAMIFICATIONS
A. Termination
As long as the Arizona Health Care Cost Containment System is active, the
Committee should also remain in effect as an overseer and link between the AHCCCS
and the Legislature that created it. The Committee also provides a good forum for public
discussion.
Also. with the possible advent of federal block grants, there is a great likelihood that
the AHCCCS will need to be revamped accordingly. This Committee is the proper body
to help review and implement any necessary changes.
XI. LEVEL OF COMMITTEE REGULATION
N/A
XII. THE USE OF PRIVATE CONTRACTORS
A. Legislative staff
The Committee may use the expcnisc and services of legislative staff, and as
necessary. may employ and contract for the: advise and services of experts in the fields
as well as other necessary professional and clerical services.
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XIII. ONGOING PROJECTS
A. 1996Legislation
The Committee, pursuant to legislation passed during the Second Regular Session
ofthe Forty-second Legislature (1996), may need to review the actions of the AHCCCS
Premium Sharing Demonstration Project Implementation Committee (HB 2508), the Joint
Legislative Study Committee on County Revenues and Responsibilities (SB 1283), and the Joint
Interim Study Committee to Study the Privatization of the Arizona State Hospital (ad hoc).
In addition, the Committee may need to review changes in the AHCCCS due to the recent
passage of the Federal Welfare Reform bill by Congress.
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Guest List (Attachment 1)
(fape 1, Side A)
Cochairman Gerard called the meeting to order at 1: 14 p.m. and attendance was noted by the
secretary.
Representative Edens
Representative Garcia
Representative Horton
Representative Kyle
Representative Gerard, Cochairman
Members Absent
S~ers Present
Members Present
Minutes of Meeting
Monday, December 12, 1994
House Hearing Room 2 - 1:00 p.m.
ARIZONA STATE LEGISLATURE
Forty-first Legislature - Second Regular Session
JOINT LEGISLATIVE COUNCIL COMMI1·IEE FOR THE
ARIZONA REALm CARE COST CONTAINMENT SYSTEM (AHCCCS)
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
12/12/94
Cochairman Gerard explained that during committee of reference hearings on behavioral health,
questions began surfacing regarding the implemen~tion of ~.B. 2067 (hereinafter "Chapter
229," Attachment 2), general mental health, and the new ~uest for proposal (RF~l..frQm"the
Depanment of HealthSeMces (PHS). A meeting of the"Conunltteewas-tnerefore called to
receive input from those with knowledge of these matters.
Jack Dillenberg, DDS, MPH, Director, Department of Health Services
Chip Carbone, Associate Director, Behavioral Health Services, Department of Health Services
Mabel Chen, MD, Director, Arizona Health Care Cost Containment System
Roger H. Austin, Deputy Director, Depanment of Health Services
Shirley Anderson, Research Analyst, House of Representatives
Senator Huppenthal
Senator Resnick
Senator Springer
Senator Day, Cochairman
Senator Kennedy
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Jack Dillenbem. DDS. MPH. Director. De,partment of Health Services CDHS), expressed
appreciation to DHS and the Arizona Health Care Cost Containment System (AHCCCS) for
providing a forum to discuss matters of importance. He introduced Chip Carbone to address the
issues of general mental health and substance abuse.
Chip Carbone. Associate Director. Behavioral Health Services. Department of Health Services
<DHS), referred to a handout entitled "General Mental Health and Substance Abuse
Implementation Plan for Title XIX Coverage" (Attachment 3) and said that for the past months
lie has worked worked closely With AHCCCS to design an implementation plan to extend..ritl~
XIX services for general mental health and substance abuse to the age 18 through 21 population
currently served by AHCCCS. He emphasized that this group represents less than~lXT
individuals. With regard to program implementation, he said the existing system will be used
WIihi few minor modifications to allow the Regional Behavioral Health Authorities (RBHA's)
to deliver the services. '
Mr. Carbone said DHS is working to exPedite a process to essentially allow MBA's to berome
certified if they are already delivering Title XIX services and meet the D"ecessary requiR.Hllelm;.
Also, entities which do not meet the requirements but do specialize in substance abuse or general
mental health will be identified and assisted through the licensing process. He noted that
referrals will be received from acute care contractors, tribes, schools, self referrals, families and
others. Clarifying revisions have been made to the service level checklist which will determine
eligibility and problem levels ranging from severe to short term. ~e stated PHS's intent to run
a pilot program~ring February to ensure the program is capturing the correct group.
Mr. Carbone said that the checklist will differentiate between serious mental illness (SM!) and
behavioral health problems and reCognize Arnold v, Sam categories. He explainedlbat the most
recent quality audit revealed thar~ililiough SMI individuals are successfully determined, those
with substance abuse problems may be inappropriately screened out.
Cochairman Gerard expressed her opinion that it seems a waste to perform such an in-depth
screenmg across the board when an individual may only have a depression problem, for instance.
Mr. Carbone submitted that the checklist scoring is done by an entrance evaluation.
Cochairman Gerard asked if there will be accountability to prevent billing for unnecessary
services. Mr. Carbone said a system will be proposed to determine appropriate care while
restncting unnecessary services.
In response to Cochairman Gerard. Mr. Carbone explained that RBHA's monitor the providers
and that DHS monitors the RBHA's.
Mr. Carbone referred again to the handout (Attachment 3) and reviewed first-year enrollee
population projections and touched upon state and federal funding needs. He reviewed a
timetable (included in Attachment 3) and said DHS hopes to have a final proposed capitation rate
by February 15, 1995.
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
2 12/12/94
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In response to Mr. Edens, Mr. Carbone said DHS is working to determine what the outcome
measures will be.
In response to Cochairman Gerard, Mr. Carbone clarified that approximately .200Jndividuals
age 18 through 21 currently being served by AHCCCS will be extended Title XIX services for
general mental health and substance abuse. H,.e. said an additional 8,000 individuals are e~ted
to qualify for these services, broken down as follows:
• approximately fifty percent for substance abuse
sixty percent for alcohol abuse
forty percent for drug abuse
• approximately fifty percent for general mental health
Cochairman Gerard questioned the feasibility of an October 1, 1995 implementation date.
Mr. Carbone expressed confidence that this date allows sufficient time for program
implementation.
Mr. Edens opined that it is unrealistic to expect the Health Care Financing Administration
(HCFA) to approve a waiver request in as little as four months. Mr. Carbone explained that
HCFA anticipates that the waiver request will not pose much of a problem because it merely
adds a new population.
Mabel Chen. MD. Director. Arizona Health Care Cost Containment System (AHCCCS), with
regard to general mental health, speculated that once the State makes its decisions, a response
from HCFA can be expected before October 1, 1995.
Cochairman Gerard questioned whether DHS requires legislative approval before proceeding
with the project. Mr. Carbone replied that a bill has been drafted to provide legislative
approval.
Cochairman Gerard asked whether Committee members have a copy of the service matrix.
Mr. Carbone offered to provide this matrix to legislative research staff.
Roeer H, Austin. Deputy Director, Department of Health Services <PHS), distributed three
studies. as follow:
• Feasibility Report of Reinsurance Offering to Regional Behavioral Health Authorities
(Attachment 4)
• Feasibility Report of Offering Varied Capitation Rates to Regional Behavioral Health
Authorities (Attachment 5)
• Report on the Continued Use of a Third Party Payer for Behavioral Health Claims
(Attachment 6). (Summary for this study included as Attachment 7.)
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
3 12/12/94
With regard to reinsurance, Mr. Austin said that~with actuaries and several
RBHA's, it was determined inappropriate to add ~s~ce--P!'9...J1'&11l.WLder.Jhe~
health area.
With regard to urban and rural areas, Mr. Austin explained that data studied with the actuaries
did not give a clear indication that the capitation difference for urban and rural operations is a
real factor.
Ms. Horton pointed out that in rural areas, transportation is an impediment to receIVIng
treatment. She asked how the difference in transportation costs for urban and rural areas will
be addressed. Mr. Austin replied that this will be considered when the capitation rate calculation
sheets are analyzed. He added that because DHS has only three years worth of data from which
to draw, the market in the RFP process will be allowed to drive this issue.
Ms. Horton said she participated in a rural health care study and found transportation costs to
be a major concern in rural areas. Mr. Austin offered to provide Committee members with
copies of the RFP.
Mr. Austin expressed his belief that continued use of the third party payer CI'TP> system is
.~ given that approximately 36 Medicaid states throughout the nation use this system.
Cochairman Gerard clarified that private companies will be contracted to handle the paperwork.
Mr. Austin concurred and said it would be inappropriate for DHS to assume this function
internally because it can be performed less expensively by outside experts in the field.
Mr. Edens suggested that the behavioral health paperwork be handled by AHCCCS, provided
the processing can be done less expensively in house.
Cochairman Gerard asked if AHCCCS is prevented by law from bidding on an RFP.
Mr. Austin replied that this process could very well be done through AHCCCS, provided that
AHCCCS wishes to accept the charge.
Cochairman Gerard opined that AHCCCS should assume the responsibility if it is capable of
dOing so.
Mr. GarcIa asked if AHCCCS's computers have the capacity to do the job of Electronic Data
SY5tem~ ("EDS." the claims processing company). Mr. Austin stated that AHCCCS has the
capability but noted that the issue is whether or not AHCCCS has the capacity.
Dr. Chen stated that if AHCCCS is to process behavioral health claims, the system data base
will have to be expanded to cover Title XIX and non-Title XIX claims. With regard to capacity,
she saJd that with sufficient resources. the new system can process the claims.
Ms. Honon inquired as to the amount of additional resources. Dr. Chen said an exact figure
is not available because she has not had an opportunity to discuss with DHS the changes in the
claims process system.
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
4 12/12/94
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Dr. Dillenberg mentioned that DHS staff released the RFP on December I, 1994.
Mr. Carbone distributed an RFP fact sheet (Attachment 8). Cochairman Gerard asserted that
it makes no difference that the Committee is meeting to discuss the RFP because the RFP has
already been released.
Mr. Carbone explained that although the RFP has been issued, DHS does have the opportunity
to modify it. Cochairman Gerard countered that the legislature has no authority to ensure that
DHS modifies the RFP. Mr. Carbone concurred. Mr. Edens pointed out that the legislature
can always rely on the appropriations process.
Mr. Carbone said DHS is not at liberty to discuss the details of the RFP because it has already
gone out to bid.
In response to Mr. Edens, Mr. Carbone said Chapter 229 requires a performance bond, either
in cash or through an irrevocable letter of credit.
Cochairman Gerard asked what percentage of the overall score is affected by meeting capitation.
Mr. Carbone replied that the entire evaluation guide is neither finished nor for public release.
Mr. Edens read language from Chapter 229 (Attachment 2 - page 4, lines 27 through 39). He
asked the location of language which states that the DHS director will consider a plan in the
event that financial criteria are not met. He stated that the intent of the legislature was to ensure
that RBHA's are financially sound. Cochairman Gerard also questioned where this authority is
granted to the director.
Senator Resnick said that subsection A in Chapter 229 allows the director to choose an
irrevocable letter of credit but does not require that that letter of credit be used. She read the
following language from page 4, lines 35 through 37:
to... An irrevocable letter of credit may be used to meet part, but no more than
fifty per cent of the minimum capitalization requirement established by the
director. to
(Tape 1. Side B)
Mr. Edens opined that DHS should not be allowed to circumvent the intent of the legislature by
makIng allowances for RBHA's which are not able to fulfill fundamental capitalization priorities.
Senator Resnick stated that if the legislature did not intend to allow leniency, it should have
drafted the language to read: "An irrevocable letter of credit shall be used.....
Mr. Austin contended it was DHS's understanding that the language was drafted to be
permissive and provide the director with flexibility. Mr. Edens submitted that DHS cannot cut
a deal on the side without some oversight.
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
5 12/12/94
Senator Resnick remarked that DHS drafted the RFP specifically in response to committee
discussions and language which appeared in Chapter 229. Ms. Horton viewed the pennissive
language as one of the many provisions intended to give flexibility to the DHS director.
Cochairman Gerard expressed her opinion that the permissive language is yet another wonder
born of a one hundred day session. She expressed disappointment with the manner in which
DHS chose to interpret Chapter 229.
Mr. Edens asked if it would be in order for DHS to privately inform Committee members of
the special arrangements to be made for two RBHA's in particular. Ms. Horton stated that
RFP's follow a legal process and cautioned against interference.
Cochairman Gerard asked if actuaries will be used to determine whether a RBHA's financial
plan is realistic. Mr. Carbone said the plan will be reviewed by a team of people qualified to
review the RFP.
Cochairman Gerard asked if noncompliance will be grounds to void a contract. Mr. Carbone
replied affirmatively but indicated that additional time can be granted at DHS's discretion.
Mr. Carbone mentioned that no special arrangements have been made with any potential bidders.
He noted that the RFP provides that failure to meet the financial requirements will result in a
lower score in one section of the RFP. Cochairman Gerard claimed it was the le&islatllre's
i~t~nt .that financial responsibility be a signi7lcanr requirement. .
Mr. Carbone indicated that the specifics for scoring sections will be determined before the bids
are received. Senator Resnick advised against this because it will alter the contracts.
Cochairman Day wondered in what other ways the RFP was drafted to interfere with competitive
bidding. She questioned whether the RFP was structured in favor of the current RBHA's
because two, in particular, are so far in debt. Mr. Carbone asserted that the RFP was not
deSIgned to provide an advantage for a specific or current bidder.
Senator Huppenthal said it may be the case that huge block grants will go to the states if the
Congress and President cannot reach an agreement on federal legislation. The impact of this,
he saId. will be enormous and could mean the end of AHCCCS as we know it.
Cochairman Gerard questioned whether or not Arizona will be bound to its RBHA contract if
the current federally funded programs no longer exist. Mr. Carbone stated that the contract will
include a provIsIon which addresses the availability of funds.
Senator Huppenthal advocated for studying in-depth analyses on the full implications of his
theory. Cochairman Gerard stated that if federal funding is vastly changed, the legislature will
at that tIme be forced into special session to address the matter. She expressed support for a
repeal clause tIed to funding changes on the federal front. -
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
6 12/12/94
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In response to Cochairman Gerard, Mr. Carbone explained that the size and membership
requirements of boards of directors have been established for certain geographic areas. He said
the move is toward smaller boards with advisory groups.
Cochairman Gerard said it is her understanding that problems arose in the past because large
boards contained too many advocates and clients focused on providing services, as opposed to
determining whether or not people actually qualify for services. Mr. Carbone gave assurances
that both sides will be represented in a balanced manner.
Mr. Carbone encouraged any party with questions to submit their questions at the bidders'
conference.
Mr. Carbone distributed a report entitled "ADHS/BHS Grievance and Appeals System"
(Attachment 9) and noted that it is prefaced by a two-page summary. He stated that an office
has been established to handle these appeals and that decisions on grievances are appealable.
In addition, the office handles requests for investigations into various matters, including physical
or sexual abuse.
Cochairman Gerard inquired as to the role of the Human Rights Office. Mr. Carbone replied
that this office lies within the director's office at the Department of Health and assists clients in
understanding use of the grievance and appeals process and in initiating filing.
In response to Mrs. Gerard, Mr. Carbone said DHS's grievance system for clients is approved
by AHCCCS. He added that of the 1,005 grievances filed in 1994, only two proceeded to
AHCCCS for a hearing.
Cochairman Gerard asked who the contact person is at DHS for a grievance problem.
Mr. Carbone said that grievances enter the department at all levels and that he refers his to
Linda Stiles for follow through. He further explained that an individual wishing to lodge a
complaint should submit to the RBHA's formal or informal grievance process. If dissatisfied
with the outcome, individuals can undergo the DHS process which will include mediation and,
if necessary. a formal hearing.
Cochcurman Day wondered how often. if ever. the RBHA's admit to being wrong. Mr. Carbone
revIewed various case resolution statistics for 1994.
In response to Mr. Garcia. Mr. Carbone said the population of the Arizona State Hospital (ASH)
totals from 800 to 1.000 individuals.
Mr. Garcia mentioned that ASH had nearly 200 complaints and asked why as much as twenty­five
percent of this population has filed grievances. Mr. Carbone indicated that these grievances
generally dealt with treatment plans. services received, facilities, treatment teams, and
determinations of appropriate intervention. He pointed out that the program is court ordered and
frequently deals with people who do not wish to participate in institutional living. He noted that
roughly seventy percent of these grievances were resolved.
Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
7 12/12/94
Teresa Alvarez, Secretary
Without objection, the meeting adjourned at 2:56 p.m.
(Attachments and tape on file in the Office of the Chief Clerk. Copy of minutes with
attachments on file with the Committee Cochairmen.)
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Joint Legislative Council Committee For The
Arizona Health Care Cost Containment System (AHCCCS)
8 12/12/94
Senator Resnick inquired as to what portion of the seventy percent were resolved in favor of the
client. Mr. Carbone indicated he does not have this information available.
Shirley Anderson. Research Analyst. House of Representatives, mentioned that a written
statement from the six RBHA's (Attachment 10) is available and will be distributed to
Committee members. She added that the executive directors of the RBHA's are available to
answer questions.
Cochairman Gerard mentioned the names of those available to represent the various RBHA's.
The Committee took several minutes to review the written statement (Attachment 10).
Cochairman Gerard expressed her belief that the Committee does not need to make any formal
recommendation at the present time. She advised that she will make contact with DHS once the
bids are received to determine whether the Committee can gather more information regarding
the weighting of the different program components. In closing, she suggested that DHS draw
upon AHCCCS's experience with regard to the RFP process.
12/14/94
taa
(Tape I, Side A)
Joint Legislative Committee For AHCCCS
Joint Legislative Committee for AHCCCS
12/6/95
ARIZONA STATE LEGISLATIJRE
Forty-second Legislature - First Regular Session
Representative Garcia
Representative Horton
Representative Preble
Representative Weiers
Representative Gerard, Cochair
Speakers Present
Members Absent
Members Present
Minutes ofMeeting
Wednesday, December 6, 1995
House Hearing Room 2 - 9:30 a.m. 4:00 p.m.
\!ahl'! Chen. Director. Arizona Health Care Cost Containment System (AHCCCS)
l.Kk Dillenherg. Director. Arizona Depanment of Health Services (ADHS)
RhllnJ;.t Baldwlll. Associate Director. Behavioral Health Services, Arizona Department of Health
Sef\lces (ADHS)
.lohn loreman. Presiding Juvenile Court Judge. Maricopa County
"] om SmIth. Chairman. Judiciary Comminee. House of Representatives
Pam II~dc, President. ComCare. Maricopa County
Sandr~j .luncL representing the City of Phoemx
Did Yost. Pohce Depanment. City of Phoemx
'I odd B. Taylor. M.D.. President. Arizona Chapter. American College of Emergency Physicians
Ron Adler. Director. Southern Arizona Mental Health Center (SAMHC)
Ma~ Ault. Program Administrator. Administration for Children, Youth & Families (ACYF),
Department of Economic Security (DES)
Susan J',;ewhe~. Policy Specialist. MentalfBehavioral Health, Administration for Children,
Youth & Families (ACYF). Depanment of Economic Security (DES)
Cochair Gerard called the meeting to order at 9:38 am. and attendance was noted by the
secretary.
Senator Huppenthal
Senator Springer
Senator Kennedy
Senator Pena
Senator Day. Cochair
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PRESEt\TATION ON MENTAL HEALTH AND SUBSTANCE ABUSE
Guest List (Attachment 1)
.........
Senator Pena asked how AHCCCS followed up to see that new coverages were explained to
members. Dr. Chen replied that AHCCCS conducts an operational review each year.
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Joint Legislative Committee for AHCCCS
2 12/6/95
Mr. Garcia asked whether the capitation rate for children was based on an actuarial study or on
projections. Dr. Chen replied that an actuarial firm experienced in mental health matters was
enlisted to help reset the children's capitation rate.
In response to Cochairs Day and Gerard, Dr. Chen explained that included in the capitaJionrate
for children is an amount which the Regional Behavioral Health Authorities (RBHA) and
i\rlzo-na Department of Health Services (ADHS) use to cover admi!ili>.1...rIDive co~
Mabel Chen, Director. Arizona Health Care Cost Containment System (AHCCCS), referred to a
document entitled Title XIX General Behavioral Health Im£lementation (Attachment 2) and
reviewed information pertaining to acute care, the Arizona Long=teIm Care System (ALTCS),
new coverages, client estimates anq coy~red~~exyi.~s.
Cochair Gerard announced that the Committee will attempt to conclude its business earlier than
scheduled so as not to interfere with a house democratic caucus scheduled for 2:00 p.m.
Cochair Day mentioned that she has heard complaints that once ADHS and the RBHA's skim
thclr adminIstrative fees from the capitation rate, there are significantly less monies left for the
scnlcc Inel
UPDAIE ON IMPLEMENTATION OF BEHAVIORAL HEALTH AND SUBSTANCE
ABUSE SERVICES
\ls. Iionon inquIred as to the capitation rates. Dr. Chen reported that the childreo'srate~
SJ:, 4li per mont~J~~~hild based on the totaLnumber of eligible persons, as opposed to the total
number of users She reported the capitation rate for general mental health and substance abuse
as $7.:':' per month per person. ---- ----
In rcsponse to Cochair Gerard, Dr. Chen indicated that for general mental health, AHCCCS
calculates that there are approximatel~ 120....000 eligible persons. She noted, however, that o..nly
~.()()(I tll 4. 70(~ eJ.!£i~le persons usc ~ervlces each month.
CochaIr Gerard inquired as to the ,:\mount of funding ayail'!.ble for ge..neral ~tal health and
~~r~n Dr. Chen repl ied that the funding can be calculated by multiplviog..!he children's rate
of$1549 by t~~~3,000 childrel') qualified for mental health. She returned attention to the
handout (Attachment 2) and reviewed rV96 budgetary figures.
.Il ·\T'\II.I .It 'STICF AND ACCESS TO BEHAVIORAL HEALTH SERVICES
Cochair Gerard inquired as to the existence Qf maiQr implementatjQUJ)l'OhJems. Ms. Baldwin
replied that based Qn information available to her, she is unaware Qf any system problems.
Jack DilJenber~. DirectQr. Arizona Department QfHealth Services (ADHS), intrQduced RhQnda
Baldwin, the fQrmer Assistant DirectQr fQr BehaviQral Health Services and current Associate
DirectQr fQr BehaviQral Health Services.
Cochair Gerard asked how many individuals have taken advantage Qfthe new cQverage?
Ms. Baldwin indicated that ADHS is wQrking with AHCCCS tQ determine a figure. She
mentioned that the additional services did not result in a flQQd Qf new peQple.
Joint Legislative Committee for AHCCCS
3 12/6/95
RhQnda Baldwin. AssQciate DirectQr. BehaviQral Health Services. ArizQna Department QfHealth
Services (ADHS), referred tQ a dQcument entitled Implementation fliTitle.XIXJ;fJ-yerage for
General Mental Health and Substance Abuse (Attachment 3) and recapped infQrmatiQn Qn
system readiness meetings, member notification and program implementatiQn. In addition. she
noted that the handout cQntains SQme key informatiQn Qn Title XIX.
In response to Mr. Garcia, Ms. Baldwin reported that ADHS estimated that 3,000 people WQuid
alr~~dy be in the systemand that growth ,c..Quld..r;.!J.s:h 8~ by ~e time.Jh~m~ramis fully
opera~ional. She predicted that between 3.000 and 4.1QO.peopleJ¥i1l be servedon a monthly
basis.
Cochalf I)ay requested an example of a case which would be better served by less duplication
and s\lclal \A,orkers. Judge Foreman recalled the case ofa young lady who was involved with
ComCan: lor mental health problems. Child Protective Services and the juvenile courts. He said
lhat obsen'mg the perspectives of the young lady' s trio of social workers recalled to mind a story
about three blInd men each encountering a different part of an elephant and not believing that
thc~ each had a hold of the same animal. Judge Foreman suggested that a better system would
he to ha\'c a single social worker conduct a general case evaluation, and perhaps-have a second
social worker perform aimentaLhealth evaluation. . .-
Senator Day asked whether there are ':"ritten eligibility guidelines fQr genefalrnental heaJt!l.
Ms. Baldwin explained that once an individual becomes Title XIX eligible, with the aid Qf a
diagnostic service manual, the clinical staff will determine whether Qr nQt the person has an
illness that fits into the category of mental health Qr substance abuse.
.I(lhn Inn:m:m. Presidin:; Juvenile Court Judi,;e. Maricopa County, said he shares the frustratiQn
(II tl1<lSC \\h(l prn\'idc sen'ices for people and mentioned that he has occasion to see the torturous
path \\ hlch resources follow in trickling down to the service level. He stated that the funding
pIpelIne needs 10 be shortened and widened. and suggested that a step tQward more sensible and
cnnslstcnt pnnislOn of sen-ices is represented by the Interagency Case Management Project
IIC\ 11' I ultl m:d by the Department of Economic Security (DES).
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(Tape 1. Side B)
Coch~m Gerard asked if"well-off' parents are required to pay for juvenile services. Judge
I'oreman an~wered affirmatively.
Dr. Dillenhcrg commented that ICMP is one of the more innovative steps in government to
WIden and ~honen the funding. pipe,
CochaIr (ierard asked whether the juvenile courts contract with providers. Judge Foreman
explained that the Administrative Office Qf the Courts contra~~s wit~ a~roJlpRfproviders.
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Joint Legislative Committee for AHCCCS
4 12/6/95
Representatl\'C Smith mentioned that he visited ComCare sites at Northern Avenue and
Mctroccnter and could not distinguish between the patients and staff members. In addition, he
reponed the following:
Ms, Honon ag.reed with Judge Foreman's suggestion to widen the funding pipeline but noted that
eligibility for Title XIX is very tightly constrained to ensure that the state only helps the very
poorest of the poor.
In response to Mr. Garcia, Judge Foreman indicated that he is unaware ofthe breakdown
between Tttle XIX eligible amiDon-Title XIX eli8ibJe chil~n who go through the juvenile
courts.
Mr. Garcia pointed out that the ~J9sting system is basically driven by medical necessity rather­than
social necessity. Judge Foreman concurred but noted that "medical necessity" seems to be
in the eye ofthe beholder and that expert opinions tend to be driven solely by funding.
Mr. Garcia suggested that the funding pipeline is narrow not because the system is clumsy and
overridden with case managers, but because it was only intended to provide services for children
on welfare or Aid to Families With Dependent Children (AFDC).
Mr. Garcia said that he will support any judge's attempts to use the power of the bench to
force services from the RBHA's. However, he shared his belief that Judge Foreman's
assessment of the number of children who are eligible for Title XIX services is completely
skewed.
Cochair Gerard clarified that Judge Foreman is not requesting that all kids sent to ComCare be
covered by Title XIX. Judge Foreman mentioned that the juvenile court's budget is over budget
and that it is difficult to decide which children will or will not receive services. In addition, he
said that the courts are not overwhelmed with affluent kids in need of services.
10m Smith. Chairman, Judiciary Committee, House of Representatives, said that during the past
summer he \'lslted all of the juvenile detention centers in the state and asked the presiding judges
ahout suppon received from the RBHA's since thirty percent of the kids are estimated to have
mental or suhstance abuse problems. He said that the judges reported receiving no services while
ComCarc and other caregivers reported otherwise.
PRISF\."l·\TION ON COMCARE
Cochair Gerard announced that the presentation of exit criteria on Arnold v. Sam. item number
four on the agenda. will be skipped.
In rcspon"c tll Ms_ I-Ionon. Ms. Hyde reiterated that ~om~<1!.e 'pro~ides immediate crisis
IIlten entlnn tnr an~ person wh0 walks through the door and addresses financial information
l~ltt:r
\\nh rqcard tll wall tImes. Ms. Hyde said that callers speak to a live person and that those in need
01' a ensls phone specialist will be transferred immediately. She added that mobile team response
lime depends on the location of the caller and the location ofthe team.
Joint Legislative Committee for AHCCCS
5 J2/6/95
Mr. Weiers asked what became of the surplus funding after ComCare consolidated three or four
of its locations. Cochair Gerard shared her understanding that ComCare used the extra funding
to contract with the Maricopa County emergency room psychiatric unit which, in the past. had
not always been reimbursed for services.
~ls. Ilydc mentioned that the urgent care center is occasionally forced to call the police for the
involuntary transport of patients. She said that in these instances, officers are required to fill out
certaIn paperv.:ork required by law which may delay them for over thirty minutes.
~ At 8:05 a.m., most employees did not seem to be working;
~ Facility visitors (e.g., police officers) complained about having to spend three to four
hours per visit and fill out a seven-page report;
~ The physician log reflected that the physician saw five or six patients per day;
~ An idle doctor was observed reading a trashy paperback; and
~ Groups of employees were sitting around discussing patients.
Representative Smith questioned whether the state can afford to continue using such a system
and pointed out that it would not be workable for his personal physician to consult with five or
six other people before making any type of diagnosis. In addition, he mentioned that the
employee tum-over rate is high, averaging from three to eight months.
Pam 11:- Ot:. President. ComCare. Maricopa County. distributed a folder entitled ComCare and the
\ /1/1"/(01'0 «(11111/\ IJehol'ioral Health Crisis Response Network (Attachment 4) containing
r-:spnn'l'''' I,' lr-:qucntl: asked questions (Section A) and information about the crisis system
(~n:llnl1 HI I{ckrnng to Section B. she reviewed information concerning services. urgent care
ccntl'r hl.:o" Il1paucnt hcds. transportation. in-home services and extra crisis stabilization unit
h-:d,
Mr. Garcia commented that client staffings represent quality assurance and are important for
maintaining accreditation. He explained that because emergency room psychiatric centers must
he staffed to handle the maximum number of people who can come in, there will be times such
as 1\ :00 in the morning when staff seems to have little work. He suggested that an emergency
room site visit on a Friday or Saturday will find the staff completely inundated.
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(Tape 2, Side A)
CochaIr Gerard surmised that the police still require access to a company such as Terros.
Ms. Hyde continued her review of section B (Attachment 4).
In response to Cochair Day, Ms. Hyde noted that all QfComCare'.s formsare required by outside
entities. - -
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Joint Legislative Committee for AHCCCS
6 12/6/95
J'\'1s .Iunek stated that needs exist for a second urgent care center within Maricopa County, mobile
team areas. and transportation services for urgent care.
After discussion among Committee members, Dr. Chen clarified that managed care programs
mu~e_not for profit.
Cochair Day asked why the juvenile courts have nothing positive to say about the RBHA system.
Ms. Hyde agreed with many ofthe previous comments about the difficulty ofworking through
several bureaucratic systems. However, she pointed out that a distinction must be made between
bureaucracy handed down from the Health Care Finance Administration (RCFA) and other
funding sources, and things over which the RBHA's have direct control.
In response to Mrs. Preble. Ms. Junck emphasized that police are not trained to provide
heha\'ll1ral health crisis services and should not have to triage or work with clients.
With regard to Representative Smith's comments, Cochair Day asked how ComCare has
streamlined its staff. Ms. Hyde said that in the time since she joined ComCare, several positions
have been cut and others consolidated. She emphasized that in addition to handling
administration, tb.e...RBHA's.alSQ function as d!~eEt service providers. With regard to
administrative cost, she referred attention to section A-7 of the ComCare handout (Attachment
4).
Sandra .J unck. representing the Citv of Phoenix, stated that the City of Phoenix has no funding or
responsihility for the behavioral health issue. However, she explained that as the system
chan~es. the Phoenix fire and police departments receive increasing numbers of time-consuming
emer~ency calls related to behavioral health.
~h . .lund explained that police dispatchers would sometimes be unable to reach a ComCare
operator ;md that. hy policy. could not hang up on the distressed caller until comfortable that the
person's needs were met.
Ms. Junck said that neither Collin DeWitt nor Michael Frazier was able to attend and mentioned
that Lt. DIck Yost is available to speak in Mr. Frazier's absence.
Dick Yost. Police Department. Citv of Phoenix, read a statement (Attachment 5) which indicated
that police and fire departments were abruptly advised in February of ]995 of the closure of the
county hospital psychiatric annex for screening of behavioral health patients -- a move which left
PRI:SE~T.i\TIOt\; B\' AMERICAN COLLEGE OF EMERGENCY PHYSICIANS
(Tape 2. Side B)
Dr 'I aylor rcviewed several suggestions. as contained in the handout (Attachment 7).
Cochair Gerard requested that Lieutenant Yost provide a status update during the upcoming few
months.
Joint Legislative Committee for AHCCCS
7 12/6/95
Ms. Ilyde mentioned that she. Dr. Taylor. Ms. Junck and Lieutenant Yost are working together in
an attcmpt to eliminate osbstacles that have developed more by practice than by Jaw.
Dr 1 avlor shared his personal belief that the number of people who require help has not risen
and that 11 IS Simply a case of ComCare not dealIng with change very well.
police and fire departments scrambling to learn as much as possible about ComCare services. He
explained that the urgent care center is considerably smaller than what had been available at the
county hospital. Further, he said that security did not initially exist, which allowed patients to
wreak havoc on the surrounding neighborhoods. In addition, he said that police and fire
departments found themselves functioning as a transportation service for behavioral health
clients.
Lieutenant Yost read a letter (Attachment 6) that the City ofPhoenix received from the President
of ComCare in November of 1995 in which ComCare agreed to implement various measures in
order to improve services to police and fire departments.
Cochair Gerard asked if the improvements have gone into effect. Lieutenant Yost replied that
although he has noticed some improvement, there remains much to be done. He added that the
police department cannot handle any more calls for service and, unlike ambulance services, is
simply not qualified to train its employees in the transporting of individuals with intravenous
hookups, etc.
'1 odd H 'J ;l\lnr. r-..1.D., President. Arizona Chapter. American Coller;e of Emergency Physicians,
dlstnnuted a handout (Attachment 7) containing his organization's perspective on the provision
or ncha\'loral hcalth care services throughout Maricopa County under the current state contract
administered nv ComCare,
Ms. Ilydc stated that calls for service are up significantly and shared her beliefthat changing the
s:'stcm tapped a nerve of need that did not previously exist.
Cochair Gerard asked whether the increased volume of calls is due to changes in the behavioral
health system or to an increase in the number of people who need help. Lieutenant Yost
speculated that the impact on law enforcement occurred as the result of system changes because
instead of being able to call Terros directly, callers must now work through ComCare which
often responds by contacting fire or police departments.
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PRESENTATION BY SOUTHERN ARIZONA MENIAL HEALTH CENTER
Mr. Adler mentioned that three to six mooths.-of operating money is typical fo~ start-up costs,
which translates into a need of$750,000 to $1 million for SAMHC.
CochaIr Da~ asked whether a S41t~ subsidy will he necessary. Mr. Adler shared his belief that
th~ \\ III be a ncr.d. for adctitional.1.UUlSllJonal funding for FY96.
CochaIr Gerard concluded th~SAMHC will rcguir~ the abilitv to retain mc:;>~la.tedJ:O revert
Jn~<2-n to a permane!l~_ or transition;~J..5.!:!illllement Mr. Adler explained that supplements will
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Joint Legislative Committee for AHCCCS
8 12/6/95
\1" Ilonnn shared her belief that RBHA contracts are not requir:ed to revert money to the state.
Sill' sut!~ested that the legislature address allowing the new SAMHC to retain funds which would
nthef\\ ISl' rn'crt lP thc state general fund
Cochair Day surmised that SAMHC will not have the funding to start up as a private agency
because it will have to return all of its state dollars. Mr. Adler concurred and added that a second
obstacle revolves around the transitional dollars for FY96.
Cochair Day requested illumination on the concerns and needs oftransitioning.from...astat~_
mental health facility to a privatized facilitr. Mr. Adler reported that at the present time there is
novehicle-[or anon-reverting fund to move from a state agency to a new gmwany. As a state
agency, he said that SAMHC has the-;-bility to retain any smplJls revenue over contract cost for.
inv~stmentinto additional services for eJiems.. He said that as ofJune 30, 1996, the "public"
SAMHC will sunset and there will be nj) prmc;siOIl.1O retain the SH'!:P)US doBars.
In response to Cochair Day, Mr. Adler explained that SAMHC typically serves indigent and
notch-group clients. He indicated that unless the state provides money for operating costs,
SAi\1HC will not be capable of succeeding as a private provider. He suggested the establi~hment
of a no~:.reverti.!}g fund which would allow any non-g~neral-fund-appropriated.dollarsto r~.
tn the new company as 2Ppo~e~d_to the £el1~Jalfund.
Ron Adler, pirector, Southern Arizona Mental Health Center (SAMHC), distributed a handout
(Attachment 8) containing the ADHS SAMHC privatizatjon workplan and the options paper for
the privatization ofSAMHC which was submitted to legislators in February of 1995. He also
distributed a second handout (Attachment 9) entitled Privatization: Status Report and reviewed
its contents. He noted that the goal is to privatizs SAMfiC by July 1 1996.
\ b. Ilonon qUl:stloncd wh,ether federal grants or private monies would also rey.~rt. Mr. Adler
indicated that these and an\' othe..r residual dollar~ at the end_oftill:.fu;.Eal~_<l! will
au"-tomallc-alh~revert. ----:=-
CochaIr Gerard remarked that after June 30. 1996. SAMHC will be no different than any other
pmatc prn\"lder. and that competing providers will offer replacement services should SAMHC
cease tn eXIst Mr. Adler agreed somewhat hut noted that SAMHC has always provided services
whIch the other traditional providers have avoided offering.
Cochair Gerard mentioned that statutory authority can easily be given for funds to not revert to
the state. Dr. Dillenberg indicated that ADHS staff is working on this.
PRESENTATION ON CHILD PROTECTIVE SERVICES AND ACCESS TO
BEHAVIORAL HEALTH SERVICES
Susan '('woem. Polin' Specialist. Mental/Behavioral Health. Administration for Children.
Youth &. T-amilies (ACYFl, Department of Economic Security (DES), in response to Mr. Garcia,
mdlcated that she read a portion of the Auditor General's report on CPS.
Cochair Gerard said that there must be information confirming that there is a problem with
ohtaJntn~ CPS services. Mr. Garcia remarked that ACYF administration is obviously unable to
;mswer certain questions and simply chooses to blame the kids.
Joint Legislative Committee for AHCCCS
9 12/6/95
be necessary for one year. He mentioned that discussions centered around a two-year transition
plan which includes setting up a system in FY96 ~~~Il allow SAMHC to .ve state-appropriated
dollars througJi"'th~RBHA'sas a s e net for one ear. He said that if there is a
residual fund balance, those dollars would revert to the RHBA in FY97 for the purpose 0
enhancing servicc;s in PiDJJl CountY. Ms. Horton advised that the aforementioned information
was merely a discussion, as opposed to an agreement, entertained by she, Representative Weiers
and the Joint Legislative Budget Committee.
\Ir (l~rcI~ said It is completely unacceptablc to him that an agency, rather than provide needed
sen Ices. c~n claIm that children are at fault. Ms. Ault stated that it certainly is the agency's
responsibility to respond to needs and find treatment for the children. She clarified that she
slmpl: knows of nn profession dealing with families and children which is not stressed by the
~~mut of SOCIal issues,
In response to Cochair Gerard, Ms. Ault indicated that ~venty five eerc~--n---lof.child-P.Iotective_
Sen'ICI.> I CPS) children are Title XIX. She noted that the r~mainin.g children receive services
Ihrou~h the Co~e_nsive Medical and.Dental £.r.ogram.(.CMDP). "
Marv Ault. Program Administrator. Administration for Children. Youth & Families (ACYFl.
Department of Economic Securitv (DES), indicated that there are increasingly more complex and
difficult vouths in the system and that everyone is stretching to meet their needs. She noted that
some of the problems taxing the system are treatment-resistant children. a lack of substance
abuse treatme!1t,_t!le availability of psyc~tric_a~intments,the.availability-Of residenJial beds, L---­and
the placement of sexually aggressive girls.
- - .~----:---
Cochair Gerard mentioned that she continues to hear complaints about the duplication oftesting. v­Ms.
Ault replied that a child psychiatrist has been retained on the committee addressing problem
issues in an attempt to solve the question of wJ~P provides the best testing and results. She
suhmItted that there seems to be a cOIl1IIljtment tQshare test results in an effort to avoid_
d_urE~~tion. She added that legal barriers should not pose a problem because confidentiality is
part of each agency's mandate.
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(Tape 3, Side A)
WIthout obJcctlon. the meeting was adjourned at I:50 p.m.
(Original mmutes, attachments and tapes on file in the Office of the Chief Clerk.)
Senator Kennedy suggested that money can always be trimmed from administration and
dedicated to services.
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Joint Legislative Committee for AHCCCS
10 12/6/95
Cochair Gerard expressed disappointment that so few individuals are willing to come forward
and testi fy at public hearings.
kC.04-~__
Teresa Alvarez, Secretary
After failed attempts at extracting information, Cochair Gerard surmised that the legislature does
not appropriate enough funding for the purchase of services and that agency representatives are
under orders not to reveal that they do not have sufficient funding.
Mr. Garcia questioned why services cannot be provided for children in need of substance abuse
treatment. Ms. Newberry replied that across the state there is a lack ofavailable resources for
substance abuse in children.
CochaIr Day suggested that the ICMP sbo1,,11d be.J'~ed ~s_a standard-..I~therthan looked UPDI1~
a model.
With regard to behavioral health services for children in foster care, Mr. Garcia asked what types
of problems the report may have been identifying. Ms. Newberry expressed her belief that some
ofthe issues were those mentioned by Ms. Aull.
Coch:m C'l:rard asked the Committee research analyst to contact Nancy Swetnam and request
t~aJ.JllLfPurt~ct.:r track of the!lumber of kids who do and do n9J qyali!i', for Title XIX. In
addition. she requested a private meeting with Bob Gilligan of DES regarding CMDP and
ComCare SCT\ICeS,
taa
III 1/96
, " Cochair Gerard questioned whether children are waiting for servj~es. Ms. Newberry said that a
waiting list for services is not maintained.
~ " / Cochair Gerard asked if funding is available to putchase seryic~ Ms. Ault replied that monies
are available for children within the system who are identified as needing such services and have
access to a provider.
MEETING NOTICE
II. AZ Council on Arthritis & Musculoskeletal Diseases
SUNSET REVIEWS OF THE
BOARD OF RESPIRATORY CARE EXAMINERS
Representative Gerard, Co-chair
Representative Aldridge
Representative Preble
Representative Foster
Representative Horton
AGENDA
Wednesday, October 23, 1996
Senate Hearing Room 2
9:00 a.m. - Noon
JOINT LEGISLATIVE COMMITTEE FOR THE ARIZONA HEALTH
CARE COST CONTAINMENT SYSTEM (AHCCCS)
OPEN TO THE PUBLIC
SENATE AND HOUSE HEALTH COMMITTEES OF REFERENCE
ARIZONA STATE LEGISLATURE
ARIZONA COUNCIL ON ARTHRITIS & MUSCULOSKELETAL DISEASES
KB/ak
-Title II of the Americans With Disabilities Act prohibits the Arizona Senate from discriminating on the basis of disability in the
provision of its services and public meetings. Individuals with disabilities may request reasonable acconvnodations, such as
interpreters or alternative formats, by contacting the Senate Secretary's Office at (602) 542-4231 (voice) as soon as possible.
Please be specific about the agenda item in which you are interested and for which you are requesting an accommodation. The
Senate may not be able to provide certain acconvnodations prior to the meeting unless they are requested a reasonable time in
advance of the meeting. This agenda will be made available in an alternative format on request.
MEMBERS:
Senator Day, Co-chair
Senator Brewer
Senator Petersen
Senator Henderson
Senator Kennedy
DATE:
PLACE:
III. Joint Legislative Committee for AHCCCS
TIME:
I. Board of Respiratory Care Examiners
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BOARD OF RESPIRATORY CARE EXAMINERS
ARIZONA STATE LEGISLATURE
SENATE AND HOUSE HEALTH COMMITTEES OF REFERENCE
SUNSET REVIEWS OF THE
STAFF
Kitty Boots, Senate Analyst
Lisa Block, House Analyst
MEMBERS EXCUSED
Senator Kennedy
Senator Henderson
Representative Preble
Minutes of the Meeting
Wednesday, October 23, 1996
9:00 a.m., Senate Hearing Room 2
JOINT LEGISLATIVE COMMITTEE FOR THE ARIZONA HEALTH CARE
COST CONTAINMENT SYSTEM
BOARD OF RESp'IRATORY CARE EXAMINERS
ARIZONA GOVERNOR'S COUNCIL ON ARTHRITIS
& MUSCULOSKELETAL DISEASES
Co-chairman Day convened the meeting at 9:10 a.m. and the attendance was noted.
Senator Day explained the purpose of the sunset hearings is to review the purpose and
function of each entity to determine whether they should be continued, revised,
consolidated or terminated.
Mary Hauf Martin, Executive Director, Board of Respiratory Care Examiners,
explained the Board was created In 1990 and oversees Respiratory Care Practitioners
(RCPs) who prOVide services in hospital settings and increasingly in alternative settings
such as skilled nursing facilities and private homes. She explained the Board must insure
an RCP cares for patients safely and effectively. Ms. Martin explained RCPs work with
health care teams to insure quality patient care and cost containment in a continually
changing environment.
In response to Senator Day's request to hear examples of ways RCPs are adapting to a
changing environment, Ms. Martin explained RCPs at S1. Joseph's Hospital in Phoenix are
now Integrated Into all departments, rather than being centralized in a department of their
own, and are Involved in total patient care, e.g. helping to move a patient as well as
MEMBERS PRESENT
Senator Day, Co-chairman
Representative Gerard, Co-chairman
Senator Brewer
Senator Petersen
Representative Aldridge
Representative Horton
Representative Foster
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Senator Day asked if Ms. Martin sees managed health care as supporting an adequate
number of home visits and extended care by Reps. Ms. Martin indicated that managed
care has worked collaboratively to provide necessary services.
performing respiratory care. She also indicated that since patients are leaving the hospital
sooner after medical procedures, RCPs have gone into homes to train patients on the use
of respiratory equipment.
In response to Representative Aldridge s request to know how long the training program
IS, Ms Martin explained it lasts approximately a year, which is longer now than in the
recent past due to enhanced education In uSing high-technology equipment.
Representative Horton referred to page five of the preliminary sunset report (filed with
onglnal minutes) and asked for the reason behind the fluctuation in the number of license
denials and total number of complaints charted there. Ms. Martin explained a backlog in
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HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
October 23, 1996
Page 2
In response to Senator Day's request to know if Ms. Martin sees services being cut back
by managed care, Ms. Martin indicated that she did not feel qualified to respond. She
emphasized there is an effort on the part of the respiratory care industry to answer the
need that exists.
Ms Martin further explained disciplinary procedures are reviewed to assure that people
are being treated fairly and equally. She indicated an independent study performed by the
Auditor General reveals the Board compares favorably to similar boards. Ms. Martin
IndIcated it has taken the Board about 60 days to process a complaint from beginning to
resolutIon, that 26 percent of complaints have resulted in disciplinary action and that 34
percent have resulted in a warning letter of concern in the past year.
Ms. Martin explained the Board is made up of three practitioners, one medical doctor, one
hospital administrator and two members of the public, emphasizing that the majority of the
Board is not made up of practitioners and takes its responsibility to protect the public
health very seriously. She noted that Board meetings are very well attended by health
care facility representatives and interested licensees.
In response to Representative Aldndge's request to know what qualifies a person to be an
Rep Ms Martin explained an applicant for a license must be a high school graduate and
graduate from an accredited respiratory therapy training program. Once training is
completed an application for a license may be filed and is granted within 24 hours at
whIch time the applicant may seek on-the-job training under the supervision of a doctor or
another licensee until he or she can pass a national exam called the CRIT. Ms. Martin
Indicated that once the applicant passes the eRIT, he or she is eligible for a permanent
license
In response to Senator Brewer's further inquiry about where applicants go to school, Ms.
Martin related the majority are attending community colleges to obtain their training.
Ms MartIn confirmed Senator Brewer's observation there are no independent, privately­owned
respiratory therapy colleges In Anzona.
David Feuerherd, Program Director, American Lung Association, expressed his
support for continuing the Board in response to Senator Day's inquiry.
In response to Representative Horton's wish to know what legislation the Board would be
pursuing next session, Ms. Martin indicated it would be developing technical legislation to
clarify language only.
October 23, 1996
Page 3
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
Ms. Martin explained that Canada, where the majority of foreign applicants are from, has
a very rigorous training program which is accepted as an equivalent by a national
organization for r~spiratory care examiners.
processing complaints occurred last year, but was alleviated once a staff position was
authorized by the Legislature.
In response to Senator Day's inquiry, ~s. Martin acknowledged that every year there has
been a gradual increase in the number of complaints. She explained that the biggest
problem behind complaints is substance abuse by praditioners. .:i:
Representative Horton asked if criteria used for foreign applicants are the same for
citizens of the United States. She asked how the Board determines how the foreign
applicants have the same standardized training.
Representative Horton asked what the Board does to screen applicants for drug abuse.
Ms Martin explained thiS is a collaborative effort between the Board and care facilities that
employ RCPs. She indicated the Board does not have the ability to perform criminal
background checks on every applicant. however does ask them specific questions about
their backgrounds and requires they submit a sworn statement that everything they have
told the Board is true and factual. Ms. Martin additionally noted that facilities routinely
perform preemployment drug screenings and also have the ability to perform "for cause"
drug screenings when necessary.
In response to Senator Brewer's request to know if the Board certifies the respiratory care
training facilities that applicants attend, Ms. Martin explained a national accreditation body,
consisting of four groups of practitioners, determines what constitutes an approved
program. She further explained the Board assures that applicants have attended an
American Medical Association-approved program.
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John Coleman, RCP and Member of the Board, explained the process whereby a patient
is transferred from a hospital setting to home care using skilled, licensed Reps.
Representative Gerard indicated she has never received a complaint about the Board,
acknowledged the need to license RCPs and recommended continuing the Board for ten
years
Representative Gerard asked if employers of RCPs have an obligation to report
unprofessional conduct or incompetency to the Board and Mr. Coleman responded
affirmatively.
Representative Gerard asked if complaints from patients received by the Board concern
quality of care. Mr. Coleman indicated the Board does not receive these types of
complaints, as these are directed to the home care company or the insurance provider.
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HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
October 23, 1996
Page 4
Representative Gerard moved that the Committee of Reference
recommend to the full body the continuation of the Board of
Respiratory Care Examiners for ten years. The motion CARRIED by a
voice vote.
Senator Day indicated that according to information she receives from constituents,
managed care cuts back on benefits to home care facilities and is not always providing
services that patients need.
In reference to Senator Day's concern about benefits being cut back in the managed
health care environment, Mr. Coleman asserted the issue requires that home-care
companies adapt their contracts with managed care health plans. He explained that
typically, depending on the patient's level of acuity, they may be seen once a week, once
every six weeks or more often in the case of ventilator patients.
Senator Brewer asked if RCPs bill directly or through the organization they work for. Mr.
Coleman explained this depends upon the environment in which the RCP is working,
noting that at this pOint In time, there IS no set fee the RCP charges to go into a home care
setting He explained that compensation for the RCPs is built into the charge for
equipment that IS reimbursed. In hospital settings, Mr. Coleman explained, payment is
disbursed through the hospital, not billed to the patient directly.
In response to Senator Brewer's reference to oxygen suppliers' problem with needing to
hire RCPs to deliver their product, Mr. Coleman stressed this is a way to protect the public.
He emphaSized that it IS perfectly appropnate and deSirable to have a licensed practitioner
teaching patients about the use of prescnptlon drugs and oxygen equipment in their
homes
Senator Day acknowledged the notice was late due to a lag in communication.
ARIZONA GOVERNOR'S COUNCIL ON ARTHRITIS AND MUSCULOSKELETAL
DISEASES
Senator Day questioned the purpose of the Council in view of the fact that the Arthritis
Foundation eXists for much the same purpose
Senator Day asked if the educational actiVities are conducted by volunteers and Ms. Kowal
confirmed that everything the Council does IS conducted on a volunteer basis.
October 23, 1996
PageS
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
Pami Kowal, Member, Governor's Council on Arthritis and Musculoskeletal Diseases,
explained that Gail Riggs, Council Chairperson, was only notified of the meeting yesterday
and could not attend with such short notice.
In response to Senator Day's inquiry about Ms. Kowal's understanding of the Council
budget matters, Ms. Kowal indicated the budget is small, has not changed and the Council
does not anticipate the need to request an increase.
Bob Gilligan, Legislative Liaison, Arizona Department of Economic Security (DES),
explained DES provides a staff person part-time to perform Council duties as well as many
other duties for DES. He indicated DES provided a little more than $600 this year to the
Council to reimburse members for travel to four meetings, and approximately $400 the
year before for the same purpose.
After some diSCUSSion it was determined that per diem expenses were compensated at the
rate of $600 for an entire year, hotel and transportation expenses at $1,200, and that 5
percent of DES clencal staff committed to the Council amounted to $3,800, for a total cost
of approximately $6.000 per year
Ms Kowal acknowledged the Foundation serves its purpose very well, but explained the
Council functions In addition to the Foundation in pursuing legislative activities and
community outreach and education
In response to Senator Day's request to know how the Council specifically serves an
education function. Ms Kowal indicated that the Council holds public forums in outlying
areas to educate people about arthntls and the Importance of early detection and
treatment
Representative Gerard read from the Executive Summary of the preliminary sunset report
(filed With anginal minutes) that the CouncIl's purpose IS to "develop recommendations the
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RepresentatIve Aldridge suggested the work of the Council should be coordinated with the
Arthritis Foundation
Representative Aldridge asserted he does not see any concrete results provided by the
Council
Representative Gerard asserted there is no need for the Council and that its function
should be handled in the private sector.
Representative Gerard asked if the Council is a pass-through agency for receiving any
type of federal monies and Ms Kowal expressed her understanding it is not.
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HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
October 23, 1996
Page 6
In response to Representative Gerard's inquiry, Ms. Kowal acknowledged the Council
would not be conducting research, only applying for grants and providing support.
Representative Gerard suggested the University of Arizona Medical Center could apply
for such a grant as well. Ms. Kowal acknowledged this and noted the Foundation also
applies for grants.
Ms. Kowal responded that the Council has been actively involved in assuring vocational
rehabilitation is continually supported and has applied for funding for particular research
grants.
In response to Senator Day's request to know how successful the Council has been in
obtaining a research grant, Ms. Kowal expressed her understanding the Council has
obtained one research grant but it has not moved forward for some reason.
State may adopt to help victims of these diseases," and asked if anything specific has
been done other than to call the congressional delegation, which is noted in the Council's
response.
Ms Kowal emphaSized that the Council IS a group of close-knit professionals who want to
provide additional support to the Foundation, especially in the legislative area to see that
arthritis IS eradicated and people educated about it. She emphasized that the Council
members would want to continue In theIr efforts even without funding.
Ms Kowal reViewed goals and objectives for the following year including setting up an
informal arthntls registry as an outreach. espeCially to outlying areas, to get people
properly channeled to see a speclalrst as soon as possible after diagnosis. She
emphaSized that the Council IS composed of many committed people with outstanding
Ideas and has only had a chance to hold one meeting out of six planned so far this year.
Ms. Kowal urged t~e Committee to allow the new Council members an opportunity to show
the State what it can do.
In response to Representative Foster's inquiry about how much the Council collaborates
with the Foundation, Ms. Kowal acknowledged it collaborates functions a great deal and
noted some members of the Board are also members of the Foundation.
Senator Day related that in a recent conversation, Ms. Riggs indicated the Council expects
no additional funding from DES and is working with the Foundation to obtain matching
funds.
Representative Horton voted against the recommendation because she had remaining
questions and felt uncomfortable about terminating the Council when Ms. Riggs could not
be present to respond
October 23, 1996
Page 7
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
Representative Gerard moved that the Committee of Reference
recommend to the full body the termination of the Arizona Govemor's
Council on Arthritis and Musculoskeletal Diseases. The motion
CARRIED by a voice vote.
Senator Day acknowledged Ms. Kowal's dedication and that of Council members, and
suggested they may enjoy the status of being appointed by the Governor. She suggested
that if members are dedicated enough, they can pursue their goals independently.
.'
Representative Horton read a recommendation from the preliminary sunset report..stating
the "Arizona legislature should increase funding" and read from goals and objectives,
noting the Council asks for a "full match of State funding to pull down maximum federal
funding for DES."
In response to Representative Horton's suggestion that the Council function as an advisory
committee to the Foundation, Ms. Kowal explained the Foundation, based in Atlanta,
Georgia, already has quite a few committees in place and questioned whether a particular
states Governor's Council could become an advisory committee, suggesting this would
probably taking quite a bit of convincing.
Senator Brewer voted against the recommendation, asserting that not enough information
was received to warrant terminatIon and suggested the Council should be continued for
one year so It could be clearly established whether money should come out of DES to fund
It or not
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Representative Horton expressed her concern the Committee does not meet frequently
enough as It IS and needs to meet more often
Representative Aldridge agreed there IS no longer a need for the Committee and Senator
Day withdrew her prevIous recommendation
JOINT LEGISLATIVE COMMITTEE FOR THE ARIZONA HEALTH CARE COST
CONTAINMENT SYSTEM (AHCCCS)
Senator Day stressed the need to continue thiS Committee, recommended doing so for ten
years and recommended changIng the statutory requirement of meeting four times a year
to "meeting at the discretion of the co-chairmen. n
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HEALTH COMMITTEES OF
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October 23, 1996
Page 8
Ms. Boots indicated the Committee has met six to seven times over the past six years to
address issues, including those fisted on page two of the preliminary sunset report (filed
with original minutes). She noted the Committee is required by statute to meet at least four
times per year and this charge has not been met.
Ms. Boots noted there are ongoing projects the Committee may choose to review, including
reviewing and holding public testimony on the rules proposals for the new AHCCCS
reimbursement pilot project, reviewing the impact of the new federal welfare reform bill and
reviewing the impact of pending Initiatives should they pass in the November election.
Kitty Boots, Senate Research Analyst, explained the Committee charge is to conduct
negotiations relating to all agreements with the federal government and the State
concerning Title XIX programs, to review and make recommendations concerning all
proposals for additions or modifications to populations covered or services provided by
AHCCCS or any state agency providing services to populations eligible under Title XIX.
She additionally explained the Committee is charged with monitoring the implementation
of additional. fees and modifications including the review of preadmission screening
instruments, the eligibility and enrollment system and the service delivery system. Ms.
Boots indicated the Committee is also to review the implementation of the hospital
payment methodology and must review and approve all hospital rate changes before the
implementation of changes in hospital rates.
Representative Gerard asserted the Committee IS not necessary and recommended using
the JOint Legislative Health Committees of Reference to treat AHCCCS issues. She
acknowledged there was a need for the overSight when AHCCCS first started up and
received Its federal waiver, but the need has run Its course.
Respectfully submitted,
(Tape and attachment"s on file in the Office of the Senate Secretary)
Without objection the meeting was adjourned at 10:30 a.m.
October 23, 1996
Page 9
Alice Kloppel,
Committee Secretary
Representative Gerard moved the Committee of Reference recommend
to the full body the termination of the Joint Legislative Oversight
Committee on the Arizona Health Care Cost Containment System
(AHCCCS), expanding the scope of the Joint Legislative Health
Committees of Reference to encompass dealing with questions
concerning AHCCCS. The motion CARRIED by a voice vote.
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
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